When MediWound’s treatment for severe burn wounds received regulatory approval early last year, the biopharmaceutical company didn’t think the drug would be saving lives of Israelis during its most prolonged war just months later.

“The son of one of our senior executives, a tank crew member, was 40 percent burned [in Gaza], and they used NexoBrid to literally save his life,” says Ofer Gonen, CEO of Israel-founded MediWound.

The novel drug NexoBrid, MediWound’s flagship product, contains a concentrate of proteolytic enzymes derived from pineapple stems. 

When applied on the skin, the enzymes in the drug selectively slice apart the tissue damaged by the burn, leaving the healthy tissue completely intact. 

“It replaced a very painful surgical alternative with an easy topical application. This drug is revolutionary,” Gonen tells ISRAEL21c. 

Impact of October 7 attacks 

NexoBrid was approved for use by the US Food and Drug Administration (FDA), as well as by regulatory agencies in 43 other countries, including Israel. 

“Israel was supposed to be a small market for us, but due to the war our drug played a crucial role in saving lives,” explains Gonen.

“All our non-US inventory had been deployed to hospitals across Israel [at the start of the war]; dozens of lives of soldiers and civilians, specifically from the October 7 attacks, were saved thanks to the drug.”

Gonen explains that a person who requires a serious surgical intervention is unlikely to survive the procedure if their body is burned 30% or more. 

The expansion of the use of the drug in the Israeli health system in the days following the Hamas attacks was so successful that “currently in Israel, everyone that needs to be treated for burns is treated with NexoBrid.” 

Additionally, says Gonen, the successful use of the drug in Israel has been generating interest from governments around the world, which have been “stockpiling it for all kinds of disasters.”

Diabetic foot ulcer drug 

In July, MediWound was selected to receive €16.25 million in blended funding from the European Innovation Council (EIC) through its accelerator program.

The funding is intended for MediWound’s pipeline drug EscharEx, meant to treat chronic wounds, primarily venous leg ulcers and diabetic foot ulcers. 

The up-and-coming treatment is based on the same active pharmaceutical ingredient as NexoBrid. The only difference is a lower concentration of enzymes, providing a gentler treatment for ulcers.

There are around 150 million insulin-dependent diabetes patients worldwide, with the official number likely to be underestimated. “A quarter of them will develop a diabetic foot ulcer in their lifetime,” says Gonen. 

“These ulcers are chronic and painful; they never heal and have a terrible smell,” he adds.

Diabetic foot ulcers increase the risk of developing a severe infection, which can potentially lead to amputation of a limb or even death. 

“A diabetic foot ulcer diagnosis is more life threatening than lung cancer, bladder cancer and breast cancer. Fifty percent of these patients will die within five years of being diagnosed,” notes Gonen. 

To keep this type of ulcer at bay, the dead tissue that forms around it must be constantly removed.

“Currently, there are two options available,” says Gonen. “One of them is to cut it off with a knife, which is very traumatic. Imagine a painful scab that you need to remove with a knife; no one prefers this avenue,” he notes.

“The second one is a very slow-acting drug. It takes something like 60 days in order for it to have a certain impact.”

MediWound’s treatment is effective in removing the dead tissue around the ulcer after one week of application, says Gonen. 

The company is in the last stage of its clinical trials for EscharEx, anticipated to hit the market by 2028-2029. 

20 years to develop a drug

MediWound was founded in 2000 by Dr. Lior Rosenberg, who for many years was chief of plastic surgery at Soroka Medical Center in Beersheva. Rosenberg, 79, remains with the company as a consultant. 

“He hated treating burns, and if you saw one picture of a severe burn, you would understand why,” Gonen tells ISRAEL21c. 

While attending a medical conference in the late 1990s, Rosenberg met a doctor who told him he was working on a pineapple-based treatment for burns. 

“That doctor took a hot iron and gave himself a third-degree burn; he then took raw material from a pineapple stem and applied it [on the burn]; after seeing the results in a few hours, our founder signed a contract with him on the spot.”

Still, a journey from that conference to FDA approval took nearly 23 years.

“You need to prove all kinds of consistencies, prove that you are able to manufacture it, and conduct many clinical trials across many countries,” notes Gonen.

He adds that NexoBrid is only the third innovative Israeli drug to be approved for use by regulatory agencies in Europe and the United States.

“Developing a drug takes 20 years and hundreds of millions of dollars in investments, with the probability of success being very low,” explains Gonen.  

“It doesn’t fit the Israeli business culture. In biotech, unlike in high- or cyber tech, you can’t have shortcuts.” 

Not a startup anymore 

Since Gonen, a biotech industry veteran, assumed the position of the CEO in 2022, MediWound has raised over $80 million. The company has raised over $200 million since its founding 24 years ago. 

MediWound currently employs 120 people, with the majority based in Israel. It generated $20 million in revenue last year from the sales of NexoBrid, helping it to become publicly traded on NASDAQ. 

Next year, the company plans to scale up its manufacturing facility in the southern Israeli city of Yavneh, where MediWound is headquartered, to keep up with the market demand.  

Since receiving regulatory approval, the company has founded a commercialization arm in Germany, and expanded its American activity. 

“We are at a point in time where the company shifts from a startup to a real company; we don’t need to raise additional capital,” Gonen says.

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