Are we on the cusp of life-changing diabetic wound treatments?

Diabetes affects 1.7 million Australians — at a cost of $14.6 billion each year — and as Dr Robert Fitridge, a vascular surgeon at Royal Adelaide Hospital and The Queen Elizabeth Hospital, explains: “Diabetic wounds are highly challenging to treat and often fail to heal properly, leaving patients at risk of serious complications.” Now, building on past discoveries, SAHMRI researchers believe they have zeroed in on the mechanism driving diabetic wound healing.

It was in 2016 that Associate Professor Christina Bursill discovered that ‘good cholesterol’, or high-density lipoprotein (HDL), can greatly accelerate the healing of diabetic wounds. The latest discovery — together with recent PhD graduate, Dr Khalia Primer — is that “HDL works by restoring the levels of an important enzyme called PDK4, which plays a critical role in enabling skin cells to generate the energy required for repair”, Bursill said. “PDK4 is essential for wound healing, but in diabetes, its levels are often too low, making it much harder for the skin to regenerate and close wounds.”

By understanding the mechanism behind HDL’s healing effects, more targeted treatments that could transform diabetic wound treatment may follow. “This gives us a much clearer picture of how HDL can be harnessed to enhance the body’s own healing processes,” Primer said. “In future, we could develop therapies that directly target PDK4 or enhance HDL function.”

A particular risk for people with diabetes is that they will develop a diabetes-related foot ulcer (DRFU). DRFUs affect around 50,000 Australians each year, resulting in 5000 amputations, with approximately 34% of people with diabetes developing DRFU during their life — those living with diabetes in rural and remote areas, and First Nations people being disproportionately affected. New discoveries to correct healing are something that Fitridge sees a great need for.

“Even with the best available care, too many wounds remain open for months or even years, increasing the likelihood of infection and amputation,” Fitridge said. “We urgently need better treatments that can heal wounds faster and more reliably. If we’re able to intervene earlier and promote more effective healing, we could potentially prevent thousands of amputations each year and significantly improve outcomes for people living with diabetes.”

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