Table 2.

Studies on mechanisms of action of CMCS hydrogels.

Effect	Mechanism of Action	Key Findings
Angiogenesis inhibition [92]	Endothelial cell migration inhibition Downregulation of pro-angiogenic factors	CMCS inhibited 2D and 3D migration of HUVECs, decreased CD34 expression in hepatocarcinoma tissues, and controlled serum levels of TIMP-1 and VEGF
Angiogenesis promotion [93]	Stimulation of growth factors	CMCS loaded with bioactive glass or magnesium ions stimulated the expression of VEGF and bFGF
Antibacterial [106]	Bacterial membrane disruption	CMCS hydrogels with silver nanoparticles showed >95% reduced rates against S. aureus and E. coli after 50 laundering cycles
Osteogenesis promotion [108]	Regulation of bone-related proteins	CMCS increased osteocalcin content and the OPG/RANKL ratio in a rabbit knee replacement model
Controlled drug release [73]	pH-responsive swelling	CMCS/starch hydrogels with CuO nanoparticles showed pH-dependent swelling and controlled release of amoxicillin
Collagen deposition [23]	Stimulation of fibroblast activity	CMCS/HA/Ag hydrogels promoted collagen fiber deposition in partial-thickness burn wounds
Anti-fungal activity [85]	Fungal growth inhibition	CMCS delayed growth of C. albicans, C. krusei, and C. glabrata
Gene therapy enhancement [88]	Reduction in host immune response	CMCS allowed for repeated administration and long-term transgene expression of IL-10 in a hepatic fibrosis model
Anti-inflammatory [87,108,109,110]	Cytokine modulation Antioxidant effect	CMCS hydrogels suppressed pro-inflammatory cytokines, increased anti-inflammatory mediators, and scavenged reactive oxygen species
Wound healing [113]	Promotion of fibroblast activity Cytokine modulation	CMCS/plantamajoside hydrogel increased cell viability, migration, and collagen deposition, reduced expression of IL-1β, IL-6, and TNF-α, and increased IL-10 expression