Inorganic-based biomaterials for rapid hemostasis and wound healing

Bioactive Inorganic Materials for Innervated Multi-Tissue Regeneration

Tissue engineering aims to repair damaged tissues with physiological functions recovery. Although several therapeutic strategies are there for tissue regeneration, the functional recovery of regenerated tissues still poses significant challenges due to the lack of concerns of tissue innervation. Design rationale of multifunctional biomaterials with both tissue-induction and neural induction activities shows great potential for functional tissue regeneration. Recently, the research and application of inorganic biomaterials attracts increasing attention in innervated multi-tissue regeneration, such as central nerves, bone, and skin, because of its superior tunable chemical composition, topographical structures, and physiochemical properties. More importantly, inorganic biomaterials are easily combined with other organic materials, biological factors, and external stimuli to enhance their therapeutic effects. This review presents a comprehensive overview of recent advancements of inorganic biomaterials for innervated multi-tissue regeneration. It begins with introducing classification and properties of typical inorganic biomaterials and design rationale of inorganic-based material composites. Then, recent progresses of inorganic biomaterials in regenerating various nerves and nerve-innervated tissues with functional recovery are systematically reviewed. Finally, the existing challenges and future perspectives are proposed. This review may pave the way for the direction of inorganic biomaterials and offers a new strategy for tissue regeneration in combination of innervation.

Recent progress in polysaccharide microsphere-based hemostatic material for intravascular and extravascular hemostasis: A review

Hemorrhage, a common consequence of diseases, surgical procedures, and traffic accidents, poses a significant threat to public health. Effective hemostasis is crucial for patient survival and prognosis, particular in case of internal bleeding. While polysaccharide microsphere-based hemostatic materials have gained clinical acceptance due to their effectiveness, good biocompatibility, and versatility in both intravascular and extravascular hemostasis, they are limited by their single function and insufficient hemostatic properties. Recently, booming developments have been witnessed in microsphere-based biomaterials to achieve a combination therapy for hemostasis. This review first examines the fundamentals of coagulation process, hemostatic mechanisms, and microsphere fabrication techniques. We then discuss the latest investigations in functionalized microsphere-based hemostatic materials for controlling intravascular and extravascular hemorrhage, focusing on design strategies, hemostatic properties, and clinical implementation. Finally, we also propose some limitations and challenges of these hemostatic materials, aiming to provide valuable insights for future research in novel polysaccharide microsphere-based biomaterial.

Zeolite firmly anchored regenerated cellulose aerogel for efficient and biosafe hemostasis

Zeolite-based hemostats are commercially available but are still troubled by the adverse effects of exothermic heat-caused tissue damage and detached zeolite-induced distal thrombosis. Here, we developed a facile and robust method to fabricate zeolite-embedded regenerated cellulose aerogel (Z-RCA) for safe and efficient hemostasis. Zeolite particles were extensively entangled by regenerated cellulose nanofibers via hydrogen bonds during the cellulose regeneration process, thus reducing the probability of zeolite detaching from aerogel. Additionally, the low loading ratio of zeolite (∼3.0 wt%) decreased the exothermic heat to promote a low-temperature enhancement of 3.4 °C during the hemostatic process. The aerogel quickly absorbed tremendous blood while releasing calcium ions, synergistically assisting zeolite to promote blood coagulation. In animal experiments, Z-RCA stopped bleeding faster than Quikclot and reduced blood loss by 62.1 wt%. Overall, the study produced a safe and efficient zeolite-based hemostat.

Facile synthesis of rapid hemostatic powder based on sodium alginate for promoting hemostasis and wound healing

Uncontrollable bleeding and excessive blood loss are the primary causes of death on the battlefield and in accidents. However, commercial hemostatic materials possess individual drawbacks for hemostasis. Here, we present a rapid hemostatic powder (SACC-GO) with high biosafety, which is fabricated by a facile ball milling method using inexpensive raw materials (sodium alginate (SA), calcium chloride, cerium nitrate and graphene oxide (GO)). The SACC-GO could immediately become gel when meeting blood, whose strength was enhanced due to specific surface area of GO and high coordination capacity of Ce3+ ions. In addition, the SACC-GO had a high water absorption rate (~2000 %) allow it to concentrate blood and release Ca2+ ions to improve blood coagulation. The in vitro and in vivo results, such as hemostasis in tail amputation, femoral hemostasis and hepatic hemostasis, exhibited excellent hemostasis effects by reducing hemostasis time and blood loss (with the majority of reductions exceeding 50 %). The SACC-GO also enhanced wound healing due to Ce ions scavenging reactive oxygen species (ROS). Thus, the SACC-GO hemostatic powder had great potential for rapid hemostasis.

Electrospun Polyphosphate Coacervate Glass Fibers in the System P2O5-CaO-MgO-Na2O-Fe2O3 for Wound Healing

This study investigates a series of phosphate-glass fibers (PGFs) in the system P2O5-CaO-MgO-Na2O-Fe2O3 with various Fe contents (0, 0.1, 0.5, 1, and 2 wt %) prepared via electrospinning of polyphosphate coacervate gels. This method is preferable over the traditional high-temperature melt-spinning technique used for PGF production as it represents a more cost-effective and sustainable route. Structural analysis performed via Fourier transform Infrared spectroscopy shows that PGFs are mainly formed by polyphosphate chains containing Q1 and Q2 units. Thermal analysis demonstrates that the amorphous nature of the PGFs can be preserved up to calcination temperatures in the range 450-520 °C, with crystallization temperatures increasing with the iron content. Dissolution studies were performed by immersing the PGFs in deionized water and analyzing the species released (P, Ca, Mg, Fe, and Na) via microwave plasma atomic emission spectroscopy at regular intervals up to 72 hours (h). Results show that both iron and phosphate anion release increases with iron loading, suggesting that the phosphate network is weakened by an increasing amount of iron. Given that PGFs are particularly advantageous in wound healing due to their fibrous morphology, their cytocompatibility was assessed by seeding human keratinocytes (HaCaTs) in contact with the dissolution products of PGFs after 24 h of immersion at three different ratios of dissolution products to cell medium (1:100, 3:100, and 5:100). No cytotoxicity was observed for any of the ratios studied. Moreover, the dissolution products of some PGFs resulted in an enhanced growth of HaCaTs, with the best result being observed when using dissolution products from PGFs containing 0.1 wt % of Fe and a dissolution product-cell medium ratio of 5:100. Dissolution products from PGFs with an Fe content up to 0.5 wt % have also demonstrated antibacterial activity against the bacterium Escherichia coli (E. coli). A preliminary test on the efficacy of PGFs in wound healing via ex vivo studies on human skin has demonstrated that the PGFs in direct contact with the wound promote 84% wound closure.

