MediWales Review - Summer 2006

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Review

In bed with Maggots & Leeches A Bug’s Life: Cleaning up MRSA

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Fighting the Resistance For 21st century medicine, infection control is not the safe bet that it might have seemed a generation ago. The postwar domination of antibiotics is being challenged by the phenomenon of bacterial resistance, now recognised worldwide as one of the most significant problems facing contemporary medicine.

The overuse that has undoubtedly contributed to antibiotic resistance raises serious issues in our approach to infection control. Nationally and internationally, campaigns are at work to challenge the ‘antibiotics on demand’ attitude, by encouraging both appropriate prescribing by physicians, and responsible usage by patients.

Meanwhile the prevention of infection transmission in clinical environments has likewise been recognised as of the highest priority. Improved cleaning is now the target of sustained campaigns, and in this issue we review three of the specialist products designed to support infection control.

A different phenomenon of equal significance is the emergence in specific situations of alternatives to antibiotic use. Included in this edition are two important examples in relation to the healing of wounds: surgical maggots, and honey.

What is interesting about these therapies is that they are both of well-established provenance, but had fallen out of fashion with the rise of antibiotic treatments.

Scientists are now using modern medicine’s technological expertise to explore the full potential of these historical remedies. The results are already proving exciting.

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Contents F E AT U R E S In bed with Maggots and Leeches 4 Biosurgicals get their teeth into wound healing

PRODUCT REVIEW A Bug’s Life: Cleaning up MRSA 12 Three new products join the weaponry of infection control On the Spot: Theranostics pinpoints the problem New kits can confirm exact diagnosis in minutes

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RESEARCH REVIEW MRSA: Sweet success with 20 an ancient remedy Manuka honey is recruited to the fight against the superbug

Maggots are their own generators, 24 hours a day, seven days a week, of antimicrobial activity, stimulatory activity, and wound debridement.

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Such a shift suggests a promising avenue to explore in searching for effective means of tackling infection that can complement antibiotic therapy while offering an alternative to the repeating pattern of drug development/resistance.

In our Autumn edition we will be looking at an issue whose implications affect the whole of the Welsh medical sector: how new products are and should be brought into the NHS. We would be most interested to hear from readers who may have relevant material to contribute, who should contact the editor by 21st August.

Coralie Palmer Editor

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Cover image: magnified maggot head

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In bed with Maggots and Leeches Coralie Palmer finds out how biosurgicals are making a unique contribution to wound healing Maggots and leeches appear the unlikeliest of partners for the 21st century clinician. Leeches were the pre-modern quack’s cure-all, and maggots riot in dirt and decay.

But while no-one’s first choice as house guests (though they might

blend right in with the current ‘Big Brother’ residents) these beasts are both, in their distinctive ways, proving highly successful as ‘biosurgicals’ – live means of treating difficult wounds.

Despite what researchers briskly call ‘the yuk factor’, maggots and leeches are increasingly being used in wound treatment in the UK and across the world. The driving force in their rehabilitation is clinicians’

experience of their effectiveness.

It seems that there are particular wound conditions where biosurgicals promote successful healing in a way that no other intervention, pharmacological or surgical, can quite replicate.

The key word here is ‘particular’.

Each bio-surgical is targeted at a very specific type of wound. The clinical home ground of the modern surgical maggot – offspring of the PHOTO: ZOOBIOTIC

common greenbottle Lucilia sericata – is chronic soft tissue wounds that have become necrotic (containing dead tissue) and possibly infected. This can happen with pressure sores, leg ulcers, or the ulcerated wounds to which diabetics are vulnerable. Such wounds are both distressing to experience and notoriously difficult to treat. Attending to them currently costs the NHS approximately £2.5 billion a year.

Maggots are highly efficient at cleaning these wounds. They produce powerful enzymes to liquidise dead tissue, consuming it along with any attendant bacteria – which are killed in their gut. At the same time, they raise the alkalinity of wounds and secrete an antimicrobial agent, both factors helping to inhibit further infection.

It’s the mix of these processes that seems to underlie the unusual speed and success of maggot therapy – which can include the clearing of MRSA from wounds.

