LICAMM Hypoxia, inflammation and local steroid metabolism during wound healing: towards a new therapy for diabetic foot ulcers

Type 2 diabetes is an unmet clinical need of global importance with a growing financial burden. Diabetic foot ulcers, characterized by chronic inflammation and hypoxia, occur in 15-25% per cent of people with diabetes (lifetime risk) and currently affect over 3 million people in the UK. Often, the lack of healing leads to amputation and strikingly up to 80% cent of people with diabetes die within five years of having an amputation or a foot ulcer.

<p>Glucocorticoid (GC) hormones are commonly used to treat a range of inflammatory disorders and cause many adverse effects including hyperglycaemia, weight gain, skin thinning, collagen loss, impaired wound healing and increased risk of infection. GC activated by 11&beta;-HSD1 regulate cell functions in tissues such as fat, muscle and liver but the effects of 11&beta;-HSD1 in the skin are poorly understood. Previous research have demonstrated increased 11&beta;-HSD1 activity during normal wound healing and improved wound healing in healthy aged mice lacking 11&beta;-HSD1 but the role of 11&beta;-HSD1 in wound healing impaired by diabetes has not been investigated.</p> <p>Quantitative Polymerase Chain Reaction following mRNA extraction and cDNA synthesis will used to analyse gene expression during wound healing in healthy mice compared to a genetic mouse model of diabetes (leptin-receptor deficient). This will be compared to mice that have been treated with the topical 11&beta;-HSD1 inhibitor carbenoxolone or placebo. Immunohistochemistry will be used to visualise changes in wound healing, inflammation and collagen remodelling.</p> <p>The role of hypoxia will also be investigated by examining the effect of 11&beta;-HSD1 inhibition on wound healing in the presence / absence of an impermeable dressing. This will be complimented by in vivo hypoxia experiments exploring the regulation of angiogenesis by 11&beta;-HSD1 in primary human skin fibroblasts.</p> <h6>This project has the scope to develop a new treatment for diabetic foot ulcers that could improve morbidity and mortality in patients with type 2 diabetes, leading to savings in NHS expenditure of &pound;1 billion annually.<br /> &nbsp;</h6> <p>References</p> <p>Tiganescu A, Walker EA, Hardy RS, Mayes AE, Stewart PM. Localization, age- and site-dependent expression, and regulation of 11&beta;-hydroxysteroid dehydrogenase type 1 in skin. J Invest Dermatol. 2011 Jan;131(1):30-6</p> <p>Tiganescu A, Tahrani AA, Morgan SA, Otranto M, Desmouliere A, Abrahams L, Hassan-Smith Z, Walker EA, Rabbitt EH, Cooper MS, Amrein K, Lavery GG and Stewart PM. 11beta-Hydroxysteroid dehydrogenase blockade prevents age-induced skin structure and function defects. J Clin Invest. 2013, 123(7), pp.3051-60</p> <p>Tiganescu A, Hupe M, Uchida Y, Mauro T, Elias PM and Holleran WM. Increased glucocorticoid activation during mouse skin wound healing. J Endocrinol. 2014, 221(1), pp.51-61</p> <p>Tiganescu A, Hupe M, Uchida Y, Mauro T, Elias PM, Holleran WM. Topical 11&beta;-Hydroxysteroid Dehydrogenase Type 1 Inhibition Corrects Cutaneous Features of Systemic Glucocorticoid Excess in Female Mice. Endocrinology. 2018, 159(1):547-556<br /> &nbsp;</p>

<p>Please note these are not standalone projects and applicants must apply to the PhD academy directly.</p> <p>Applications can be made at any time. You should complete an <a href="https://medicinehealth.leeds.ac.uk/faculty-graduate-school/doc/apply-2">online application form</a> and attach the following documentation to support your application.&nbsp;</p> <ul> <li>a full academic CV</li> <li>degree certificate and transcripts of marks (or marks so far if still studying)</li> <li>Evidence that you meet the programme&rsquo;s minimum English language requirements (if applicable, see requirement below)</li> <li>Evidence of funding to support your studies</li> </ul> <p>To help us identify that you are applying for this project please ensure you provide the following information on your application form;</p> <ul> <li>Select PhD in Medicine, Health &amp; Human Disease as your planned programme of study</li> <li>Give the full project title and name the supervisors listed in this advert</li> </ul>

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