Hello, it's Anthony Choudhury from the webinar vet, welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast. I so much enjoy doing these podcasts because it always gives me an opportunity to speak to interesting people that are doing really innovative things. It's one of our value words within the within webinar vets, which is innovation, and gonna be speaking today to Mandy Wallace and Jacob Adams who are involved in the Noxano company.
In fact, Jacob is the founder. Of the company and Noxano is an innovative company that is looking at wound care treatment dedicated to really trying to improve how we can use wound care products to improve healing in both human and veterinary medicine. So thrilled to have you both on.
First of all, I'd like to introduce Jacob. Jacob, as the founder of the company, what brought you to creating such a, a clever product and maybe just tell us a little bit about your background and, and how you came to sort of create the, the product? Well, thank you for having me today, Doctor Chadwick.
So, my background is I am a chemist, a physical organic chemist to be specific, so I'm very interested in reaction mechanisms and how we produce molecules. That said, I had a coworker several years ago who was a type one diabetic, lifelong, very active individual, and other than that, there was no obvious pathologies that he was suffering from. So, one day on a Friday, I said goodbye to him, for the weekend, and on Monday, he didn't show up to work.
And when we got in touch with him, found out that he was in the hospital and they were evaluating whether they would amputate his lower limb. And that was my introduction to diabetic foot ulcers, and the, the pathway from diabetic foot ulcers to veterinary medicine is simply that, as we looked into diabetic foot ulcers, we realised that there were effective treatments to close even long term chronic wounds, and there were plenty of examples in the literature, but there weren't really effective means to deliver a very important molecule nitric oxide. It's a gas, and so it either comes from a gas cylinder or it's produced from a pharmaceutical and we thought we could do something to deliver nitric oxide directly to the wound bed in a convenient and cost effective manner.
We developed it and tested it on humans in a clinical trial in Columbus, Ohio. And as we proceed through the FDA for approval here in the United States, we decided to, launch a veterinary product as well. It turns out that nitric oxide is a breakdown product of the amino acid arginine and works quite well to heal veterinary wounds.
As we started to introduce the product, we we got introduced to Doctor Wallace, who maintained an interest in this area, and in fact had some experience, treating with, . It's topical edennophil specifically, which is a . A phosphodiesterase inhibitor, which effectively increases the con it sort of functions by increasing the concentration of cyclic GMP, as a pseudo nitric oxide increasing agent in the vascular system.
And so, we decided that we could create something that would be cost effective and fit into the continuum of care of veterinary medicine. And I, I think we've done that and I, I hope that, the vets who listened to this will be excited by what they hear, today from Doctor Wallace. So that's a little bit of the intro in the background, but, we're excited about the veterinary applications here.
And just maybe talk to me a little bit, Jacob, about how we actually, how it's delivered, what is the mechanism of delivery, what's the, the clever tool that you've created? So what we've done is we've created a reservoir which has no nitric oxide in it. And in order to activate the delivery of nitric oxide, all the vet does is wet the product.
You simply add water or saline to our pads and our gels, and they become active and will deliver nitric oxide for up to one week as long as they stay wet. So water activation is the key here. And how do you keep them wet on the on the actual wound itself?
Well, so in this case, I can only advise, I think I'll turn this over to Doctor Wallace as a practical nature of that whatever you can do to occlude the dressing, is what we recommend. Brilliant. Mandy, perhaps before we go into the product specifically, just tell everybody about your background.
Obviously, like myself, you're a veterinarian, er tell us a little bit about your history there. Yes, absolutely. So, I am originally from Mississippi and went to veterinary school at Mississippi State University.
After graduating there, I did a rotating small animal internship at Colorado State University, followed by a research fellowship at the University of Pennsylvania, and then ended up, thankfully going to the University of Florida to do my small animal surgery residency and completed a master's there. During my time there, one of the classes I took was in biomaterials for my master's, and I got very interested in novel products and novel biomaterials that can be used for a variety of veterinary applications. I also had the good fortune, of treating a lot of wounds during my residency and one dog in particular that really stuck with me, was a puppy that had, wounds over about 45 to 50% of her body that were from a burn.
