Repair of dural defects with electrospun bacterial cellulose membranes in a rabbit experimental model

Bacterial Cellulose Electrospun Fiber Mesh Coated with Chitin Nanofibrils for Eardrum Repair

In this study, we develop a bio-based and bioactive nanofibrous patch based on bacterial cellulose (BC) and chitin nanofibrils (CNs) using an ionic liquid as a solvent for BC, aimed at tympanic membrane (TM) repair. Electrospun BC nanofiber meshes were produced via electrospinning, and surface-modified with CNs using electrospray. The rheology of the BC/ionic liquid system was investigated. The obtained CN/BC meshes underwent comprehensive morphological, physicochemical, and mechanical characterization. Cytotoxicity tests were conducted using L929 mouse fibroblasts, revealing a cell viability of 97.8%. In vivo tests on rabbit skin demonstrated that the patches were nonirritating. Furthermore, the CN/BC fiber meshes were tested in vitro using human dermal keratinocytes (HaCaT cells) and human umbilical vein endothelial cells as model cells for TM perforation healing. Both cell types demonstrated successful growth on these scaffolds. The presence of CNs resulted in improved indirect antimicrobial activity of the electrospun fiber meshes. HaCaT cells exhibited an upregulated mRNA expression at 6 and 24 h of key proinflammatory cytokines crucial for the wound healing process, indicating the potential benefits of CNs in the healing response. Overall, this study presents a natural and eco-sustainable fiber mesh with great promise for applications in TM repair, leveraging the synergistic effects of BC and CNs to possibly enhance tissue regeneration and healing. Impact statement Repair of tympanic membrane perforations following chronic otitis media is a main clinical issue in otologic surgery, where the underlying infection obstacles self-healing. To address this challenge, our study proposes a bio-based patch made of nanoscale carbohydrate materials (i.e., bacterial cellulose electrospun fibers and chitin nanofibrils) processed via green solvents. The scaffold is nonirritating in vivo, and cytocompatible with fibroblasts, endothelial cells, and keratinocytes. In epithelial cells, it stimulates the expression of the antimicrobial peptide human beta defensin 2, with a pathway of cytokine expression compatible with the wound healing process. Therefore, it could be applied with unsolved infective pathology.

Dural Reconstruction Materials for the Repairing of Spinal Neoplastic Cerebrospinal Fluid Leaks

Spinal tumors often lead to more complex complications than other bone tumors. Nerve injuries, dura mater defect, and subsequent cerebrospinal fluid (CSF) leakage generally appear in spinal tumor surgeries and are followed by serious adverse outcomes such as infections and even death. The use of suitable dura mater replacements to achieve multifunctionality in fluid leakage plugging, preventing adhesions, and dural reconstruction is a promising therapeutic approach. Although there have been innovative endeavors to manage dura mater defects, only a handful of materials have realized the targeted multifunctionality. Here, we review recent advances in dura repair materials and techniques and discuss the relative merits in both preclinical and clinical trials as well as future therapeutic options. With these advances, spinal tumor patients with dura mater defects may be able to benefit from novel treatments.

Biodegradable Piezoelectric Polymers: Recent Advancements in Materials and Applications

Recent materials, microfabrication, and biotechnology improvements have introduced numerous exciting bioelectronic devices based on piezoelectric materials. There is an intriguing evolution from conventional unrecyclable materials to biodegradable, green, and biocompatible functional materials. As a fundamental electromechanical coupling material in numerous applications, novel piezoelectric materials with a feature of degradability and desired electrical and mechanical properties are being developed for future wearable and implantable bioelectronics. These bioelectronics can be easily integrated with biological systems for applications, including sensing physiological signals, diagnosing medical problems, opening the blood-brain barrier, and stimulating healing or tissue growth. Therefore, the generation of piezoelectricity from natural and synthetic bioresorbable polymers has drawn great attention in the research field. Herein, the significant and recent advancements in biodegradable piezoelectric materials, including natural and synthetic polymers, their principles, advanced applications, and challenges for medical uses, are reviewed thoroughly. The degradation methods of these piezoelectric materials through in vitro and in vivo studies are also investigated. These improvements in biodegradable piezoelectric materials and microsystems could enable new applications in the biomedical field. In the end, potential research opportunities regarding the practical applications are pointed out that might be significant for new materials research.

