We can heal that (continued)
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The biofilm revolution
At the center of Wolcott's confidence is the theory that biofilms
are the principal obstacle in the healing of chronic wounds.
Biofilms are bacteria that latch onto surfaces -- teeth, the
inside of water pipelines, heart valves, catheters, human tissues
and countless other surfaces -- and then form complex colonies
that secrete a goo-like armor that makes them highly tolerant of
antibiotics and disinfectants. Biofilms are considered a
multi-billion dollar industrial and medical problem. |
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Pat Secor and Dr. Garth James |
The word "biofilm" was coined in 1978 by Bill Costerton, former director
of MSU's Center for Biofilm Engineering, in a paper published in
Scientific American. Thirteen years later, MSU founded the Center for
Biofilm Engineering, which has become the oldest, largest and best known
biofilm research center in the world. It has research and testing
partnerships with 22 companies, with medical biofilms being the
fastest-growing sector of corporate interest.
Research at MSU's center has found that biofilm colonies are complex:
There is evidence the bacteria may communicate with each other, as well
as with the living tissue to which they are attached. Additionally,
there is evidence the colony divides the labor: Some bacteria latch onto
surfaces, others secrete protective goo and others harvest nutrients.
The biofilm model represents a big change in the way science and
medicine have traditionally thought about bacteria.
"If you study a single ant, you can count its legs, see what it feeds on
and where it goes. That's been the history of our understanding of
bacteria. We've studied them individually," said Phil Stewart, director
of the Center for Biofilm Engineering.
"But think how much you miss about what ants do when you just put one
under the magnifying glass. You miss all the socially coordinated labor
and the structures that are far bigger than any one ant could build.
Bacteria working together may not be as visible as ants, but we are
already seeing that they may be as complex," Stewart said.
"The biofilm concept bumps bacteria up the tree of life from
super-primitive organisms to something a little smarter than we
previously gave them credit for," Stewart added. "Thinking about them as
multi-cellular creatures is a pretty radical change. I think it's
revolutionary."
It was revolutionary for Wolcott.
Epiphany
In the late 1990s, Wolcott was a demoralized specialist in treating
chronic wounds. He repeatedly watched infections defeat his efforts to
heal and was left with no recourse but to have a patient's foot or leg
amputated.
He did so knowing that 70 percent of diabetics who undergo an amputation
die within five years due to the stress placed on their heart from their
altered circulatory system. During those five years they are likely to
have more amputations and to rate their quality of life worse than
cancer patients, according to some studies.
"All I could do was watch these people die a piece at a time," Wolcott
said.
Desperate to find a solution to the chronic-wounds part of the diabetes
problem, Wolcott attended a wound-care conference in 2002. A last-minute
replacement speaker made a hasty presentation that included an
illustration of biofilms by Peg Dirckx of MSU's Center for Biofilm
Engineering.
Wolcott now refers to Dirckx's illustration as "the epiphany slide."
"I knew the failure of these wounds to heal had something to do with the
bacteria, but I was still groping for an answer," Wolcott said. "When I
saw that slide, it explained everything. Biofilms are fundamentally,
radically different. When you embrace the biofilm model it explains
everything with chronic wounds, from why the wounds won't heal to why
some treatments work better than others."
Wolcott contacted Garth James, director of medical projects at the MSU
center, and a partnership was born. In 2006, the National Institutes of
Health awarded MSU a $2.9 million grant to expand its research into the
biofilm-chronic wound connection. That grant will be used in partnership
with Wolcott and the division of dermatology at the University of
Washington's Department of Medicine.
MSU is doing basic research on biofilms using specimens provided by
Wolcott, who eventually may provide a venue for clinical trials.
But even now, Wolcott's understanding of the biofilm model has led him
to experiment with new treatments that are helping his patients.
"We used to have -- literally -- 10 to 15 patients a month in for
amputations. Now we've gone months without any. It's huge," Wolcott
said. "I can confidently look patients in the eye and say I'm 80 percent
certain that their wound is going to heal."
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