Hyaluronic acid and chitosan-based nanosystems: a new dressing generation for wound care

Evaluation of the restorative effect of ozone and chitosan-hyaluronic acid with and without mesenchymal stem cells on wound healing in rats

This study evaluated the effect of ozone, chitosan-hyaluronic (Cs-HA) acid and mesenchymal stem cells (MSCs) on wound healing in rats. A total of 64 rats were randomly divided into four groups: control, ozone, Cs-HA + ozone and Cs-HA + ozone + MSCs. A 5 mm full-thickness wound was created on the back of each rat. The wound area was measured macroscopically on days 3, 5, 9 and 14. Tissue sections were prepared for histopathological evaluation of inflammation, collagen arrangement, neovascularization and epithelial tissue rearrangement. Macroscopic assessment showed differences in wound area on days 5, 9 and 14. Histopathological examination showed that the Cs-HA + ozone + MSCs and Cs-HA + ozone groups had significantly higher vascularization on day 3 compared to the ozone-treated and control groups. All treatment groups had significantly better collagen arrangement than the control group. On day 5, no significant difference was observed between different groups. On day 9, the inflammation level in the Cs-HA + ozone + MSCs group was significantly lower than in the other groups. All treatment groups had significantly better vascularization compared to the control group. On day 14, the rate of inflammation was significantly lower in the treatment groups than in the control group. Significantly higher collagen arrangement levels were observed in the Cs-HA + ozone and Cs-HA + ozone + MSCs groups compared to the control and ozone groups. All treatment groups had significantly better epithelial tissue rearrangement than the control group. Overall, the results of this study indicated that treatment with ozone, Cs-HA acid, Cs-HA and MSCs accelerated wound healing in rats. The effect of using Cs-HA acid with mesenchymal cells was better than the other types of treatment. Larger clinical trials are needed to assess these factors for improving chronic wound treatment.

Magnesium Ions Promote the Induction of Immunosuppressive Bone Microenvironment and Bone Repair through HIF-1α-TGF-β Axis in Dendritic Cells

The effect of immunoinflammation on bone repair during the recovery process of bone defects needs to be further explored. It is reported that Mg2+ can promote bone repair with immunoregulatory effect, but the underlying mechanism on adaptive immunity is still unclear. Here, by using chitosan and hyaluronic acid-coated Mg2+ (CSHA-Mg) in bone-deficient mice, it is shown that Mg2+ can inhibit the activation of CD4+ T cells and increase regulatory T cell formation by inducing immunosuppressive dendritic cells (imDCs). Mechanistically, Mg2+ initiates the activation of the MAPK signaling pathway through TRPM7 channels on DCs. This process subsequently induces the downstream HIF-1α expression, a transcription factor that amplifies TGF-β production and inhibits the effective T cell function. In vivo, knock-out of HIF-1α in DCs or using a HIF-1α inhibitor PX-478 reverses inhibition of bone inflammation and repair promotion upon Mg2+-treatment. Moreover, roxadustat, which stabilizes HIF-1α protein expression, can significantly promote immunosuppression and bone repair in synergism with CSHA-Mg. Thus, the findings identify a key mechanism for DCs and its HIF-1α-TGF-β axis in the induction of immunosuppressive bone microenvironment, providing potential targets for bone regeneration.

Comparison of Ba-Hao burn ointment gauze and petrolatum gauze in split graft donor site healing: A randomized, prospective, and self-control study

Background and Aims

To assess patient comfort, wound healing, and scarring at the 6-month follow-up of split-skin graft donor sites treated with Ba-Hao burn ointment (BHBO) gauze, a compound preparation of traditional Chinese medicine since 1970s, compared with petrolatum gauze.

Methods

Thirty patients admitted to the Department of Burns of the First Affiliated Hospital of Anhui Medical University between September 2021 and September 2022 participated in this randomized, prospective, self-control clinical study. After harvesting the split skin, donor sites were divided into two parts along the midline. BHBO gauze was applied to half of the donor wounds, and petrolatum gauze was applied to the other half. The wound healing time, pain scores on the postoperative Days 3, 6, and 9, and Vancouver Scar Scale (VSS) score at the 6-month follow-up were assessed.

Results

The wound healing time was significantly shorter in the BHBO group than in the control group (10.07 ± 1.48 days vs. 11.50 ± 1.74 days, p < 0.001). On postoperative Days 3 and 6, the pain scores quantified by visual analog scores were significantly lower in the BHBO group than in the control group (5.33 ± 1.54 and 4.17 ± 1.51, respectively vs. 7.57 ± 1.41 and 5.20 ± 1.47, respectively). The difference in the visual analog scale score on postoperative Day 9 between the groups was not significant (p > 0.05). Microbiological assessment revealed the absence of bacterial contamination in both groups. At the 6-month follow up, the VSS score was significantly lower in the BHBO group (6.67 ± 1.92) than in the control group (9.57 ± 1.55).

Conclusion

BHBO resulted in faster donor-site healing, reduced postoperative pain, and improved scar quality at the 6-month follow-up than petrolatum gauze alone.

Hyaluronic acid-decorated curcumin-based coordination nanomedicine for enhancing the infected diabetic wound healing

Persistent over-oxidation, inflammation and bacterial infection are the primary reasons for impaired wound repairing in diabetic patients. Therefore, crucial strategies to promote diabetic wound repairing involve suppressing the inflammatory response, inhibiting bacterial growth and decreasing reactive oxygen species (ROS) within the wound. In this work, we develop a multifunctional nanomedicine (HA@Cur/Cu) designed to facilitate the repairing process of diabetic wound. The findings demonstrated that the synthesized infinite coordination polymers (ICPs) was effective in enhancing the bioavailability of curcumin and improving the controlled drug release at the site of inflammation. Furthermore, in vitro and in vivo evaluation validate the capacity of HA@Cur/Cu to inhibit bacterial growth and remove excess ROS and inflammatory mediators, thereby significantly promoting the healing of diabetic wound in mice. These compelling findings strongly demonstrate the enormous promise of this multifunctional nanomedicine for the treatment of diabetic wound.

The naringin/carboxymethyl chitosan/sodium hyaluronate/silk fibroin scaffold facilitates the healing of diabetic wounds by restoring the ROS-related dysfunction of vascularization and macrophage polarization

Chronic diabetic wounds remain a globally recognized clinical challenge, which occurs mainly due to the disturbances of wound microenvironmental induced by high concentrations of reactive oxygen species (ROS). Impairments in angiogenesis and inflammation in the wound microenvironment ultimately impede the normal healing process. Therefore, targeting macrophage and vascular endothelial cell dysfunction is a promising therapeutic strategy. In our study, we fabricated artificial composite scaffolds composed of naringin/carboxymethyl chitosan/sodium hyaluronate/silk fibroin (NG/CMCS/HA/SF) to promote wound healing. The NG/CMCS/HA/SF scaffold demonstrated favorable anti-inflammatory, anti-oxidative, and pro-angiogenic properties in both in vitro and in vivo experiments, effectively promoting the healing of diabetic wounds. The positive therapeutic effects observed indicate that the composite scaffolds have great potential in clinical wound healing applications.

