A Deeper Dive Into Biomarkers In Wound Care

Welcome back to Podiatry Today Podcasts, where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the assistant editorial director for Podiatry Today. In this episode, we are taking a closer look at our March feature on biomarkers in wound care with the author, Windy Cole, DPM. Dr. Cole is an adjunct professor and director of wound care research at Kent State University College of Podiatric Medicine. She's board certified by the American Board of Foot and Ankle Surgery and the American Board of Wound Management. She's been a dedicated wound care advocate for two decades, with interests focused on medical education, diabetic foot care, wound care, limb salvage, and clinical research. She's also a member of the board of directors for the American College of Clinical Wound Specialists.

Welcome back, Dr. Cole, and we appreciate you taking the time to share more about this emerging topic. We know that chronic non-healing wounds cause significant morbidity and mortality in patients worldwide. Can you discuss with our audience the idea of leveraging biomarkers to direct diagnosis and to monitor healing progression in these at-risk patients?

Dr. Windy Cole, DPM:

Absolutely. We know that the wound healing process is complex, to say the least, and it really relies on a number of intercellular, intracellular, and extracellular communications occurring at the same time within the wounded tissues. These signals have to occur to support tissue repair and regeneration. There are a wide array of local physiological conditions and systemic factors that exist in our patients that cause delays in tissue healing and therefore contribute to wound chronicity. As wound management clinicians, we now have the ability to test and track wound biomarkers to really give us a better idea of which of these parameters might be often our patients. And as healthcare practitioners, we can then better tailor our treatments accordingly. It'll help us to be proactive as opposed to practicing reactive wound management.

Dr. Jennifer Spector:

Going back to the beginning a little bit, what exactly is a biomarker, and what are some commonly tested biomarkers in wound management?

Dr. Windy Cole, DPM:

As a group, biomarkers are considered objectively quantifiable substances or even metrics that can indicate the presence of normal or pathophysiological processes. We're more interested in these predictive biomarkers because they could be very useful to us in forecasting those patients and what their outcomes may be so that we could better direct the most appropriate treatment pathway. Detecting and tracking these biomarkers can help clinicians better measure what we are managing. In the last few years, point-of-care technologies have really emerged, allowing this biomarker data to be collected at bedside, and it allows us as clinicians to have a more complete clinical picture of each individual patient and each individual wound. Some of these markers we're currently looking at in the wound care space include tissue pH, temperature, oxygen saturation, bacterial bioburden, and protease levels.

Dr. Jennifer Spector:

Can you share with the audience a bit more, possibly, about how protease levels can be used as a predictive biomarker to aid in wound management?

Dr. Windy Cole, DPM:

Matrix metalloproteinases, otherwise known as MMPs, are critically important enzymes that are found in every phase of wound healing. During the healing cascade, fibroblasts, keratinocytes, endothelial cells, and other inflammatory cells will synthesize and release these proteases. The key to proteases and where they become more helpful in wound healing is having the right amount at the right location for the right duration of time. When there are elevated levels of MMPs, which we often see in tissues that are wounded and have been wounded for a prolonged duration, is this unregulated level of MMPs. And this can lead to dysregulation and disorganization of the wound microenvironment, and then, therefore, we'll see a degradation of the extracellular matrix. And this will all kind of set up this perfect storm to contribute to the chronicity of non-healing wounds.

Studies have shown that there are new point-of-care devices that can help us to determine if protease levels are off in our wounds, and wound check is one of those devices. It's a protease status swab that helps to detect elevated levels of active human proteases and chronic wound tissue. And this test detects those elevated serine proteases like neutrophil elastase and others, and results are available in as little as 15 minutes. Again, this information can help drive patient-specific therapy to help us to choose those things that might help modulate harmful proteus activity and get those chronic wounds back on that healing pathway.

Dr. Jennifer Spector:

Knowing that, are there other point-of-care tests that are readily available that can assist clinicians in tracking additional biomarkers?

Dr. Windy Cole, DPM:

Yes. There's a host of new technologies that are entering into the space. I've been using fluorescence imaging devices for many years. These devices are commercially available that allow clinicians to visualize the pathologic levels of bacterial contamination. When bacterial levels become high, 10 to the 4th or greater, we know that bad things happen in our wounds, infections occur, abscesses, osteomyelitis, so fluorescence imaging has been helpful in my clinical practice. Near-infrared spectroscopy devices are on the market, and they can help clinicians to determine oxygen saturation of wounded tissues and track oxygen saturations through the cycle of healing and the treatment course. There are numerous thermal imaging technologies that exist, and we can use these devices to track tissue temperature, and we know that increased temperature in the wound can be a marker of inflammation and even possibly of infection as well. And there are new innovations entering this space at a really accelerated rate. It's really exciting. All you have to do is walk through the exhibit hall of any wound care conference, and you'll see some of these new and innovative devices.

Dr. Jennifer Spector:

They absolutely can. I'm sure SAWC Spring is going to be a great opportunity for people to learn more about a lot of these devices and services available to clinicians. Do you have any additional thoughts that you'd like to add as we close out this podcast?

Dr. Windy Cole, DPM:

As wound care providers, we're encouraged to always look for better tools for our toolbox, this will allow us to better measure what we manage. And with these devices, we can better prepare to help our patients repair. I think early detection of wounds that are not on this healing trajectory and might possibly not have success with our standard of care therapies. Utilizing these devices will help us to improve patient outcomes and really save healthcare dollars. So keep an eye out for a feature article on this topic in Podiatry Today, and here I'll expand on some of these ideas that we discussed in this podcast.

Dr. Jennifer Spector:

We certainly do hope that listeners of this podcast will go to podiatrytoday.com to the Issues section to check out the March issue of Podiatry Today, specifically with this feature from Dr. Cole. We'd like to thank you, Dr. Cole, for being with us today, and thank the listeners for joining us as well. Be sure to check out other episodes of Podiatry Today Podcasts on podiatrytoday.com, SoundCloud, Apple Podcasts, and your favorite podcast platforms.