Recent advances in ROS-modulating materials for sepsis treatment

Sepsis is a life-threatening systemic inflammatory response syndrome caused by uncontrolled immune reactions to infection. During its onset, immune cells produce reactive oxygen species (ROS) as critical signaling mediators to activate immune responses and coordinate antimicrobial defense. Moderate ROS level is essential for immune activation, whereas its excessive accumulation disrupts redox homeostasis, induces oxidative injury, and accelerates multi-organ failure. Advances in material science and nanotechnology have enabled the development of ROS-modulating materials that regulate oxidative dynamics, enabling both antibacterial and antioxidant therapies. ROS-generating materials, including Fenton-type/peroxidase nanozymes, photosensitizers, and sonosensitizers, produce controlled oxidative bursts to eliminate pathogens and attenuate antibiotic-resistant infections with spatiotemporal precision. In contrast, ROS-scavenging materials, such as antioxidant natural enzymes, antioxidant nanozymes, and polyphenol-derived antioxidants, efficiently neutralize excessive radicals and restore redox homeostasis and protect tissues from oxidative injury. Beyond internal modulation, extracorporeal catalytic hemoperfusion has emerged as a promising strategy for continuous ROS removal directly from the bloodstream. This review comprehensively summarizes recent progress in ROS-modulating materials, including ROS-generating and ROS-scavenging systems as well as extracorporeal catalytic hemoperfusion therapies, and discusses their catalytic mechanisms, targeting strategies, therapeutic potential, biocompatibility, and translational challenges in sepsis treatment.