A silk nanofiber and hyaluronic acid composite hemostatic sponge for compressible hemostasis

Uncontrolled traumatic blood loss is a leading cause of hemorrhagic shock and death, highlighting the critical need for compressible and rapid hemostatic first-aid materials. In this study, silk nanofibers (MA-SNFs) were prepared through maleic acid (MA) hydrolysis decorated with enriched carboxyl groups. The MA-SNFs were then combined with hyaluronic acid (HA) through EDC/NHS crosslinking to form a porous sponge (i.e., MA-SNF/HA) through freeze-drying. The fabricated MA-SNF/HA sponges demonstrated excellent blood compatibility (hemolysis ratio < 5 %), outstanding hemocompatibility (blood clotting index (BCI) < 35 % within 60 s), and good cytocompatibility (cell viability >85 %). Among the different sponges prepared, M4-H6 (MA-SNFs: HA = 4:6) exhibited the best liquid reabsorption capacity after 80 % compression, outperforming M6-H4 and M5-H5 sponges. Furthermore, M4-H6 sponge absorbed liquid rapidly (~30 s) while matching the liquid absorption capacity of commercial gelatin sponge (GS), which require over 5 min for similar absorption (2232.84 ± 141.69 %). These findings suggest that M4-H6 sponge is highly suitable for compressible hemostasis applications and provide further insights into its potential hemostatic mechanism.

SiO2-based inorganic nanofiber aerogel with rapid hemostasis and liver wound healing functions

Non-compressible hemostasis and promoting tissue healing are important in soft tissue trauma repair. Inorganic aerogels show superior performance in rapid hemostasis or promoting tissue healing, but simultaneously promoting non-compressive hemostasis and soft tissue healing still remains a challenge. Herein, SiO2-based inorganic nanofiber aerogels (M2+@SiO2, M=Ca, Mg, and Sr) were prepared by freeze-drying the mixture of bioactive silicates-deposited SiO2 nanofibers and SiO2 sol. These M2+@SiO2 aerogels have a three-dimensional highly-interconnected porous structure, remarkable flexibility, high absorption, good hydrophilicity, negative zeta potential, and bioactive ions releasing capacity. M2+@SiO2 aerogels not only exhibited satisfactory hemostasis activities in vitro, but also possessed high hemostatic efficacy in compressible rabbit femoral artery injury bleeding model and non-compressible rat liver puncture bleeding model compared to medical gauze and gelatin sponge. M2+@SiO2 aerogel had low blood clotting index of Ca. 10 % and short partial thromboplastin time of ca. 82 s in vitro, and could greatly short bleeding time by >50 % and decrease blood loss by about 80 % compared to medical gauze and gelatin sponge in non-compressible hemostasis. Sr2+@SiO2 aerogel showed optimal bioactivities on promoting cell proliferation, cell migration, and the expression of liver function and angiogenesis related genes and proteins in vitro. Importantly, Sr2+@SiO2 aerogel possessed a noteworthy function to promote liver soft tissue healing in vivo by releasing bioactive ions and providing a highly-interconnected porous structure to support vascular development and tissue regeneration. Overall, Sr2+@SiO2 aerogel has great potential for integrated rapid hemostasis and soft tissue healing, which is promising in soft tissue trauma therapy. STATEMENT OF SIGNIFICANCE: Non-compressible hemorrhage and soft tissue impairment are the main causes of mortality in emergency trauma. Inorganic aerogels with high porosity and outstanding flexibility can rapidly absorb blood to pro-coagulation and fill in irregular trauma without compression, but the low bioactivity limited the ability to promote soft tissue healing. Herein, SiO2-based inorganic nanofiber aerogels (M2+@SiO2, M=Ca, Mg, and Sr) were prepared by freeze-drying the mixture of bioactive silicates-deposited SiO2 nanofibers and SiO2 sol. M2+@SiO2 aerogels possessed high bioactivity and exhibited superior hemostatic performance in compressible and non-compressible bleeding model. Furthermore, Sr2+@SiO2 aerogel showed optimal bioactivities on cell responses and effectively promoted liver healing by releasing bioactive ions and providing highly-interconnected porous support structure for vascular development and tissue regeneration.

Fish scale gelatin/diatom biosilica composite hemostasis sponge with ultrafast dispersing and in situ gelation for hemorrhage control

Rapid control of hemorrhage is vital in first-aid and surgery. As representative of emergency hemostatic materials, inorganic porous materials achieve rapid hemostasis through concentrating protein coagulation factors by water adsorption to accelerate the coagulation reaction process, however their efficacy is often limited by the insufficient contact of material with blood and the lack of blood clot strength. Herein, we report an ultrafast dispersing and in situ gelation sponge (SG/DB) based on anchoring interface effect for hemorrhage control using freeze drying method after mixing fish scale gel (SG) and tert-butyl alcohol (TBA) pre-crystallized diatom biosilica (DB). This design retains the hierarchical porous structure of DB in SG matrix, and granting the SG/DB the capability to disperse ultrafast, achieving dissolution in both water and blood within 3 s. The DB and SG released by disintegration of SG/DB can activate intrinsic coagulation pathway and strengthen fibrin clot gelation through the anchoring interface effect, even realizing coagulation of anticoagulant whole blood without calcium ion activation. Animal studies showed 10%T-SG/DB has superior hemostatic properties to various commercially available hemostatic materials (rat liver and artery, 100 s; rabbit liver, artery, and heart, 3.2, 4.6, and 2.9 min, respectively), reducing bleeding by 30 % compared to QuikClot Combat Gauze®, and is easily removable without residue.

