The International Diabetes Federation estimates that type 2 diabetes mellitus (T2DM) will affect 642 million people by 2040. Chronically inflamed, hypoxic wounds are common in T2DM and represent a global unmet clinical need. Each year, diabetic foot ulcers cost the NHS £650 million and cause 1 in 200 UK deaths. This mortality is greater than colon, breast and prostate cancer combined. Glucocorticoids are used to treat a range of inflammatory conditions (e.g. asthma, eczema, polymyalgia rheumatica) although long-term therapy is precluded by their adverse side-effects including delayed wound repair and increased infection risk. Glucocorticoid excess drives impaired wound healing through the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) which activates cortisol from cortisone in peripheral tissues including skin. In human skin fibroblasts, we found that 11β-HSD1 regulates over 600 genes in response to inflammation (e.g. suppression of angiogenesis which is essential for effective healing). In these cells, hypoxia (a hallmark of diabetic ulcers) induces 11β-HSD1, which prevents expression of pro-angiogenic vascular endothelial growth factor. In mice, we demonstrated that 11β-HSD1 activity increases during the inflammatory phase of wound healing and topical 11β-HSD1 inhibition improves wound healing during systemic glucocorticoid excess, in aged mice and models of diabetes (importantly, without exacerbation of normal inflammatory responses). Here, I present GC-SHEALD the first randomized, double-blind, placebo-controlled trial to explore 11β-HSD1 inhibition as a novel therapy for wound healing in type 2 diabetes (https://doi.org/10.1186/ISRCTN74621291).
11 Nov 2019 - 13 Nov 2019