Maggot head showing ‘hooks’ used to penetrate tissue

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Two Welsh companies – Zoobiotic and Biopharm - are world leaders in maggot and leech therapy respectively. Both companies were developed out of research-based operations, and their international research networks played – and still play – an important part in their rationale and their growth. And for both companies, a positive press on their early work gave a vital initial boost to the use of these therapies.

Leech anatomy

to move through the tissue even after the leech detaches. This extremely efficient pumping system keeps the wound nourished until the veins heal and circulation is restored.

Though not yet widely accepted as a standard option, biosurgicals continue to grow in popularity. But this means more than a new treatment at the point of care.

Establishing their routine use in a clinical environment has demanded the solving of some unusual problems, from one end of the medical supply chain to the other.

What are the logistics of farming, packaging, and distribution? How are health professionals informed about their use, and how do patients react to them?

Wounds where the medicinal leech, Hirudo medicinalis, currently has its unlikely day could not be more different. It’s now used extensively in plastic and reconstructive surgery, to promote the reattachment of severed body parts such as toes or fingers. Even with the advances in microsurgery, suturing veins is extremely difficult.

Hence a common problem in these wounds: if blood does not flow through the damaged veins, it becomes congested at the site of the wound, and the tissue will begin to die.

This is where the leech comes in.

Attached to the wound, it acts as an organic ‘pump’, sucking blood through the damaged site. An anaesthetic in its saliva makes the bite painless, while the anticoagulant it secretes, hirudin, means that the blood will continue

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PICTURE: BIOPHARM

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It was the research of Zoobiotic’s Technical Director Dr Steve Thomas into dressings for necrotic wounds that led him to explore maggot therapy.

Observers of battlegrounds from the Napoleonic Wars to the Trenches have noted that soldiers were less likely to die from septiciaemia if their wounds were maggot-infested rather than not. Maggot therapy was still being used in hospitals until the 1930s, but from the ‘40s onwards advances in antibiotics and surgery saw it superseded and all but forgotten.

But even intensive antibiotic treatment and repeated surgery can fail with necrotic wounds, not to speak of the problems of antibioticresistant bacteria. It was in just

PHOTO: ZOOBIOTIC

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The small operation at the Princess of Wales Hospital, Bridgend, ultimately became the first Welsh NHS spin-out company as Zoobiotic, now supplying over 3000 centres throughout the UK and Europe. To do so it had to become expert not only in the clinical processes of maggot therapy but in the weird and wonderful systems of its mass production and supply.

The production process begins in the ‘Fly Room’ (Jeff Goldblum hovering, as it were, in the wings) where the flies are kept in plasticcovered wire cages and fed on sugar. Egg production is controlled by feeds of raw liver, which supplies the protein necessary for breeding, and on which eggs are laid in dense ‘rafts’. The eggs are then bathed in a solution rendering them surgically sterile, and placed on a sterile medium to hatch overnight as bacteria-free maggots, approved for medical use.

On receiving the pack the carer makes up the patient’s ‘maggot dressing’. A hole the size of the wound is cut into a hydrocolloid

sheet, which is laid over the wound.

With the saline solution the maggots are rinsed out of their pot onto the net, which is then inverted onto the wound, taped to the hydrocolloid, and covered with an appropriate dressing.

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(These strange creatures are also galvanised by air pressure changes, so they were often kept in bottles to signal storms; a Devon museum today has a replica of the ‘leech barometer’ displayed at the 1851 Great Exhibition). This did not deter American researcher Doctor Robert Sawyer, a leech enthusiast from childhood. Doctor Sawyer saw great potential in the unique qualities of leech saliva, and his work led him to found Biopharm in 1985.

Being ‘free-range’ within the wound chamber is one of the factors making maggots so effective in cleaning a wound: they can travel to every point of the infection.

Zoobiotic has just launched a radically new maggot dressing, LarvE® BioFOAM™, which combines free-range efficacy with the convenience of ‘bagged’ maggots. The new dressing, the subject of an international patent submission, is a net pouch containing maggots with many tiny foam chips, which have been proven to markedly stimulate maggot activity.