[Fundamentals and practice of the application of nasal packing in sinonasal surgery]

BACKGROUND AND OBJECTIVES

This paper presents an overview on nasal packing materials which are available in Germany. The current literature is analyzed whether there are robust criteria regarding use nasal packing after sinonasal surgery, whether there are fundamental and proven advantages or disadvantages of products, and what this means in clinical practice.

MATERIALS AND METHODS

Selective literature analysis using the PubMed database (key words "nasal packing", "nasal tamponade", "nasal surgery", "sinonasal surgery", or "sinus surgery"), corresponding text books and resulting secondary literature.

RESULTS AND CONCLUSIONS

Because of systematic methodological shortcomings, the literature does not help in the decision-making about which nasal packing should be used after which kind of sinonasal surgery. In fact, individual approaches for the many different clinical scenarios are recommended. In principle, nasal packing aims in hemostasis, should promote wound healing, and should not result in secondary morbidity. Nasal packing materials should be smooth (non-absorbable materials), inert (absorbable materials), and should not exert excessive pressure. Using non-absorbable packing entails the risk of potentially lethal aspiration and ingestion. For safety reasons inpatient control is recommended as long as this packing is in situ. With other, uncritical packing materials and in patients with special conditions, outpatient control could be justified.

Current issues and potential solutions for the electrospinning of major polysaccharides and proteins: A review

Biopolymers, especially polysaccharides and proteins, are the promising green replacement for petroleum based polymers. Due to their innate properties, they are effectively used in biomedical applications, especially tissue engineering, wound healing, and drug delivery. The fibrous morphology of biopolymers is essentially required for the effectiveness in these biomedical applications. Electrospinning (ES) is the most advanced and robust method to fabricate nanofibers (NFs) and provides a complete solution to the conventional methods issues. However, the major issues regarding fabricating polysaccharides and protein nanofibers using ES include poor electrospinnability, lack of desired fundamental properties for a specific application by a single biopolymer, and insolubility among common solvents. The current review provides the main strategies for effective electrospinning of the major biopolymers. The key strategies include blending major biopolymers with suitable biopolymers and optimizing the solvent system. A systematic literature review was done to provide the optimized solvent system of the major biopolymers along with their best possible biopolymeric blend for ES. The review also highlights the fundamental issues with the commercialization of ES based biomedical products and provides future directions to improve the fabrication of biopolymeric nanofibers.

Effect of Chitosan on the Number of Streptococcus mutans in Saliva: A Meta-Analysis and Systematic Review

We conducted a meta-analysis and systematic review to investigate the efficacy of chitosan-containing chewing gums, and to test their inhibitory effects on Streptococcus mutans. The systematic search was performed in three databases (Cochrane Library, EMBASE, and PubMed) and included English-language randomized-controlled trials to compare the efficacy of chitosan in reducing the number of S. mutans. To assess the certainty of evidence, the GRADE tool was used. Mean differences were calculated with a 95% confidence interval for one outcome: bacterial counts in CFU/mL. The protocol of the study was registered on PROSPERO, registration number CRD42022365006. Articles were downloaded (n = 6758) from EMBASE (n = 2255), PubMed (n = 1516), and Cochrane (n = 2987). After the selection process, a total of four articles were included in the qualitative synthesis and three in the quantitative synthesis. Our results show that chitosan reduced the number of bacteria. The difference in mean quantity was -4.68 × 105. The interval of the random-effects model was [-2.15 × 106; 1.21 × 106] and the prediction interval was [1.03 × 107; 9.40 × 106]. The I2 value was 98% (p = 0.35), which indicates a high degree of heterogeneity. Chitosan has some antibacterial effects when used as a component of chewing gum, but further studies are needed. It can be a promising antimicrobial agent for prevention.

Chitosan/Polylactic Acid Nanofibers Containing Astragaloside IV as a New Biodegradable Wound Dressing for Wound Healing

The ideal wound dressing should adequately protect the wound from bacterial infection and provide a suitable healing environment for the wound. Thus, we prepared a biodegradable functional nanofiber dressing with good antibacterial and biocompatibility by electrospinning technology. The average diameter of the dressing was 354 ± 185 nm, and the porosity was 93.27%. Scanning electron microscopy (SEM) showed that the dressing was smooth without beading. It was also characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The wettability and water vapor permeability of the dressing were tested; the results showed that the dressing had good wettability and permeability. The ability of drug release indicates that continuous release over a period of time is beneficial to wound healing. Finally, the antibacterial effect and in vivo pharmacodynamic evaluation of AS/CS/PLA nanofiber dressing were studied; the result showed that it had significant antibacterial activity and the ability to promote wound healing.

pH-responsive scaffolds for tissue regeneration: In vivo performance

A myriad of pH-sensitive scaffolds has been reported in recent decades. Information on their behaviour in vitro under conditions that mimic the pH changes that occur during tissue regeneration is abundant. Differently, the in vivo demonstration of the advantages of pH-responsive systems in comparison with non-responders is more limited. The in vivo scenario is very complex and the intricate relationship between the host response, the overall pathological conditions of the patient, and the risk of colonization by microorganisms is very difficult to imitate in in vitro tests. This review aims to shed light on how the changes in pH between healthy and damaged states and also during the healing process have been exploited so far to develop polymer-based scaffolds that actively contribute in vivo to the healing process avoiding chronification. The main strategies so far tested to prepare pH-responsive scaffolds rely on (i) changes in ionization of natural polymers, ionizable monomers and clays, (ii) reversible cross-linkers, (iii) coatings, and (iv) production of CO2 gas. These strategies are analysed in detail in this review with the description of relevant examples of their performance on specific animal models. The versatility of the techniques used to prepare biocompatible and environment-friendly pH-responsive scaffolds that have been implemented in the last decade may pave the way for a successful translation to the clinic. STATEMENT OF SIGNIFICANCE: We report here on the most recent advances in pH-responsive polymer-based scaffolds that have been demonstrated in vivo to be suitable for wound and bone healing. pH is a critical variable in the tissue regeneration process, and small changes can speed up or completely stop the process. Although there is still a paucity of information on the performance in the complex in vivo environment, recently reported achievements using scaffolds endowed with pH-responsiveness through ionic natural polymers, ionizable monomers and clays, reversible cross-linkers, coatings, or formation of CO2 ensure a promising future towards clinical translation.

Nano-residronate loaded κ-carrageenan-based injectable hydrogels for bone tissue regeneration

Bone tissue possesses intrinsic regenerative capabilities to address deformities; however, its ability to repair defects caused by severe fractures, tumor resections, osteoporosis, joint arthroplasties, and surgical reconsiderations can be hindered. To address this limitation, bone tissue engineering has emerged as a promising approach for bone repair and regeneration, particularly for large-scale bone defects. In this study, an injectable hydrogel based on kappa-carrageenan-co-N-isopropyl acrylamide (κC-co-NIPAAM) was synthesized using free radical polymerization and the antisolvent evaporation technique. The κC-co-NIPAAM hydrogel's cross-linked structure was confirmed using Fourier transform infrared spectra (FTIR) and nuclear magnetic resonance (1H NMR). The hydrogel's thermal stability and morphological behavior were assessed using thermogravimetric analysis (TGA) and scanning electron microscopy (SEM), respectively. Swelling and in vitro drug release studies were conducted at varying pH and temperatures, with minimal swelling and release observed at low pH (1.2) and 25 °C, while maximum swelling and release occurred at pH 7.4 and 37oC. Cytocompatibility analysis revealed that the κC-co-NIPAAM hydrogels were biocompatible, and hematoxylin and eosin (H&E) staining demonstrated their potential for tissue regeneration and enhanced bone repair compared to other experimental groups. Notably, digital x-ray examination using an in vivo bone defect model showed that the κC-co-NIPAAM hydrogel significantly improved bone regeneration, making it a promising candidate for bone defects.

