egf study

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. * 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. DYNAMIC
REPARATIVE
PROCESS
ORDERLY
WOUND
HEALING INTERACTIVE

4. CELL RECRUITMENT IN WOUNDS
Platelets Neutrophils
Macrophages
Fibroblasts
Lymphocytes
Post Wound Days

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. WOUND HEALING involves
 Leucocytes
 Extracellular Matrix
 Fibroblasts
 Macrophages
 Epithelial cells
 Endothelial cells
 Cytokines / Growth factors

7. Recombinant Human Epidermal Growth Factor

8. Aim
To validate the efficacy of Recombinant
Human Epidermal Growth Factor in healing of
Diabetic Foot Ulcers at Biochemical and
Molecular levels

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. 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. Histologic analysis
 Matrix alignment
 Cellular infiltration
 Differentiation of Epithelial layers

12. Biochemical analysis
 Quantitative estimation of Collagen /
Proteoglycans

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. 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

19. Day 1 Day 14

20. Day 1 Day 21

21. Day 1 Day 30

22. Day 1 Day 14

23. 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

24. Thank You !