Maggot therapy is still comparatively unfamiliar, which means information and clinical support is at a premium. They run regular ‘Maggot Training Days’ at Bridgend, where health professionals are acquainted with every aspect of therapeutic maggots from their history, to the analysis of their effects, to practical demonstrations of their application.

‘We’ve produced bagged maggots for some time,’ said Steve, ‘but their performance was not as impressive as free-range maggots – until now.

I’m convinced this new dressing will revolutionise maggot therapy treatment for many types of wounds.’

Larve BioFoam Dressing

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The image problem of the leech is possibly even more acute, given their long association with the futile process of blood-letting.

Egg-laying on raw liver

At this stage they’re about the size of a grain of rice. The ordering and packaging of these unusual goods is as much a product of the company’s research expertise as their breeding. Zoobiotic’s website includes a ‘maggot calculator’, a table enabling the user to work out the number of maggots needed to treat a wound at each application.

Under the brand name LarvE®, the maggots are sealed into small plastic pots and mailed out as a pack with a vial of saline solution and a piece of net.

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patients, ‘It’s a miracle what they’ve done. I’d recommend them to anybody.’

The maggots remain in this ‘chamber’, dutifully eating their fill until gorged 2-3 days later. They will not eat live flesh and they cannot develop beyond larvae without moving into dry conditions – i.e. outside the wound chamber. When the dressing is removed, some maggots will already have headed for the net, and the stragglers are picked up with tweezers. They’re then sealed back into the pots and disposed of as surgical waste. (A tad poignant perhaps – one would like to think of them being set free with a bad apple each.) Dressings are repeated until the wound is clean.

such cases that Steve’s work with maggot therapy yielded impressive results. When these were described in a national women’s magazine, there was an enthusiastic response from the public: demand accelerated, and continued to grow.

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One recurring query at these sessions is patients’ reactions. This is not the problem one might expect, despite the maggot’s lack of fluffy charm. The target wounds are such that maggot therapy is often the only alternative to worsening pain and disfigurement, repeated surgery, or even amputation. ‘My family were horrified, but it didn’t worry me,’ said one of Bridgend’s successfully treated diabetic

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from Cardiff airport within the hour, and their use saved the child’s ear.

The resulting US publicity put Biopharm on the medical map.

They now supply 15,000 leeches a year to the UK NHS, and through their offices overseas supply leeches internationally. Given the nature of the wounds they treat the need for leeches is often urgent, so Biopharm has 24-hour emergency service.

Leech farming was of course once common, and indeed leeches were still being used medicinally through to the early 1960s. Nevertheless their supply for the modern medical market demanded some new technologies, it being no longer sufficient to wade barelegged through ponds while they attach themselves.

As well as supplying the initially very small demand for surgical leeches, his new company held regular international research conferences on the subject. A surgeon delegate at one of these subsequently operated on a small boy in Boston to re-attach a severed ear. When venous congestion threatened the loss of the ear, the surgeon phoned through an emergency request to Biopharm for leeches. They were despatched Breeding them on site brings its own unique problems, as my guide, Biopharm’s Marketing Director Carl Peters explained. Kept in water in aquarium tanks, the leeches lay their eggs in a ‘foam’ that hardens into a cocoon. But just before the offspring are due to emerge three weeks later, Paul snips open the cocoon and delivers the minute leeches by ‘caesarean’. If they’re left to emerge iindependently, he says, it is quite impossible to track or contain them: ‘they go all over the place’.

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Over the next four months, the babies get up to four feeds of blood – contained, after much experiment, in sausage skins. ‘It didn’t work giving them blood alone,’ said Paul.

‘They like something to get their teeth into.’ (300 teeth in fact, in three jaws.) By this time they’re hospital size, but before they can be used, they must be starved.

Leech Cocoons

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The emptier the leech, the hungrier and the cleaner it is. The ‘cleaning room’ contains a double layer of tanks, all of them full of leeches. As they expel their waste, they’re moved from one tank to the next, each time becoming a little leaner, a little cleaner, and a little more active. The final tank is full of highly animated ribbons. When I peer over the top it, I’ve barely focused before a trio are swarming up the side, their questing heads waving about excitedly.