Clinical management of dural defects: A review

Dural defects are common in spinal and cranial neurosurgery. A series of complications, such as cerebrospinal fluid leakage, occur after rupture of the dura. Therefore, treatment strategies are necessary to reduce or avoid complications. This review comprehensively summarizes the common causes, risk factors, clinical complications, and repair methods of dural defects. The latest research progress on dural repair methods and materials is summarized, including direct sutures, grafts, biomaterials, non-biomaterial materials, and composites formed by different materials. The characteristics and efficacy of these dural substitutes are reviewed, and these materials and methods are systematically evaluated. Finally, the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.

Electrospun Nanofibers for Dura Mater Regeneration: A Mini Review on Current Progress

Dural defects are a common problem in neurosurgical procedures and should be repaired to avoid complications such as cerebrospinal fluid leakage, brain swelling, epilepsy, intracranial infection, and so on. Various types of dural substitutes have been prepared and used for the treatment of dural defects. In recent years, electrospun nanofibers have been applied for various biomedical applications, including dural regeneration, due to their interesting properties such as a large surface area to volume ratio, porosity, superior mechanical properties, ease of surface modification, and, most importantly, similarity with the extracellular matrix (ECM). Despite continuous efforts, the development of suitable dura mater substrates has had limited success. This review summarizes the investigation and development of electrospun nanofibers with particular emphasis on dura mater regeneration. The objective of this mini-review article is to give readers a quick overview of the recent advances in electrospinning for dura mater repair.

Potential use of bioactive nanofibrous dural substitutes with controlled release of IGF-1 for neuroprotection after traumatic brain injury

For patients suffering from traumatic brain injury (TBI), the closure of dural defects after decompressive craniectomy is the prerequisite to restoring normal physiological functions. It is also an urgent challenge to provide a neuroprotection effect against the primary and secondary nerve damage during long-term recovery. To solve these issues, we herein develop a class of bioactive, nanofibrous dural substitutes that can long-term release insulin-like growth factor 1 (IGF-1) for improving the survival and neurite outgrowth of neural cells after TBI. Such dural substitutes were polycaprolactone (PCL) nanofibers encapsulated with hyaluronic acid methacryloyl (HAMA)/IGF-1 by blend or coaxial electrospinning techniques, achieving bioactive PCL/HAMA/IGF nanofibrous dural substitutes with different release profiles of IGF-1. The nanofibrous dural substitutes exhibited good mechanical properties and hydrophobicity, which prevent cerebrospinal fluid leakage, maintain normal intracranial pressure, and avoid external impact on the brain. We also found that the viability and neurite outgrowth of SH-SY5Y cells and primary neurons were significantly enhanced after neurite transection or oxygen and glucose deprivation treatment. Taken together, such PCL/HAMA/IGF nanofibrous dural substitutes hold promising potential to provide neuroprotection effects after primary and secondary nerve damage in TBI, which would bring significant benefits to the field of neurosurgery involving the use of artificial dura mater.

Dual-Modal Imaging and Synergistic Spinal Tumor Therapy Enabled by Hierarchical-Structured Nanofibers with Cascade Release and Postoperative Anti-adhesion

Most treatments for spinal cancer are accompanied by serious side effects including subsequent tumor recurrence, spinal cord compression, and tissue adhesion, thus a highly effective treatment is crucial for preserving spinal and neurological functionalities. Herein, trilayered electrospun doxorubicin@bovine serum albumin/poly(ε-caprolactone)/manganese dioxide (DOX@BSA/PCL/MnO₂) nanofibers with excellent antiadhesion ability, dual glutathione/hydrogen peroxide (GSH/H₂O₂) responsiveness, and cascade release of Mn²⁺/DOX was fabricated for realizing an efficient spinal tumor therapy. In detail, Fenton-like reactions between MnO₂ in the fibers outermost layer and intra-/extracellular glutathione within tumors promoted the first-order release of Mn²⁺. Then, sustained release of DOX from the fibers' core layer occurred along with the infiltration of degradation fluid. Such release behavior avoided toxic side effects of drugs, regulated inflammatory tumor microenvironment, amplified tumor elimination efficiency through synergistic chemo-/chemodynamic therapies, and inhibited recurrence of spinal tumors. More interestingly, magnetic resonance and photoacoustic dual-modal imaging enabled visualizations of tumor therapy and material degradation in vivo, achieving rapid pathological analysis and diagnosis. On the whole, such versatile hierarchical-structured nanofibers provided a reference for rapid and potent theranostic of spinal cancer in future clinical translations.

