Instant clot forming and antibacterial wound dressings: Achieving hemostasis in trauma injuries with S‐nitroso‐N‐acetylpenicillamine—tranexamic acid—propolis formulation

• Published in: Journal of biomedical materials research. Part A Vol. 112; no. 11; pp. 1930 - 1940
• Main Authors: Nguyen, Dieu Thao, Pant, Jitendra, Sapkota, Aasma, Goudie, Marcus James, Singha, Priyadarshini, Brisbois, Elizabeth J, Handa, Hitesh
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2024; Wiley Subscription Services, Inc
• Subjects: Animals; Anti-Bacterial Agents - pharmacology; Antibacterial activity; Antiinfectives and antibacterials; Bandages; Blood; Blood Coagulation - drug effects; Cell proliferation; Cell signaling; Copolymers; excessive blood loss; Fibrin; First aid; Hemostasis; Hemostasis - drug effects; Hemostatics; Humans; Inflammation; Injuries; Injury prevention; instant clotting; L-Lactate dehydrogenase; Lactate dehydrogenase; Lysis; Medical dressings; Multidrug resistance; Nitric oxide; nitric oxide (NO); Polycarbonate; Polyurethane carbonates; Propolis; Resins; S-Nitroso-N-Acetylpenicillamine - chemistry; S-Nitroso-N-Acetylpenicillamine - pharmacology; Scanning electron microscopy; Silicones; tranexamic acid (TXA); Tranexamic Acid - pharmacology; Trauma; trauma injuries; wound dressings; Wound healing; Wound Healing - drug effects; Wound infection; Wounds and Injuries - complications; nitric oxide (NO); excessive blood loss; instant clotting; tranexamic acid (TXA); wound dressings; trauma injuries; propolis
• ISSN: 1549-3296; 1552-4965; 1552-4965
• DOI: 10.1002/jbm.a.37738

Wound infection and excessive blood loss are the two major challenges associated with trauma injuries that account for 10% of annual deaths in the United States. Nitric oxide (NO) is a gasotransmitter cell signaling molecule that plays a crucial role in the natural wound healing process due to its antibacterial, anti‐inflammatory, cell proliferation, and tissue remodeling abilities. Tranexamic acid (TXA), a prothrombotic agent, has been used topically and systemically to control blood loss in reported cases of epistaxis and combat‐related trauma injuries. Its properties could be incorporated in wound dressings to induce immediate clot formation, which is a key factor in controlling excessive blood loss. This study introduces a novel, instant clot‐forming NO‐releasing dressing, and fabricated using a strategic bi‐layer configuration. The layer adjacent to the wound was designed with TXA suspended on a resinous bed of propolis, which is a natural bioadhesive possessing antibacterial and anti‐inflammatory properties. The base layer, located furthest away from the wound, has an NO donor, S‐nitroso‐N‐acetylpenicillamine (SNAP), embedded in a polymeric bed of Carbosil®, a copolymer of polycarbonate urethane and silicone. Propolis was integrated with a uniform layer of TXA in variable concentrations: 2.5, 5.0, and 7.5 vol % of propolis. This design of the TXA–SNAP–propolis (T‐SP) wound dressing allows TXA to form a more stable clot by preventing the lysis of fibrin. The lactate dehydrogenase‐based platelet adhesion assay showed an increase in fibrin activation with 7.5% T‐SP as compared with control within the first 15 min of its application. A scanning electron microscope (SEM) confirmed the presence of a dense fibrin network stabilizing the clot for fabricated dressing. The antibacterial activity of NO and propolis resulted in a 98.9 ± 1% and 99.4 ± 1% reduction in the colony‐forming unit of Staphylococcus aureus and multidrug‐resistant Acinetobacter baumannii, respectively, which puts forward the fabricated dressing as an emergency first aid for traumatic injuries, preventing excessive blood loss and soil‐borne infections.