Thiolated chitosan hydrogel combining nitric oxide and silver nanoparticles for the effective treatment of diabetic wound healing.

Nitric oxide (NO) has shown significant potential in chronic wound healing due to its ability of promoting blood circulation. However, excessive NO can trigger local inflammatory response, potentially hindering wound healing. Therefore, controlled and sustained NO release to minimize pro-inflammation effects during treatment is in great demand for diabetic wounds. Herein, an injectable thiolated chitosan hydrogel loaded with NO donors (GNO) and silver nanoparticles (AgNPs) is presented for effective diabetic wound treatment, from which NO was released stably and sustainably responsive to reactive oxygen species (ROS) at the wound site. The combination of NO and AgNPs demonstrated robust antibacterial activity and biofilm dissipation. During diabetic wound treatments, the sustained release of NO promoted blood vessel regeneration while inhibiting inflammatory factors, thereby accelerating wound healing. This combined approach achieves efficient antibacterial action, biofilm prevention, inflammation suppression, vascular repair, improved local blood circulation, ultimately facilitating the reconstruction of epithelial structures at the wound site, thereby providing a promising solution for the diabetic chronic wound healing.