Hemostatic and antimicrobial properties of chitosan-based wound healing dressings: A review

Uncontrolled bleeding and microbial infections pose significant hurdles in wound healing, and the use of specialized functional dressings is pivotal in overcoming these obstacles. Among the various wound dressings currently under investigation, those based on chitosan and its derivatives have garnered significant attention due to their superior biocompatibility, antimicrobial properties, hemostatic capabilities, and healing promoting ability. In this comprehensive review, we initially delve into the hemostatic capabilities of chitosan, elucidating its interactions with blood cells and plasma proteins. We also dissect the intricate antimicrobial mechanisms of chitosan, which operate through both intracellular and extracellular pathways. The centerpiece of this review is the systematic classification of dressings based on chitosan and its derivatives, across various forms, such as hydrogels, sponges, membranes, fibers, and powders. This is followed by an exhaustive analysis of their hemostatic and antibacterial efficacy in wound healing, providing a robust foundation for further research and the advancement of clinical applications in the field.

Application trends of hydrogen-generating nanomaterials for the treatment of ROS-related diseases

Reactive oxygen species (ROS) play essential roles in both physiological and pathological processes. Under physiological conditions, appropriate amounts of ROS play an important role in signaling and regulation in cells. However, too much ROS can lead to many health problems, including inflammation, cancer, delayed wound healing, neurodegenerative diseases (such as Parkinson's disease and Alzheimer's disease), and autoimmune diseases, and oxidative stress from excess ROS is also one of the most critical factors in the pathogenesis of cardiovascular and metabolic diseases such as atherosclerosis. Hydrogen gas effectively removes ROS from the body due to its good antioxidant properties, and hydrogen therapy has become a promising gas therapy strategy due to its inherent safety and stability. The combination of nanomaterials can achieve targeted delivery and effective accumulation of hydrogen, and has some ameliorating effects on diseases. Herein, we summarize the use of hydrogen-producing nanomaterials for the treatment of ROS-related diseases and talk about the prospects for the treatment of other ROS-induced disease models, such as acute kidney injury.

New insights in large-pores mesoporous silica microspheres for hemostatic application

Hemorrhages are still considered a common cause of death and despite the availability of different hemostatic agents it is still necessary to develop more effective hemostats for bleeding managements in emergency situations. Herein, large-pores mesoporous silica microspheres (MSM) were synthesized, and their surface was modified to enrich the hydroxyls population with the aim of achieving a material with enhanced water adsorption capacity and high hemostatic ability. The success of surface modification was investigated by Fourier Transform Infrared spectroscopy (FT-IR) and thermogravimetric analysis (TGA), which confirmed the increase in the amount of surface hydroxyl groups. A hemolysis assay as well as a clotting test were carried out to evaluate the hemocompatibility and hemostatic ability, respectively. It was found that the modified material presented the lowest hemolytic ratio and the lowest clotting time. The novelty of the paper is mainly due to the coupling of the hemostatic ability test with the adsorption microcalorimetry of water. In fact, being the water adsorption on the material surface a crucial factor in the hemostatic activity, microcalorimetry was used for the first time to study the adsorption of water and estimate its heat of adsorption. The data obtained showed that the modified MSM presents a surface able to adsorb a higher amount of water, compared to the pristine MSM, with a low molar heat of adsorption (about 35 kJ/mol), which renders the modified MSM presented in the present study an excellent candidate for producing novel hemostats.

Scaffolds functionalized with matrix metalloproteinase-responsive release of miRNA for synergistic magnetic hyperthermia and sensitizing chemotherapy of drug-tolerant breast cancer

Combining hyperthermia and chemotherapy for maximum anticancer efficacy remains a challenge because drug-tolerant cancer cells often evade this synergistic treatment due to drug resistance and asynchronous drug release. In this study, multifunctional scaffolds were designed to efficiently treat drug-tolerant breast cancer by improving the sensitization of breast cancer cells and synchronizing anticancer drug release with magnetic hyperthermia. The scaffolds contained microRNA-encapsulated matrix metalloproteinase-cleavable liposomes, doxorubicin-encapsulated thermoresponsive liposomes and Fe3O4 nanoparticles. The scaffolds could release microRNA specifically to improve the sensitization of breast cancer cells to anticancer drugs. The scaffolds also showed excellent hyperthermia effects under alternating magnetic field irradiation. Moreover, doxorubicin release was synchronized with magnetic hyperthermia. In vitro and in vivo studies demonstrated that the scaffolds effectively reduced drug resistance and eliminated doxorubicin-tolerant MDA-MB-231 cells through the synergistic effect of magnetic hyperthermia and sensitizing chemotherapy. Additionally, the scaffolds could support the proliferation and adipogenic differentiation of stem cells for adipose tissue regeneration after killing cancer cells at a late therapeutic stage. These composite scaffolds offer an innovative strategy for treating breast cancer, with synergistic anticancer effects and regenerative functions.

Empirical use, phytochemical, and pharmacological effects in wound healing activities of compounds in Diospyros leaves: A review of traditional medicine for potential new plant-derived drugs

ETHNOPHARMACOLOGICAL RELEVANCE

Wound healing extracts' activity is increasingly being studied in the field of traditional medicine. Among medicinal plants, Diospyros is known to have healing effects on wounds, along with activities such as anti-biofilm, anti-inflammatory, antibacterial, antioxidant, and regulation of the immune system. However, the current use of the leaves could be more optimal, and the scientific basis needs to be improved.

AIM OF THIS REVIEW

This review aimed to critically examine the literature on the traditional use and bioactive metabolites of several Diospyros species, demonstrating the significant potential in wound healing, antibacterial, anti-biofilm, regulatory effect on the immune system, anti-inflammatory, and antioxidant activities. The critical analysis was conducted to provide robust perspectives and recommendations for future studies on the use of Diospyros potential resources of wound healing material, including related activities.