These leeches are hospital-ready, but specialist products are needed to support their transport and maintenance. An order of leeches is packed into one of a range of custom containers – aerated but escapeproof – with Biopharm’s Hirudo Gel or Hirudo Mix, or distilled water with Hirudosalt. These agents provide the right environment, so that the leeches stay healthy while kept in the hospital’s pharmacy refrigerator.

The Leech has 300 teeth in 3 jaws

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When a leech is applied to the patient, the treatment site will first be masked with gauze pierced with a small hole. Using tweezers, the clinician attaches the leech to the wound site by steering its head to the hole. When replete (30-60 minutes), it will detach, to be returned to its patient-specific container. Once sufficient applications have been made to restore circulation, used leeches are rendered first ‘narcotised’ (i.e. dead drunk) and then dead, by an 8% alcohol solution. Not the worst way to go.

Biopharm, like Zoobiotic, originally ran regular courses for users that explained the rationale and modus operandi of leech therapy. But its use became so widely accepted in UK cosmetic surgery units that over time the numbers of trained ‘leechwranglers’ reached a critical mass, and the knowledge is now largely self-maintaining. Courses are however still run on request.

PHOTO: BIOPHARM

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Where patients’ sensibilities are concerned, as with maggots, the stark choices faced by leech recipients tend to reconcile them to their bizarre guests: better a leech than a lost digit. According to researcher Robert Weinkove, children often give them names (though for adults who remain squeamish, doctors in Philadelphia have developed a plastic shield to hide them during treatment.)

As biosurgicals become more widely used so they become less strange, and experience promotes both patient and clinical acceptance.

Maggots have been available on prescription from GPs in the UK since early 2004, and in a three-year study of 600 patients, Dr Pauline Raynor of the University of York is beginning the world’s biggest ever maggot trial.

In 2004 a French company received the first FDA clearance to market leeches as a medical device, and

this year, in the wake of a number of studies indicating that leech attachment improved osteoarthritis of the knee, Beth Israel Medical Center in New York will become one of the first US hospitals to offer this therapy.

Research is undoubtedly the key to gaining wider recognition of the part biosurgicals can play in the hightechnology environment of the modern medical profession.

Further research is needed both to provide rigorous validation of current usage and to explore the potential of the constituents involved.

The chemical make-up of both leech and maggot saliva is a complex and highly promising focus for analysis. But the potential for use of each creature entire, with all its combined processes, offers an equally important direction for research.

The efficacy of maggot therapy in tackling MRSA colonisation of wounds is a potent example, as Steve Jones describes: ‘Maggots are their own generators, 24 hours

a day seven days a week, of antimicrobial activity, stimulatory activity, and wound debridement.’

Understanding how such mechanisms work in their totality could yet yield undreamt-of solutions to persistent problems, not least in developing alternatives for tackling the antibiotic-resistant bacteria that are increasingly bedevilling modern medicine.

Zoobiotic Ltd Unit 2-4 Dunraven Business Park Coychurch Road, Bridgend, CF31 3AP Tel: 0845 2301810 Fax: 01656 668047 Email: tony_fowler@zoobiotic.com Web: www.zoobiotic.com Biopharm UK Ltd 2 Bryngwili Road Hendy Carmarthenshire SA4 0XT Tel : 01792-885595 Fax : 01792-882440 Email : uksales@biopharmleeches.com Web : www.biopharm-leeches.com

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A bug’s life: cleaning up MRSA

In particular the common bacterium Staphylococcus aureus has become an issue both because of its ubiquity – it is present on moist skin surfaces in some 30% of the population – and the fact that various strains have developed resistance to popular antibiotics.

When one of these resistant strains enters broken skin, it can cause active serious infection which is difficult to treat.

These factors have made MRSA a significant problem for NHS hospitals. In the National Audit Office’s 2004 report, the Department of Health’s mandatory MRSA reporting system revealed an 8% increase in the number of S.Aureus bloodstream infections between 2001-2 and 2003-4 – out of which about 40% were MRSA. This makes the UK’s rate among the worst in Europe.

