Calcium loaded biodegradable porous microspheres for the hemostasis of coagulopathy

The development of efficient hemostatic materials is a challenge for patients with coagulation disorders. In this study, we developed advanced biodegradable porous microspheres for the hemostasis of coagulopathy. The microspheres were fabricated using multiblock amphiphilic poly(ε-caprolactone-r-glycolide) (PCGA)/poly(ethylene glycol) (PEG) polyurethanes (PUE). Calcium ions were loaded in the porous microspheres (CPBMs) via solution immersion. The microspheres possessed high porosity, uniform particle and pore sizes, and excellent biocompatibility. The CPBMs demonstrated an ultra-high water absorption capacity of 45 times and a rapid calcium ion release rate to accelerate the coagulation cascade. The CPBMs significantly promoted platelet aggregation, red blood cell adhesion and fibrin formation, and outperformed commercially available hemostatic agents. The in vivo studies on liver injury and tail amputation models in both healthy and coagulopathic rats revealed superior hemostasis compared to the modified starch-based powders (BT) and Yunnan Baiyao (YB) hemostatic powders.

Emerging Frontiers in In Situ Forming Hydrogels for Enhanced Hemostasis and Accelerated Wound Healing

With a surge in the number of accidents and chronic wounds worldwide, there is a growing need for advanced hemostatic and wound care solutions. In this regard, in situ forming hydrogels have emerged as a revolutionary biomaterial due to their inherent properties, which include biocompatibility, biodegradability, porosity, and extracellular matrix (ECM)-like mechanical strength, that render them ideal for biomedical applications. This review demonstrates the advancements of in situ forming hydrogels, tracing their evolution from injectable to more sophisticated forms, such as sprayable and 3-D printed hydrogels. These hydrogels are designed to modulate the pathophysiology of wounds, enhancing hemostasis and facilitating wound repair. The review presents different methodologies for in situ forming hydrogel synthesis, spanning a spectrum of physical and chemical cross-linking techniques. Furthermore, it showcases the adaptability of hydrogels to the dynamic requirements of wound healing processes. Through a detailed discussion, this article sheds light on the multifunctional capabilities of these hydrogels such as their antibacterial, anti-inflammatory, and antioxidant properties. This review aims to inform and inspire continued advancement in the field, ultimately contributing to the development of sophisticated wound care solutions that meet the complexity of clinical needs.

Hydrophobic Polystyrene-Modified Gelatin Enhances Fast Hemostasis and Tissue Regeneration in Traumatic Brain Injury

Hemostatic sealant is required to deal with blood loss, especially in the scenario of traumatic brain injury (TBI), which presents high rates of morbidity and disability. Hemostasis in surgery with traditional gelatin-based sealants often leads to blood loss and other issues in brain because of the hydrophilic gelatin swelling. Herein, hydrophobic effects on the hemostasis in TBI surgery are studied by tuning the chain length of polystyrene (PS) onto methylacrylated gelatin (Gel-MA). The hydrophobicity and hemostatic efficiency can be tuned by controlling the length of PS groups. The platelet activation of modified sealants Gel-MA-2P, Gel-MA-P, and Gel-MA-0.5P is as much as 17.5, 9.1, and 2.1 times higher than Gel-MA in vitro. The hemostatic time of Gel-MA-2P, Gel-MA-P, and Gel-MA-0.5P groups is 2.0-, 1.6-, and 1.1-folds faster than that in Gel-MA group in TBI mice. Increased formation of fibrins and platelet aggregation can also be observed in vitro by scanning electron microscopy. Animal's mortality is lowered by 46%, neurologic deficiency is reduced by 1.5 times, and brain edema is attenuated by 10%. Protein expression is further investigated to exhibit toxic iron-related processes caused by delayed hemostasis and activation of platelets via PI3K/PKC-α signaling. The hydrophobic Gel-MA has the potential in hemostatic TBI and promotes nervous system recovery in brain with the potentials in clinics.