Bacterial cellulose-based composites for nerve tissue engineering

Nerve injuries and neurodegenerative disorders are very serious and costly medical challenges. Damaged nerve tissue may not be able to heal and regain its function, and scar tissue may restrict nerve cell regeneration. In recent years, new electroactive biomaterials have attracted widespread attention in the neural tissue engineering field. Bacterial cellulose (BC) due to its unique properties such as good mechanical properties, high water retention, biocompatibility, high crystallinity, large surface area, high purity, very fine network, and inability to absorb in the human body due to cellulase deficiency, can be considered a promising treatment for neurological injuries and disorders that require long-term support. However, BC lacks electrical activity, but can significantly improve the nerve regeneration rate by combining with conductive structures. Electrical stimulation has been shown to be an effective means of increasing the rate and accuracy of nerve regeneration. Many factors, such as the intensity and pattern of electrical current, have positive effects on cellular activity, including cell adhesion, proliferation, migration and differentiation, and cell-cell/tissue/molecule/drug interaction. This study discusses the importance and essential role of BC-based biomaterials in neural tissue regeneration and the effects of electrical stimulation on cellular behaviors.

Bacterial cellulose as a potential biopolymer in biomedical applications: a state-of-the-art review

Throughout history, natural biomaterials have benefited society. Nevertheless, in recent years, tailoring natural materials for diverse biomedical applications accompanied with sustainability has become the focus. With the progress in the field of materials science, novel approaches for the production, processing, and functionalization of biomaterials to obtain specific architectures have become achievable. This review highlights an immensely adaptable natural biomaterial, bacterial cellulose (BC). BC is an emerging sustainable biopolymer with immense potential in the biomedical field due to its unique physical properties such as flexibility, high porosity, good water holding capacity, and small size; chemical properties such as high crystallinity, foldability, high purity, high polymerization degree, and easy modification; and biological characteristics such as biodegradability, biocompatibility, excellent biological affinity, and non-biotoxicity. The structure of BC consists of glucose monomer units polymerized via cellulose synthase in β-1-4 glucan chains, creating BC nano fibrillar bundles with a uniaxial orientation. BC-based composites have been extensively investigated for diverse biomedical applications due to their similarity to the extracellular matrix structure. The recent progress in nanotechnology allows the further modification of BC, producing novel BC-based biomaterials for various applications. In this review, we strengthen the existing knowledge on the production of BC and BC composites and their unique properties, and highlight the most recent advances, focusing mainly on the delivery of active pharmaceutical compounds, tissue engineering, and wound healing. Further, we endeavor to present the challenges and prospects for BC-associated composites for their application in the biomedical field.

Fabrication strategies and biomedical applications of three-dimensional bacterial cellulose-based scaffolds: A review

Bacterial cellulose (BC), an extracellular polysaccharide, is a versatile biopolymer due to its intrinsic physicochemical properties, broad-spectrum applications, and remarkable achievements in different fields, especially in the biomedical field. Presently, the focus of BC-related research is on the development of scaffolds containing other materials for in-vitro and in-vivo biomedical applications. To this end, prime research objectives concern the biocompatibility of BC and the development of three-dimensional (3D) BC-based scaffolds. This review summarizes the techniques used to develop 3D BC scaffolds and discusses their potential merits and limitations. In addition, we discuss the various biomedical applications of BC-based scaffolds for which the 3D BC matrix confers desired structural and conformational features. Overall, this review provides comprehensive coverage of the idea, requirements, synthetic strategies, and current and prospective applications of 3D BC scaffolds, and thus, should be useful for researchers working with polysaccharides, biopolymers, or composite materials.