Preventing transmission of MRSA in hospitals, either from person to person or via contaminated environment or equipment, is therefore crucial. Skin scales may contaminate all surfaces if they become airborne, and staphylococci can survive for long periods in dust.

This means that effective methods of cleaning both human and nonhuman surfaces in hospitals are essential for infection control.

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Products from three Welsh SMEs are using novel technologies aimed at preventing the spread of such bacteria in a hospital environment, offering improvements to both the heating and the cleaning of surfaces, and the cleaning of human skin.

Xetal Consultants, based in Neath, have developed HotfootTM a versatile heating membrane and control system that provides an antibacterial and anti-microbial, wipeclean, radiant-heated surface over any large area.

These are qualities that make it ideal for environments such as surgical operating theatres and recovery rooms. The convection currents associated with traditional heating, which cause dust particles and bacteria to circulate, are minimised by the Hotfoot radiant heat system.

In the energy-efficient Hotfoot membrane, a thermal barrier applied to the back of the membrane directs the heat outward from the surface. Using a sophisticated control system, energy is drip fed into the system to maintain a constant room temperature, with the membrane presenting a safe-to-touch surface temperature of 42.5C.

Staphylococcus aureus PHOTO: XETAL CONSULTANTS

Antibiotic-resistant infection has become a significant and growing problem in NHS hospitals.

Ward layout incorporating Hotfoot heating system

The control system is the really clever bit,’ said Managing Director John Bryant. ‘The membrane is structured in floor and wall panels.

If for example you have a fourmembrane panel array, each is checked individually by the controller 50 times a second – sequentially, on a one-at-a-time basis. Sometimes the stored temperature of the panel will mean there is no requirement for the available pulse of mains power, so that maybe only two out of the four require power for that fiftieth of a

second. This means both greater control and greater economy.’

consideration by a number of health trusts.

Xetal is working in partnership with Komfort Office Systems, which is developing a modular system for the construction of work spaces readyequipped with everything needed for a particular room’s function – such as in the creation of hospital wards, clean rooms and laboratories. In this system, wall panels incorporate a space behind their surface which would accommodate the hotfoot membrane. Trials are under

A further benefit is that Hotfoot is not only economical in use but in manufacture. The membrane is made from recycled carbon fibre ends produced by the motor and aeronautical industries – waste which would otherwise be landfilled.

So as well as offering infection control mechanisms, this is a heating system with a limited ecological footprint.

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PHOTO: STERITOUCH

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Hands – the cleaning of them, and by them – are a prime target in the drive to prevent infection in hospitals.

Liquid on cement coated with SteriTouchTM

PHOTO: STERITOUCH

These have gradually replaced more uncomfortable, yet easily cleaned, hard plastic hospital chairs or linoleum. SteriTouchTM, the Abertillery developer and manufacturer of their original antimicrobial additive, has developed a new coating product to tackle precisely this problem.

The company’s Antimicrobial Porous Surface Protector joins a range of specialist additive products

including masterbatch (to impregnate plastic products with antibacterial properties during manufacture) powder coats, paints and waterproofing systems.

Independent laboratory tests have demonstrated that bacteria, including MRSA, E. coli and salmonella, were reduced by 99.999% within 24 hours of coming into contact with any of the SteriTouch products.

The new coating is a water-based treatment that can be applied to any porous surface, including fabric, wood, carpets, cement and plaster. It will not only protect the surface from liquids such as blood, coffee and oil, but also reduce the adhesion of dirt and waste, particularly chewing gum. Additionally, the treatment will continually act to reduce the growth of bacteria and mould.

SteriTouchTM masterbatch

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The additive exploits the natural antimicrobial properties of silver, recognised since Classical times as effective against infections and spoilage. Silver works because pathogens cannot avoid its antimicrobial effects by mutating.

Antimicrobial silver is now used extensively to combat organisms in wounds and burns.

Longevity is another substantial benefit offered by the additive. While most antimicrobial products have no control over the release rate of the active agent, SteriTouch works by ‘release on demand’, which prolongs its effective life. As accelerated life testing has demonstrated, the additive will remain active for the lifetime of the coating, and needs no specialist treatment during that time – making it a useful and cost-effective weapon in the infection control armoury.

patients and health professionals, and the objects in the environment around them - from tray surfaces to basins, door knobs to tap handles that are constantly in touch with the human hand. Each wipe is used for one object or person, once only ensuring that cross-infection is prevented.