Preparation and evaluation of a novel alginate-arginine-zinc ion hydrogel film for skin wound healing

In this paper, the mixed solution of sodium alginate (SA) and arginine (Arg) was dried into a film and then crosslinked with zinc ion to form sodium alginate-arginine-zinc ion (SA-Arg-Zn²⁺) hydrogel for skin wound dressings. SA-Arg-Zn²⁺ hydrogel had higher swelling ability, which was beneficial to absorbing wound exudate. Moreover, it exhibited antioxidant activity and strong inhibition against E. coli and S. aureus, and had no obvious cytotoxicity to NIH 3T3 fibroblasts. Compared with other dressings utilized in rat skin wound, SA-Arg-Zn²⁺ hydrogel showed better wound healing efficacy and the wound closure ratio reached to 100 % on the 14th day. The result of Elisa test indicated that SA-Arg-Zn²⁺ hydrogel down-regulated the expression of inflammatory factors (TNF-α and IL-6) and promoted the growth factor levels (VEGF and TGF-β₁). Furthermore, H&E staining results confirmed that SA-Arg-Zn²⁺ hydrogel could reduce wound inflammation and accelerate re-epithelialization, angiogenesis and wound healing. Therefore, SA-Arg-Zn²⁺ hydrogel is an effective and innovative wound dressing, moreover, the preparation technique is simple and feasible for industrial application.

A clinical perspective of chitosan nanoparticles for infectious disease management

Infectious diseases and their effective management are still a challenge in this modern era of medicine. Diseases, such as the SARS-CoV-2, Ebola virus, and Zika virus, still put human civilization at peril. Existing drug banks, which include antivirals, antibacterial, and small-molecule drugs, are the most advocated method for treatment, although effective but they still flounder in many instances. This calls for finding more effective alternatives for tackling the menace of infectious diseases. Nanoformulations are progressively being implemented for clinical translation and are being considered a new paradigm against infectious diseases. Natural polymers like chitosan are preferred to design nanoparticles owing to their biocompatibility, biodegradation, and long shelf-life. The chitosan nanoparticles (CNPs) being highly adaptive delivers contemporary prevention for infectious diseases. Currently, they are being used as antibacterial, drug, and vaccine delivery vehicles, and wound-dressing materials, for infectious disease treatment. Although the recruitment of CNPs in clinical trials associated with infectious diseases is minimal, this may increase shortly due to the sudden emergence of unknown pathogens like SARS-CoV-2, thus turning them into a panacea for the management of microorganisms. This review particularly focuses on the all-around application of CNPs along with their recent clinical applications in infectious disease management.

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.

Self-assembled hyaluronic acid-coated nanocomplexes for targeted delivery of curcumin alleviate acute kidney injury

Acute kidney injury (AKI) is a pathological process with high morbidity, and drug resistance is easy to occur due to untargeted drug therapy. Curcumin can repair acute kidney injury. The expression of the CD44 receptor in renal tubular epithelial cells is abnormally elevated during AKI, and hyaluronic acid (HA) has the ability to bind specifically to the CD44 receptor. In this study, we developed a hyaluronic acid-coated liposome (HALP) nanocomplexes that targeted renal epithelial cells and its effect of relieving AKI was investigated. HALP was formed by self-assembly through the electrostatic interaction of curcumin-loaded cationic liposomes (LP) with hyaluronic acid and responds to the release of curcumin in the acidic microenvironment of lesions to treat AKI. HALP had good stability and biocompatibility. The in vitro results showed that compared to LP, HALP exhibited higher antioxidant, anti-inflammatory, and anti-apoptotic capacities. The AKI model suggested that HALP could not only target and accumulate in the injured kidney but also had an excellent ability to reduce the inflammatory response, which decreased tubular necrosis and restored kidney function.

The Impact of Polyethylene Glycol-Modified Chitosan Scaffolds on the Proliferation and Differentiation of Osteoblasts

The objective of this study was to investigate the influence of polyethylene glycol (PEG) incorporated chitosan scaffolds on osteoblasts proliferation and differentiation. The chitosan polymer was initially modified by the predetermined concentration of the photoreactive azido group for UV-crosslinking and with RGD peptides (N-acetyl-GRGDSPGYG-amide). The PEG was mixed at different ratios (0, 10, and 20 wt%) with modified chitosan in 96-well tissue culture polystyrene plates to prepare CHI-100, CHI-90, and CHI-80 scaffolds. PEG-containing scaffolds exhibited bigger pore size and higher water content compared to unmodified chitosan scaffolds. After 10 days of incubation, the cell number of CHI-90 (1.1 × 106 cells/scaffold) surpasses that of CHI-100 (9.2 × 105 cells/scaffold) and the cell number of CHI-80 (7.6 × 105 cells/scaffold) were significantly lower. The ALP activity of CHI-90 was the highest on the fifth day indicating the favored osteoblasts' early-stage differentiation. Moreover, after 14 days of osteogenic culture, calcium deposition in the CHI-90 scaffolds (2.7 μmol Ca/scaffold) was significantly higher than the control (2.2 μmol Ca/scaffold) whereas on CHI-80 was 1.9 μmol/scaffold. The results demonstrate that PEG-incorporated chitosan scaffolds favored osteoblasts proliferation and differentiation; however, mixing relatively excess PEG (≥20% wt.) had a negative impact on osteoblasts proliferation and differentiation.

Fabrication and in vitro characterization of zinc oxide nanoparticles and hyaluronic acid-containing carboxymethylcellulose gel for wound healing application

Chronic wounds, such as burns and diabetic ulcers, are complex wounds sustained by the skin that require life-long rehabilitation and have the potential to deteriorate and get infected. The number of patients with this ailment has been steadily increasing. This illness demands the use of new dressings with the best capabilities for managing wound healing. This study created an gel with carboxymethylcellulose (CMC), hyaluronic acid (HA), and zinc oxide nanoparticles (ZnO NPs). According to the findings, the manufacturing technique with a 1:4 ratio of HA and CMC gel had the best viscosity. Additionally, varying concentrations of zinc oxide nanoparticles (ZnO NPs) were added to the formula. Variations included 0.05, 0.125, 0.5, 1.0, 3.0, 5.0, and 10% by weight. In order to find the ideal dose and formulation, physical properties, an anti-bacterial test, and a cell migration assay were carried out. The samples with concentration of 0.5, 1.0, 3.0, 5.0 and 10% w/v showed ability to kill gram-positive and gram-negative bacteria. Wound healing experiments showed that cells proliferated for HA/CMC/ZnO gel with a weight-to-volume ratio of 0.05% and 1.0% w/v. In conclusion, according to all (physical and biological) characterization, the HA/CMC/ZnO gel with a weight-to-volume ratio of 1.0% w/v was found to have a considerable standard for wound-healing materials, demonstrating a promising effect against bacteria.

