Neotherix bioresorbable scaffold technology is well suited to the repair of acute (surgical and traumatic) wounds as well as the repair of chronic wounds. Our initial clinical focus is on dermatology - in particular, the repair of lesions created by the surgical excision of skin cancers. Other clinical targets are likely to be in aesthetic surgery, periodontology, surgery to repair other soft tissue tumours, colorectal surgery and abdominal wall repair.

Skin cancers account for more than 50% of all cancers in the US [1] where there are more than 2 million cases of non-melanoma skin cancer each year at a total direct cost of treatment of $1.5bn [2]. There are expected to be almost 100,000 new cases diagnosed in the UK this year [3]. 80% of these cancers are basal cell carcinomas which tend to be localised with some lateral spread. 20% are squamous cell carcinomas which are deeper, have marginal involvement and a risk of metastasis [4]. There were estimated to be more than 76,000 new cases of invasive melanoma in the US in 2013 [5]. The worldwide incidence of skin cancers has been rising at rates between 3-10% per year over the last decade [6].

Most skin cancers are small (just a few mm in diameter) and can be treated by simple excision and suturing. Larger lesions (>6 mm diameter on the face and >20 mm on the torso) are likely to be referred to a plastic surgeon or a dermatologist. Based on research performed to date, the Neotherix bioresorbable scaffold product is thought to be particularly suitable for the treatment of lesions resulting from the surgical excision of skin cancers.

Restorative dentistry is a large market and area of clinical need with tooth loss, dental caries and oral cancer being major drivers of the need for replacement tissues. Procedures such as gingival grafting, root coverage and removal of oral cancer typically require tissue to be taken from another (donor) site in the mouth and transplanted into the repair area. Subsequent bacterial infection is a frequent complication and a major cause of graft loss and surgical re-work.

Our aim is to deliver an antimicrobial agent at the surgical site via a novel resorbable tissue scaffold into which the agent is incorporated. Proof-of-concept work has shown that we are able to synthesise tissue scaffolds incorporating an antimicrobial agent, and that these scaffolds support the growth of human dental pulp stem cells. The antimicrobial agent is released progressively over time, which causes bacterial death on activation at doses harmless to the human cells.

This technology has considerable potential for improving tissue regeneration strategies by preventing or reducing the infective burden on newly-forming tissues. Compared to other approaches we anticipate it to offer the following benefits:

• Highly efficacious one- or two-stage treatment allowing cost and time savings for health systems globally
• Infection resistance for regenerative materials, devices and procedures
• Reduced need for the use of antibiotics
• Improved cosmetic outcome and improvement in patient quality of life
• Prolonged and improved construct survival reducing the need for revision surgery

Although our current focus is on periodontology and oral biology, the technology combining the regenerative benefits of a tissue repair scaffold with delivery of antimicrobial agent would have application in wound management, sports medicine, plastic and reconstructive surgery and in other surgical specialties where there is a known risk of loss of implanted or repaired tissue to infection.

1. Bowen, GM, White, GL, and Gerwels, J, American Family Physician, 2005, 72, 845-848.
2. American Academy of Dermatology (Skin Cancer Stats & Facts ).
3. Cancer Research UK (Skin cancer risks and causes ).
4. Alam, M and Ratner, D, The New England Journal of Medicine, 2001, 344, 975-983.
5. American Cancer Society (Cancer Facts & Figures 2013 ).
6. Rigel, DS et al, in Cancer of the Skin, Elsevier Saunders, 2005.