20 November 2017

Non-healing wounds have a huge impact on quality of life of those affected, and are costly for the healthcare system. They are the most expensive healthcare problem facing Sweden today, according to Johan Junker, senior researcher at the Centre for Disaster Medicine and Traumatology, and the Department of Clinical and Experimental Medicine.

Johan Junker, forskare Katastrofmedicinskt centrum

The cost of treating venous ulcers is estimated at between SEK 260 million and 600 million per year. And that is only venous ulcers. In addition to chronic wounds, the care of wounds also includes acute wounds. These can be wounds from accidents or other events such as burns or tumour removals. Chronic wounds are persistent and don’t heal. They are often diabetes related, venous ulcers and other types of wounds, and are complications of other diseases.

As coordinator for the research programme in experimental traumatology at the Centre for Disaster Medicine and Traumatology, Johan Junker has a number of research projects in the field of wound healing. One concerns treating wounds that are or risk becoming infected and not healing; another is about the treatment of traumatic wounds such as burns and the development of methods for skin transplantation.

“In a way it might seem strange to lump together acute and chronic wounds, but certain new treatment forms we want to develop are applicable to both types of wounds,” says Johan Junker.

Johan Junker, senior researcher KMCJohan Junker at the Experimental Plastic Surgery laboratory. Photo: Susanna Lönnqvist.
Johan Junker’s research career began at the Laboratory for Experimental Plastic Surgery at LiU’s Department of Clinical and Experimental Medicine. The research at this lab focussed on wound healing and transplantation. Johan’s work and subsequent doctoral thesis investigated tissue engineering and reprogramming of fibroblasts, a type of connective tissue cell. Following his thesis he had a short postdoc at the University Hospital in Bergen, Norway, before continuing to Harvard Medical School and Brigham and Women’s Hospital in Boston. Johan’s original plan was to stay in Boston for one year, possibly extending to two. But after three weeks at the lab, it was already decided, according to Professor Elof Eriksson. Johan was to stay for two years. As this two-year period was coming to an end, his position was converted to Director of Tissue Engineering and Plastic Surgery Research at Brigham and Women’s Hospital, and a faculty position at Harvard Medical School.

“What was supposed to be one year in Boston ended up as four. I arrived at a lab that was a leader in gene therapy, and not so much in wound healing or tissue engineering. But during my time there the lab developed more in that direction.”

In terms of methods and the research environment, motivation was key.
“The most obvious difference between the environments in Boston and Sweden was that the people at Elof Eriksson’s lab were extremely goal-oriented and had a specific purpose for being there. Leaving work early one afternoon was simply not an option.”

The demanding but stimulating environment was a good fit for Johan and his wife Klara, also a researcher. They had their first child during their time in Boston, and this was part of the reason why they made their way back to Sweden. The distance to family and friends became more tangible when their child was born. But they did have one stopover before Linköping and Sweden:
“Moving straight back to Sweden would have been too big a step, so we moved to Copenhagen!”

Major grants for wound chambers

One of the projects that was commenced in Boston and that Johan Junker has continued to work on is the wound chamber. A wound chamber is applied on top of a wound, creating a controllable surface where substances can be administered, that is isolated from the surrounding tissue. Johan Junker’s research identifies infection as one of the main obstructions in the healing of wounds.
“As long as a wound is infected, it has little chance of healing. The influence of the infection is important for chronic wounds, burns and major traumatic wounds.”

For burns that have become infected, it gets extremely complicated. Burn patients are a group that isn’t suited to high dosages of antibiotics systemically, where antibiotics are administered in the blood stream.
“The general condition of the patients is sometimes so bad that their organs can’t withstand a high systemic dosage of antibiotics, but in the wound chamber you can give extremely high dosages very locally.”

Johan Junker says that limiting the administration of antibiotics surely sounds logical, and that many others have had the same thought. The problem is that no one has successfully developed a robust system for doing it easily and efficiently. Various pumps and biomaterials with a reservoir effect have been tested where materials slowly release substances over a long period.
“But this leads to extremely complicated pharmaco-dynamic processes underneath the bandage. Everything that is added: where does it go? In our system we know exactly what we put into the chamber and how much is left, and what hasn’t been assimilated by the patient.”

Johan Junker, KMCJohan Junker was granted SEK 5.2 million in research funding from the Kamprad Family Foundation for the project “Treatment of chronic wounds with new technology”. Project participants are the Centre for Disaster Medicine and Traumatology, the Hand and Plastic Surgery Clinic, the Dermatology Clinic and the Infection Clinic at Linköping University Hospital, Harvard Medical School and Linköping University.Johan Junker also points to other advantages of the wound chamber: it is easy to use and it works like a bandage. This ease of use opens up a number of applications, which are being tested in other projects. For instance, being able to use the chamber to treat traumatic wounds before the patient arrives at the hospital, that is, treating the wound as soon as possible. With a contaminated wound, early intervention can prevent infection. The same applies to burn patients.
“With a burn, a large area on the body becomes extremely sensitive and discharges fluids uncontrollably. Temperature control doesn’t work. The chamber can enclose the environment and physically cover the wound, which are also positive for the patient. Plus, the wound and its healing process can be sampled, without having to remove the chamber.”

For healthcare staff, no special knowledge is required and no special equipment is required to use the chamber, it is like putting on a bandage.  This enables testing the chamber in resource-poor environments, where the Centre for Disaster Medicine and Traumatology has contacts with low-income countries.
“Even in Sweden the chamber can have a big impact. There are people with wounds who go to the doctor for 20 years, so for the patients of course it means a lot of costs and suffering. But at the global level, there are so many more who don’t have access to any healthcare at all, so spreading the technology in resource-poor regions gives the greatest clinical impact.”

For Johan Junker, improving the lives of large numbers of people is one effect of his work, but it’s not the only thing that motivates him.
“What drives me is being at the forefront of some sort of learning process, the curiosity of learning something new. Personally I could have done research in other fields than healthcare. You never know what effect a research project will have, but if it helps improve people’s quality of life, I’m happy.”

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