Plasma-activated antimicrobial hydrogel therapy (PAHT) for combatting infections in diabetic foot ulcers

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In 2018 there were over 4.5 million people with diabetes in the UK, with this number expected to rise to 5 million by 2025. One of the most serious complications of diabetes is ulceration of the feet - a Diabetic Foot Ulcer (DFU). This is caused by a poor blood supply and nerve damage, meaning that patients cannot feel when they are starting to damage their feet by, for example, having poorly fitting shoes. Around 34% of patients with diabetes are likely to develop a DFU.Once a DFU is established it can rapidly become infected (50% likelihood); once infected it is difficult to treat, taking months or even years to heal. Soft tissue infection can lead to bone infection, which is really only treatable by amputation. By the time a patient's DFUs get to the stage of requiring amputation the prognosis for the patient is grim: 70% of patients with DFU-associated amputations are dead within 5 years.Infected DFUs are treated by antibiotics and surgical wound debridement: cutting away infected tissue. However antibiotics are becoming less effective, and with the rise of "superbugs" (known as antimicrobial resistance, AMR) infection will present a serious threat to anyone with an open wound. Consequently, there is an urgent need for non-antibiotic approaches for treating infected DFUs, to augment antibiotic treatment and to extend the "lifetime" of existing antibiotics (whilst new ones are developed).The clinical need is to treat infected DFUs at an earlier stage before bone infection takes hold. And in a manner that doesn't just kill the surface bacteria (and fungi), but reaches microorganisms buried deep within the dense slimy colonies (biofilms) in which the organisms live. Our novel technology is based upon utilising electrically-excited gases (known as cold atmospheric plasma, CAP) to create and deliver potent antimicrobial agents deep into infected wounds via interaction of the CAP with a wound dressing and the wound itself. Antimicrobial agents are released from wound dressings applied over the DFU. In this research project, we will develop this technology and demonstrate its potential in robust laboratory-based models of real-world biofilms that are found in DFUs. To ensure that this project realises the potential to deliver patient benefit (as soon as possible) we will map out how to assess the health economic benefits and the parameters needed for a robust clinical trial. We will engage with healthcare providers and patients early, and will achieve this through a range of outreach activities. This project is an important step in realising a novel technology treatment package that is cheap and easy to use, and which has the potential to greatly improve the care of patients with DFUs and decrease the need for amputation. This would improve patient quality of life, improve survival rates and save the NHS money.