Research

While research on the pathogenesis and treatment of chronic wounds has been ongoing for decades, one of the critical issues in this context is the lack of an integrative perspective in research methodology. Researchers have for the most part focused on specific therapies and their efficacy and safety, rather than viewing the treatment of chronic wounds holistically. One example is investigation of the use of individual growth factors to accelerate wound healing. Although utilization of growth factors is an important treatment component, potentially more significant is an approach that views the wound healing process as incorporating biochemical, molecular, and genetic activity—taking into account the totality of all transactional components that comprise wound healing.

The chronic wound researcher today has two basic options:

• continuing along the path of single treatment investigation, or
• pursuing a course of action that integrates the underlying mechanisms of wound healing.

The integrated approach focuses on what makes a wound heal or not heal on the most fundamental levels of physiological activity. If the investigator who takes this approach can come to comprehensively understand the nature of these fundamental activities, then any wound at any stage of progression should be ultimately reparable.

In recognition of our Program's efforts in advancing wound healing research, in 2005 the National Institutes for Health (NIH) awarded Dr. Brem a $1.5 million grant to investigate: the efficacy of electronic medical records in improving patient care results; decreasing amputation rates in people with diabetes; and decreasing the prevalence of stage IV pressure ulcers.

Ongoing Research

Key in the wound healing process is angiogenesis. As we age, angiogenesis tends to decline. For the elderly with diabetes or peripheral arterial disease, this impairment of angiogenesis makes the emergence of chronic wounds increasingly difficult to manage.

A full understanding of the wound healing process must include understanding how a wound heals genetically. We are currently investigating this process utilizing gene array technology. It is our firm belief that the results of this investigation will do much to bridge the perceived gap in translational or bench-to-bedside research in wound healing. We hope use our improved understanding to derive therapies that target new receptor locations, evoking rapid responses in the healing process.

We are also engaged in a study that utilizes novel delivery mechanisms for the growth factor VEGF (vascular endothelial growth factor) via polymers, specifically polyanhydrides. While polymer-based delivery of growth factors has been investigated previously, often for cancer treatments, this is its first application for wound healing. In addition to testing the efficacy and safety of VEGF via polyanhydrides, this study seeks to more generally investigate the utilization of polymers as a delivery mechanism in a wound environment.

We have developed a statistical model of wound healing rates, based on wound size rather than time to closure. We believe that a model emphasizing wound size is more effective in predicting the actual healing of a wound than one emphasizing time to closure. This approach corresponds with our holistic view of the wound healing process, allowing for the actual behavior of the wound—progression as well as healing—rather than imposing a fixed methodological structure on the wound healing process (i.e., time to closure; the implication is that all wounds will necessarily heal).

We look forward to a time when wounds will be, if not preventable, then treatable—meaning that even the possibility of progression to a more advanced stage will be truly remote. Ideally, the wound care practitioner is both an investigator and a clinician, someone who understands that clinical work is most effective when supported by rigorous, innovative research, and that the entire focus of laboratory studies must be for the benefit of the growing number of patients who suffer from chronic wounds.