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E FFICACY O F R ECOMBINANT H UMAN E PIDERMAL G ROWTH F ACTOR I N H EALING D IABETIC F OOT U LCERS – B IOCHEMICAL A ND M OLECULAR A NALYSIS – P RELIMINARY R ESULTS. * Dr.Rajesh Kesavan * Dr.Vijay Viswanathan # Dr.Mary Babu # Ms. Ramya * Ms.Sivagami.
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EFFICACY OF RECOMBINANT HUMAN EPIDERMAL GROWTH FACTOR IN HEALING DIABETIC FOOT ULCERS –BIOCHEMICAL AND MOLECULAR ANALYSIS – PRELIMINARY RESULTS
* 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
DYNAMIC WOUND HEALING REPARATIVE PROCESS INTERACTIVE ORDERLY
Neutrophils Platelets Macrophages Fibroblasts Lymphocytes CELL RECRUITMENT IN WOUNDS Post Wound Days
Injury Hours Days Weeks COMPONENTS OF WOUND HEALING Cell Types Involved Coagulation process Platelets Platelets Macrophages Neutrophils Inflammatory process Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells Migratory / Proliferative process Remodeling process Fibroblasts
WOUND HEALING involves • Leucocytes • Extracellular Matrix • Fibroblasts • Macrophages • Epithelial cells • Endothelial cells • Cytokines / Growth factors
Aim To validate the efficacy of Recombinant Human Epidermal Growth Factor in healing of Diabetic Foot Ulcers at Biochemical and Molecular levels
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
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
Histologic analysis • Matrix alignment • Cellular infiltration • Differentiation of Epithelial layers
Biochemical analysis • Quantitative estimation of Collagen / Proteoglycans
Results Total no. of patients = 16Group 1 (EGF) = 8Group 2 (Placebo) = 8
Day 1 Day 14
Day 1 Day 21
Day 1 Day 30
Day 1 Day 14
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