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£1.7m project to explore groundbreaking new treatment for biofilm infections in foot ulcers

3 February 2021

Press release from Lancaster University 

A new £1.7m project to explore using plasma jets and antimicrobial dressings to treat debilitating – and potentially deadly – wound infections launches today.

The groundbreaking Plasma-activated Antimicrobial Hydrogel Therapy (PAHT) would provide a new treatment modality for biofilm infections in diabetic foot ulcers (DFUs), a type of wound which make up around 10 per cent of the 2.2m wounds reported annually in the UK.

More than a third of the +4.5m diabetics in the UK have a lifetime risk of foot ulcers, of which 50 per cent become infected. Around 10 per cent of these patients then require lower limb amputation due to tissue and bone infection. The prognosis for these patients is bleak; 44 per cent usually die within five years.

The project will explore using plasma (electrically excited gas) jet technology combined with anti-microbial dressings to improve outcomes for these patients, while avoiding increasing anti-microbial resistance (AMR) within the population caused by increased antibiotic usage.

Lead investigator Professor Rob Short, from Lancaster University’s Material Science Institute, said: “Wound infections are responsible for an estimated 37,000 deaths each year in the EU, costing €7bn annually. Infections can lead to permanent disability, decreased quality of life and premature death for patients.

“Also, the emergence of new bacterial strains resistant to all current antibiotics is a potential time-bomb. In response, bodies such as the World Health Organisation have called for a reduction in antibiotic use and innovation to improve infection control and combat anti-microbial resistance (AMR).

“We will develop a multi-pronged strategy to treat infected DFUs which is both effective and less likely to promote AMR. Plasma technology will be used to deliver antimicrobial reactive oxygen and nitrogen species (RONS) into the wound, with the concomitant delivery of potent antimicrobial agents from hydrogel wound dressings.

“We believe this treatment could have significant impact on the huge numbers of patients who require limb amputations or suffer premature death as a result of infections.”

Led from Lancaster University, the project also brings in the institution’s expertise in skin cell biology (Dr Sarah Allinson), Health Economics (Professors. Bruce Hollingsworth and Ceu Mateus) and Clinical Trial Design (Professor Thomas Jaki).

External partners include Bath University, on wound dressing development and Glasgow University, on model biofilm development. Local clinical/study trials will be delivered via University Hospitals of

Morecambe Bay NHS Foundation Trust, through a partnership set up by Lancaster’s Health Innovation Campus, and industry partner global wound-care company ConvaTec .

Dr Paul Smith - Consultant Diabetologist and Clinical Lead for Diabetic Foot Disease, University Hospitals of Morecambe Bay NHS Foundation Trust, said: “Diabetic foot disease is a cause of considerable morbidity and disability, and treatment is often compounded by side-effects and resistance associated with antibiotic use, so we are delighted to be to collaborating on this exciting study to investigate treating diabetic foot wound infections using plasma technology.”

ConvaTec is a UK-based, global medical technology company focused on therapies and products for the management of chronic and acute conditions, holding leading market positions in advanced wound care, ostomy care, critical care and infusion care.

Dr Daniel Metcalf, Associate Director of the Infection Prevention Centre of Excellence at the ConvaTec Global Development Centre, said: "Having recognised the role of biofilm in delayed wound healing, ConvaTec have already developed a number of products that have shown a range of clinical and economic benefits including infection prevention, protection of at-risk skin, improved patient outcomes and reduced total cost of care. We are very much looking forward to being part of this exceptional research consortium and see real potential in the collaborative nature of this project. This study aligns with our scientific strategy for wound care and offers the potential to learn, develop and enhance novel anti-biofilm technologies in order to improve patient care and clinical outcomes.”

The University of Bath is engineering hydrogel wound dressings which contain antimicrobial molecules and identified a number of wide-reaching benefits from the project.

Professor Toby Jenkins added: “We believe the technology being developed, which combines cold atmospheric plasma and novel gel wound dressings, has the potential to make a real impact on the lives of patients living with chronic wounds within a few years.

“Moreover, this project team which combines materials scientists with microbiologists and clinicians brings together unique skill sets which providing a high probability of project success as they build on previous research by the partners developing the fundamental technologies.”

Biofilms are surface associated aggregates of bacteria and fungi which are glued together. These represent a significant clinical challenge due to the inability of antimicrobials to successfully penetrate them and kill the microorganisms within. Professor Gordon Ramage and his group at the University of Glasgow, have developed innovative models to test and develop new innovative treatment strategies for complex biofilms with the support and funding from the National Centre for Biofilms Research.

Professor Gordon Ramage said: “We are now in a position to use models that truly represent the biofilms in patient’s diabetic foot ulcers, which will provide a quicker and more reliable route to developing new treatment strategies and ultimately to enhanced clinical care of this patient group.”

The project has been supported by a £1.35m grant from the Engineering and Physical Sciences Research Council (EPSRC), partner funding and industry contribution from ConvaTec.