MEDICAL TEXTILES, LEEDS: THINGS THAT REALLY MATTER Dr. Parikshit Goswami Centre for Technical Textiles, University of Leeds, UK Lecturer in Textile Technology NIFT Kolkata

About me Lecturer in Textile Technology MSc Medical Textiles Programme Leader Member of Board Working Group on Sustainability-EDANA Research Interest o Chemical functionalisation of materials

SCHOOL OF DESIGN, UNIVERSITY OF LEEDS School of Design Medical Textiles

Textiles, Leeds and open innovation Textiles at Leeds A Brand Name…

Medical textiles Externally funded healthcare-related research ococ a. £3 million An extensive and constantly evolving area Simple wipe to a complex composite structure for bone replacement Areas of application: oIoI mplantable materials/tissue engineering (artificial ligaments etc) oNoN on-implantable materials (wound dressings, hygiene products, ostomy pouches) oHoH ealthcare environment materials (surgical gowns, materials to reduce healthcare associated infection (HAI))

A Few Case Studies…

Drug Delivery Patches

Drug delivery systems

Transdermal drug delivery patches One billion transdermal patches- manufactured each year Conventional patches- o Up to 95 % of the active drug remains in the patch o Expensive and disposal issues o Only one drug could be delivered

Leeds technology The technology developed at Leeds o Show superiority to existing patches o Higher drug exhaustion o Longer lifetime of the patch o Improved control on drug release profile o Provides sustained bioavailability o More than one drug could be loaded in the patch o With separate and controlled release profiles Who will really benefit from this technology?

Alzheimer’s disease Alzheimer’s disease- most common cause of dementia o Accounting for % of cases Affects 15 million people worldwide o Particularly those over 80 years of age o % of people aged 85 or over in the Western world o Regarded as a major threat to public health Feasibility of using Leeds Technology o Demonstrated using two Alzheimer’s drug compounds FDA considers patches as ‘combination products’ consisting of a medical device and drug product.

Ostomy Pouch

Ostomy pouch Over 120,000 people live with a stoma in the UK o Surgically-created opening in the bowel o Allows the removal of waste out of the body o Into a pouch or other collection device- Ostomy pouch Three main types of stoma o Colostomy, Ileostomy, Urostomy o 1.23 million new cases of large bowel cancer were diagnosed in 2008 o 333,000 were in Europe (EU 27)

Ostomy pouch The NHS spends more than £630 million each year in England o Products such as stoma appliances, incontinence pads and dressings Growing problem- o Increasing bowel cancer incidence o Falling mortality rates o Increasing population o Increased life expectancy Inevitably will lead to the creation of more stomas

Stoma patients Major concern amongst stoma patients Changing and disposing of their ostomy device o Current disposal practices are crude and unhygienic o Results in:  Poor psychological adjustment  Impaired quality of life  Social withdrawal

Environmental impact In the UK alone- o 36.5 million used stoma pouches are disposed off every year o Primarily to landfill sites Some diseases found in faecal matter o Toxoplasmosis, tape worm, hook warm o Can survive for up to 10 years Faecal contamination can include o Hepatitis A, B or C, fungal spores, worm infestations o A number of pathogenic organisms and other infectious diseases

Waste disposal- flushability Landfill sites are decreasing in number o Limited biodegradation in landfill (if any?) Incineration? Contaminated fabrics? Massive infrastructure already in place o Sewage farm - an industrial biodegradation process Disposable nonwoven products being brought to market o Flushability of products – not as significant in design o Disposable products have revolutionised modern lifestyle o Need to address waste management issues

Present state-of-the-art Only Partially Flushable 4 layers

Leeds Technology First commercially available fully flushable ostomy pouch User perspective o No soiled waste to carry away from the toilet o Removing many of the concerns related to-  Lack of discretion and fear of exposure  psychological issues, social withdrawal  extended dependence on NHS nursing The novelty of this product o Capture a significant proportion of the current market

Does it really matter… UK is managed centrally- NHS Project is in collaboration with Welland Medical o British Company o 32 distributers worldwide o Direct exploitation of the market

Market size The market for ostomy and incontinence products Steady, large and growing market Projected to reach $11.1 billion by the year 2015 The largest markets for ostomy products o The United States, Japan and Europe The European Market o Worth between $780 million and $1 billion o Growing rates 5-7% o United Kingdom accounted for more than 75% of the European market

Product performance

Chronic Kidney Diseases (CKD)

How big is the problem? CKD- In England, between o More than 1.8 million people have been diagnosed o Further million people- not yet been officially diagnosed o Only cure- kidney transplantation o Significantly reduced quality of life o And associated diseases (e.g. cardiovascular diseases) o High mortality rates For NHS o £1.64 billion (renal problems)

CKD Kidney filters waste products from the blood o Excretes them via the formation of urine Malfunction or failure of the kidney o Metabolic and dietary waste products gradually accumulate within the body (Uremic Toxins) o Results in malfunction of cells and organs o Over 150 different toxins ((European Uremic Toxin Work Group) Chronic Kidney Diseases (CKD)

Uremic toxins Uremic Toxins Water soluble, low mol. wt. (e.g. urea and creatinine) Middle molecular weight (e.g. β 2 -microglobulin and cytokines) Protein bound (e.g. indolic and phenolic compounds) Fundamental approach for treatment- Is the removal of these toxins from the blood.

Current treatment Haemodialysis- widely used in the treatment of CKD o Artificial removal processes o To mimic the natural function of the kidney Haemofiltration and Haemodiafiltration None capable of effectively remove all types of toxins from the blood

Project at Leeds Been identified to attribute to cardiovascular disease and progression of kidney failure

Project at Leeds Clinical need to remove large protein bound molecule is clear Our approach o With an additional novel filter system o Stable bonding reagent (synthesised at Leeds) o Fabricated using nano-technology o This can specifically capture target molecules (uremic toxins)

The Design

Advantages Improvement in patients’ quality of life o By reducing cardiovascular diseases Reduced mortality rates Reduced treatment time frequency An optimised dialysis treatment o Contribute to cost reduction within the health care sector

Wound Dressing

Wound dressing Chronic wounds: 6.5 million people - $25 billion Impaired healing – Inflammation stage is prolonged Resistance to antibiotics Silver impregnated dressings Alternative metals, e.g. zinc as well as non-metal bactericides Naturally derived compounds?

Nature…

Why antimicrobial?

Fundamental work on the delivery mechanism… Hybrid Nanofibre Nonwovens from Chitosan/Cellulose Acetate G. Salihu, P.Goswami, and S. Russell, “Hybrid electrospun nonwovens from chitosan/cellulose acetate,” Cellulose, vol. 19, no. 3, pp. 739–749, 2012.

Stratification approach to Healthcare Let’s consider three very good friends…

MSc Medical Textiles

Thank you Any Questions?