Recent Advances in Functional Wound Dressings

Significance: Nowadays, the wound dressing is no longer limited to its primary wound protection ability. Hydrogel, sponge-like material, three dimensional-printed mesh, and nanofiber-based dressings with incorporation of functional components, such as nanomaterials, growth factors, enzymes, antimicrobial agents, and electronics, are able to not only prevent/treat infection but also accelerate the wound healing and monitor the wound-healing status. Recent Advances: The advances in nanotechnologies and materials science have paved the way to incorporate various functional components into the dressings, which can facilitate wound healing and monitor different biological parameters in the wound area. In this review, we mainly focus on the discussion of recently developed functional wound dressings. Critical Issues: Understanding the structure and composition of wound dressings is important to correlate their functions with the outcome of wound management. Future Directions: "All-in-one" dressings that integrate multiple functions (e.g., monitoring, antimicrobial, pain relief, immune modulation, and regeneration) could be effective for wound repair and regeneration.

Nano-Clays for Cancer Therapy: State-of-the Art and Future Perspectives

To date, cancer continues to be one of the deadliest diseases. Current therapies are often ineffective, leading to the urgency to develop new therapeutic strategies to improve treatments. Conventional chemotherapeutics are characterized by a reduced therapeutic efficacy, as well as them being responsible for important undesirable side effects linked to their non-specific toxicity. In this context, natural nanomaterials such as clayey mineral nanostructures of various shapes (flat, tubular, spherical and fibrous) with adjustable physico-chemical and morphological characteristics are emerging as systems with extraordinary potential for the delivery of different therapeutic agents to tumor sites. Thanks to their submicron size, high specific surface area, high adsorption capacity, chemical inertia and multilayer organization of 0.7 to 1 nm-thick sheets, they have aroused considerable interest among the scientific community as nano systems that are highly biocompatible in cancer therapy. In oncology, the nano-clays usually studied are halloysite, bentonite, laponite, kaolinite, montmorillonite and sepiolite. These are multilayered minerals that can act as nanocarriers (with a drug load generally between 1 and 10% by weight) for improved stabilization, efficient transport and the sustained and controlled release of a wide variety of anticancer agents. In particular, halloysite, montmorillonite and kaolinite are used to improve the dissolution of therapeutic agents and to delay and/or direct their release. In this review, we will examine and expose to the scientific community the extraordinary potential of nano-clays as unique crystalline systems in the treatment of cancer.

The Discovery and Development of Natural-Based Biomaterials with Demonstrated Wound Healing Properties: A Reliable Approach in Clinical Trials

Current research across the globe still focuses strongly on naturally derived biomaterials in various fields, particularly wound care. There is a need for more effective therapies that will address the physiological deficiencies underlying chronic wound treatment. The use of moist bioactive scaffolds has significantly increased healing rates compared to local and traditional treatments. However, failure to heal or prolonging the wound healing process results in increased financial and social stress imposed on health institutions, caregivers, patients, and their families. The urgent need to identify practical, safe, and cost-effective wound healing scaffolding from natural-based biomaterials that can be introduced into clinical practice is unequivocal. Naturally derived products have long been used in wound healing; however, clinical trial evaluations of these therapies are still in their infancy. Additionally, further well-designed clinical trials are necessary to confirm the efficacy and safety of natural-based biomaterials in treating wounds. Thus, the focus of this review is to describe the current insight, the latest discoveries in selected natural-based wound healing implant products, the possible action mechanisms, and an approach to clinical studies. We explore several tested products undergoing clinical trials as a novel approach to counteract the debilitating effects of impaired wound healing.

Advancements in the studies of novel nanomaterials for inner ear drug delivery

Hearing loss is currently one of the most prevalent sensory disorders worldwide. Because both the blood-labyrinth barrier and the limited blood circulation in the inner ear restrain the effective delivery of most drugs to the inner ear tissues, current treatments for hearing loss are limited to mainly medication, hearing devices and cochlear surgery for therapeutic purposes, whereas treatments lack a noninvasive targeted drug-delivery system. With the continuously rapid development of new nanomaterials, the nanodelivery systems are expected to provide a potentially effective method of clinical treatment for hearing loss. This paper reviews the advantages and disadvantages of the commonly used drug-delivery methods and novel nanomaterials for inner ears as well as advancements in the targeted treatment of hearing loss.

Zinc improves antibacterial, anti-inflammatory and cell motility activity of chitosan for wound healing applications

We report the successful preparation and characterization of chitosan-Zn complex (ChiZn) in the form of films, intended to enhance the biological performance of chitosan by the presence of Zn as antibacterial agent and biologically active ion. The influence of Zn chelation on morphology and structure of chitosan was assessed by scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy and infrared spectroscopy. The biodegradability study of ChiZn showed a sustained release of Zn up to 2 mg/mL. No toxic response was observed toward stromal cell line ST-2 in indirect contact with the ChiZn films. The dissolution product of ChiZn showed improved wound closure (88% closure) compared to the positive control group (70% closure). Moreover, ChiZn exhibited antibacterial activity against S. aureus together with a slight increase (~30%) in the secretion of VEGF and moderate decrease in nitric oxide evolution. Our findings indicate that ChiZn could be used as a safe and effective wound healing agent.

Bacterial cellulose reinforced chitosan-based hydrogel with highly efficient self-healing and enhanced antibacterial activity for wound healing

Biocompatible hydrogels with versatile functions are highly desired for demanding the complicated tissue issues, including irregular site and motional wound. Herein, a bio-based hydrogel with multifunctional properties is designed based on quaternized chitosan and dialdehyde bacterial cellulose. As a functional wound dressing, the hydrogel shows rapid self-healing performance and injectable behaviors due to dynamic Schiff-base interactions and presents superior antibacterial activity against E. coli (gram-negative) and S. aureus (gram-positive). The constructed 3D hydrogel also exhibits proper compressive property, desired water retention capacity. To be mentioned, the hydrogel could mimic the structure of natural extracellular matrix (ECM) in the presence of bacterial cellulose nanofibers. Thus, the biopolymer-based hydrogel shows good biocompatibility in terms of cell proliferation and cell spreading. The prepared chitosan-based hydrogel with self-healing, antibacterial, and low cost will become a promising biomaterial for wound healing.

Role of Nitric Oxide-Releasing Glycosaminoglycans in Wound Healing

Two glycosaminoglycan (GAG) biopolymers, hyaluronic acid (HA) and chondroitin sulfate (CS), were chemically modified via carbodiimide chemistry to facilitate the loading and release of nitric oxide (NO) to develop a multi-action wound healing agent. The resulting NO-releasing GAGs released 0.2-0.9 μmol NO mg^-1 GAG into simulated wound fluid with NO-release half-lives ranging from 20 to 110 min. GAGs containing alkylamines with terminal primary amines and displaying intermediate NO-release kinetics exhibited potent, broad spectrum bactericidal action against three strains each of Pseudomonas aeruginosa and Staphylococcus aureus ranging in antibiotic resistance profile. NO loading of the GAGs was also found to decrease murine TLR4 activation, suggesting that the therapeutic exhibits anti-inflammatory mechanisms. In vitro adhesion and proliferation assays utilizing human dermal fibroblasts and human epidermal keratinocytes displayed differences as a function of the GAG backbone, alkylamine identity, and NO-release properties. In combination with antibacterial properties, the adhesion and proliferation profiles of the GAG derivatives enabled the selection of the most promising wound healing candidates for subsequent in vivo studies. A P. aeruginosa-infected murine wound model revealed the benefits of CS over HA as a pro-wound healing NO donor scaffold, with benefits of accelerated wound closure and decreased bacterial burden attributable to both active NO release and the biopolymer backbone.

