India is highly dependent on imports for wound-care products. A November 2019 paper estimated these imports at $765 million in 2016. Since about half a million non-emergency surgeries were postponed indefinitely during the pandemic, their requirement will only increase. Meanwhile, the global market is pegged to be $24.5 billion by 2027.

R&D efforts are on in India to manufacture wound dressings for local use and, hopefully, exports too. For example, research on nitric oxide releasing dressing has been on at the Bhabha Atomic Research Centre (BARC) since 2015, with some good results.

The research began as an offshoot of work on biofilm for biofouling control.

According to Hiren Joshi, scientific officer at BARC, the primary focus turned to addressing the problem of slow-healing wounds, particularly diabetic foot ulcer. Left untreated, it could lead to amputation to control the infection. The reasons for non-healing include high blood sugar levels accelerating the growth of infectious bacteria in the wound and impairment of the nitric oxide generating pathway. Nitric oxide is a bioactive molecule the body synthesises in response to a wound, and it activates the healing process.

Low-cost variant

Meanwhile, a research team from the chemical engineering department of IIT-Guwahati says it has developed a low-cost, non-toxic, bio-degradable, and composite wound dressing. It costs ₹0.188 per sq cm, which is 66 per cent cheaper than similar materials such as the 3M Tegaderm IV Transparent Film (1633IN) at ₹0.565 per sq cm.

The new material uses polyvinyl alcohol, a synthetic polymer, and starch, a natural polymer, as the base. The polymeric network is modified with organic additives such as glycerol and an organic acid, which serve as a crosslinker, plasticiser and antibacterial agent. This aids healing by providing moistness in and around the wound and allows the body’s enzymes to act more effectively.

The research at IIT-Guwahati was part of the PhD work of Aritra Das. For the cell culture facility and to measure the toxic potential of the material, a collaboration was formed with Srirupa Bhattacharyya, former doctoral fellow at the department of biosciences and bioengineering. The team needs more funding and welcomes funds from private sector too.

At the Institute of Life Sciences, Bhubaneswar, Sanjeeb Sahoo has reportedly developed a prototype of a ‘turmeric’ adhesive bandage, which uses curcumin, the active ingredient in turmeric, as a base. He says it can heal wounds faster, even in diabetics. The bandage has been patented in India, the US, Europe and Australia.

In Bengaluru, Fibroheal Woundcare, a company registered under the government’s Start-up India programme, has developed wound dressing from silk and silk proteins extracted from the cocoons left behind by fully grown moths. The wound dressing is already in the market and helps in controlling infection and inflammation, maintains moisture balance and ensures speedy wound closure.

Lessons from fruit flies

Meanwhile, research conducted on fruit flies by Sveta Chakrabarti and Sandhya Visweswariah of the Indian Institute of Science, Bangalore, indicates how immune response is activated through pathways. The study found that hydrogen peroxide produced at the wound activates specific signalling pathways in the haemocytes (blood cells of invertebrates) of fruit flies and helps home in cells to the site of damage to activate wound healing.

Vivek Verma of IIT-Kanpur has developed a bio-degradable, non-immunogenic wound dressing based on agarose, a natural polymer derived from seaweed agar, for the treatment of infected diabetic and other chronic wounds. The dressing may be single-layered, bilayer, or multi-layered hydrogel films, depending on the wound.

Verma is now working to incorporate all the active agents in a single or multilayer arrangement. “This advanced wound dressing has the potential to be converted into a commercial product, and it can provide an active bandage for the treatment and management of chronic wounds at competitive cost,” says Verma.

The advanced wound dressing market in India is monopolised by foreign companies and this can be broken if products developed in labs make their way to the market.