Responsive nitric oxide‐releasing antibacterial materials for biofilm‐associated infections: Mechanisms, design strategies, and applications

Abstract Global health is seriously threatened by bacterial diseases, especially when it comes to bacterial biofilms. Such infections may worsen immune evasion and bacterial drug resistance, making treatment more difficult and raising the cost of healthcare. However, it has been shown that traditional techniques, such as the use of antibiotics and mechanical removal, are only partially effective in eliminating biofilms. Gas therapy is an alternative promising antibacterial therapeutic approach. Because of its numerous antibacterial qualities, nitric oxide (NO) is particularly a prospective contender. The clinical potential of NO has been demonstrated in certain applications, whereby it generates reactive oxygen and nitrogen species that effectively disperse biofilms and eradicate bacteria in deep tissues. NO‐releasing materials can induce NO release from exogenous stimuli (including light, ultrasound, magnetic, and electric) or endogenous stimuli (including pH, reactive oxygen species, glucose, enzyme, and glutathione), which provides a significant advantage in treating broad and deep infections. This paper reviews the antimicrobial mechanisms of NO, NO‐releasing materials, and their application in skin and wound infection, implant‐related and orthopedic infection, and oral and periodontal infection treatment. Particular concern is given to the crucial function of NO in biofilm regulation, to explore theoretical insights and effective guidance for future research and innovation.