A review of current advancements for wound healing: Biomaterial applications and medical devices

Wound healing is a complex process that is critical in restoring the skin's barrier function. This process can be interrupted by numerous diseases resulting in chronic wounds that represent a major medical burden. Such wounds fail to follow the stages of healing and are often complicated by a pro‐inflammatory milieu attributed to increased proteinases, hypoxia, and bacterial accumulation. The comprehensive treatment of chronic wounds is still regarded as a significant unmet medical need due to the complex symptoms caused by the metabolic disorder of the wound microenvironment. As a result, several advanced medical devices, such as wound dressings, wearable wound monitors, negative pressure wound therapy devices, and surgical sutures, have been developed to correct the chronic wound environment and achieve skin tissue regeneration. Most medical devices encompass a wide range of products containing natural (e.g., chitosan, keratin, casein, collagen, hyaluronic acid, alginate, and silk fibroin) and synthetic (e.g., polyvinyl alcohol, polyethylene glycol, poly[lactic‐co‐glycolic acid], polycaprolactone, polylactic acid) polymers, as well as bioactive molecules (e.g., chemical drugs, silver, growth factors, stem cells, and plant compounds). This review addresses these medical devices with a focus on biomaterials and applications, aiming to deliver a critical theoretical reference for further research on chronic wound healing.

Clinical efficacy of chitosan-based hydrocolloid dressing in the treatment of chronic refractory wounds

This retrospective study aimed to explore the clinical efficacy of chitosan-based hydrocolloid dressing in treating chronic refractory wounds. A total of 80 patients with chronic refractory wounds were randomly divided into the control group (n = 40) and the study group (n = 40). The control group was given inert saline gauze, while the study group was given chitosan-based hydrocolloid dressing. After 3 weeks of treatment, the wound healing efficiency, itching pain score, changes in the wound area, dressing change frequency, and cost were measured. There was a significant difference in the wound healing effect (t = 2.738), and degree of pain (t = 4.76) between the study and control groups, after 3 weeks of treatment. Similarly, a prominent reduction in the itching frequency (t = 8.62), and wound area (t = 6.379) was observed in the study group compared to the control group (P < .05). Moreover, the frequency and total cost of dressing change in the study group were also lower than the control group and the difference was statistically significant (P < .05). To summarise, the application of chitosan-based hydrocolloid dressing in treating chronic refractory can effectively alleviate pain, accelerate wound healing, relieve itching pain, and reduce the overall cost and frequency of dressing change.

Hyaluronic acid and chitosan-based electrospun wound dressings: Problems and solutions

To date, available review papers related to the electrospinning of biopolymers including polysaccharides for wound healing were focused on summarizing the process conditions for two candidates, namely chitosan and hyaluronic acid. However, most reviews lack the discussion of problems of hyaluronan and chitosan electrospun nanofibers for wound dressing applications. For this reason, it is required to update information by providing a comprehensive overview of all factors which may play a role in the electrospinning of hyaluronic acid and chitosan for applications of wound dressings. This review summarizes the fabricated chitosan and hyaluronic acid electrospun nanofibers as wound dressings in the last years, including methods of preparations of nanofibers and challenges for the electrospinning of both pure chitosan and hyaluronic acid and strategies how to overcome the existing difficulties. Moreover, in this review the biological roles and mechanisms of chitosan and hyaluronic acid in the wound healing process are explained including the advantages of nanofibers for ideal wound management using the common solvents, copolymers enhancing spinning process, and the most biologically active incorporated substances thereby providing drug delivery in wound healing.

Chitosan/hyaluronan nanogels co-delivering methotrexate and 5-aminolevulinic acid: A combined chemo-photodynamic therapy for psoriasis

Psoriasis does not respond adequately to the monotherapy, tailoring combined strategies for synergistical treatment remains challenging. We fabricated chitosan/hyaluronan nanogels to co-load methotrexate (MTX) and 5-aminoleavulinic acid (ALA), i.e., MTX-ALA NGs, for a combined chemo-photodynamic therapy for psoriasis. Compared with MTX-ALA suspension, the NGs enhanced the penetration and retention of MTX and ALA through and into the skin in vitro and in vivo (p < 0.001). NGs enhanced the cellular uptake (p < 0.001), protoporphyrin IX conversion (p < 0.001), and reactive oxygen species generation (3.93-fold), subsequently exerted the synergistical anti-proliferation and apoptosis on lipopolysaccharide-irritated HaCaT cells with the apoptosis rate of 78.6%. MTX-ALA NGs efficiently ameliorated the skin manifestations and down-regulated the proinflammatory cytokines of TNF-α and IL-17A in imiquimod-induced psoriatic mice (p < 0.001). Importantly, MTX-ALA NGs reduced the toxicities of oral MTX to the liver and kidney. The results support that MTX-ALA NG is a convenient, effective, and safe combined chemo-photodynamic strategy for psoriasis treatment.

Ionic liquid functionalized injectable and conductive hyaluronic acid hydrogels for the efficient repair of diabetic wounds under electrical stimulation

The treatment and care of diabetic wounds remains a global challenge due to the the high rates of amputation, recurrence, and mortality. It has been proven that electrical stimulation has...

Nanocarriers for Inner Ear Disease Therapy

Hearing loss is a common disease due to sensory loss caused by the diseases in the inner ear. The development of delivery systems for inner ear disease therapy is important to achieve high efficiency and reduce side effects. Currently, traditional drug delivery systems exhibit the potential to be used for inner ear disease therapy, but there are still some drawbacks. As nanotechnology is developing these years, one of the solutions is to develop nanoparticle-based delivery systems for inner ear disease therapy. Various nanoparticles, such as soft material and inorganic-based nanoparticles, have been designed, tested, and showed controlled delivery of drugs, improved targeting property to specific cells, and reduced systemic side effects. In this review, we summarized recent progress in nanocarriers for inner ear disease therapy. This review provides useful information on developing promising nanocarriers for the efficient treatment of inner ear diseases and for further clinical applications for inner ear disease therapy.

Development of novel hyaluronic acid/human-like collagen bio-composite membranes: A facile "surface modification-assembly" approach

The merits of hyaluronic acid (HA) as a representative biological carbohydrate polymers especially in bioactivity and tailorability makes it ideal building block for the engineering of tissue engineering scaffolds. HA-based bio-composites integrate the characteristics of multi-component materials, possessing versatility and further improving the therapeutic efficacy. Human like collagen (HLC), which is hydrophilic, biomimetic, and bio-safe, with human tissue-derived collagen biofunction, has attracted extensive attention worldwide. Herein, we developed a novel method for HA/HLC bio-composite membranes preparation, comprising one-step surface modification-assembly process by which the HLC self-assembles are simultaneously loaded on the oxidized-modified HA (oxi-HA) from the surface/interface micro-scale. Comprehensive material characterizations and in vitro/in vivo biostudies proved that the HLC/oxi-HA composite membranes exhibited significantly enhanced biological activity, hemostatic performances, and wound healing properties compared to that of the pristine HA. The results of this study highlight the great potential of the prepared biomimetic HLC/oxi-HA bio-composites as a new generation of multifunctional HA-based wound-healing materials.