And with her, I got to really test my knowledge of how to treat wounds and how, and using a lot of innovative products and really fell in love with the thought of wound healing, how do we make it better? And as all veterinarians know, we deal with wounds so often. As I moved into my role, on faculty at the University of Georgia, I, experienced more and more wounds, had the opportunity, like Jacob mentioned, to work with the topical sildenafil product, but did not have the success that we had hoped in testing that particular product.
I was really excited, when I started to hear about the not sign and restore product and how it would have the same nitric oxide qualities I was looking for, but in a product that was more easily, usable and readily available for veterinarians to apply into their practise currently. It sounds like a really novel product, you know, that it is available in the pad and is obviously activated by, by water. How do we keep that activation going for the week?
Is it because it's against the wound and that wound is moist, so it's more for moist wounds that will keep the product working for that, for that week period. Yeah, so it's what we, we have done, in using that and then they also have a gel product as well. And so a gel that's separate from the pad, and we tested both of those products.
The gel itself stays remarkably moist. You unbelievably moist, honestly. When we put it on the product and what we've done is use an occlusive type dressing over it.
So a telop pad covered by something like Ioan or some sort of, occlusive or semi-occlusive dressing has seemed to keep it moist. I've not tried it out for a week. The most I've done is to.
3 days, but I've been very happy with the, how well we were able to keep it moist. And I do think some of that is the wound exudate getting into the product and keeping it moist and then some of that is applying some sort of, of semi-inclusive dressing over it in order to maintain the moisture within the product. Of course you get these terrible cases with burns and so on, sometimes accidental, sometimes, due to cruelty they can be really upsetting cases, but this sounded like it was a real .
Fantastic case for you, presumably the animal recovered really well poster, you know, with all the wound work that you've done on it. Problem I think always with, with wound dressing is it can become very expensive, but as you say, you've made this so it's very cost effective to do. What sort of costings are you looking at for the sort of dressings that you're using on and perhaps give us a couple of examples of, Where you're using it mostly in your, in your practise as a, as a surgeon.
Absolutely. So I actually have a, a case that I used it on last week. In fact, so we have, a, English bulldog, which we see a lot of here at the University of Georgia as that's our, football team's mascot.
And he had some pretty severe traumatic wounds of unknown origin. They believe he was attacked by either a wild animal or or another dog. And he had had multiple surgeries, one of which developed a very bothersome multi-drug resistant infection and, right over the elbow.
So just a terrible location, especially in a dog with, legs that are not as quite as long and straight as we would hope. And so, in that case, we're dealing with this very bad infection. One of the great things That nitric oxide is that can, can combat infection.
And we really didn't have a lot of good options for this wound. So, in this case, it was a very awkward location right over the front of the elbow, kind of going up toward the shoulder. And we used the notano Restore pad in that situation.
Moistened it. It fit perfectly in there and then we were able to cover that with a telfa and with Ioan, so we didn't have to keep him in a super large bandage and allowed him to have the mobility he needed without having a massive bandage to keep that on. So I thought that was a really good use of that, especially in a case where we didn't have great granulation tissue.
In the study that we did, we showed that the Nano restore pad, developed granulation tissue up to 2 days faster than our control dressings. And so in this particular case where I'm looking to build granulation tissue, that was a great option for that case. And we did develop granulation tissue faster than I would have expected, given the nature of the wound and, and how long it had been going on for.
I also think it's great for surgical site infections, where you need to build some granulation tissue, have some wound contraction before, closure. I love it for that, especially the gel. And then anywhere where you just have a really large wound that you would like increased contraction for, in a quicker manner.
So we found that in our study as well that The, Nxano restored gel and pad improved wound contraction faster, and at a higher rate overall as compared to our controls. So, we were seeing a big jump in our wound contraction at 5 days, whereas the controls were. Closer to 8 days, which is going to allow you to close your wounds faster, make those wounds smaller for closure and give you even more surgical options.
So, that's where I tend to, to reach for this is really in any stage of wound healing, but particularly when I want increased granulation and increased, wound contraction. And obviously with most wounds they're very surface positioned. We want to, if we can reduce the use of antibiotics, you know, we know that there's antibiotic resistance in human and animal medicine, and of course, Too much use of antibiotics means that when we really do need them, we won't have the option of them.
So being able to use products like this topically is, is a huge advantage because antibiotic resistance is becoming an increasingly big problem, isn't it, all over the world. It, it really is. And that's, you know, when we look to human medicine and we look at the people who are really pushing the envelope with veterinary wound management, we're seeing this real transition toward topical, antimicrobial.
