By Hadeer Ibrahim

My name is Dr Hadeer Ibrahim, MBBS, MSc. I am part of an enthusiastic research group working on EB at the University of Birmingham and Birmingham University Hospitals, UK. My PhD research as part of this group is trying to find out why some wounds in EB will not heal and what we can do to help. I would like to develop personalised and targeted treatment for faster wound healing, resulting in a better quality of life for people living with any type of EB.

 

Who/what inspired you to work on EB?

I completed my postgraduate Master’s studies in dermatology, along with my speciality training, as a dermatology assistant lecturer at the Faculty of Medicine, Suez Canal University and University Hospitals, Egypt. There I first met people with different blistering skin diseases including EB. I saw that taking care of the non-healing wounds was overwhelming to the patients and their caregivers and significantly affected their lives. We have no clear answer to why many wounds are not healing despite all the meticulous efforts of doctors, nurses, caregivers and the people living with EB themselves. That inspired me to try to get an answer through a PhD project.

 

Which aspect of EB are you most interested in?

Non-healing wounds present a significant problem for people living with EB and lead to a lower quality of life day to day. Complications include the need for ongoing daily wound care, itch, pain, an increased risk of skin cancer, and fusion of fingers forming “mitten hands”. We understand how and why EB blisters form, but we do not know why some fail to heal for months or years despite good wound care. We believe that the underlying cause may be the presence of “biofilms” on the wound surface. Biofilms are a mixture of different microbes living within a slimy layer that the microbes produce themselves. The biofilm is strongly attached to the wounded skin and can make the microbes within it resistant to traditional antibiotic treatments. Biofilms are known to slow down wound healing even though wounds harbouring biofilms often show no signs of infection such as pus, swelling or redness. Biofilms also cannot be detected by traditional wound swabbing methods, and do not respond to regular wound care and antibiotic use. However, wounds with biofilms studied in other diseases, including diabetes, burn patients, and people with chronic skin ulcers (venous wounds), can respond well to anti-biofilm measures resulting in improved healing.

 

What does the funding from DEBRA mean to you?

Our initial research using different imaging techniques has shown, for the first time, the presence of biofilms on chronic wounds of different EB subtypes. The DEBRA UK funding will help to confirm our observational results using genetic analysis of these biofilms to reveal the types of microbes present, as well as possible differences between EB subtypes. This has never been studied and will involve the use of new techniques in a collaborative project.

 

What difference will your work make to people living with EB?

An increased understanding of why EB wounds fail to heal will help us to develop new therapies targeted at the biofilms and the microbes living in them. This will lead to a more personalised approach to therapy, resulting in better wound management and faster healing of chronic wounds in EB patients.

EB is not a common medical condition, however, the impact it has on EB patients and their families cannot be overlooked. Working with those fantastic people while on the project and seeing how welcoming, cooperative, optimistic and encouraging they are, despite what they are going through on a daily basis, is another story. This project is giving me more than deeper insights into medical and laboratory results. It is helping me learn more about humanity and empowers me to do all I can to be worthy of the EB community’s trust.

 

Who’s on your team and what do they do to support your EB research?

I was lucky to join an experienced and enthusiastic EB research group. The experts who became my supervisors have different specialities that complement each other to reach a better understanding of non-healing wounds, biofilms and promising new treatments. The research group includes Dr Josefine Hirschfeld, my principal investigator, who has been conducting a lot of research on immunology and microbiology and is particularly interested in the interaction between microbes and our immune cells. Dr Sarah Kuehne is a senior lecturer in Biomedical Sciences/Microbiology with enormous experience and many publications on biofilm-related studies. Prof Iain Chapple, the Head of Research for the Institute of Clinical Sciences, has been involved in many studies on different aspects of EB, focusing on EB patients' priorities for selecting his research topics. Prof Adrian Heagerty is a consultant dermatologist and Honorary Professor of Dermatology at the University of Birmingham and leads several active research groups working on EB. He heads the half-national epidermolysis bullosa service at University Hospital Birmingham NHS Foundation Trust and helps to recruit people living with EB to research studies, as well as directing our research aim towards their best interests. Dr Mohammed Hadis is a lecturer in materials science and has extensive experience in biomaterials research. This is a great help in developing anti-biofilm treatments using different materials to aid better wound healing. Finally, I can never forget the precious chance given to me by the Egyptian government through a generous scholarship to come to the UK and carry out my PhD studies on EB.

 

How do you relax when you’re not working on EB?

While working on such a big project, having a work-life balance is challenging but I understand how crucial it is for my physical and mental health. I try to keep active playing tennis, swimming and going to the gym along with some meditation through hiking and yoga. In addition, I try to take regular breaks where I travel and have quality time with family and friends, visiting new cities and exploring different cultures. This helps me recharge for the research journey.

This project is facing many challenges, from the rarity of EB, which limits the number of volunteers for research projects, to the shortage, or sometimes absence, of information in this field. However, the belief of everyone involved in this study, in the doors it can open wide for a better understanding of EB, and the direct effect it can have on EB patients and their caregivers’ quality of life, make us determined to achieve the objectives of this research.

 

What these words mean:

Biofilm  = a thin coating that contains living microorganisms.

Chronic = long-lasting.

Immunology = the study of immune cells and proteins and how they work together in our immune system.

Materials science = studying the physical and chemical characteristics of substances (materials), their potential uses and how to make them.

Biomaterials = substances for use in medical treatments.

Microbiology = the study of microbes.

Microbes = microorganisms = living creatures such as bacteria that are too small to see without a microscope.

PhD = Doctor of Philosophy = a qualification gained through carrying out research to a high standard.

 

Full glossary of scientific terms