Marine Polysaccharides for Wound Dressings Application: An Overview

Wound dressings have become a crucial treatment for wound healing due to their convenience, low cost, and prolonged wound management. As cutting-edge biomaterials, marine polysaccharides are divided from most marine organisms. It possesses various bioactivities, which allowing them to be processed into various forms of wound dressings. Therefore, a comprehensive understanding of the application of marine polysaccharides in wound dressings is particularly important for the studies of wound therapy. In this review, we first introduce the wound healing process and describe the characteristics of modern commonly used dressings. Then, the properties of various marine polysaccharides and their application in wound dressing development are outlined. Finally, strategies for developing and enhancing marine polysaccharide wound dressings are described, and an outlook of these dressings is given. The diverse bioactivities of marine polysaccharides including antibacterial, anti-inflammatory, haemostatic properties, etc., providing excellent wound management and accelerate wound healing. Meanwhile, these biomaterials have higher biocompatibility and biodegradability compared to synthetic ones. On the other hand, marine polysaccharides can be combined with copolymers and active substances to prepare various forms of dressings. Among them, emerging types of dressings such as nanofibers, smart hydrogels and injectable hydrogels are at the research frontier of their development. Therefore, marine polysaccharides are essential materials in wound dressings fabrication and have a promising future.

Biomaterials for Soft Tissue Repair and Regeneration: A Focus on Italian Research in the Field

Tissue repair and regeneration is an interdisciplinary field focusing on developing bioactive substitutes aimed at restoring pristine functions of damaged, diseased tissues. Biomaterials, intended as those materials compatible with living tissues after in vivo administration, play a pivotal role in this area and they have been successfully studied and developed for several years. Namely, the researches focus on improving bio-inert biomaterials that well integrate in living tissues with no or minimal tissue response, or bioactive materials that influence biological response, stimulating new tissue re-growth. This review aims to gather and introduce, in the context of Italian scientific community, cutting-edge advancements in biomaterial science applied to tissue repair and regeneration. After introducing tissue repair and regeneration, the review focuses on biodegradable and biocompatible biomaterials such as collagen, polysaccharides, silk proteins, polyesters and their derivatives, characterized by the most promising outputs in biomedical science. Attention is pointed out also to those biomaterials exerting peculiar activities, e.g., antibacterial. The regulatory frame applied to pre-clinical and early clinical studies is also outlined by distinguishing between Advanced Therapy Medicinal Products and Medical Devices.

Chitosan-Coated Poly(lactic acid) Nanofibres Loaded with Essential Oils for Wound Healing

Chronic skin wounds are characterised by a non-healing process that makes necessary the application of wound dressings on the damaged area to promote and facilitate the recovery of skin’s physiological integrity. The aim of the present work is to develop a bioactive dressing that, once applied on the injured tissue, would exert antibacterial activity and promote adhesion and proliferation of fibroblasts. Nanofibres consisting of poly(lactic acid) (PLA) and essential oils (EOs) were electrospun and coated with a medium molecular weight chitosan (CS). Black pepper essential oil (BP-EO) or limonene (L), well-known for their antibacterial properties, were added to the PLA/acetone solution before electrospinning; phase separation phenomena occurred due to the poor solubility of the EOs in the PLA solution and led to fibres having surface nano-pores. The porous electrospun fibres were coated with CS to produce hydrophilic membranes that were easy to handle, biocompatible, and suited to promote cellular proliferation. The fibrous scaffolds were tested in terms of mechanical resistance, wettability, antibacterial activity, in-vitro cytotoxicity, and ability to promote fibroblasts’ adhesion and proliferation. The results obtained proved that the CS coating improved the hydrophilicity of the fibrous mats, enhanced EO’s antibacterial potential, and promoted cell adhesion and proliferation.

Advantages of Hyaluronic Acid and Its Combination with Other Bioactive Ingredients in Cosmeceuticals

This study proposes a review on hyaluronic acid (HA) known as hyaluronan or hyaluronate and its derivates and their application in cosmetic formulations. HA is a glycosaminoglycan constituted from two disaccharides (N-acetylglucosamine and D-glucuronic acid), isolated initially from the vitreous humour of the eye, and subsequently discovered in different tissues or fluids (especially in the articular cartilage and the synovial fluid). It is ubiquitous in vertebrates, including humans, and it is involved in diverse biological processes, such as cell differentiation, embryological development, inflammation, wound healing, etc. HA has many qualities that recommend it over other substances used in skin regeneration, with moisturizing and anti-ageing effects. HA molecular weight influences its penetration into the skin and its biological activity. Considering that, nowadays, hyaluronic acid has a wide use and a multitude of applications (in ophthalmology, arthrology, pneumology, rhinology, aesthetic medicine, oncology, nutrition, and cosmetics), the present study describes the main aspects related to its use in cosmetology. The biological effect of HA on the skin level and its potential adverse effects are discussed. Some available cosmetic products containing HA have been identified from the brand portfolio of most known manufacturers and their composition was evaluated. Further, additional biological effects due to the other active ingredients (plant extracts, vitamins, amino acids, peptides, proteins, saccharides, probiotics, etc.) are presented, as well as a description of their possible toxic effects.

Nanomaterials applied in wound healing: Mechanisms, limitations and perspectives

Internal and external factors cause various types of wounds on the skin. Infections, nonhealing chronic wounds, and aesthetic and functional recovery all cause challenges for clinicians. The development of nanotechnology in biomedicine has brought many new materials, methods and therapeutic targets for the treatment of wounds, which are believed to have great prospects. In this work, the nanomaterials applied in different stages to promote wound healing and systematically expounded their mechanisms were reviewed. Then, the difficulties and defects of the present research and suggested methods for improvement were pointed out. Moreover, based on the current application status of nanomaterials in wound treatment, some new ideas for subsequent studies were proposed and the feasibility of intelligent healing by real-time monitoring, precision regulation, and signal transmission between electronic signals and human nerve signals in the future were discussed. This review will provide valuable directions and spark new thoughts for researchers.

Polymeric Biomaterials for the Treatment of Cardiac Post-Infarction Injuries

Cardiac regeneration aims to reconstruct the heart contractile mass, preventing the organ from a progressive functional deterioration, by delivering pro-regenerative cells, drugs, or growth factors to the site of injury. In recent years, scientific research focused the attention on tissue engineering for the regeneration of cardiac infarct tissue, and biomaterials able to anatomically and physiologically adapt to the heart muscle have been proposed as valuable tools for this purpose, providing the cells with the stimuli necessary to initiate a complete regenerative process. An ideal biomaterial for cardiac tissue regeneration should have a positive influence on the biomechanical, biochemical, and biological properties of tissues and cells; perfectly reflect the morphology and functionality of the native myocardium; and be mechanically stable, with a suitable thickness. Among others, engineered hydrogels, three-dimensional polymeric systems made from synthetic and natural biomaterials, have attracted much interest for cardiac post-infarction therapy. In addition, biocompatible nanosystems, and polymeric nanoparticles in particular, have been explored in preclinical studies as drug delivery and tissue engineering platforms for the treatment of cardiovascular diseases. This review focused on the most employed natural and synthetic biomaterials in cardiac regeneration, paying particular attention to the contribution of Italian research groups in this field, the fabrication techniques, and the current status of the clinical trials.

