Synopsis of Our Research on Wound Healing

The healing of wounds is a complex process involving a number of stages, including coagulation, inflammation, remodeling and finally development of full strength skin. Impaired wound healing and/or skin ulcers occur in patients with peripheral arterial occlusive disease, deep vein thrombosis, diabetes, pressure sores and burns. Despite intense investigation, the precise mechanisms associated with impaired healing are poorly understood.

The Sutton team made a serendipitous finding when studying the anti-inflammatory role of the natural anticoagulant, activated protein C (APC). In addition to arthritis, APC proved to be beneficial to prevent type I diabetes and to heal chronic wounds. The wound healing study has progressed soundly through 2006-07. The study now involves collaboration of numerous RNSH staff from various departments including Dermatology, Rheumatology, Endocrinology, Severe Burns Unit, Vascular Surgery, Pharmacy and the Clinical Governance Unit

Chronic leg ulcers are a major public health burden associated with high direct health-care costs and substantial negative impact on the quality of life of patients and carers.  Despite recent advances in wound care many ulcers still fail to heal, leading to serious complications.  In 2006-07, research in the Sutton laboratory has resolved mechanisms underlying APC’s actions in wound healing.  In addition, ethics approval to conduct an open-labelled pilot clinical trial in patients with chronic wounds was obtained. The preliminary results of this study conducted by Kaley Whitmont, Sara Tritton and Ian Reid are exciting, with patients showing dramatic improvement in healing and no adverse reactions were identified

Our team was approved to run 3 randomised, double blind, placebo controlled clinical trials examining the efficacy of APC on i) split skin grafts, ii) burns, and iii) chronic leg ulcers.  The trials are an essential step toward the validation of the therapeutic use of APC in wound healing.  Topical application of APC is likely to emerge as a highly cost-effective treatment for this difficult health problem.  The results have potential to make an enormous contribution to the international knowledge of wound healing as well as having a significant impact on the patients and the society as a whole with reduced public health burden.