Wound care innovation for the tropics

Chronic non-healing wounds (diabetic foot ulcers, pressure injuries, and venous leg ulcers) disproportionately affect the elderly population. Tropical climate further complicates the prognosis of chronic wounds as a humid and warm environment is favourable for bacterial infection. Chronic wounds such as diabetic foot ulcers often lead to amputations and pose significant health care challenges to clinicians. Singapore has the second-highest proportion of people with diabetes among developed nations and roughly around four diabetes-related amputations in a day. Better care and treatments for diabetic foot ulcers and other chronic wounds could prevent poor prognosis and save lives. Chronic wounds incur high costs and negatively impact mobility, well-being, and quality of life.

Our Approach

The Wound Care Innovation for the Tropics (WCIT) programme is a  first-of-its-kind research program focusing on wound care in tropical climates. Our focus is to transform the care of chronic wounds, deliver better health outcomes and reduce economic burdens.

Our approach encompasses the following areas of research

  1. World's largest library of Asian chronic wound samples to identify biomarkers and drug targets.
  2. Develop innovations in advance dressings, diagnostics, and practice support patients.
  3. Improved wound models to support preclinical testing.
  4. First central wound registry in Asia with over 800 patients to improve health service delivery.
  5. Forge strong clinical ties with five new wound-focused center's set up in Singapore in the past two years.

By accelerating the development of novel wound care therapies and practices, our programme aims to position Singapore as a new focal point in Asia for its world-class research and development in the field of chronic wounds.

Key Projects

Multi-Omics technologies for investigation of biomarkers

Multi-Omics technologies for investigation of biomarkers

The 'Omics' approach applies cutting-edge technologies to comprehensively profile biological molecules (biomarkers) in the body, such as proteins, metabolites, and wound microbes.

In particular for wound care research, the discovery of biomarkers for chronic non-healing wounds is done using the largest library of wound samples in the world with >2,000 samples from 250+ multi-ethnic patients in Singapore.

These biomarkers can provide unprecedented insight into diabetic foot ulcers and venous leg ulcers, and guide a new generation of diagnostic, prognostic and therapeutic applications for improving wound care.

Platform Technology – in vitro and in vivo models of wound healing

Platform Technology – in vitro and in vivo  models of wound healing

The Asian Skin Biobank has various in vitro wound models that enables the evaluation of novel wounds. This Skin-in-a-dish model is developed from human skin reconstructed ex vivo using de-cellularised native human dermal scaffolds and donor keratinocytes.

Another breakthrough innovation is the world’s first perturbed wound healing in vivo model which recapitulates many features of human chronic wounds. This was developed by Prof David Becker, who has a joint appointment with SRIS and NTU.

Singapore Wound Registry

Singapore Wound Registry

This is the world’s first major wound care registry based on Asian data in a tropical climate. It has collected anonymised information from >800 patients on Venous Ulcers, Pressure Ulcers and Diabetic Foot Ulcers from major hospitals in Singapore. Data on patients with chronic wounds were also analysed retrospectively.

This Wound Registry collaboration provides healthcare practitioners with practical insights for improved clinical protocols and better patient outcomes.

Pressure Sensors for Venous Leg Ulcers

Pressure Sensors for Venous Leg Ulcers

Sensors are incorporated into the compression bandage to measure pressure. This innovation could be used in the training of nurses so they apply the correct amount of pressure when bandaging patients’ venous leg ulcers, to improve the effectiveness of compression therapy. The sensors are made of thin multi-layer film consisting of an array of micron-sized chambers, each filled with dye solution. Upon compression, the microchambers will rupture and release the dye to indicate that sufficient pressure has been achieved.

Haloflow for Prediction and Evaluation of Diabetic Foot Ulcers

Haloflow for Prediction and Evaluation of Diabetic Foot Ulcers

This Haloflow system enables the detection of early phase micro- and macro-vascular disease in diabetic patients before serious clinical manifestations appear. Assessments can be done non-invasively using a portable hand-held probe.

Antibacterial and Bio-functional Wound Dressings

Antibacterial and Bio-functional Wound Dressings

Cationic hydrogel dressings that are highly effective against bacteria and biofilms. They are available as stable non-leaching gels as well as leaching gels that can release active components in response to bacterial enzymes, and be easily incorporated into dressings.