Treatment challenges and delivery systems in immunomodulation and probiotic therapies for periodontitis

Introduction: Periodontitis is a widespread illness that arises due to disrupted interplay between the oral microbiota and the host immune response. In some cases, conventional therapies can provide temporary remission, although this is often followed by disease relapse. Recent studies of periodontitis pathology have promoted the development of new therapeutics to improve treatment options, together with local application using advanced drug delivery systems.Areas covered: This paper provides a critical review of the status of current treatment approaches to periodontitis, with a focus on promising immunomodulation and probiotic therapies. These are based on delivery of small molecules, peptides, proteins, DNA or RNA, and probiotics. The key findings on novel treatment strategies and formulation of advanced delivery systems, such as nanoparticles and nanofibers, are highlighted.Expert opinion: Multitarget therapy based on antimicrobial, immunomodulatory, and probiotic active ingredients incorporated into advanced delivery systems for application to the periodontal pocket can improve periodontitis treatment outcomes. Translation of such adjuvant therapy from laboratory to patient is expected in the future.

Nanotechnology Approaches in Chronic Wound Healing

Significance: The incidence of chronic wounds is increasing due to our aging population and the augment of people afflicted with diabetes. With the extended knowledge on the biological mechanisms underlying these diseases, there is a novel influx of medical technologies into the conventional wound care market. Recent Advances: Several nanotechnologies have been developed demonstrating unique characteristics that address specific problems related to wound repair mechanisms. In this review, we focus on the most recently developed nanotechnology-based therapeutic agents and evaluate the efficacy of each treatment in in vivo diabetic models of chronic wound healing. Critical Issues: Despite the development of potential biomaterials and nanotechnology-based applications for wound healing, this scientific knowledge is not translated into an increase of commercially available wound healing products containing nanomaterials. Future Directions: Further studies are critical to provide insights into how scientific evidences from nanotechnology-based therapies can be applied in the clinical setting.

Self-Associating Polymers Chitosan and Hyaluronan for Constructing Composite Membranes as Skin-Wound Dressings Carrying Therapeutics

Chitosan, industrially acquired by the alkaline N-deacetylation of chitin, belongs to β-N-acetyl-glucosamine polymers. Another β-polymer is hyaluronan. Chitosan, a biodegradable, non-toxic, bacteriostatic, and fungistatic biopolymer, has numerous applications in medicine. Hyaluronan, one of the major structural components of the extracellular matrix in vertebrate tissues, is broadly exploited in medicine as well. This review summarizes that these two biopolymers have a mutual impact on skin wound healing as skin wound dressings and carriers of remedies.

A Composite Nanosystem as a Potential Tool for the Local Treatment of Glioblastoma: Chitosan-Coated Solid Lipid Nanoparticles Embedded in Electrospun Nanofibers

Glioblastoma multiforme (GBM) is one of the most prevalent and aggressive brain tumors for which there is currently no cure. A novel composite nanosystem (CN), consisting of chitosan-coated Solid Lipid Nanoparticles (c-SLN) embedded in O-carboxymethyl chitosan (O-CMCS)-containing nanofibers (NFs), was proposed as a potential tool for the local delivery of lipophilic anti-proliferative drugs. Coacervation was selected as a solvent-free method for the preparation of stearic acid (SA) and behenic acid (BA)-based SLN (SA-SLN and BA-SLN respectively). BA-SLN, containing 0.75% w/w BA sodium salt and 3% w/w poly(vinyl alcohol) (PVA), were selected for the prosecution of the work since they are characterized by the lowest size functional to their subsequent coating and incorporation in nanofibers. BA-SLN were coated with chitosan (CS) by means of a two-step coating method based on the physical absorption of positively charged CS chains on the SLN negative surface. Nile Red (NR), chosen as the hydrophobic model dye, was dissolved in a micellar solution of BA sodium salt and then added with a coacervating solution until pH ≅ 2.5 was reached. Immunocytochemistry analyses highlighted that CS-coated BA-SLN (c-BA-SLN) exhibited a higher accumulation in human glioblastoma cells (U-373) after 6 h than CS-free BA-SLN. Finally, the c-BA-SLN dispersion was blended with a solution consisting of freely soluble polymers (O-CMCS, poly(ethylene oxide) and poloxamer) and then electrospun to obtain NFs with a mean diameter equal to 850 nm. After the NFs dissolution in an aqueous media, c-BA-SLN maintained their physicochemical properties and zeta potential.

Versatile Use of Chitosan and Hyaluronan in Medicine

Chitosan is industrially acquired by the alkaline N-deacetylation of chitin. Chitin belongs to the β-N-acetyl-glucosamine polymers, providing structure, contrary to α-polymers, which provide food and energy. Another β-polymer providing structure is hyaluronan. A lot of studies have been performed on chitosan to explore its industrial use. Since chitosan is biodegradable, non-toxic, bacteriostatic, and fungistatic, it has numerous applications in medicine. Hyaluronan, one of the major structural components of the extracellular matrix in vertebrate tissues, is broadly exploited in medicine as well. This review summarizes the main areas where these two biopolymers have an impact. The reviewed areas mostly cover most medical applications, along with non-medical applications, such as cosmetics.

Comparative Evaluation of Different Chitosan Species and Derivatives as Candidate Biomaterials for Oxygen-Loaded Nanodroplet Formulations to Treat Chronic Wounds

Persistent hypoxia is a main clinical feature of chronic wounds. Intriguingly, oxygen-loaded nanodroplets (OLNDs), filled with oxygen-solving 2H,3H-decafluoropentane and shelled with polysaccharides, have been proposed as a promising tool to counteract hypoxia by releasing a clinically relevant oxygen amount in a time-sustained manner. Here, four different types of chitosan (low or medium weight (LW or MW), glycol-(G-), and methylglycol-(MG-) chitosan) were compared as candidate biopolymers for shell manufacturing. The aim of the work was to design OLND formulations with optimized physico-chemical characteristics, efficacy in oxygen release, and biocompatibility. All OLND formulations displayed spherical morphology, cationic surfaces, ≤500 nm diameters (with LW chitosan-shelled OLNDs being the smallest), high stability, good oxygen encapsulation efficiency, and prolonged oxygen release kinetics. Upon cellular internalization, LW, MW, and G-chitosan-shelled nanodroplets did not significantly affect the viability, health, or metabolic activity of human keratinocytes (HaCaT cell line). On the contrary, MG-chitosan-shelled nanodroplets showed very poor biocompatibility. Combining the physico-chemical and the biological results obtained, LW chitosan emerges as the best candidate biopolymer for future OLND application as a skin device to treat chronic wounds.

