Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China.
Department of Mechanical Engineering, University of Manitoba, Winnipeg, R3T 2N2, Manitoba, Canada.
Adv Mater. 2024 Oct;36(40):e2405290. doi: 10.1002/adma.202405290. Epub 2024 Jul 16.
In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large-diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self-assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β-sheet nanofiber and solvent-induced self-assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60 s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.
在紧急情况下，非静脉曲张性上消化道出血（NVUGIB）的内镜止血被认为是金标准干预措施。然而，目前的内镜止血对于处理高再出血风险的大直径或深部位病变的出血非常具有挑战性。在此，报道了一种新型止血肽水凝胶（HPH），它由自组装肽序列 CFLIVIGSIIVPGDGVPGDG（PFV）和明胶甲基丙烯酰（GelMA）组成，可通过蓝激光内镜（BLE）触发，用于治疗非静脉曲张性上消化道出血，而无需担心再次出血。PFV 与 GelMA 溶液接触后，立即原纤维化为 β-折叠纳米纤维，并通过溶剂诱导自组装形成 HPH 凝胶。HPH 纳米纤维网络通过包裹血细胞和激活血小板及凝血因子，甚至在凝血功能障碍的血液中，引发超快凝血。除了在动脉和肝损伤模型中表现出显著的止血性能外，HPH 通过防止再出血风险，在猪 NVUGIB 模型中，在 60 秒内即可实现即时止血管理。这项工作首次展示了 BLE 用于 NVUGIB 干预的非凡止血剂，拓宽了潜在的应用场景，包括凝血功能障碍患者，并具有广阔的临床前景。
