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Shi J, Wang D, Wang H, Yang X, Gu S, Wang Y, Chen Z, Chen Y, Gao J, Yu L, Ding J. An injectable hemostatic PEG-based hydrogel with on-demand dissolution features for emergency care. Acta Biomater 2022; 145:106-121. [PMID: 35436591 DOI: 10.1016/j.actbio.2022.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Uncontrolled bleeding from internal noncompressible wounds is a major cause of prehospital death in military personnel and civilian populations. An ideal hemostatic sealant for emergency care should quickly control blood loss and be removed without debridement for the follow-up treatment in the operating room, yet the lack of suitable materials to meet both requirements is the bottleneck. Herein, we suggest an injectable and dissolvable hydrogel sealant for hemorrhage management of noncompressible wounds. To this end, a 4-arm poly(ethylene glycol) (PEG) crosslinker modified with thioester linkages and terminated with aldehyde groups is designed and synthesized, and to modulate the gel properties and make it suitable as a hemostatic sealant, a mixed amino component composed of poly(ethylene imine) and adipic dihydrazide is employed to react with the PEG crosslinker to form the adhesive and elastic sealant for the first time. The aldehyde groups provide the adhesion to the tissues, and the amino component affords the procoagulant ability. More importantly, the thioester moieties allow the on-demand dissolution of sealant via a thiol-thioester exchange reaction upon exposure to an exogenous thiolate solution. In the rat femoral artery puncture and liver injury models, the administration of the hydrogel sealant dramatically reduces blood loss, and its subsequent removal does not induce rebleeding. Consequently, this hydrogel sealant with the unique feature of on-demand dissolution can not only efficiently control bleeding in emergent scenarios, but also allow non-traumatic re-exposure of wounds during subsequent surgical care. STATEMENT OF SIGNIFICANCE: Sealants, adhesives or hemostatic dressings currently used in emergency situations not only require manual pressure to control bleeding, but also face removal by cutting and mechanical debridement to enable eventual surgical treatment. In this study, we design and develop an injectable and adhesive hydrogel sealant with good procoagulant capacity and on-demand dissolution feature. The application of the hydrogel sealant substantially reduces bleeding from internal noncompressible wounds without the need for direct pressure, and demonstrates for the first time that its controlled removal without debridement does not cause rebleeding. Considering that there are currently no commercial wound sealant systems with the feature of on-demand dissolution, the hydrogel sealant developed by us is expected to address an unmet clinical need.
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Affiliation(s)
- Jiayue Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Danni Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Hancheng Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Xiaowei Yang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Siyi Gu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Yaoben Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Zhiyong Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Yu Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Jingming Gao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
| | - Lin Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China.
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai 200438, China
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Abstract
Wound management is a major global challenge and a big financial burden to the healthcare system due to the rapid growth of chronic diseases including the diabetes, obesity, and aging population. Modern solutions to wound management include hydrogels that dissolve on demand, and the development of such hydrogels is of keen research interest. The formation and subsequent on-demand dissolution of hydrogels is of keen interest to scientists and clinicians. These hydrogels have excellent properties such as tissue adhesion, swelling, and water absorption. In addition, these hydrogels have a distinctive capacity to form in situ and dissolve on-demand via physical or chemical reactions. Some of these hydrogels have been successfully used as a dressing to reduce bleeding in hepatic and aortal models, and the hydrogels remove easily afterwards. However, there is an extremely wide array of different ways to synthesize these hydrogels. Therefore, we summarize here the recent advances of hydrogels that dissolve on demand, covering both chemical cross-linking cases and physical cross-linking cases. We believe that continuous exploration of dissolution strategies will uncover new mechanisms of dissolution and extend the range of applications for hydrogel dressings.
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Affiliation(s)
- Hao Lu
- Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021 China
| | - Long Yuan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medial University), Chongqing, 400038 China
| | - Xunzhou Yu
- Institute of Burn Research, South-West Hospital, State Key Lab of Trauma, Burn and Combined Injury, Third Military Medical University (Army Medical University), Gaotanyan Road No. 30, Shapingba District, Chongqing, 400038 China
| | - Chengzhou Wu
- Department of Respiratory, Wuxi Country People’s Hospital, Chongqing, 405800 China
| | - Danfeng He
- Institute of Burn Research, South-West Hospital, State Key Lab of Trauma, Burn and Combined Injury, Third Military Medical University (Army Medical University), Gaotanyan Road No. 30, Shapingba District, Chongqing, 400038 China
| | - Jun Deng
- Institute of Burn Research, South-West Hospital, State Key Lab of Trauma, Burn and Combined Injury, Third Military Medical University (Army Medical University), Gaotanyan Road No. 30, Shapingba District, Chongqing, 400038 China
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