Nonspecific protein adsorption impedes the sustainability of materials in biologically related applications. Such adsorption activates the immune system by quick identification of allogeneic materials and triggers a rejection, resulting in the rapid failure of implant materials and drugs. Antifouling materials have been rapidly developed in the past 20 years, from natural polysaccharides (such as dextran) to synthetic polymers (such as polyethylene glycol, PEG). However, recent studies have shown that traditional antifouling materials, including PEG, still fail to overcome the challenges of a complex human environment. Zwitterionic materials are a class of materials that contain both cationic and anionic groups, with their overall charge being neutral. Compared with PEG materials, zwitterionic materials have much stronger hydration, which is considered the most important factor for antifouling. Among zwitterionic materials, zwitterionic hydrogels have excellent structural stability and controllable regulation capabilities for various biomedical scenarios. Here, we first describe the mechanism and structure of zwitterionic materials. Following the preparation and property of zwitterionic hydrogels, recent advances in zwitterionic hydrogels in various biomedical applications are reviewed.

The design of three-dimensional crosslinked units with a spatial structure is of great significance for improving the mechanical properties of hydrogels. However, almost all the nanocomposites incorporated in hydrogels were defined as rigid nanofillers without further discussion on the potential contribution from the spatial structure change. In this work, the 3D nano chemical crosslinker multilayer graphene oxide acrylate (mGOa) was developed as a pressure-responsive crosslinker to achieve both low elastic modulus and high compression stress by synergizing more polymer chains against the loading force through interlayer sliding. Results showed that the hydrogel crosslinked by only 2 mg/mL mGOa nano chemical crosslinker in the poly­(2-hydroxyethyl methacrylate-co-acrylamide) hydrogel (molar ratio: 1:1) can effectively enhance the mechanical strength up to 14.1 ± 2.1 MPa at a high compressive strain (90.6%) with an elastic modulus of less than 0.03 MPa at the initial 5% compression, whereas the hydrogel crosslinked by methacrylated single-layer graphene oxide (sGOa) or a small-molecule chemical crosslinker, N,N′-methylene bisacrylamide, can only reach 2.3 ± 0.8 MPa and 1.4 ± 0.4 MPa, respectively. In addition, the instantaneous modulus of the mGOa crosslinked hydrogel rapidly increased to the peak value with the increase of strain. The repeated compression test of HcA-mGOa hydrogels showed the responsive increase of the modulus, which was promoted by the synergism of polymer chains under compression. This indicated that the interlayer sliding of mGOa is the key contributor to mechanical strength enhancement, which provides a new rationale to design tough hydrogels.

As a nonspecific protein adsorption material, a strong hydration layer provides zwitterionic hydrogels with excellent application potential while weakening the interaction between zwitterionic units, leading to poor mechanical properties. The unique anti-polyelectrolyte effect in ionic solution further restricts the application value due to the worsening mechanical strength. To overcome the limitations of zwitterionic hydrogels that can only be used in scenarios that do not require mechanical properties, several methods for strengthening mechanical properties based on enhancing intermolecular interaction forces and polymer network structure design have been extensively studied. Here, we review the works on preparing tough zwitterionic hydrogel. Based on the spatial and molecular structure design, tough zwitterionic hydrogels have been considered as an important candidate for advanced biomedical and soft ionotronic devices.