Nitric oxide (NO) represents a potential wound therapeutic agent due to its ability to regulate inflammation and eradicate bacterial infections. Two broad strategies exist to utilize NO for wound healing; liberating NO from endogenous reservoirs, and supplementing NO from exogenous sources. This progress report examines the efficacy of a variety of NO‐based methods to improve wound outcomes, with particular attention given to diabetes‐associated chronic wounds.

S-nitrosothiol (RSNO)-modified mesoporous silica nanoparticles (MSNs) were doped into polyurethane (PU) to achieve extended NO-releasing coatings. Parameters influencing the synthesis of RSNO-functionalized nitric oxide (NO)-releasing MSNs were evaluated to elucidate the impact of pore structure on NO-release characteristics. The porous particles were characterized as having larger NO payloads and longer NO-release durations than that of nonporous particles, a feature attributed to recombination of the NO radical in confined intraporous microenvironments. Nitric oxide-release kinetics, particle leaching, and thermal stability of the RSNO-modified MSNs dispersed in PU were evaluated as a function of PU structure to determine the feasibility of preparing a range of NO-releasing polymers for biomedical device coating applications. The NOrelease kinetics from the PUs proved to be highly extended (>30 d) and consistent over a range of polyurethane properties. Furthermore, RSNO-modified MSN leaching was not observed from the PUs. The NO-release payloads were also maintained for 4 days for polymers stored at 0 °C.

Analytical performance and tissue interactions of nitric oxide (NO)-releasing continuous glucose sensors were evaluated over a 28 d study in a diabetic swine model. Interstitial glucose was detected using an implanted needletype amperometric glucose sensor. Two NO-release durations from the sensor surface were achieved by doping the membranes with nonporous (14 d release) or porous (30 d release) S-nitrosothiol-functionalized silica nanoparticles. Numerical and clinical accuracy of the sensors were assessed at time points (1, 7, 14, 21, and 28 d) following implantation. Nitric oxide-releasing sensors demonstrated accurate glucose detection over a time period directly correlated with the active release of NO. Silica particle-doped sensors that released NO for 30 d showed standard-compliant accuracy (i.e., mean absolute relative difference ≤ 15%) for >3 weeks post-implantation. Histological staining for inflammatory biomarkers suggested that the observed performance improvement was the result of decreased inflammatory cell count and a lower density collagen capsule.

Nitric oxide (NO)-releasing polymers have proven useful for improving the biocompatibility of in vivo glucose biosensors. Unfortunately, leaching of the NO donor from the polymer matrix remains a critical design flaw of NO-releasing membranes. Herein, a toolbox of NO-releasing silica nanoparticles (SNPs) was utilized to systematically evaluate SNP leaching from a diverse selection of biomedical-grade polyurethane sensor membranes. Glucose sensor analytical performance and NO-release kinetics from the sensor membranes were also evaluated as a function of particle and polyurethane (PU) chemistries. Particles modified with N-diazeniumdiolate NO donors were prone to leaching from PU membranes due to the zwitterionic nature of the NO donor modification. Leaching was minimized (<5% of the entrapped silica over 1 month) in low water uptake PUs. However, SNP modification with neutral S-nitrosothiol (RSNO) NO donors lead to biphasic leaching behavior. Particles with low alkanethiol content (<3.0 wt % sulfur) leached excessively from a hydrogel PU formulation (HP-93A-100 PU), while particles with greater degrees of thiol modification did not leach from any of the PUs tested. A functional glucose sensor was developed using an optimized HP-93A-100 PU membrane doped with RSNO-modified SNPs as the outer, glucose diffusion-limiting layer. The realized sensor design responded linearly to physiological concentrations of glucose (minimum 1-21 mM) over 2 weeks incubation in PBS and released NO at >0.8 pmol cm s for up to 6 days with no detectable (<0.6%) particle leaching.

The tissue response to polyurethane (PU)-coated implants employing active and/or passive FBR mitigation techniques was evaluated over a 28 day study in a diabetic swine model. Active FBR mitigation was achieved through the sustained release of nitric oxide (NO) from a mesoporous silica nanoparticle-doped PU coating. Passive FBR mitigation was achieved through the application of a foam-or fiber-based topcoat. These topcoats were designed to possess topographical features known to promote tissue integration with foamcoated implants having pore sizes of approximately 50 μm and fiber-coated implants consisting of fiber diameters of less than 1 μm. Nitric oxide-release profiles were minimally impacted by the presence of either topcoat. Inflammatory cell density and collagen density at the implant− tissue interface were assessed at 7, 14, 21, and 28 days following implantation. Nitric oxide-releasing implants had significantly lower inflammatory cell density and collagen density than non-NO-releasing controls. The presence of a topcoat did not significantly impact inflammatory cell density, though top-coated textured implants resulted in significantly lower collagen density, irrespective of NO release. Overall, coatings that combine NO release with surface texture demonstrated the greatest potential for tissue-based biomedical device applications.