Bacterial cellulose: Is it really a promising biomedical material?

Bacterial cellulose (BC) is currently considered a promising biomaterial due to its specific structure and properties. However, despite extensive research, questions about its fundamental properties, especially biocompatibility, remain. Thus, the purpose of this review is to analyze the results of in vivo trials from different areas of biomedicine, including wound healing, tissue engineering, drug delivery, and biomedical implants. The primary question guiding our review was "Why is bacterial cellulose still not used in clinical practice?" Analysis of the literature has shown that the results of in vivo studies often contradict each other. For example, BC caused and did not cause an immune response in an equal number of reviewed articles. Its efficacy in pure form generally does not differ significantly from that of materials already on the market. Conversely, BC may prove to be a valuable material in the long term, not because of its efficacy, but rather because of its affordability and ease of use. Additionally, challenges associated with immune reactions, long-term biocompatibility, and the necessity for standardized experimental protocols must be addressed. We expect that this review will encourage a more thoughtful investigation of BC to bring it into practical medicine.