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Impy Wipes, from Aberdare, has developed a solution to this problem in the form of a dermatologically friendly, single-use bactericidal wipe. Laboratory tests have demonstrated that the wipe, using a compound derived from grapefruit extract, destroys both gastrointestinal bacteria (salmonella, listeria, E. coli, botulinus etc) and MRSA. The formulation works by destroying the cell wall of a bacterium - a phenomenon to which cells cannot develop resistance by mutating.

Bleach and alcohol also kill bacteria in this way. But unlike these more aggressive counterparts, the Impy formulation does not degrade surfaces or damage skin – which makes this cosmetic-grade compound suitable for daily use.

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product stays active as a residue on the surface, any contaminant that leaches to the surface after cleaning is also subsequently destroyed.’

As well as being used by the Welsh Ambulance Services Trust, Impy Wipes is now an approved supplier to Welsh Health Supplies, giving Trusts through Wales access to this simple and highly effective infection control tool.

Xetal Consultants Ltd 28 Crynant business Park, Neath SA10 8PA Tel: 01639 751056 Fax: 01639 751058 Email: jdickson@xetal.co.uk Web: www.xetal.co.uk

Given the growth of MRSA incidence, circumstances where a bacteriacide might be called for – such as a contamination outbreak – are on the increase. Here alcoholbased formulations are widely available, but the concentrations needed tend to cause adverse skin reactions in the users with all but very occasional use.

These factors mean that Impy can be used to clean both the skin of

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The importance of scrupulous handwashing with soap and water is emphasised by both the RCN and the Association of Medical Microbiologists. This is still the NHS protocol for infection control, which does not require the use of a bactericide.

A different hygiene problem for clinical environments is presented by porous surfaces such as soft furnishings and carpets.

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SteriTouch® Ltd Unit 15 Roseheyworth Business Park Abertillery Gwent NP13 1SP Tel: 01495 211400 Fax: 01495 211404 Email: info@steritouch.com Web: www.steritouch.com

A significant factor in the effectiveness of the wipe is its residual decontamination effect.

Tests made with the help of Biotrace Ltd showed that a surface cleaned with an Impy Wipe will continue to show a fall in contamination after cleaning.

‘An alcohol gel will decontaminate a porous surface,’ managing director Tony Rolls explained, ‘evaporate within 15 seconds – and then the contaminants which had previously leached into that porous surface will rise up to the top. So it can be more contaminated after cleaning than before. But because our

Impy Wipes Fairhaven Hirwaun Road Aberdare CF44 9AR Tel: 01685 810316 Email: arolls@impywipes.co.uk Web: www.impywipes.co.uk

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Products On the Spot: Theranostics pinpoints the problem A new generation of pointof-care diagnostic kits is now coming onto the market, which enable GPs to confirm a diagnosis in minutes.

BBI are working with the company to develop a fast theranostic tool for screening people with this deficiency, which is difficult to diagnose. ‘This particular disease,’ explained managing director Julian Barnes, ‘is easily mistaken for non-hereditary emphysema or Chronic Obstructive Pulmonary Disease (COPD). As a result less than 10% of people with Alpha-1 have been properly diagnosed.’

One collaboration is with US company Talecris Biotherapeutics, makers of a drug for treating AAT (Alpha-1 Antitrypsin) deficiency. This is an inherited disorder leding to reduced levels of the naturally occurring protein AAT, a significant cause of liver disease in adults. It is most common in the Caucasian populations of northern Europe and North America, where it affects sine 150,000 people. It is also the most common cause of genetic liver disease in children, and genetic emphysema in adults.

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partnership, with major diagnostic company Phadia (formerly Pharmacia Diagnostics of Uppsala, Sweden) BBI has developed three allergy testing kits. Each one checks for sensitivity to particular allergens – in the first two tests, those provoking allergic asthma and hayfever in children and adults respectively; in the third, those causing eczema.

