Transcript

Robert J. Klein, DPM, FACFAS, CWS:

Hi, I'm Robert Klein. I am a podiatrist who practices wound care and limb preservation full-time. I am the division chair for wound care for Prisma Health. We're located in South Carolina. And I'm also a clinical associate professor of surgery at the University of South Carolina School of Medicine in Greenville, South Carolina. 

Proteases are basically enzymes that break down protein. And proteases are not necessarily bad, but when there's a high abundance of proteases within a wound, that's when they can become problematic. Proteases can destroy a healthy tissue. They can break down growth factors. They can break down extracellular matrix and collagen. And they can also lead to chronic inflammation. As we think about the wound healing cascade or wound healing cycle, a lot of the times the wounds that we see especially in our wound care centers are stuck in that chronic inflammatory phase of the wound healing cycle. And in many instances, because there's a high abundance of proteases. And those proteases break down that extracellular matrix. They degrade the growth factors. They impede cell function. So that high abundance of proteases can be problematic in the wounds that we see. 

Signs that there might be excess proteases within the wound can be a variety of things. You could have slough or devitalized tissue in the wound. You can have wounds that have high amounts of exudate. You have wounds that have just stalled and had not progressed on to the normal wound healing expectations that we would normally want to see within wound healing, wounds that become infected. Those are all potential signs or symptoms of wounds that might have high abundances of proteases. And then there are certain patient populations where we need to be mindful of proteases, such as our diabetic patients and our patients who have impaired blood flow with those with peripheral arterial disease or peripheral vascular disease.

Proteases and the BIOMES℠ intersect quite well. The clinician can use the BIOMES tool, and that's how I look at it, is more of the tool to help me guide for treatment for my patients and hopefully prevent wounds from getting stuck in chronic inflammation and not healing. 

Protease targeting dressings are very interesting dressings. So say you have a wound that has a lot of proteases or maybe a lot of exudate. That's probably a wound that has a lot of proteases within the wound that can break down that extracellular matrix and can lead that wound to stay into a chronic inflammatory state. So being aware of wounds that may have a high abundance of proteases, you should consider dressings that address high levels of protease activities because they can deactivate the proteases and they can throw the proteases off of the wound bed so they don't break down those extracellular matrix that collagen degrade the growth factors. And it just can prevent those wounds from stalling or becoming chronically inflamed. 

I think implement in these strategies is really important. We want to take our wounds on to closure as quickly as possible. As we talked about in some of the previous questions, a lot of the wounds that we see are stuck in that chronic inflammatory phase of the wound healing cycle. So we know that they probably have a high abundance of proteases. We know that they're breaking down extracellular matrix and collagen and degrading growth factors. So if we can incorporate protease-reducing dressings into our wound healing thought process, that again can serve as a tool, as a clinician, to take our wounds onto closure, to prevent wounds from stalling, and to prevent those wounds from becoming chronically inflamed.

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