Credit: CNBP

It’s a bold move, the sort of innovation that can only come from having your feet in two different camps. But for Dr Christina Bursill, the Centre for Nanoscale BioPhotonics’s chief investigator in vascular health, that’s the power of a culture of true collaboration; it opens minds to the unexpected.

Dr Bursill’s work exploring the role of HDL cholesterol — the good cholesterol that reduces your chance of heart attack — in cardiovascular health has intersected with a growing interest in wound care, a field that has changed little over nearly a century. So, when the somewhat radical idea of applying HDL cholesterol directly to wounds to promote healing was floated at a lab meeting the response was: why not?

A world-first clinical trial of topical HDL is slated for 2020, with particularly exciting applications in treating diabetics. Dr Bursill hopes topical HDL might reduce the number of amputations in patients with diabetic ulcers that won’t heal and, in doing so, save lives.

But how did research that began in the cardiovascular space lead to a breakthrough in wound care?

Dr Bursill, who spent 5 formative years in a postdoctoral post in the Departments of Cardiovascular Medicine and Pathology at Oxford University, has led teams examining the role of HDL in forming new blood vessels in the heart for the past 8 years. Quick growth of new vessels after a heart attack is vital, to restore blood supply to areas of low oxygen.

Her work in unravelling the mysteries of ‘good’ cholesterol was revealing; its proven anti-inflammatory properties and the fact that it could help in the formation of new blood vessels was clearly crucial in the battle against heart disease, but she could see other obvious applications, too.

‘Those two things alone would point to it being a wound healing agent,’ she explains, ‘but not many people have their feet in both worlds to be able to recognise that.’

Researchers with their feet planted exclusively in atherosclerosis (the build-up of fatty deposits within the main arteries of the heart) might struggle, she concedes, to see how HDL, which travels through the blood and is thus usually infused, could promote wound healing.

‘Deciding to add it topically to the skin, in the HDL world, is a little out there,’ she laughs.

‘Out there’ or not, Dr Bursill and her team’s research — especially in powerful, effective mouse modelling — supports the hypothesis that good cholesterol, added topically to wounds, is beneficial.

‘We’ve seen good examples of wound closure, particularly if the mice are diabetic,’ she says. ‘It seems particularly effective in rescuing diabetes-impaired wound healing.’

And Dr Bursill’s role as a chief investigator at the CNBP — her engagement with a range of innovations in wound care developed across multidisciplinary teams — has expanded the future possibilities for topical HDL. She hopes that ‘smart’ bandages — a silk scaffold embedded with advanced data-gathering sensors — might prove to be an effective delivery vehicle for good cholesterol.

‘The Centre opened my eyes to this amazing smart dressing development. That is something I wouldn’t have been looking at it weren’t for the CNBP,’ she says.

Dr Bursill received a grant in late 2019 and hopes to begin a world-first clinical trial to apply HDL cholesterol topically to diabetic foot ulcers, in collaboration with the Royal Adelaide Hospital and Prof Robert Fitridge.

With diabetes on the rise worldwide, the prognosis for patients with diabetic ulcers is grim. And in Australia, says Dr Bursill, there are 4400 major diabetes-related amputations each year. What’s more, according to a 2014 study, if you are unlucky enough to have an amputation, your chances of survival are less than 50% after 5 years.

For Dr Bursill, success would look like this: better wound healing with less inflammation and, for diabetics, lives saved. Not a bad outcome for an ‘out there’ idea.