April 2022

Harnessing Bacteria to Improve Healing in Chronic Skin Wounds (Studentship)

Dr Holly Wilkinson is a Lecturer in Wound Healing at the Hull York Medical School. She and her collaborators, Prof. Matthew Hardman (Hull York Medical School), Mr George Smith (Vascular Group, Hull York Medical School) and Mr Paolo Matteucci (Plastics Department, Hull University Teaching Hospitals NHS Trust), have been awarded a British Skin Foundation PhD studentship entitled “Modulating Skin Bacteria to Improve Wound Healing in the Elderly”.

Here Holly explains what they hope to achieve by studying skin bacteria in chronic non-healing wounds.

Above image: Dr Holly Wilkinson

Non-healing skin wounds are a major problem

Chronic, non-healing wounds are a life-threatening skin condition affecting 1 in 4 diabetics and 1 in 20 people over the age of 65. Due to their high prevalence, they cost the NHS a staggering £6 billion per year to treat. Chronic skin wounds reduce quality of life by causing pain, odour, social isolation and depression. Unfortunately, current treatments for these debilitating skin wounds are inadequate, meaning a large number of wounds still don’t heal even following best practice care. In patients with non-healed wounds on their legs, the only feasible treatment option is often amputation, yet risk of death following a wound-related amputation is over 50%. There is therefore an urgent need to develop new treatments to improve the lives of patients living with these devastating wounds. The goal of our research group is to understand the biological risk factors that lead to chronic skin wounds so we can develop therapies that will heal these wounds effectively.

Our skin bacteria can predict whether our wounds will heal

Our bodies are home to trillions of microorganisms known as the “microbiota”. We know that the resident microbiota is important for maintaining health and preventing “bad” (pathogenic) bacteria from causing infections. Our knowledge of how this works in the gut is extensive, but much less is known about the skin microbiota. Researchers have now begun to profile the billions of bacteria that inhabit our skin to understand how they contribute to skin health and disease. Indeed, our recent data showed a strong correlation between the type of microorganisms inhabiting chronic skin wounds and the likelihood that the wounds would heal. Specific pathogenic bacteria are also known to delay skin repair in laboratory models, while “friendly” commensal bacteria do not. The implications of these findings for the clinic are huge, especially considering that up to 85% of wound-related amputations occur following infection. A detailed understanding of how skin microbiota cause poor healing has the potential to revolutionise how we treat chronic wounds.

Above image: Microscopy images of human skin wounds created in the laboratory. Skin wounds treated with pathogenic bacteria heal more slowly than untreated (control) wounds and wounds treated with commensal bacteria.

Can manipulating skin bacteria be the key to improving poor healing?

Bacterial modulation is emerging as a new strategy to target many age-related diseases caused by pathogenic bacteria. In the gut, modulation of microbiota with probiotics (beneficial bacteria) extends lifespan and reduces colonic inflammation. Probiotic modulation of gut microbiota can even alleviate symptoms of inflammatory skin disease. In our recently awarded BSF-funded PhD studentship, we will be taking this area of research further to determine how “good” and “bad” skin bacteria influence wound healing. We will first profile the microbiota of patient chronic wounds. We will then assess how alterations in skin bacteria affect healing in the young and elderly using our unique laboratory human skin wound model (banner image). We will then manipulate the skin microbiota by treating non-healing skin wounds with probiotics to see if this can improve wound healing. If successful, this research will support follow-on clinical studies and could transform the way we treat a wide range of skin diseases.

The generosity of British Skin Foundation donors has given Holly and the Team the opportunity to undertake this important project, which they hope will lead to a breakthrough in the understanding and treatment of chronic non-healing skin wounds.

Dr Holly Wilkinson, Hull York Medical School

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