MATERIALS AND METHODS

Exploratory studies on Diospyros species over the past 20 years were examined, with a focus on general information, practical use, secondary metabolite, and pharmacological activities related to wound healing. Data were meticulously collected from scientific databases including Scopus, ScienceDirect, Web of Science, Taylor & Francis, Google Scholar, PubMed as well as various botanical and biodiversity sources. Furthermore, manual searches were conducted to ensure comprehensive coverage. Reference manager software was used to manage articles and remove duplicates, then the gathered data were summarized and verified, ensuring the thoroughness and validity of the review process.

RESULTS

The results showed that Diospyros leaves have great potential to be harnessed as herbal medications, evidenced by both scientific findings and community uses. Various substances, including flavonoids, coumarins, tannins, terpenoids, steroids, lignans, quinones, and secoiridoids were identified. Chemical compound investigations in both in vivo and in vitro studies of Diospyros leaves reported wound healing activity, as well as antibacterial, anti-inflammatory, anti-biofilm, antioxidant, and immunomodulatory properties.

CONCLUSION

The review highlights the traditional uses and bioactive metabolites of Diospyros species in wound healing, identifying various beneficial compounds such as flavonoids and tannins. These compounds demonstrate various therapeutic effects, including antibacterial, anti-biofilm, anti-inflammatory, antioxidant, and immunomodulatory activities. Diospyros leaf extracts have a favorable safety profile, but further studies, including in vivo investigations and clinical trials, are necessary to confirm their efficacy and safety for clinical applications. Diospyros leaf extracts have significant potential for the development of wound healing substances due to the wide range of bioactivities targeting various stages of wound healing.

Research progress and application of chitosan dressings in hemostasis: A review

Hemorrhage affects human health, and severe bleeding remains a leading contributor to trauma-related mortality. The speed and effectiveness of the application of hemostatic materials are critical. Conventional hemostatic dressings such as bandages and gauze are gradually being replaced by new types of hemostatic dressings due to their poor hemostatic and antibacterial properties. Chitosan, a biopolymer, is biodegradable and nontoxic and possesses hemostatic and antibacterial properties. Chitosan induces hemostasis through direct contact with red corpuscles and platelets, independent of the coagulation pathways of the host, rendering it an optimal hemostatic dressing. It is widely used in wound care, particularly to stop bleeding, promote wound healing, and provide antimicrobial properties. This article reviews the recent research and development of chitosan-based hemostatic dressings, focusing on trauma hemostasis, burn hemostasis, diabetic skin ulcer hemostasis and other aspects. It also emphasizes the significance of chitosan dressings in wound hemostasis and healing, identifies their research opportunities in hemostasis and wound healing, and explores new research directions.

A hybrid 3D-printed and electrospun bilayer pharmaceutical membrane based on polycaprolactone/chitosan/polyvinyl alcohol for wound healing applications

Skin injuries resulting from physical trauma pose significant health risks, necessitating advanced wound care solutions. This investigation introduces an innovative bilayer wound dressing composed of 3D-printed propolis-coated polycaprolactone (PCL/PP) and an electrospun composite of polyvinyl alcohol, chitosan, polycaprolactone, and diltiazem (PVA/CTS/PCL/DTZ). SEM analysis revealed a bilayer structure with 89.23 ± 51.47 % porosity and uniformly distributed nanofibers. The scaffold tensile strength, with pore sizes of 100, 300, and 500 μm, was comparable to native skin. However, smaller pore sizes reduced water vapor transmission from 4211.59 ± 168.53 to 2358.49 ± 203.63 g/m2. The incorporation of DTZ lowered the contact angle to 35.23 ± 3.65°, while the addition of PCL reduced the degradation rate and modulated the release of DTZ by approximately 50 %. Moreover, lower pH increased the degradation rate and decreased swelling. The inclusion of propolis enhanced antibacterial activity, and 10 % DTZ promoted the viability, proliferation, and migration of fibroblasts and adipose-derived stem cells. However, increasing DTZ concentration to 12 % reduced cell viability. In vivo tests on rats demonstrated effective wound healing and anti-inflammatory properties of the bilayer samples. Regarding the aforementioned results, the PCL/PP-PVA/CTS/PCL/DTZ (10 % w/w) bilayer wound dressing is a promising candidate for wound healing applications.

External Bleeding and Advanced Biomacromolecules for Hemostasis

Hemorrhage is a significant medical problem that has been an active area of research over the past few decades. The human body has a complex response to bleeding that leads to blood clot formation and hemostasis. Many biomaterials based on various biomacromolecules have been developed to either accelerate or improve the body's natural response to bleeding. This review examines the mechanisms of hemostasis, types of bleeding, and the in vitro or in vivo models and techniques used to study bleeding and hemostatic materials. It provides a detailed overview of the diverse hemostatic materials, including those that are highly absorbent, wet adhesives, and those that accelerate the biochemical cascade of blood clotting. These materials are currently marketed, under preclinical testing, or being researched. In exploring the latest advancements in hemostatic technologies, this paper highlights the potential of these materials to significantly improve bleeding control in clinical and emergency situations.

