Could The Latest Nobel Prize-Winning Discoveries Help Preserve Limbs?

The Nobel Prize in Physiology or Medicine was recently awarded jointly to a pair of researchers investigating the way in which we perceive external stimuli, such as pressure and temperature.¹

Based on previous work that studied the mechanisms responsible for eliciting the burning sensation caused by exposure to the chemical compound found in chili peppers, capsaicin, David Julius, PhD, a scientist at the University of California, San Francisco, discovered a heat-sensing receptor encoded by a single sensory neuron gene. This receptor activates at temperatures high enough to cause pain. Furthermore, subsequent research led to the discovery of additional temperature-sensing receptors.¹

In addition, Ardem Patapoutian, PhD, a molecular biologist at Scripps Research in La Jolla, California, identified a previously unknown ion channel responsible for mechanosensitivity, i.e. sense of touch, in cells. The newly discovered ion channels, Piezo1 and Piezo2, have since been shown to play a role in key physiological processes such as blood pressure, respiratory function and urinary bladder control.¹

The real-world application of these discoveries is truly exciting, and much of the focus of clinical research in the future will involve studies of chronic pain--especially in the shadow of our nation’s opioid epidemic. But, what about patients with diabetes and peripheral neuropathy who lack the “gift of pain?”² Might we someday be poised to reverse the pathways leading to these conditions or even develop therapies designed to elicit a response to impending tissue loss?

These are certainly interesting questions to consider.  However, besides making recommendations for preventative measures such as wearing therapeutic footwear, avoiding barefoot walking, and inspecting feet daily, we must often rely on our patient’s other senses to detect diabetic foot complications. And, as more data becomes available, remote patient monitoring (RPM) for the diabetic foot may prove an invaluable “sixth sense” for detecting potential issues.

For example, a recent study published in BMJ Open Diabetes Research & Care found that among 83 participants in an enhanced therapy group (standard foot care plus at-home foot temperature monitoring) those who reduced their activity level following detection of a “hot spot” demonstrated a significant reduction in the incidence of ulcer recurrence compared to the standard care group.³ And, in a study we published last year with Kaiser Permanente, incorporation of once-daily foot temperature monitoring into a diabetic foot ulcer prevention program resulted in elimination of all major amputations and led to a 52 percent reduction in all-cause hospital admissions.⁴ Indeed, the future of diabetic foot care may be closer than we can see or feel.

Dr. Isaac is a Diplomate of the American Board of Foot and Ankle Surgery (ABFAS) and serves as Co-Director of Research with Foot & Ankle Specialists of the Mid-Atlantic (FASMA).  

References

1. Press release: The Nobel Prize in Physiology or Medicine 2021. NobelPrize.org. Nobel Prize Outreach AB 2021. Available at: https://www.nobelprize.org/prizes/medicine/2021/press-release/ . Accessed October 5, 2021.

2. Yancey P, Brand PW. The Gift of Pain: Why We Hurt & What We Can Do About It. Zondervan;1997.

3. Bus SA, aan de Stegge WB, van Baal JG, Busch-Westbroek T, Nollet F, van Netten JJ. Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial (DIATEMP). BMJ Open Diabetes Res Care. 2021;9(1):e002392.

4. Isaac AL, Swartz TD, Miller ML, et al. Lower resource utilization for patients with healed diabetic foot ulcers during participation in a prevention program with foot temperature monitoring. BMJ Open Diabetes Res Care. 2020;8(1):e001440.