Nitric Oxide-Releasing Bacterial Cellulose/Chitosan Crosslinked Hydrogels for the Treatment of Polymicrobial Wound...

Polymicrobial wound infections are a major cause of infectious disease-related morbidity and mortality worldwide. In this study, we prepared a nitric oxide (NO)-releasing oxidized bacterial cellulose/chitosan (BC_TO/CHI) crosslinked hydrogel to effectively treat polymicrobial wound infections. Linear polyethyleneimine diazeniumdiolate (PEI/NO) was used as the NO donor. The aldehyde group of BC_TO and the amine of CHI were used as crosslinked hydrogel-based materials; their high NO loading capacity and antibacterial activity on the treatment of polymicrobial-infected wounds were investigated. The blank and NO-loaded crosslinked hydrogels, namely BC_TO-CHI and BC_TO-CHI-PEI/NO, were characterized according to their morphologies, chemical properties, and drug loading. BC_TO-CHI-PEI/NO exhibited sustained drug release over four days. The high NO loading of BC_TO-CHI-PEI/NO enhanced the bactericidal efficacy against multiple bacteria compared with BC_TO-CHI. Furthermore, compared with blank hydrogels, BC_TO-CHI-PEI/NO has a favorable rheological property due to the addition of a polymer-based NO donor. Moreover, BC_TO-CHI-PEI/NO significantly accelerated wound healing and re-epithelialization in a mouse model of polymicrobial-infected wounds. We also found that both crosslinked hydrogels were nontoxic to healthy mammalian fibroblast cells. Therefore, our data suggest that the BC_TO-CHI-PEI/NO developed in this study improves the efficacy of NO in the treatment of polymicrobial wound infections.