Preparation and Biochemical Activity of Copper-Coated Cellulose Nonwoven Fabric via Magnetron Sputtering and Alginate-Calcium Ion Complexation

Alginate-based materials have gained significant recognition in the medical industry due to their favorable biochemical properties. As a continuation of our previous studies, we have introduced a new composite consisting of cellulose nonwoven fabric charged with a metallic copper core (CNW-Cu0) covered with a calcium alginate (ALG-Ca2+) layer. The preparation process for these materials involved three main steps: coating the cellulose nonwoven fabric with copper via magnetron sputtering (CNW → CNW-Cu0), subsequent deposition with sodium alginate (CNW-Cu0 → CNW-Cu0/ALG-Na+), followed by cross-linking the alginate chains with calcium ions (CNW-Cu0/ALG-Na+ → CNW-Cu0/ALG-Ca2+). The primary objective of the work was to supply these composites with such biological attributes as antibacterial and hemostatic activity. Namely, equipping the antibacterial materials (copper action on representative Gram-positive and Gram-negative bacteria and fungal strains) with induction of blood plasma clotting processes (activated partial thromboplastin time (aPTT) and prothrombin time (PT)). We determined the effect of CNW-Cu0/ALG-Ca2+ materials on the viability of Peripheral blood mononuclear (PBM) cells. Moreover, we studied the interactions of CNW-Cu0/ALG-Ca2+ materials with DNA using the relaxation plasmid assay. However, results showed CNW-Cu0/ALG-Ca2+'s cytotoxic properties against PBM cells in a time-dependent manner. Furthermore, the CNW-Cu0/ALG-Ca2+ composite exhibited the potential to interact directly with DNA. The results demonstrated that the CNW-Cu0/ALG-Ca2+ composites synthesized show promising potential for wound dressing applications.

Blood Coagulation Activities and Influence on DNA Condition of Alginate-Calcium Composites Prepared by Freeze-Drying Technique

The aim of this research was to synthesize and characterize alginate-calcium composites using a freeze-drying method, with a focus on their potential applications in biomedicine. This study specifically explored the biochemical properties of these composites, emphasizing their role in blood coagulation and their capacity to interact with DNA. Additionally, the research aimed to assess how the cross-linking process influences the structural and chemical characteristics of the composites. Detailed analyses, including microscopic examination, surface area assessment, and atomic absorption spectrometry, yielded significant results. The objective of this study was to examine the impact of calcium chloride concentration on the calcium content in alginate composites. Specifically, the study assessed how varying concentrations of the cross-linking solution (ranging from 0.5% to 2%) influence the calcium ion saturation within the composites. This investigation is essential for understanding the physicochemical properties of the materials, including calcium content, porosity, and specific surface area. The results are intended to identify the optimal cross-linking conditions that maximize calcium enrichment efficiency while preserving the material's structural integrity. The study found that higher calcium chloride concentrations in alginate cross-linking improve the formation of a porous structure, enhanced by two-stage freeze-drying. Increased calcium levels led to a larger surface area and pore volume, and significantly higher calcium content. Furthermore, assays of activated partial thromboplastin time (aPTT) showed a reduction in clotting time for alginate composites containing calcium ions, indicating their potential as hemostatic agents. The aPTT test showed shorter clotting times with higher calcium ion concentrations, without enhanced activation of the extrinsic clotting pathway. The developed alginate material with calcium effectively supports hemostasis and reduces the risk of infection. The study also explored the capacity of these composites to interact with and modify the structure of plasmid DNA, underscoring their potential for future biomedical applications.

Hemostatic Dressing Immobilized with ε-poly-L-lysine and Alginate Coated Mesoporous Bioactive Glass Prevents Blood Permeation by Pseudo-Dewetting Behavior

The integration of hemostats with cotton fabrics is recognized as an effective approach to improve the hemostatic performance of dressings. However, concerns regarding the uncontrollable absorption of blood by hydrophilic dressings and the risk of distal thrombosis from shed hemostatic agents are increasingly scrutinized. To address these issues, this work develops an advanced dressing (AQG) with immobilized nano-scale mesoporous bioactive glass (MBG) to safely and durably augment hemostasis. The doubly immobilized MBGs, pre-coated with ε-poly-L-lysine and alginate, demonstrate less than 1% detachment after ultrasonic washing. Notably, this MBG layer significantly promotes the adhesion, aggregation, and activation of red blood cells and platelets, adhered five times more red blood cells and 29 times more platelets than raw dressing, respectively. Specially, with the rapid formation of protein corona and amplification of thrombin, dense fibrin network is built on MBG layer and then blocked blood permeation transversely and longitudinally, showing an autophobic pseudo-dewetting behavior and allowing AQG to concentrate blood in situ and culminate in faster hemostasis with lower blood loss. Furthermore, the potent antibacterial properties of AQG extend its potential for broader application in daily care and clinical setting.

Calcium Ion-Coupled Polyphosphates with Different Degrees of Polymerization for Bleeding Control

The development of efficient hemostatic materials is crucial for achieving rapid hemorrhage control and effective wound healing. Inorganic polyphosphate (polyP) is recognized as an effective modulator of the blood coagulation process. However, the specific effect of polyP chain length on coagulation is not yet fully understood. Furthermore, calcium ions (Ca2+) are essential for the coagulation process, promoting multiple enzyme-catalyzed reactions within the coagulation cascade. Hence, calcium ion-coupled polyphosphate powders with three different degrees of polymerization (CaPP-n, n = 20, 50, and 1500) are synthesized by an ion-exchange reaction. CaPP exhibits a crystalline phase at a low polymerization degree and transitions to an amorphous phase as the polymerization degree increases. Notably, the addition of Ca2+ enhances the wettability of polyP, and CaPP promotes hemostasis, with varying degrees of effectiveness related to chain length. CaPP-50 exhibits the most promising hemostatic performance, with the lowest blood clotting index (BCI, 12.1 ± 0.7%) and the shortest clotting time (302.0 ± 10.5 s). By combining Ca2+ with polyP of medium-chain length, CaPP-50 demonstrates an enhanced ability to accelerate the adhesion and activation of blood cells, initiate the intrinsic coagulation cascade, and form a stable blood clot, outperforming both CaPP-20 and CaPP-1500. The hemostatic efficacy of CaPP-50 is further validated using rat liver bleeding and femoral artery puncture models. CaPP-50 is proven to possess hemostatic properties comparable to those of commercial calcium-based zeolite hemostatic powder and superior to kaolin. In addition, CaPP-50 exhibits excellent biocompatibility and long-term storage stability. These results suggest that CaPP-50 has significant clinical and commercial potential as an active inorganic hemostatic agent for rapid control of bleeding.

