Advancements in Functional Dressings and a Case for Cotton Technology: Protease Modulation, Hydrogen Peroxide Generation and ESKAPE Pathogen Antibacterial Activity

Authors: Edwards, Judson; Prevost, Nicolette; Hinchliffe, Doug; Nam, Sunghyun; Madison, Crista

Submitted to: International Journal of Molecular Sciences
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/15/2025
Publication Date: 1/7/2026
Citation: Edwards, J.V., Prevost, N.T., Hinchliffe, D.J., Nam, S., Madison, C.A. 2026. Advancements in Functional Dressings and a Case for Cotton Technology: Protease Modulation, Hydrogen Peroxide Generation and ESKAPE Pathogen Antibacterial Activity. International Journal of Molecular Sciences. 27(2):610. https://doi.org/10.3390/ijms27020610.
DOI: https://doi.org/10.3390/ijms27020610

Interpretive Summary: The process of wound healing may be divided in to four distinct but overlapping phases; 1)hemostasis, 2)inflammation, 3) proliferation, and 4) remodeling. There are both physical and molecular markers that have been identified as key to skin repair and advancing a robust trajectory to healing. Here we consider three functional marker features that have received increased attention for their role in promoting healing in hard to heal wounds: control of protease levels, hydrogen peroxide generation, and antibacterial efficacy against multi-drug resistance bacteria (ESKAPE pathogens). A chronic wound is one that fails to heal in a timely fashion due to one or more pathologies precipitated by the onset of conditions including infection, radiation damage, hypoxia, diabetes, venous insufficiency, malnutrition or ingestion of pharmacological agents. The result is a stalled healing process trapped in the inflammatory stage of healing. Dressings used to treat chronic wounds have been divided in to categories based on the control of moisture since moist wounds heal faster. Some of these dressings also possess functional properties as protease modulation to control destructive proteases, antibacterial activity or hydrogen peroxide generating properties to serve as antibacterials or to initiate cell proliferation. In recent years there have been a reports on a number of research and development approaches to enhance intelligent dressings with multifunctional properties. This paper reviews some functional properties of existing dressings and reports on how some these properties can be elicited with a new cotton technology based on unbleached cotton fibers combined with strategic modifications. Thus, introducing functional marker features needed in wound healing. The findings of the work suggest the importance of considering these new forms of cotton fiber technology in the design of advanced wound dressing approaches to treat hard to heal wounds.

Technical Abstract: The development of functionality in wound dressings has progressed since the discovery by Winter that moist wounds heal more rapidly. Approaches to incorporate functionality on several fronts of wound healing have been targeted. Here we consider three functional features that have received increased attention for their role in promoting healing in hard to heal wounds: control of protease levels, hydrogen peroxide generation, and antibacterial efficacy against multi-drug resistance bacteria (ESKAPE pathogens). We review some clinically employed dressings used to treat chronic and burn wounds that have been characterized for their functional protease modulating activity and contrast one well studied analog with a cotton-based technology. Similarly hydrogen peroxide generation profiles were obtained for dressings in different moist wound healing categories, and contrasted with a modified form of a known hemostatic cotton-based technology. We examined ascorbic acid modified forms of a cotton-based tech-nology used for bleeding control in an ESKAPE antibacterial assessment using the AATCC 100 test. The results for the cotton-based technology was significant protease uptake, hydrogen peroxide generation capacities at proliferative and antimicrobial levels, and > 99.99% efficacy against ESKAPE pathogens. These results reflect the importance of considering new forms of cotton fiber technology for incorporation in advanced wound dressing approaches.