• Richmond T Bergner, Sarah Onida, Rahul Velineni, Konstantina Spagou, Manjit S Gohel, Marielle Bouschbacher, Serge Bohbot, Joseph Shalhoub, Elaine Holmes, and Alun H Davies.
• Section of Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK. Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
• Ann. Surg. 2023 Feb 1; 277 (2): e467e474e467-e474.

ObjectiveThe aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.Summary Background DataVenous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.MethodsTwenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.ResultsA differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.ConclusionsThis study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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