Efforts. So really avoiding oral antibiotics when we can using, topical products like sugar or honey, silver, immacain-based, topicals rather than giving them systemically. And I think Nxano fits so well into that because we know that it can provide those antimicrobial properties while also giving other benefits toward wound healing that maybe we can't get from some of the other products.
And certainly, you know, as a dermatologist, the shampoos can be so useful because, Go back 2030 years and we, we sort of said right, we're going to give 3 or 4 weeks of antibiotics and there was no real scientific basis for that. It was in the textbooks and we all followed the textbooks, and now we're finding, well, we need to play around with length of antibiotic courses that we give and so on and so the more we can use, particularly shampoos that can cover the whole body, but then if there are particular areas that have a a a wound that's not granulating well, then I think this product really fits in well. In that particular area, doesn't it?
It does, yes. I think that's a great area where we really are, especially, you know, in humans are looking at chronic wounds, and I think we obviously have those in veterinary medicine as well. I think of decubital ulcers as a big one, you know, dogs that have been recumbent, we have these wounds over the elbow, we really don't have great surgical options and we're often looking at second.
Attention healing. I think this is a great option for that because of the increased wound contracture, that we can get those closed hopefully more, more quickly than we would be able to otherwise and without using new things like skin flaps and grafts that we know, or have their use, but also have a higher failure rate as well. Well, I think this is the thing with decubital ulcers, there's a tendency to then try and cut as much of the tissue out and then of course it doesn't heal again and then you end up with a, a bigger problem than you started with, which, which is never, never good.
We, we want to do no harm, so these sort of products can really help. Do you, do you find with things like road traffic accidents, obviously you lavage the wound, you then put this treatment on, you you then cover it. 3 to 4 days you come back and you can potentially then see if there are things that you can bring together.
You've got better tissue then to, to actually work on, but I suppose a lot of the time. If you haven't stitched early, these are greater. Issues where they can just heal by secondary intention.
Potentially so, yes. So, you know, with our traumatic wounds, I'm tending, at least for the first day or two, wanting to check the wound every day. And so, I may go the first day with like a typical wet to dry bandage or, or something of that nature, just so I can see if there's further necrosis before I'm going to go a few days, placing this.
But the good thing is you could place this on day one and remove it even if it, though it would go 3 to 4 days or more, we can replace it daily and we did do that, in the early part of our, research study. We did daily changes. And the nice thing is if the granulation builds so nicely in, in our study, we actually did not go in with the intention of closing any of the wounds.
Every wound was meant to close by second intention so that we could see it out as far as it would go. And so I think that's a great option if it, you know, if you do that and it contracts enough after 3 or 4 days where you weren't having to close it or you can give it one more round without closing, I think that's obviously a benefit and maybe even, you know, likely more cost effective because, the cost of this is, Inexpensive enough that at least in my hospital, I could get 2 packs of suture or I could get this. And most wounds are going to take more than 2 packs of suture.
So, you know, and the cost of, you know, anaesthesia, packs, sterilising, all those sort of things. So, you know, I think if we can use this and make those wounds smaller or even avoid closure, that's even better. Obviously I think we're mainly talking about dogs here, but is this, we know the problem with proud flesh in in horses.
Is this a product that you've also tried in horses as well? Since I know Doctor Wallace hasn't done that personally, I'll jump in here. Yes, in fact, one of the key features of nitric oxide in, physiology is moving, from the inflammatory state to the proliferative state.
And so it, it's responsible for the polarisation switch and macrophages and it seems, at least based on my understanding of the literature that, being in the inflammatory state is where the proud flesh develops in equine wounds. And so anecdotally, we have seen that we we do not cause proud flesh. We are looking to study that in a more rigorous manner but we think that's the reason is because the polarisation switch to get out of the inflammatory phase.
Cos that would be really powerful because horses do like to create and produce proud flesh, don't they? So it would be a a great product if we can add that one in as well, an extra indication. Yes, absolutely, and so we're, we're based in Cincinnati, Ohio, and for the listeners in the UK you've probably at least heard of Kentucky, as a very, horse heavy area of the United States.