Bacterial Cellulose and Its Applications

The sharp increase in the use of cellulose seems to be in increasing demand in wood; much more research related to sustainable or alternative materials is necessary as a lot of the arable land and natural resources use is unsustainable. In accordance, attention has focused on bacterial cellulose as a new functional material. It possesses a three-dimensional, gelatinous structure consisting of cellulose with mechanical and thermal properties. Moreover, while a plant-originated cellulose is composed of cellulose, hemi-cellulose, and lignin, bacterial cellulose attributable to the composition of a pure cellulose nanofiber mesh spun is not necessary in the elimination of other components. Moreover, due to its hydrophilic nature caused by binding water, consequently being a hydrogel as well as biocompatibility, it has only not only used in medical fields including artificial skin, cartilage, vessel, and wound dressing, but also in delivery; some products have even been commercialized. In addition, it is widely used in various technologies including food, paper, textile, electronic and electrical applications, and is being considered as a highly versatile green material with tremendous potential. However, many efforts have been conducted for the evolution of novel and sophisticated materials with environmental affinity, which accompany the empowerment and enhancement of specific properties. In this review article, we summarized only industry and research status regarding BC and contemplated its potential in the use of BC.

Bacterial Cellulose Properties Fulfilling Requirements for a Biomaterial of Choice in Reconstructive Surgery and Wound Healing

Although new therapeutic approaches for surgery and wound healing have recently made a great progress, there is still need for application of better and use novel methods to enhance biocompatibility as well as recovery and healing process. Bacterial Cellulose (BC) is natural cellulose in the form of nanostructure which has the advantages of being used in human body. The medical application of BC in reconstructive, cardiac and vascular surgery as well as wound healing is still under development, but without proved success of repetitive results. A review of studies on Bacterial Cellulose (BC) since 2016 was performed, taking into account the latest reports on the clinical use of BC. In addition, data on the physicochemical properties of BC were used. In all the works, satisfactory results of using Bacterial Cellulose were obtained. In all presented studies various BC implants demonstrated their best performance. Additionally, the works show that BC has the capacity to reach physiological as well as mechanical properties of relevance for various tissue replacement and can be produced in surgeons as well as patient specific expectations such as ear frames, vascular tubes or heart valves as well as wound healing dressings. Results of those experiments conform to those of previous reports utilizing ADM (acellular dermal matrix) and demonstrate that the use of BC has no adverse effects such as ulceration or extrusion and possesses expected properties. Based on preliminary animal as well as the few clinical data BC fittings are promising implants for various reconstructive applications since they are biocompatible with properties allowing blood flow, attach easily to wound bed and remain in place until donor site is healed properly. Additionally, this review shows that BC can be fabricated into patient specific shapes and size, with capability to reach mechanical properties of relevance for heart valve, ear, and muscle replacement. Bacterial cellulose appears, as shown in the above review, to be one of the materials that allow extensive application in the reconstruction after soft tissue defects. Review was created to show the needs of surgeons and the possibilities of using BC through the eyes and knowledge of biotechnologists.

A hydrogel spinal dural patch with potential anti-inflammatory, pain relieving and antibacterial effects

CSFL caused by spinal dural defect is a common complication of spinal surgery, which need repair such as suture or sealants. However, low intracranial pressure symptoms, wound infection and prolonged hospital associated with pin-hole leakage or loose seal effect were often occurred after surgical suture or sealants repair. Stable, pressure resistance and high viscosity spinal dural repair patch in wet environment without suture or sealants was highly needed. Herein, a bioactive patch composed of alginate and polyacrylamide hydrogel matrix cross-linked by calcium ions, and chitosan adhesive was proposed. This fabricated patch exhibits the capabilities of promoting defect closure and good tight seal ability with the bursting pressure is more than 790 mm H₂O in wet environment. In addition, the chitosan adhesive layer of the patch could inhibit the growth of bacterial in vitro, which is meaningful for the postoperative infection. Furthermore, the patch also significantly reduced the expression of GFAP, IBA-1, MBP, TNF-α, and COX-2 in early postoperative period in vivo study, exerting the effects of anti-inflammatory, analgesic and adhesion prevention. Thus, the bioactive patch expected to be applied in spinal dural repair with the good properties of withstanding high pressure, promoting defect closure and inhibiting postoperative infection.

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A self-adhesive spinal dural patch that can be applied directly by pressing.

