Functionalized polysaccharides for infection-resistant and regenerative therapies in gynecology

Gynecological infections and implant-related complications, such as bacterial vaginosis (BV), pelvic inflammatory disease (PID), and endometritis, are exacerbated by biofilm-forming pathogens such as G. vaginalis, E. coli, and S. aureus, posing significant clinical challenges worldwide. These biofilms, resistant to antibiotics, contribute to chronic infections and device failures in gynecological implants. Rising antibiotic resistance underscores the need for innovative biomaterials. Chitosan, hyaluronic acid (HA) and alginate are three representative natural polysaccharides, showing broad application potential in antibacterial materials and tissue engineering due to their excellent biocompatibility, biodegradability and modifiable structures. In their natural forms, they exhibit a certain degree of anti-biofilm activity by inhibiting bacterial adhesion and disrupting bacterial membranes. Functional modification significantly enhances their antibacterial performance such as AMPs grafting, cross-linking, quaternization, and nanocomposites. This review explores the antibacterial mechanisms of natural polysaccharides in the vaginal microbiome and endometrial tissue, highlighting advances in functionalization with antimicrobial peptides, nanoparticles, and chemical modifications to enhance antibacterial efficacy. The toxicological effects of natural polysaccharide materials on gynecological tissues generally show the characteristics of mainly protective and restorative effects, rather than causing damage. Natural polysaccharides and their applications offer promising potential for infection-resistant, regenerative therapies in gynecology, promising safer and more effective interventions.