Alginate based hemostatic materials for bleeding management: A review

Severe bleeding has caused significant financial losses as well as a major risk to the lives and health of military and civilian populations. Under some situations, the natural coagulation mechanism of the body is unable to achieve fast hemostasis without the use of hemostatic drugs. Thus, the development of hemostatic materials and techniques is essential. Improving the quality of life and survival rate of patients and minimizing bodily damage requires fast, efficient hemostasis and prevention of bleeding. Alginate is regarded as an outstanding hemostatic polymer because of its non-immunogenicity, biodegradability, good biocompatibility, simple gelation, non-toxicity, and easy availability. This review summarizes the basics of hemostasis and emphasizes the recent developments regarding alginate-based hemostatic systems. Structural modifications and mixing with other materials have widely been used for the improvement of hemostatic characteristics of alginate and for making multifunctional medical devices that not only prevent uncontrolled bleeding but also have antibacterial characteristics, drug delivery abilities, and curing effects. This review is hoped to prepare critical insights into alginate modifications for better hemostatic properties.

Tannic acid coating gauze immobilized with thrombin with ultra-high coagulation activity and antimicrobial property for uncontrollable hemorrhage

Rapid and safe hemostasis is crucial for the survival of bleeding patients in prehospital care. It is urgent to develop high performance hemostatic material to control the massive hemorrhage in the military field and accidental trauma. In this work, an efficient protein hemostat of thrombin was immobilized onto commercial gauze, which was mediated by self-polymerization and anchoring of tannic acid (TA). Through TA treatment, the efficient immobilization of thrombin was achieved, preserving both the biological activity of thrombin and the physical properties of the dressing, including absorbency, breathability, and mechanical performance. Moreover, in the presence of TA coating and thrombin, Gau@TA/Thr could obviously shortened clotting time and enriched blood components such as plasma proteins, platelets, and red blood cells, thereby exhibiting an enhanced in vitro coagulation effect. In SD rat liver volume defect and artery transection hemorrhage models, Gau@TA/Thr still had outstanding hemostatic performance. Besides, the Gau@TA/Thr gauze had inherent antibacterial property and demonstrated excellent biocompatibility. All results suggested that Gau@TA/Thr would be a potential candidate for treating uncontrollable hemorrhage in prehospital care.

Exploring the mechanistic role of silk sericin biological and chemical conjugates for effective acute and chronic wound repair and related complications

OBJECTIVE

The current review is designed to elaborate and reveal the underlying mechanism of sericin and its conjugates of drug delivery during wounds and wound-related issues.

SIGNIFICANCE

Wound healing is a combination of different humoral, molecular, and cellular mechanisms. Various natural products exhibit potential in wound healing but among them, sericin, catches much attention of researchers due to its bio-functional properties such as being biodegradable, biocompatible, anti-oxidant, anti-bacterial, photo-protector, anti-inflammatory and moisturizing agent.

METHODS AND RESULTS

Sericin triggers the activity of anti-inflammatory cytokines which decrease cell adhesion and promote epithelial cell formation. Moreover, sericin enhances the anti-oxidant enzymes in the wounded area which scavenge the toxic consequences of reactive species (ROS).

CONCLUSIONS

This article highlights the mechanisms of how topical administration of sericin formulations along with 4-hexylresorcinol,\Chitosan\Ag@MOF-GO, polyvinyl alcohol (PVA), platelet lysate and UV photo cross-linked hydrogel sericin methacrylate which recruits a large number of cytokines on wounded area that stimulate fibroblasts and keratinocyte production as well as collagen deposition that led to early wound contraction. It also reviews the different sericin-based nanoparticles that play a significant role in rapid wound healing.

Porous silicon-based sensing and delivery platforms for wound management applications

Wound management remains a great challenge for clinicians due to the complex physiological process of wound healing. Porous silicon (PSi) with controlled pore morphology, abundant surface chemistry, unique photonic properties, good biocompatibility, easy biodegradation and potential bioactivity represent an exciting class of materials for various biomedical applications. In this review, we focus on the recent progress of PSi in the design of advanced sensing and delivery systems for wound management applications. Firstly, we comprehensively introduce the common type, normal healing process, delaying factors and therapeutic drugs of wound healing. Subsequently, the typical fabrication, functionalization and key characteristics of PSi have been summarized because they provide the basis for further use as biosensing and delivery materials in wound management. Depending on these properties, the rise of PSi materials is evidenced by the examples in literature in recent years, which has emphasized the robust potential of PSi for wound monitoring, treatment and theranostics. Finally, challenges and opportunities for the future development of PSi-based sensors and delivery systems for wound management applications are proposed and summarized. We hope that this review will help readers to better understand current achievements and future prospects on PSi-based sensing and delivery systems for advanced wound management.

Smart composite scaffold to synchronize magnetic hyperthermia and chemotherapy for efficient breast cancer therapy

Combination of different therapies is an attractive approach for cancer therapy. However, it is a challenge to synchronize different therapies for maximization of therapeutic effects. In this work, a smart composite scaffold that could synchronize magnetic hyperthermia and chemotherapy was prepared by hybridization of magnetic Fe3O4 nanoparticles and doxorubicin (Dox)-loaded thermosensitive liposomes with biodegradable polymers. Irradiation of alternating magnetic field (AMF) could not only increase the scaffold temperature for magnetic hyperthermia but also trigger the release of Dox for chemotherapy. The two functions of magnetic hyperthermia and chemotherapy were synchronized by switching AMF on and off. The synergistic anticancer effects of the composite scaffold were confirmed by in vitro cell culture and in vivo animal experiments. The composite scaffold could efficiently eliminate breast cancer cells under AMF irradiation. Moreover, the scaffold could support proliferation and adipogenic differentiation of mesenchymal stem cells for adipose tissue reconstruction after anticancer treatment. In vivo regeneration experiments showed that the composite scaffolds could effectively maintain their structural integrity and facilitate the infiltration and proliferation of normal cells within the scaffolds. The composite scaffold possesses multi-functions and is attractive as a novel platform for efficient breast cancer therapy.