Selected Publications

1. Goh OQ, Ganesan G, Graves N, et al. Incidence of chronic wounds in Singapore, a multiethnic Asian country, between 2000 and 2017: a retrospective cohort study using a nationwide claims database. BMJ Open 2020;10:e039411. doi: 10.1136/bmjopen-2020-039411

2. Lo ZJ, Lim X, Eng D, Car J, Hong Q, Yong E, Zhang L, Chandrasekar S, Tan GWL, Chan YM, Sim SC, Oei CW, Zhang X, Dharmawan A, Ng YZ, Harding K, Upton Z, Yap CW, Heng BH. Clinical and economic burden of wound care in the tropics: a 5-year institutional population health review. Int Wound J. 2020 Jun;17(3):790-803. doi: 10.1111/iwj.13333. Epub 2020 Mar 9. PMID: 32149471; PMCID: PMC7948834.

3. Maxim V. Kiryukhin, Hooi Hong Lau, Su Hui Lim, Giorgiana Salgado, Chen Fan, Yi Zhen Ng, David I. Leavesley, and Zee Upton. Arrays of Biocompatible and Mechanically Robust Microchambers Made of Protein–Polyphenol–Clay Multilayer Films. ACS Biomater. Sci. Eng. 2020, 6, 10, doi: org/10.1021/acsbiomaterials.0c00973

4. Wu Y, Raju C, Hou Z, Si Z, Xu C, Pranantyo D, Marimuthu K, De PP, Ng OT, Pethe K, Kang ET, Chan-Park MB. Mixed-charge pseudo-zwitterionic copolymer brush as broad spectrum antibiofilm coating. Biomaterials. 2021 Jun;273:120794. doi: 10.1016/j.biomaterials.2021.120794 Epub 2021 Apr 5. PMID: 33887644.

5. Upton Z, Fernandez M. Wound Care Innovation for the Tropics-An Industry-Facing Singaporean Initiative Focussed on Wounds and Wound Care in Asian Populations. Int Wound J. 2018 Apr;15(2):183-184. doi: 10.1111/iwj.12919.PMID: 29683268; PMCID: PMC7950040.

6. Fan C, El Andaloussi S, Lehto T, Kong KW, Seow Y. Smad binding decoy reduces extracellular matrix expression in human hypertrophic scar fibroblasts. Mol Med Rep. 2020 Dec;22(6):4589-4600. doi: 10.3892/mmr.2020.11549.Epub 2020 Sep 29. PMID: 33173952; PMCID: PMC7646840.

7. Leung CM , Dhand C , Mayandi V , Ramalingam R , Lim FP , Barathi VA , Dwivedi N , Orive G , Beuerman RW , Ramakrishna S , Toh YC , Loh XJ , Verma NK , Chua AWC , Lakshminarayanan R . Wound healing properties of magnesium mineralized antimicrobial nanofibre dressings containing chondroitin sulphate - a comparison between blend and core-shell nanofibres. doi: https://doi.org/10.1039/D0BM00530D Biomater Sci. 2020 Jun 21;8(12):3454-3471.

8. Chan KS, Chan YM, Tan AHM, Liang S, Cho YT, Hong Q, Yong E, Chong LRC, Zhang L, Tan GWL, Chandrasekar S, Lo ZJ. Clinical validation of an artificial intelligence-enabled wound imaging mobile application in diabetic foot ulcers. Int Wound J. 2021 May 4. doi: 10.1111/iwj.13603 Epub ahead of print. PMID: 33942998.

9. Foong HF, Kyaw BM, Upton Z, Tudor Car L. Facilitators and barriers of using digital technology for the management of diabetic foot ulcers: A qualitative systematic review. Int Wound J. 2020 Oct;17(5):1266-1281.  Epub 2020 May 10. PMID: 32390305; PMCID: PMC7948580. doi: 10.1111/iwj.13396.

10. Chua HM, Zhao Z, Ng KW. 2020 Nov;41(21):e2000254. Cryogelation of Human Hair Keratins. Macromol Rapid Commun.  Epub 2020 Aug 9. PMID:32776404  Epub 2020 Aug 9. PMID: 32776404 doi: org/10.1002/marc.202000254.

11. Djordjevic I, Pokholenko O, Shah AH, Wicaksono G, Blancafort L, Hanna JV, Page SJ, Nanda HS, Ong CB, Chung SR, Chin AYH, McGrouther D, Choudhury MM, Li F, Teo JS, Lee LS, Steele TWJ. CaproGlu: Multifunctional tissue adhesive platform. Biomaterials. 2020 Nov;260:120215. Epub 2020 Jul 11. PMID: 32891870. doi: 10.1016/j.biomaterials.2020.120215 

Press

Contact us

For more information on the WCIT Programme, please contact Jason Kow from the Strategic Partnerships and Business Development team.