Each kit detects different types of Immunoglobulin E (IgE) antibodies that are found at elevated levels in the blood of people with allergies.

This provides a more specific diagnosis, enabling a more targeted treatment. ‘In general,’ said Lyn Rees, BBI’s Sales and Marketing Director, ‘doctors can’t be sure which allergens are causing the problem and will prescribe antihistamines, which have a broad-spectrum effect. If you can identify the particular allergens, you can treat people more effectively.’

Until recently, being tested for a condition to establish a diagnosis meant waiting for your results to be processed by a central laboratory.

British Biocell International is one of the companies leading the field in the development of point-of-care test diagnostics. This expertise puts it at the forefront in the development of a new class of diagnostics called theranostics, which predict whether or not a particular drug will work for a particular patient. Two of BBI’s current collaborations demonstrate very clearly the way that such diagnostics can improve the care of patients.

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BBI’S Allergy testing kit

Current screening methods for AAT are typically performed using standard blood tests, where results can take days or even weeks to obtain. The BBI-Talecris collaboration is designed to provide a easy-to-use testing tool that gives results at the point of care.

The results of the screening will determine whether or not the patient requires a follow-up test. These can be expensive and the results can take time. By pre-screening their patients, physicians can select those at a higher risk of having Alpha1 because of low circulating levels of AAT, thus eliminating the need for costly additional screening of the lower risk patients.

Baines says that such ‘theranostic’ partnerships are now more commonplace. In a second working

The move to developing theranostic tests exemplifies the way in which the paradigm in drugs is changing – from one-size-fits-all blockbuster, to a personalised approach, where medicines are tailored to genetic subgroups. One of the best-known examples is the theranostic test that predicts which breast cancer patients are among the 30% carrying a genetic variant that means they will respond to the antibody treatment Herceptin. The ‘tailored’ approach of theranostics is very much the direction of the future.

British Biocell International Ltd Golden Gate Ty Glas Avenue Cardiff CF14 5DX Tel: 029 2074 7232 Fax: 029 2074 7242 Email: info@bbigold.com Web: www.bbigold.com Source: Advances Wales 49 & 50; BBI

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Research

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Research MRSA: Sweet success with an ancient remedy Scientists at the University of Wales Institute, Cardiff (UWIC) have been awarded £28,000 by the British Society for Antimicrobial Chemotherapy to research the role of New Zealand manuka honey in the fight against the superbug MRSA. Dr Rose Cooper, principal lecturer at the School of Applied Sciences, will examine how the honey, affects cell division in MRSA. Honey is a very ancient remedy: a 2500 BC Sumerian clay tablet records it as being used as a wound ointment. Egyptian, Greek, Roman, Indian and Chinese civilisations also made use of its curative properties.

It is now known that honey is an effective antiseptic wound dressing, mainly as a result of the antibacterial activity of hydrogen peroxide that is produced in honey by the enzyme glucose oxidase.

There can however be a risk of wound botulism from the clostridial spores sometimes found in honey, so that honey for wound care needs to be specifically developed for that use. Hence the interest in manuka honey: the flowers of the wild manuka bush have natural antiseptic properties which increase the antibacterial qualities of honey made from them.

Honey was in fact used as a wound treatment in UK hospitals up until the 1970s. With the development of modern antibiotics and sophisticated wound dressings, honey began to be disregarded. But the continued use and misuse of antibiotics has led to the emergence of antibiotic-resistant bacteria, including MRSA, while the development of new antibiotics has slowed.

This is an environment where new and different remedies are required.

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Review

PHOTO: ROGER DONOVAN

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PHOTO: ROGER DONOVAN

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The UWIC School has been researching the potential of honey as a wound treatment since1997, when Dr Cooper met the world’s leading expert Professor Peter Molan, of New Zealand’s Waikato University.

At that time no-one was researching the topic in the UK and honey was regarded as an out-dated treatment in modern medicine. But Professor Molan went on to develop innovative wound dressings containing honey, and he and Dr Cooper have since demonstrated its effectiveness in inhibiting several causes of wound infection, including MRSA. In the past decade there have been many reports of case studies, experiments using animal models, and randomised controlled clinical trials that provide a large body of very convincing evidence for the effectiveness of honey. During that time staff and students at the UWIC School have been involved in a number of studies into the therapeutic potential of Welsh and Portuguese honeys, as well as

investigations into the mechanisms by which honey affects human cells.