Evaluation of bone marrow-derived mesenchymal stem cells with eggshell membrane for full-thickness wound healing in a rabbit model

Biomaterials capable of managing wounds should have essential features like providing a natural microenvironment for wound healing and as support material for stimulating tissue growth. Eggshell membrane (ESM) is a highly produced global waste due to increased egg consumption. The unique and fascinating properties of ESM allow their potential application in tissue regeneration. The wound healing capacity of bone marrow-derived mesenchymal stem cells (BM-MSCs), ESM, and their combination in rabbits with full-thickness skin defect (2 × 2 cm2) was evaluated. Twenty-five clinically healthy New Zealand White rabbits were divided into five groups of five animals each, with group A receiving no treatment (control group), group B receiving only fibrin glue (FG), group C receiving FG and ESM as a dressing, group D receiving FG and BM-MSCs, and group E receiving a combination of FG, ESM, and BM-MSCs. Wound healing was assessed using clinical, macroscopical, photographic, histological, histochemical, hematological, and biochemical analysis. Macroscopic examination of wounds revealed that healing was exceptional in group E, followed by groups D and C, compared to the control group. Histopathological findings revealed improved quality and a faster rate of healing in group E compared to groups A and B. In addition, healing in group B treated with topical FG alone was nearly identical to that in control group A. However, groups C and D showed improved and faster recovery than control groups A and B. The macroscopic, photographic, histological, and histochemical evaluations revealed that the combined use of BM-MSCs, ESM, and FG had superior and faster healing than the other groups.

Therapeutic Potential of Nanocarrier Mediated Delivery of Peptides for Wound Healing: Current Status, Challenges and Future Prospective

Wound healing presents a complex physiological process that involves a sequence of events orchestrated by various cellular and molecular mechanisms. In recent years, there has been growing interest in leveraging nanomaterials and peptides to enhance wound healing outcomes. Nanocarriers offer unique properties such as high surface area-to-volume ratio, tunable physicochemical characteristics, and the ability to deliver therapeutic agents in a controlled manner. Similarly, peptides, with their diverse biological activities and low immunogenicity, hold great promise as therapeutics in wound healing applications. In this review, authors explore the potential of peptides as bioactive components in wound healing formulations, focusing on their antimicrobial, anti-inflammatory, and pro-regenerative properties. Despite the significant progress made in this field, several challenges remain, including the need for standardized characterization methods, optimization of biocompatibility and safety profiles, and translation from bench to bedside. Furthermore, developing multifunctional nanomaterial-peptide hybrid systems represents promising avenues for future research. Overall, the integration of nanomaterials made up of natural or synthetic polymers with peptide-based formulations holds tremendous therapeutic potential in advancing the field of wound healing and improving clinical outcomes for patients with acute and chronic wounds.

Anti-adhesive and antibacterial chitosan/PEO nanofiber dressings with high breathability for promoting wound healing

Wound dressings are crucial for wound healing. Ideal wound dressings should possess many functions such as wettability, antibacterial activity and anti-adherent property to promote wound healing. In the present study solution blown spinning (SBS) technology was applied to prepare chitosan/polyethylene oxide (CS/PEO) nanofiber dressings in high efficiency. The obtained nanofiber dressings were treated with anhydrous ethanol to improve the fiber structure and enhance the functionality of the fiber dressings. The results show that the treated nanofibers had higher crystallinities and higher CS contents. The CS/PEO nanofiber dressings fabricated by using no additives and crosslinking had excellent wettability, water stability and antibacterial activity against Escherichia coli and Staphylococcus aureus reached to over 99.99 %. In addition, the CS/PEO nanofiber dressings exhibited high breathability, antioxidant activity and anti-adhesion function. The in vivo animal experiment confirmed that the nanofiber dressings enhanced cell proliferation and significantly accelerated the wound healing within 10 days. The developed CS/PEO nanofiber dressings have great potential in the clinical field of wound healing.

Self-Oxidated Hydrophilic Chitosan Fibrous Mats for Fatal Hemorrhage Control

Enriching erythrocytes and platelets in seconds and providing a fast seal in bleeding sites is vital to fatal hemorrhage control. Herein, hydrophilic chitosan fibrous mats (CECS-D mats) are fabricated by introducing hydrophilic carboxyethyl groups and subsequent catechol groups onto chitosan fibers. Due to strong hydrophilicity, CECS-D mats exhibit rapid liquid-absorption capacity, especially instantaneous absorptivity to the rabbit blood, which can achieve erythrocyte and platelet aggregations quickly by concentrating blood, thus promoting the formation of blood clots. Furthermore, the mats are self-oxidated to form quinone-amine adducts or quinone multimers by adjusting pH conditions, which not only provides tissue adhesion but also induces erythrocyte aggregation and platelet adhesion, further enhancing the seal and triggering quick closure to achieve fast hemostasis. Therefore, the mats reveal superior hemostatic performance in rabbit liver and spleen models over CECS mats and gauze. Especially in the fatal femoral artery injury model of rabbits, the mats reduce the blood loss by ∼75% and shortened the bleeding time by ∼50% compared with CECS mats, which have been reported to have the same hemostatic effect as commercialized Celox products in a swine femoral artery injury model. Besides, the mats are cytocompatible and degradable as well as antibacterial. This chitosan mat is a promising hemostatic material for fatal hemorrhage control.

State of the art, trends, hotspots, and prospects of injection materials for controlling bleeding

Traumatic haemorrhage is a prevalent clinical condition, and effective and timely haemostasis is crucial for the preservation of patients' lives. In recent years, injectable hemostatic materials have gained significant attention due to their excellent hemostatic efficacy, biocompatibility, and biodegradability, making them widely applied in the treatment of incompressible traumatic haemorrhage. Systematic analysis of injectable hemostatic materials is crucial for research in this area. This article provides a comprehensive review of the development and research trends of injectable hemostatic materials over the past 20 years using visualization techniques. Analysis of collaboration and co-citation networks revealed localized research collaboration networks, highlighting the need for enhanced international collaboration in the field of injectable hemostatic materials. Current research focuses primarily on hemostatic materials, hemostatic processes, and hemostatic mechanisms. Injectable hemostatic materials with excellent performance offer promising strategies for wound healing. This review provides a comprehensive and systematic summary of injectable hemostatic materials, offering valuable guidance for the development and clinical application of novel injectable hemostatic materials. Additionally, visualized methodology and mapping analysis are effective data mining methods that provide approaches and strategies for clear knowledge network analysis. These methods facilitate better understanding and interpretation of research dynamics in the field of injectable hemostatic materials, thereby guiding and inspiring future research.