Cincinnati is on the border, with Kentucky, so we have quite a number of, fantastic veterinarians who have used this product and, and reported really great results in equine. And I think the Georgians like the horses as well, don't they, and the Tennesseans. Yes, yes, lots, lots of horses here and I know that we've had here at the University of Georgia, you know, I've obviously been raving about this since our study, and we've had a lot of interest from our large animal colleagues as well as our colleagues in exotics and zoo medicine, who are really excited at using it in some of their more interesting species.
Yeah, I was gonna say as well, it, it, it would be really fascinating because of course the skin in in reptiles and so on is completely different, but it will be really interesting to see if it can have some indications in, in those fields as well. Yes, we're looking at setting up a study, actually with one of Dr. Wallace's colleagues, a reptile model, later this year.
But, but, since we've launched the product, we know we have a number of zoos across the United States that have adopted the use. And, it's, it's really been a, a, a fun experience for the non-veterinarian on this call, to say that, seeing jaguars or, ostriches or elephants, or these types of exotic animals are just beautiful and majestic, using our product and actually having very nice healing results from them. That's OK for you to say, Jacob, but you don't have to take the dressing off 2 or 3 days later off the Jaguar, do you?
I, I, I am just amazed by the, exotic vets and the work that they do. God bless them because I, I, I don't think I have the nerve to do that. And what other areas, you know, as a very innovative company do you see yourself going into as well as the, the, the product that you've got at the moment, are there other products in the, in the range that work in similar ways or have you got other areas that you can tell us without breaking the Official Secrets Act?
Oh, for sure, yes. And so, so in the veterinary field, we're looking at things like otitis externa. We have done an initial test on that and it looks very promising.
One of the, initial questions is, of course, do you, do you do any damage? Can we remove this from the ear? We're through that phase of the testing.
The second is to resolve the issue, and the, the early indications are that, that we can treat the otitis externna as well. You mentioned that you're a dermatologist. We have partnered with a couple of dermatologists here in the United States, and so far we're seeing some very promising results on the early cases that they have tried, and so we think that, if you're dealing with, anything that's a skin based issue, that we, we are likely to be able to help you out with that.
And I think it's really important with otitis, it's a very common condition. And of course we end up using a lot of polypharmacy, so people don't always do cytology, which is one of my things that I used to enjoy doing because you can then be very specific. Is it fungal?
Does it look bacterial, or is it just looking more inflammatory. So again, by using products like this, and often just normalising the skin barrier. Then the bacteria or the fungus don't have that opportunity to stay within the ear and will be, will be destroyed that way.
So this is sounding very interesting as well, so please keep us informed how the, the work is going on the otitis external. We we like to sort sort these cases out, Jacob, before the surgeons have to go in with their, with their scalpel blades and mutilate the poor dog's ear. Yes, and we hope we can be a useful tool to veterinarians like you to save those that that trauma for the animals.
That's that's really fascinating and it's so interesting to see that we take a product and then we see how we can develop the range of use of it and it sounds like there are. Many more possibilities with this particular product as well, so we will watch intently to see how it develops over time. Obviously, you're based in America, the product is out there.
Is it commercially available in America yet or is it still undergoing trials with with people like Mandy? Yes, we're widely available in the United States. We're available through all the major distributors, so our American veterinarians can get that, and we are actively pursuing a launch of the product in the UK and across Europe in 2024, so hopefully, you and vets like you will have access to this product very soon.
That sounds fantastic, and we'll, we'll look forward to watching out for that. It's, it's always interesting again, as I say, you know, as an innovative company yourself, but one, we also have it as one of our value words that we're able to show vets what the future is, and often the future is actually happening in human medicine, and it's really powerful to see that we've been able to take a human product and bring it into the veterinary field and and help us with these. Difficult cases which can be often very upsetting obviously for the animal, but also for the for the pet parent as well.
Yes, we're, and we're happy to just be a tool to help you guys improve health outcomes and of course the stress that that deals on both the animal and the pet parent, reducing that is just a wonderful outcome. Jacob, it's been so good to speak to you, obviously also Mandy as well. I think it's a product that we need to see more of as it comes across to the UK and I'm looking forward to hearing some really good stories from our vets in Britain and Europe as well.
So thank you so much for agreeing to come on the podcast today. Thank you for having us, Dr. Chadwick.
Thanks everyone for listening, hope to see you on a podcast very soon. This is Anthony Chadwick, the webinar vet. And this has been that chat.
Take care, bye bye.
