Living biomaterials: A promising approach to promoting wound healing

Wound healing plays an important role in re-establishing the structure and physiological function of damaged tissues during the repair process. However, certain extrinsic factors (e.g., pathogenic infection or persistent inflammatory response) may interfere with this repair process and even trigger secondary tissue damage. Therefore, exploring innovative therapeutic strategies for wound recovery has become an important direction of current medical research. Living organism therapy is a promising technique that utilizes the unique biological activity of living organisms to modulate the wound microenvironment and promote tissue repair. Despite the current remarkable breakthroughs in the field of bioengineering and regenerative medicine, there are still some critical problems with living organism-based wound therapies, such as immune response, inability to control their proliferation, and poor targeting. Biomaterials are capable of interacting with biological systems and their good biocompatibility can be used as delivery vehicles for living organisms to enhance their therapeutic efficacy. Living biomaterials, which combine living organisms with biomaterials, show considerable promise in wound healing. In this review, we firstly describe the physiological process of wound healing and its conventional therapies, and provide an overview of the types of living organisms commonly used in wound healing. Then, we comprehensively summarize the different delivery systems used for living organisms. Moreover, the various strategies of living biomaterials in promoting wound healing are systematically summarized. Finally, we analyze the application of living biomaterials in clinical translation and discuss current challenges, potential solutions, and future research directions in this area.