Ernest Azzopardi’s research has shown antibiotics could be engineered to target an infected area directly.Ernest Azzopardi’s research has shown antibiotics could be engineered to target an infected area directly.

Research by a Maltese plastic surgeon based in the UK has resulted in a breakthrough in the way antibiotics are administered to treat life-threatening infections. Ernest Azzopardi’s research has found it possible to custom-engineer antibiotics to concentrate at the location of the infection rather than allow them to move indiscriminately to unaffected organs, potentially avoiding severe side effects, such as kidney and liver failure.

All antibiotics currently being used are made up of very small molecules that travel along the entire body until the infection is found.

Dr Azzopardi’s research showed that antibiotics could be engineered into very large molecules, making it possible for them to physically target the infected area directly.

Dr Azzopardi conducted his research in the field of nanomedicine, the science of diagnosing, treating and preventing disease and traumatic injury using molecular tools and knowledge of the human body over a period of three years, at Cardiff University.

This ground-breaking research lies at the interface between plastic surgery, drug development and nanomedicine and has also contributed to an entirely new class of antibiotics.

When contacted, Dr Azzopardi, who is currently based at the Welsh Centre for Burns and Plastic Surgery in Swansea, said bacteria such as MRSA, which quickly become resistant to antibiotics, are a major cause of apprehension to doctors and surgeons as they lead to severe complications.

While MRSA has become a household name, newer and more dangerous bacteria such as Acinetobacter and E. coli are emerging.

“Increasingly, cocktails of antibiotics or older and much more toxic antibiotics are used as a last resort.

“Compounded by decades of pharmaceutical under-investment, the antibiotic development pipeline has all but dried up.

“These exciting discoveries, which have already been tested on infections from burn patients, are expected to help reverse this trend,” Dr Azzopardi said.

He explained that some bacteria yield useful products, such as botulinum toxin (botox) which, when appropriately produced and administered, is useful in anything from squint surgery to reducing wrinkles.

Most bacteria, however, have a devastating effect on patients. Infection remains a leading cause of death and disability in surgical patients.

“My previous work in field of burn and reconstructive surgery identified a common set of culprit bacteria responsible for infecting burn wounds and resulting in increased deaths.

“Very few, if any, new antibiotic classes have been released in several decades and these bacteria have become more and more resistant to them,” he said.

Having identified these bacteria, the next step was to prove that a prototype could be built.

The antibiotic development pipeline has all but dried up so these exciting discoveries are expected to help reverse this trend

As part of the research, antibiotics were custom-welded on to large sugar molecule chains. Tests showed that amylase, an enzyme that breaks sugars down, concentrates around an infection, providing an ideal trigger to unveil and activate the antibiotic.

Asked about the benefits to patients, Dr Azzopardi explained that the technology has the potential of achieving many advantages.

“Most of the dose of an antibiotic is currently wasted as only a part of it goes to where the infection really is.

“Using this technology, it is possible to target a dose to the infection itself. Less antibiotic goes where it is not needed, resulting in fewer side-effects.

“The antibiotics also have the potential of acting for longer, avoiding the need for repetitive dosing, increasing a patient’s comfort,” he said.

Side effects of current antibiotics may include serious damage to the kidneys and the brain.

After reading for medicine and surgery in Malta, Dr Azzopardi trained within the Oxford and Welsh schools of surgery, specialising in plastic surgery and nanomedicine.

During this time, he read simultaneously for MRCS and Master in Surgery. His PhD degree, supported by a STEPS Scholarship and part-financed by the European Union through the European Social Fund, was awarded with no corrections, an honour reserved for the most gifted studies.

The importance of these discoveries has since been recognised by prizes and citations. Dr Azzopardi was recently awarded the highly-coveted Syme Medal for his scientific contributions in the field of burn and wound infection.

Dr Azzopardi’s continuing research into nanomedicine, as well as the wider remits of reconstructive and aesthetic plastic surgery, has been published in several journals.

He said the next phase of the research will concentrate on finding the most suitable doses, followed by human trials in the near future.

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