Catechol-chitosan/carboxymethylated cotton-based Janus hemostatic patch for rapid hemostasis in coagulopathy

Uncontrolled bleeding is the leading cause of death, and the death risk of bleeding from coagulopathy is even higher. By infusing the relevant coagulation factors, bleeding in patients with coagulopathy can be clinically treated. However, there are not many emergency hemostatic products accessible for coagulopathy patients. In response, a Janus hemostatic patch (PCMC/CCS) with a two-layer structure of partly carboxymethylated cotton (PCMC) and catechol-grafted chitosan (CCS) was developed. Ultra-high blood absorption (4000 %) and excellent tissue adhesion (60 kPa) were both displayed by PCMC/CCS. The proteomic analysis revealed that PCMC/CCS has significantly contributed to the creative generation of FV, FIX, and FX, as well as to the substantial enrichment of FVII and FXIII, re-paving the initially blocked coagulation pathway of coagulopathy to promote hemostasis. The in vivo bleeding model of coagulopathy demonstrated that PCMC/CCS was substantially more effective than gauze and commercial gelatin sponge at achieving hemostasis in just 1 min. The study provides one of the first investigations on procoagulant mechanisms in anticoagulant blood conditions. Rapid hemostasis in coagulopathy will be significantly affected by the results of this experiment.

Hydrophobically modified hydrogel with enhanced tissue adhesion and antibacterial capacity for wound healing

The increasing emergence of drug-resistant bacteria and bacteria-infected wounds highlights the urgent need for new kinds of antibacterial wound dressing. Herein, we reported a novel bio-adhesive and antibacterial hydrogel consisting of hydrophobically modified gelatin, oxidized konjac glucomannan, and dopamine. This kind of functional hydrogel was endowed with developed stability in a liquid environment and strong tissue adhesion, even much higher than the commercial fibrin glue to wounds. The excellent bacteria-killing efficiency of hydrophobically modified hydrogel against S. aureus and E. coli was verified, as well as the low hemolysis ratio against erythrocytes in vitro. The hydrogel also exhibited good cytocompatibility in terms of supporting cell proliferation. Most importantly, these abovementioned properties could be customized by altering the substitution degree of hydrophobic groups during manufacturing, demonstrating its great potential in biomedical fields such as tissue adhesive and wound dressing.

Current status of hemostatic agents, their mechanism of action, and future directions

The bleeding problem might seem straightforward, but it involves a plethora of complex biochemical pathways and responses. Hemorrhage control remains one of the leading causes of “preventable deaths” worldwide. The past few decades have seen a wide range of biomaterials and their derivatives targeted to serve as hemostatic agents, but none can be deemed as an ideal solution. In this review, we have highlighted the current diversity in hemostatic agents and their modalities. We have enclosed a comprehensive outlook of the proposed solutions and their clinical performance so far. In addition to these, several promising compositions are still in their infancy or developmental phases. The inclusion of novel upcoming nanocomposites has further widened the potencies of existing formulations as well.

Cohesion Design-Led Tough Sealants with Controllably Dissolvable Properties

Leakage is a common complication of surgeries and injuries, causing pain and increasing the economic burden on patients. Although there are commercially available sealants for leakage prevention, few of them are entirely satisfactory due to disease transmission, high cost, and poor biocompatibility. In addition, none of them can be controllably removed for further healthcare. In this paper, by using cohesion design, a sealant based on amino-modified gelatin (AG) and bi-polyethylene glycol N-hydroxysuccinimide active ester (Bi-PEG-SS) was fabricated. To increase the bursting pressure, the cohesion strength was enhanced by increasing the cross-linking density of the sealant. To endow the sealant with controllably dissolvable properties, the smart succinic ester units were introduced into the cohesion network. Both the in vitro and in vivo experiments showed that this sealant processed high bursting pressure with efficient hemorrhage control. Moreover, no side effects were observed after 7 days of in vivo sealing, including little inflammation and fibrogenesis. These results, together with the easy availability of the raw materials, revealed that this sealant might be a promising alternative for leakage sealing.

