1% Acetic Acid as an Effective and Cytocompatible Antimicrobial Agent with Enhanced Activity in Acellular Dermal Matrix for Wound Management

Abstract

Abstract Objectives To evaluate the antimicrobial efficacy, antibiofilm activity, cytocompatibility, and biomaterial compatibility of 1% acetic acid (AA), including its application within acellular dermal matrix (ADM) for advanced wound management. Methods Antimicrobial activity of 1% AA was assessed using broth microdilution, isothermal microcalorimetry, and an in vitro disc-based antimicrobial model against clinically relevant bacterial strains, including Pseudomonas aeruginosa, Staphylococcus aureus (MRSA), Escherichia coli, and Enterococcus faecalis. Biofilm susceptibility was evaluated at multiple exposure times. Cytocompatibility was tested in dermal fibroblasts and NIH 3T3 fibroblasts following exposure to 1% AA and ADM impregnated with 1% AA. Results Acetic acid showed consistent antimicrobial activity with minimum inhibitory concentrations of 0.06-0.12%, whereas Betadine (povidone-iodine) exhibited higher values (3.16-6.25%). Isothermal microcalorimetry confirmed concentration-dependent inhibition of bacterial metabolism, with complete suppression at concentrations ≥0.25%. In planktonic assays, 1% AA fully inhibited P. aeruginosa and MRSA growth, while partially reducing E. coli and E. faecalis. In biofilm models, the highest susceptibility was observed in P. aeruginosa, with complete eradication after short exposure. Cytotoxicity testing showed negligible effects of 1% AA on fibroblast viability, in contrast to the strong cytotoxicity of Betadine. ADM impregnated with 1% AA maintained cytocompatibility and supported fibroblast proliferation. Conclusion 1% acetic acid demonstrates broad-spectrum antimicrobial and antibiofilm activity with favourable cytocompatibility. Its incorporation into acellular dermal matrix may represent a promising strategy for localized, biomaterial-based wound therapy.