Polyphenols: A Promising Avenue in Therapeutic Solutions for Wound Care

In chronic wounds, the regeneration process is compromised, which brings complexity to the therapeutic approaches that need to be adopted, while representing an enormous loss in the patients’ quality of life with consequent economical costs. Chronic wounds are highly prone to infection, which can ultimately lead to septicemia and morbidity. Classic therapies are increasing antibiotic resistance, which is becoming a critical problem beyond complex wounds. Therefore, it is essential to study new antimicrobial polymeric systems and compounds that can be effective alternatives to reduce infection, even at lower concentrations. The biological potential of polyphenols allows them to be an efficient alternative to commercial antibiotics, responding to the need to find new options for chronic wound care. Nonetheless, phenolic compounds may have some drawbacks when targeting wound applications, such as low stability and consequent decreased biological performance at the wound site. To overcome these limitations, polymeric-based systems have been developed as carriers of polyphenols for wound healing, improving its stability, controlling the release kinetics, and therefore increasing the performance and effectiveness. This review aims to highlight possible smart and bio-based wound dressings, providing an overview of the biological potential of polyphenolic agents as natural antimicrobial agents and strategies to stabilize and deliver them in the treatment of complex wounds. Polymer-based particulate systems are highlighted here due to their impact as carriers to increase polyphenols bioavailability at the wound site in different types of formulations.

Hyaluronic acid electrospinning: Challenges, applications in wound dressings and new perspectives

Hyaluronic acid (HA) has already been consolidated in the literature as an extremely efficient biopolymer for biomedical applications. In addition to its biodegradability, HA also has excellent biological properties. In the nanofiber form, this polymer can mimic biological tissues, mainly the layers of the skin, and therefore has great potential as structures for the construction of wound dressings. Despite the numerous efforts from the scientific community proposing new dressings, this is an area in constant evolution. A dressing that brings together all the properties of an ideal dressing has not been developed yet. Electrospinning is a simple and versatile technique that correctly aligned with the functional properties of HA can produce multifunctional nanofiber structures capable of promoting skin recover quickly. This review discusses (i) key strategies for successful electrospinning of HA, (ii) main challenges and advances found in the electrospinning process, (iii) the bioactive properties of this polymer in the treatment of wounds, as well as (iv) the results obtained in the last decade by the in vitro and in vivo evaluation of the healing properties of these nanosystems.

Nanocarriers for drug delivery to the inner ear: Physicochemical key parameters, biodistribution, safety and efficacy

Despite the high incidence of inner ear disorders, there are still no dedicated medications on the market. Drugs are currently administered by the intratympanic route, the safest way to maximize drug concentration in the inner ear. Nevertheless, therapeutic doses are ensured for only a few minutes/hours using drug solutions or suspensions. The passage through the middle ear barrier strongly depends on drug physicochemical characteristics. For the past 15 years, drug encapsulation into nanocarriers has been developed to overcome this drawback. Nanocarriers are well known to sustain drug release and protect it from degradation. In this review, in vivo studies are detailed concerning nanocarrier biodistribution, their pathway mechanisms in the inner ear and the resulting drug pharmacokinetics. Key parameters influencing nanocarrier biodistribution are identified and discussed: nanocarrier size, concentration, surface composition and shape. Recent advanced strategies that combine nanocarriers with hydrogels, specific tissue targeting or modification of the round window permeability (cell-penetrating peptide, magnetic delivery) are explored. Most of the nanocarriers appear to be safe for the inner ear and provide a significant efficacy over classic formulations in animal models. However, many challenges remain to be overcome for future clinical applications.

Synthesis of Biocompatible and Environmentally Nanofibrous Mats Loaded with Moxifloxacin as a Model Drug for Biomedical Applications

Biopolymeric chitosan structure (Cs) is rationally investigated owing to its potentiality in pharmaceutical applications. The synthetic routes of biomimetic Cs-based blend electrospun nanofibers were studied. Herein, biocompatible crosslinked electrospun polyvinyl alcohol (PVA)/Cs-reduced gold nanoparticles (Cs(Rg))/β-CD (beta-cyclodextrin) in pure water were fabricated. To this end, supportive PVA as a carrier, Cs bio modifier, and gold reductant and β-CD as smoother, inclusion guest molecule, and capping agent exhibit efficient entrapment of moxifloxacin (Mox) and consequently accelerate release. Besides, PVA/Cs(Rg)/β-CD paves towards controlled drug encapsulation-release affinity, antimicrobial, and for wound dressing. Without losing the nanofiber structure, the webs prolonged stability for particle size and release content up to 96.4%. The synergistic effect of the nanoformulation PVA/Cs(Rg)/β-CD against pathogenic bacteria, fungus, and yeast, including Staphylococcus aureus, Escherichia coli, Candida albicans, and Aspergillus niger, posed clear zones up to 53 φmm. Furthermore, a certain combination of PVA/Cs (Rg)/β-CD showed a total antioxidant capacity of 311.10 ± 2.86 mg AAE/g sample. In vitro cytotoxicity assay of HePG2 and MCF-7 NF6 can eradicate 34.8 and 29.3 µg/mL against selected cells.

Graphene Oxide/Copper Nanoderivatives-Modified Chitosan/Hyaluronic Acid Dressings for Facilitating Wound Healing in Infected Full-Thickness Skin Defects

PURPOSE

Wound healing, especially of infected wounds, remains a clinical challenge in plastic surgery. This study aimed to manufacture a novel and multifunctional wound dressing by combining graphene oxide/copper nanocomposites (GO/Cu) with chitosan/hyaluronic acid, providing significant opportunities for the therapy of wound repair in wounds with a high risk of bacterial infection.

METHODS

In this study, GO/Cu-decorated chitosan/hyaluronic acid dressings (C/H/GO/Cu) were prepared using sodium trimetaphosphate (STMP) crosslinking and the vacuum freeze-drying method, and chitosan/hyaluronic acid dressings (C/H) and GO-incorporated chitosan/hyaluronic acid dressings (C/H/GO) served as controls. The surface characterization, in vitro degradation under various pH values, antimicrobial potential, cytocompatibility and in vivo therapeutic efficacy in a bacteria-infected full-thickness skin defect model were systematically evaluated.

RESULTS

Our experimental results indicated that the acidic environment facilitated the release of copper (CuNPs and Cu2+) from the dressings, and prepared C/H/GO/Cu dressings exhibited significant in vitro antimicrobial activities against the two tested bacterial strains (ATCC35984 and ATCC25923). All three dressings showed satisfactory cytocompatibility with mouse fibroblasts (NIH/3T3-L1). Moreover, remarkably accelerated wound healing was found in the C/H/GO/Cu group, with controlled inflammatory infiltration and improved angiogenesis in granulation tissues. In addition, no pathological damage was noted in the tissue structures of the tested organs (heart, lung, liver and kidney) in any of the four groups.

CONCLUSION

Collectively, GO/Cu-incorporated chitosan/hyaluronic acid dressings suggested a synergistic antimicrobial efficacy and acceptable biocompatibility both in vitro and in vivo, as well as a significantly accelerated healing process of bacteria-infected wounds. Thus, the multifunctional C/H/GO/Cu composite is expected to be a potential alternative for wound dressings, especially for the management of intractable wounds caused by bacterial infection.