One of the world's leading experts in foot fungus has been recruited to test whether a machine invented in Scotland can successfully destroy unsightly toenail infections.
Dr Aditya Gupta is leading the year-long clinical trial in Ontario, Canada using a pioneering device created by Stirling-based start-up, Emblation, which will deliver doses of microwave energy to patients suffering from onychomycosis - a common fungal nail infection that is estimated to affect one in seven people.
The condition causes thickened, rough and yellowed nails which are brittle and prone to breaking off, with the fungus often spreading to neighbouring toenails or the other foot.
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Sometimes entire nails lift off causing pain and swelling in the skin around the nail. In extreme cases patients have to undergo surgery to remove their toenails.
Current treatments include over-the-counter creams and ointments which require daily applications, but are generally weak and ineffective.
Patients with very severe cases can be prescribed oral antifungal tablets which the toxicity means they have to have their liver functions tested before, during, and after treatment, which lasts around three months.
Emblation's device, known as SWIFT, uses microwave energy to kill the fungus and boost the immune response, halting the spread of infection so that the diseased nail can grow out and be replaced by a normal, healthy nail.
Dr Matt Kidd, director of research and development for Emblation, said: "The toenail is basically invisible to the microwaves so they go straight through.
"We're killing the fungus but we're also alerting the immune system to the presence of something strange there.
"The fungus itself secretes things that inhibit an immune response - so with the fungus dead and the immune system alerted, we're in with a chance of fighting back against the nail fungus.
"It doesn't cause any scarring - it's a bit nippy - but it doesn't leave a mark so it has a great advantage against other treatments like laser therapy.
"We did some work with the University of Plymouth where they grew the fungus in some agar plates and then we treated that with the microwave probe, trying different powers and times until we saw one that punched a hole right through the fungus and thought 'well, that's the one we'll use'."
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The clinical trial has been around three years in the making, with the Emblation team determined to persuade Dr Gupta - a leading researcher on onychomycosis - to get on board.
"I managed to snag him with persistence - emails and phonecalls," said Dr Kidd.
"He had a soft spot for me because he's spent some time in Glasgow - he studied in the UK. He was intrigued by our device."
The trial, which began in July, has so far recruited around 20 patients with a further 25 expected to join by the end of the year.
Participants are being randomly split into three groups of 15: Group A will receive a total of nine treatments - weekly in the first month, then monthly for four months; Group B will get seven treatments beginning with one per fortnight in the first month followed by monthly treatment for four months; Group C will get treatment every two weeks for six months, resulting in a total of 12 doses.
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All patients will be monitored for 12 months, with the results used to evaluate the optimum dosing regime.
Dr Kidd said this "pilot study" can then be used as a basis to expand into randomised control trials where the machine can be compared against other interventions, such as creams or alternative devices.
The goal is to obtain approval from US medical regulators, the FDA, which would pave the way to much wider use in healthcare - including in the UK.
The technology is already used to treat verrucas and has shown positive results against other forms of warts, which are caused by viruses.
A Glasgow University study, published in the Lancet, also showed that the precise bursts of microwave energy from the SWIFT device could be used in to destroy lab-grown cervical cancer cells associated with the human papillomavirus (HPV).
Emblation was founded in 2007 by Herriott-Watt graduates, Gary Beale and Eamon McErlean, with the aim of making smaller, lighter and cheaper microwave devices that were more accessible to clinicians working in fields such as oncology and dermatology.
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