Biopolymers for Surgical Applications

Biopolymers have gained significant attention as a class of polymer materials with a wide range of applications, especially in the medical and pharmaceutical field. Due to particular characteristics, such as biocompatibility, biodegradability, non-toxicity, and functionality, they have become promising candidates for various surgical applications, including as bioadhesives, sealants, wound dressings, sutures, drug carriers, coating materials, etc. Recent research shows that further modification of biopolymers by advanced techniques can improve their functionality i.e., antibacterial activity, cell viability, drug-releasing capability, good wet adhesion performance, and good mechanical properties. This mini review aims to provide a brief report on the type of biopolymers and recent developments regarding their use in various surgical applications.

The Topical Hemostatic Materials for Coagulopathy

Medical sciences have witnessed significant progresses in hemostatic materials which have saved lives by supporting natural hemostatic ability. However, for the treatment of coagulopathy, where natural hemostatic ability is dysfunctional,...

Preparation and biomedical application of injectable hydrogels

The preparation of multifunctional injectable hydrogels, as well as the classification of injectable hydrogels according to different functions, most summarize the applications of injectable hydrogels in different biomedical fields.

How Do Amphiphilic Biopolymers Gel Blood? An Investigation Using Optical Microscopy

Amphiphilic biopolymers such as hydrophobically modified chitosan (hmC) have been shown to convert liquid blood into elastic gels. This interesting property could make hmC useful as a hemostatic agent in treating severe bleeding. The mechanism for blood gelling by hmC is believed to involve polymer-cell self-assembly, i.e., insertion of hydrophobic side chains from the polymer into the lipid bilayers of blood cells, thereby creating a network of cells bridged by hmC. Here, we probe the above mechanism by studying dilute mixtures of blood cells and hmC in situ using optical microscopy. Our results show that the presence of hydrophobic side chains on hmC induces significant clustering of blood cells. The extent of clustering is quantified from the images in terms of the area occupied by the 10 largest clusters. Clustering increases as the fraction of hydrophobic side chains increases; conversely, clustering is negligible in the case of the parent chitosan that lacks hydrophobes. Moreover, the longer the hydrophobic side chains, the greater the clustering (i.e., C₁₂ > C₁₀ > C₈ > C₆). Clustering is negligible at low hmC concentrations but becomes substantial above a certain threshold. Finally, clustering due to hmC can be reversed by adding the supramolecule α-cyclodextrin, which is known to capture hydrophobes in its binding pocket. Overall, the results from this work are broadly consistent with the earlier mechanism, albeit with a few modifications.

Thermoresponsive Chitosan/DOPA-Based Hydrogel as an Injectable Therapy Approach for Tissue-Adhesion and Hemostasis

Chitosan (CS) hydrogels are widely used in wound hemostatic agents due to their superior biocompatibility, biodegradability, and hemostatic effect. However, most of them fail to achieve great hemostatic effect because of poor adhesion to bleeding tissues. Also, the conventional implantation surgery of hemostatic hydrogels to internal bleeding wounds may cause secondary trauma to the human body. In this work, catechol-hydroxybutyl chitosan (HBCS-C) has been designed and prepared by grafting hydroxybutyl groups and catechol groups to the CS backbones. The multifunctional HBCS-C hydrogels are fabricated with the properties of thermosensitivity, injectability, tissue-adhesion, biodegradation, biocompatibility, and wound hemostasis. They exhibit excellent liquid-gel transition at different temperatures, through the changes of hydrophilic-hydrophobic interaction and hydrogen bonds generating from hydroxybutyl groups. By the multiple interactions between catechol groups/amino groups and tissues, the biocompatible hydrogels can strongly adhere on the surface of tissue. To further study, the bleeding rat-liver models are made to evaluate the hemostatic effects. After injecting the hydrogel precursor solution into the rat body, the hydrogels are not only formed in situ within 30 s but are also firmly adhered to the bleeding tissues which shows effective hemostasis. The injectability and tissue-adhesion improvement in this study gives a new insight into hemostatic agents, and the multifunctional hydrogels have a great potential in the biomedical application.