The team has developed an international reputation and has attracted consultancy work from companies developing wound care products based on honey.

May 2005 saw the publication of Honey: a modern wound management product, which Dr Cooper helped to write and edit. It seems that the book was timely.

‘During the past eighteen months,’ said Doctor Cooper, ‘a range of wound care products containing honey have become available on prescription and nurses are returning to honey for treating wounds. Sterile honey contained in tubes has also become available in chemists’ shops for those needing to treat minor wounds.

‘It’s expected that the clinical use of honey will rapidly increase now that licensed products are available. Our research at UWIC is helping to

provide objective evidence that’s influencing the attitude of healthcare professionals.’

Meanwhile it has just been announced that Christie Hospital in Manchester is beginning a study involving 60 cancer patients to assess whether manuka honey can reduce the risk of post-operative infection, particularly by antibioticresistant bacteria. It seems that the ancient world’s respect for honey as a wound therapy is increasingly being matched by the interest of modern medicine in its potential for treating problem wounds.

Dr Rose Cooper Principal Lecturer School of Applied Sciences UWIC Western Avenue Cardiff CF5 2SG Tel: 029 2041 6845 Email: rcooper@uwic.ac.uk

Source: UWIC; Umagazine; Journal of Community Nursing

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Events

Review

Doing Business with the MoD Our most recent core seminar event on 22nd June, successfully explained for the 60 delegates how the MoD seeks to exploit medical technology and also to purchase medical supplies.

Two speakers from the Defence Diversification Agency, with whom MediWales worked to develop the event, set out their 2-way process for technology transfer. In essence, they help to offer defence technology to non-defence companies, or to offer civil technology to the MoD or the Home Office. This process was amplified by a description of some

DDA brokering activity carried out in Scotland, in which the demand for medical supplies was matched against the local companies’ ability to provide them.

The theme was further developed by a description of the medical technology that the DDA can offer from QinetiQ, which is a £1bn turnover R&D company that is partly owned by the MoD. In this case they offer proven technology from the defence domain to solve medical problems such as the automatic diagnosis of breast cancer, improving MRI scan blurred images and foetal heart scanning.

The event’s main speaker was the buyer from the MoD’s Medical Supplies Integrated Project Team based at Andover, whose team

purchase all of the MoD’s medical supplies. Her theme was that the MoD is a specialist market with particular requirements for the storage and use of medical supplies in venues that are far removed from the classic NHS setting. Typical examples were tented military hospitals in either the desert or on ice caps. All of her requirements are advertised nationally in the “MoD Defence Contracts Bulletin” that is published every 2 weeks.

Delegate feedback confirmed that this proved to be one of our most popular events. The high quality briefings on technology and sales opportunities given by the speakers matched the very competitive medical market where MediWales members operate and in which the use of advanced technology is paramount.

Previewing….

MediWales Annual Innovation Awards

Working with the NHS September 06

This new annual event feeds into the UK-wide Medilink initiative to highlight and celebrate successful innovations in the bioscience sector. The awards will include categories such as product innovation from the public and private sectors as well as academia, and also for the most successful collaborations between these sectors.

This fundamental relationship is of great importance to most MediWales members. It impacts many aspects of provision in the medical sector, including:

The awards will be open to all MediWales members and application forms will be sent out in August. The awards ceremony will take place at our Annual Dinner in October, and winners will automatically be entered for the Medilink UK awards.

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Identification of product need

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Access to clinical expertise

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Access to clinical trials

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Product evaluation

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Purchasing

The UK market for selling to the NHS has undergone considerable change over recent years. While this event does not promise to make selling to NHS easy, it will

seek to clarify appropriate points of contact in the product development process and to illustrate the requirements the NHS has of new products and services.

We will be following our familiar format with presentations from both buyers and sellers, and we aim to include among them both key NHS personnel and companies that have made a success of this market.