Is the microbiome our doorway to a new type of woundcare?

A new technology, which will be featured in the November edition of US medical journal, “Wounds”, could have the potential to change the approach to woundcare, its developers claim.

The creators of micropore particle technology (MPPT) say that the development makes it possible to “prove that the killing of bacteria is ineffective in the treatment of wound infection” and that, instead, the skin microbiome should be supported.

The technology is based on exploiting the skin’s own unique and constantly changing and adapting ecosystem of micro-organisms, the microbiome.

The microbiome ensures there is no “vacant space” where disease-causing microbes can gain a foothold. A great diversity of species ensures that no single species takes over control of the microbiome. Infection of the wound occurs when one or a few species become strong enough to take over control from the immune system. Infection is therefore an unbalance in the microbiome.

The researchers say that main reason why a wound does not heal is infection. They add that for decades it has been standard practice to use antibiotics and antiseptics to indiscriminately kill the bacteria. This approach, they claim, works by “carpet-bombing”, leaving the area vulnerable. Many will be wiped out leading to a reduction in diversity. Invasion will occur immediately by the survivors, but the distribution is left to chance and is likely to be unbalanced – which means that renewed infection can occur. The result, according to the research, is that these treatments cause further damage to the body’s defences.

MPPT technology consists of small, highly porous particles that use a combination of capillary flow and evaporation to remove exudate, i.e. fluid on the wound surface. This micro-pumping process removes the toxins and enzymes that bacteria and fungi secrete to inhibit the immune cells. In parallel, the pumping action creates holes in the biofilm that bacteria and fungi secrete as a shield against the immune cells. The result is that MPPT disrupts the two main defence systems of bacteria and fungi, whereby the immune cells regain their ability to selectively remove bacteria and fungi to create the balance it wants in the microbiome. The researchers describe MPPT as “a passive immunotherapy that returns the control of the microbiome and the healing process to the immune system”.

MPPT has been evaluated in a large clinical study and it was found that MPPT reduced the time to achieving a non-infected healing wound by 60% compared to an antibiotic and an antiseptic and reduced the number of hospitalisation days by 31%. MPPT has also been used on nonhealing wounds, e.g. diabetic foot, venous leg and pressure ulcers as well as pyoderma gangrenosum, which had not responded to a range of therapies and in all cases MPPT was reportedly able to promote healing.

It may also be possible to use MPPT as a research tool. Currently, a large amount of research is being conducted to describe the composition of the skin microbiome and how it changes in disease. MPPT could, it is claimed, be useful in studying the steps from disease to a healthy state.

Because the technology does not rely on antimicrobial properties, it is not limited by antimicrobial resistance nor will it contribute to the generation of new resistance, say the researchers. A significant contributor to the creation of AMR is the unsuccessful use of antibiotics in treating wounds.

In the UK alone, annually 2.2 million wounds require extended treatment and the direct costs of care to the UK National Health Service is £5.3 billion annually (Guest et al. 2015). In community care, Guest et al. (2017) reported that 48% of the wounds are chronic.

The full article, Time to Abandon Antimicrobial Approaches in Wound Healing: A Paradigm Shift will be published in the November edition of Wounds – A Compendium of Clinical Research and Practice.