Evidence library

Peer-reviewed research on nitric oxide, foam delivery, and wound healing.

Explore peer-reviewed work on nitric oxide biology, NOxy’s topical foam platform, and wound-care evidence. Links lead to the publisher or DOI record.

Retrospective real-world analysis2026

A Retrospective Real-World Data Analysis of Pressure Ulcer Healing With Nitric Oxide-Delivering Foam Among Older Adults

Rhonda Sullivan; Zwelithini Mzwandile Tunyiswa; Windy Cole; Lisa Gould; Mervin Low · International Wound Journal 23(5):e70911

In this retrospective, propensity-matched analysis of 400 older adults in skilled nursing facilities, modeled 12-week healing was 63% with nitric oxide-delivering foam and 34% with matched standard of care. Posterior probabilities favored the foam for most stage-specific comparisons.

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In vitro protease assay2026

Testing protease activity in the presence of a nitric oxide-generating foam

Daniel J. Gibson · Journal of Wound Care 35(Sup7a):S42–S46

In a six-enzyme laboratory assay, the undiluted individual components and their 1:1 mixture reduced or eliminated detectable protease activity. The authors call for additional testing in wound fluid or wound-fluid surrogates.

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Field leadership / trial-design perspective2026

Proposed addendum to the 2006 US Food and Drug Administration guidance on chronic cutaneous ulcers and burn wounds: wound research endpoints and clinical trial design

Windy Cole; Mitch Sanders; Vickie Driver; Marissa Carter; Peggy Dotson; Caroline Fife; Sarah Griffiths Langbord; Francis James; Holly Korzendorfer; Maribel Henao; Alisha Oropallo; Joseph Rolley; Robert Snyder; Marjana Tomic-Canic; Zwelithini Tunyiswa; Howard Walthall · Wounds 38(6):155–165

The Wound Care Collaborative Community proposes modernizing the 2006 FDA guidance with standardized preclinical reporting, digital wound assessment, biomarkers, innovative trial designs, and validated alternative and patient-reported endpoints while retaining complete closure as the principal endpoint.

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Scientific review2024

A continuous mode of action of nitric oxide in hard-to-heal wound healing

David A. Bell; C. Michael Miller; Rhonda Sullivan · Journal of Wound Care 33(12):912–925

This scientific review organizes published evidence for nitric oxide across four interrelated wound-healing domains: blood flow and signaling, inflammation and immune response, microbial burden and biofilm, and tissue repair and remodeling.

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In vitro biofilm model2024

Antimicrobial effects of an acidified nitrite foam on drip flow reactor biofilm

C. Michael Miller; Garth A. James; David A. Bell; Greg Schultz · Journal of Wound Management 25(1):16–21

In a drip-flow reactor model, one five-minute exposure to acidified nitrite foam significantly reduced all six biofilms tested, with organism-specific reductions ranging from 1.5 to 5.8 log10 CFU/cm².

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Ex vivo porcine dermal model2024

Acidified nitrite foam anti-microbial action in an ex vivo porcine dermal model

C. Michael Miller; Ellen E. Lantz; Aaron D. Strickland; David A. Bell; Greg Schultz · Journal of Wound Management 25(1):11–15

In an ex vivo porcine dermal model, one five-minute exposure prevented 4.5–8.6 log10 of biofilm growth across six pathogens. One exposure reduced mature biofilms by 1.2–2.5 log10; two exposures reduced them by 2.2–4.5 log10.

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