The hierarchical porous structures of diatom biosilica-based hemostat: From selective adsorption to rapid hemostasis

Here, we developed a Ca2+ modified diatom biosilica-based hemostat (DBp-Ca2+) with a full scale hierarchical porous structure (pore sizes range from micrometers to nanometers). The unique porous size in stepped arrangement of DBp-Ca2+give it selective adsorption capacity during coagulation process, resulted in rapid hemorrhage control. Based on in vitro and in vivo studies, it was confirmed that the primary micropores of DBp-Ca2+gave it high porosity to hold water (water absorption: 78.46 ± 1.12 %) and protein (protein absorption: 83.7 ± 1.33 mg/g). Its secondary mesopores to macropores could reduce of water diffusion length to accelerate blood exchange (complete within 300 ms). The tertiary stacking pores of DBp-Ca2+ could absorb platelets and erythrocytes to reduce more than 50 % of thrombosis time, and provided enough contact between Ca active site and coagulation factors for triggering clotting cascade reaction. This work not only developed a novel DBs based hemostat with efficient hemorrhage control, but also provided new insights to study procoagulant mechanism of inorganic hemostat with hierarchical porous structure from selective adsorption to rapid hemostasis.

Local Clays from China as Alternative Hemostatic Agents

In recent years, the coagulation properties of inorganic minerals such as kaolin and zeolite have been demonstrated. This study aimed to assess the hemostatic properties of three local clays from China: natural kaolin from Hainan, natural halloysite from Yunnan, and zeolite synthesized by our group. The physical and chemical properties, blood coagulation performance, and cell biocompatibility of the three materials were tested. The studied materials were characterized by using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray fluorescence spectroscopy (XRF), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). All three clays showed different morphologies and particle size, and exhibited negative potentials between pH 6 and 8. The TGA and DSC curves for kaolin and halloysite were highly similar. Kaolin showed the highest water absorption capacity (approximately 93.8% ± 0.8%). All three clays were noncytotoxic toward L929 mouse fibroblasts. Kaolin and halloysite showed blood coagulation effects similar to that exhibited by zeolite, indicating that kaolin and halloysite are promising alternative hemostatic materials.

An Overview of Recent Developments in the Management of Burn Injuries

According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.

Chitosan-Based Biomaterials for Hemostatic Applications: A Review of Recent Advances

Hemorrhage is a detrimental event present in traumatic injury, surgery, and disorders of bleeding that can become life-threatening if not properly managed. Moreover, uncontrolled bleeding can complicate surgical interventions, altering the outcome of surgical procedures. Therefore, to reduce the risk of complications and decrease the risk of morbidity and mortality associated with hemorrhage, it is necessary to use an effective hemostatic agent that ensures the immediate control of bleeding. In recent years, there have been increasingly rapid advances in developing a novel generation of biomaterials with hemostatic properties. Nowadays, a wide array of topical hemostatic agents is available, including chitosan-based biomaterials that have shown outstanding properties such as antibacterial, antifungal, hemostatic, and analgesic activity in addition to their biocompatibility, biodegradability, and wound-healing effects. This review provides an analysis of chitosan-based hemostatic biomaterials and discusses the progress made in their performance, mechanism of action, efficacy, cost, and safety in recent years.

Sustainable sepiolite-based composites for fast clotting and wound healing

Uncontrolled bleeding and bacterial coinfection are the major causes of death after an injury. Fast hemostatic capacity, good biocompatibility, and bacterial coinfection inhibition pose great challenges to hemostatic agent development. A prospective sepiolite/Ag nanoparticles (sepiolite@AgNPs) composite has been prepared by using natural clay sepiolite as template. A tail vein hemorrhage mouse model and a rabbit hemorrhage model were used to evaluate the hemostatic properties of the composite. The sepiolite@AgNPs composite can quickly absorb fluid to subsequently stop bleeding due to the natural fibrous crystal structure of sepiolite, and inhibit bacterial growth with the antibacterial ability of AgNPs. Compared with commercially-available zeolite material, the as-prepared composite exhibits competitive hemostatic properties without exothermic reaction in the rabbit model of femoral and carotid artery injury. The rapid hemostatic effect was due to the efficient absorption of erythrocyte and activation of the coagulation cascade factors and platelets. Besides, after heat-treatment, the composites can be recycled without significant reduction of hemostatic performance. Our results also prove that sepiolite@AgNPs nanocomposites can stimulate wound healing. The sustainability, lower-cost, higher bioavailability, and stronger hemostatic efficacy of sepiolite@AgNPs composite render these nanocomposites as more favorable hemostatic agents for hemostasis and wound healing.

Morphological, cytotoxicity, and coagulation assessments of perlite as a new hemostatic biomaterial

Hemorrhage control is vital for clinical outcomes after surgical treatment and pre-hospital trauma injuries. Numerous biomaterials have been investigated to control surgical and traumatic bleeding. In this study, for the first time, perlite was introduced as an aluminosilicate biomaterial and compared with other ceramics such as kaolin and bentonite in terms of morphology, cytotoxicity, mutagenicity, and hemostatic evaluations. Cellular studies showed that perlite has excellent viability, good cell adhesion, and high anti-mutagenicity. Coagulation results demonstrated that the shortest clotting time (140 seconds with a concentration of 50 mg mL^-1) was obtained for perlite samples compared to other samples. Therefore, perlite seems most efficient as a biocompatible ceramic for hemorrhage control and other biomaterial designs.