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A spinal dural patch maintains more than 790 mm H₂O sealing pressure in a wet environment.

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A spinal dural patch with potential anti-inflammatory, analgesic and anti-bacterial properties.

A biomimetic hierarchical small intestinal submucosa-chitosan sponge/chitosan hydrogel scaffold with a micro/nano structure for dural repair

The dura mater is an essential barrier to protect the brain tissue and the dural defects caused by accidents can lead to serious complications. Various materials have been applied to dural repair, but it remains a challenge to perfectly match the structure and properties of the natural dura mater. Small intestinal submucosa has been developed for dural repair because of its excellent biocompatibility and biological activity, but its application is tremendously limited by the rapid degradation rate. Chitosan has also been broadly investigated in tissue repair, but the traditional chitosan hydrogels exhibit poor mechanical properties. A nanofiber chitosan hydrogel can be constructed based on an alkaline solvent, which is equipped with surprisingly high strength. Therefore, based on the bilayer structure of the natural dura mater, a biomimetic hierarchical small intestinal submucosa-chitosan sponge/chitosan hydrogel scaffold with a micro/nano structure was fabricated, which possessed a microporous structure in the upper sponge and a nanofiber structure in the lower hydrogel. The degradation rate was remarkably reduced compared with that of the small intestinal submucosa in the enzymatic degradation experiment in vitro. Meanwhile, the chitosan nanofibers brought high mechanical strength to the bilayer scaffold. Moreover, the hierarchical micro/nano structure and the active factors in the small intestinal submucosa have a fantastic effect on promoting the proliferation of fibroblasts and vascular endothelial cells. The bilayer scaffold showed good histocompatibility in the experiment of in vitro subcutaneous implantation in rats. Thus, the biomimetic hierarchical small intestinal submucosa-chitosan sponge/chitosan hydrogel scaffold with micro/nano structure simulates the structure of the natural dura mater and possesses properties with excellent performance, which has high practical value for dural repair.

A double-layer dura mater based on poly(caprolactone-co-lactide) film and polyurethane sponge: preparation, characterization, and biodegradation study

Synthetic, biodegradable polymers hold great potential in dura mater substitution. In this study, a dura mater-mimetic double-layer film@sponge composite was developed. The composite contains a poly(caprolactone-co-lactide) (PCLA) film and polyurethane (PU) sponge, which simulates the hard and soft layers of dura mater, respectively. PCLA films were prepared by a solution-casting method and showed excellent mechanical properties and tolerance to water. PU sponge was hydrophilic and had a high water-absorption rate (about 500%). The double-layer composite (film@sponge) integrated the good mechanical properties of the films and the good water absorption of the sponge. The excellent biocompatibility and biodegradability of the PCLA film@PU sponge composites were verified by in vitro degradation and cytotoxicity study and the in vivo implantation in the back of rats. Importantly, the film@sponge composite had a suitable degradation rate and good biocompatibility, holding potential in the field of dural repair.

In vivo Evaluation of Fibrous Collagen Dura Substitutes

Dura substitutes are applied in duraplasty to repair lost or damaged dura. Collagen-based dura substitutes are mainstream products in both the US and Chinese markets. In this study, dura substitute devices with potential dura regeneration ability are evaluated. The dura substitutes are composed of fibrous type I collagen that were purified from bovine tendon. Physical and chemical characterization demonstrated that the tested dura substitute has desirable porous scaffolding structures and is composed of highly purified type I collagen. The collagen dura substitutes were further investigated in vivo with a rabbit model for 6 months to evaluate their safety and performance to repair and regenerate dura. No inflammation or infection was observed during the course of in vivo study. The integration of the collagen dura substitutes with surrounding tissue was normal as compared to native tissue. The macroscopic and microscopic histological assessments of the sampled animal tissue showed that the damaged dura were regenerated. The collagen dura substitutes were resorbed between 3 and 6 months along with newly regenerated dura. Both tissue adhesion and dura repair was the worst in blank control group as compared to those in the collagen dura substitutes. Taken together, regenerative collagen dura substitutes demonstrated with suitable physicochemical properties. The in vivo evaluation in a rabbit model further demonstrated the safety and performance of such substitutes for dura repair and regeneration.