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1362574355 egf study

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egf study

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1362574355 egf study

  1. 1. EEFFICACYFFICACY OO FF RRECO MBINANTECO MBINANT HHUMANUMAN EEPIDERMALPIDERMAL GG RO WTHRO WTH FFACTO RACTO R IINN HHEALINGEALING DDIABETICIABETIC FFO O TO O T UULCERS –LCERS – BBIO CHEMICALIO CHEMICAL AANDND MMO LECULARO LECULAR AANALYSIS –NALYSIS – PPRELIMINARYRELIMINARY RRESULTSESULTS
  2. 2. * Dr.Rajesh Kesavan * Dr.Vijay Viswanathan # Dr.Mary Babu # Ms. Ramya * Ms.Sivagami * MV Hospital for Diabetes and Diabetes Research Centre, Royapuram, Chennai # Central Leather Research Institute, Chennai
  3. 3. DYNAMIC REPARATIVE PROCESS ORDERLY WOUND HEALING INTERACTIVE
  4. 4. CELL RECRUITMENT IN WOUNDS Platelets Neutrophils Macrophages Fibroblasts Lymphocytes Post Wound Days
  5. 5. COMPONENTS OF WOUND HEALING Coagulation process Inflammatory process Migratory / Proliferative process Remodeling process Cell Types Involved Platelets Platelets Macrophages Neutrophils Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells Fibroblasts Injury Hours Days Weeks
  6. 6. WOUND HEALING involves  Leucocytes  Extracellular Matrix  Fibroblasts  Macrophages  Epithelial cells  Endothelial cells  Cytokines / Growth factors
  7. 7. Recombinant Human Epidermal Growth Factor
  8. 8. Aim To validate the efficacy of Recombinant Human Epidermal Growth Factor in healing of Diabetic Foot Ulcers at Biochemical and Molecular levels
  9. 9. Study Design  Two groups - Intervention group and Control group  8 patients in each group  Randomized single blind study  Clinically uninfected foot ulcers in patients with type II diabetes  Ulcer size between 5 to 20 cm diameter  ABI > 0.8  Ethics committee approval and patient consent
  10. 10. Methodology  Rh-EGF ointment - Intervention group  Placebo ointment - Control group  Patients were instructed to dress the wounds everyday  Standard offloading methods followed where appropriate  Punch biopsy at Day 0 and Day 14  Patients reviewed every week
  11. 11. Histologic analysis  Matrix alignment  Cellular infiltration  Differentiation of Epithelial layers
  12. 12. Biochemical analysis  Quantitative estimation of Collagen / Proteoglycans
  13. 13. Total no. of patients = 16 Group 1 (EGF) = 8 Group 2 (Placebo) = 8 Group 1Group 1 Group 2Group 2 pp No. of patientsNo. of patients 8 8 Age (in years)Age (in years) 56.1 (11.9) 56.6 (8.5) NS Duration of DMDuration of DM 17.7 (6.6) 15.4 (5.8) NS Mean length (inMean length (in cm)cm) 5.4 (2.9) 2.6 (0.7) 0.02 Mean Breadth (inMean Breadth (in cm)cm) 3.7 (0.9) 1.7 (0.4) 0.00001 HealedHealed 3 (38%) 2 (25%) Time taken to healTime taken to heal (in days)(in days) 21 (5.1) 23 (7.5) NS Results
  14. 14. Quantitative estimation of Collagen TestTest ((µg/mg)µg/mg) ControlControl ((µg/mg)µg/mg) Day 0Day 0 0.83 0.87 Day 15Day 15 3.78 1.313
  15. 15. Day 1 Day 14
  16. 16. Day 1 Day 21
  17. 17. Day 1 Day 30
  18. 18. Day 1 Day 14
  19. 19. Conclusion Preliminary results indicate that  EGF increases collagen content of wounds  EGF hastens deposition of collagen in a proper whorled arrangement  It increases the no. of fibroblasts seen in the matrix  Angiogenesis is more prominent in the EGF gp  Chr. Inflammatory cells are seen in abundance in the control group  EGF accelerates healing in diabetic foot ulcers
  20. 20. Thank You !

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