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* Dr.Rajesh Kesavan * Dr.Vijay Viswanathan # Dr.Mary Babu # Ms. Ramya * Ms.Sivagami

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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* Dr.Rajesh Kesavan * Dr.Vijay Viswanathan # Dr.Mary Babu # Ms. Ramya * Ms.Sivagami

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  1. EFFICACY OF RECOMBINANT HUMAN EPIDERMAL GROWTH FACTOR IN HEALING DIABETIC FOOT ULCERS –BIOCHEMICAL AND MOLECULAR ANALYSIS – PRELIMINARY RESULTS

  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 WOUND HEALING REPARATIVE PROCESS INTERACTIVE ORDERLY

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

  5. 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

  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. Results Total no. of patients = 16Group 1 (EGF) = 8Group 2 (Placebo) = 8

  14. Quantitative estimation of Collagen

  15. Day 1 Day 14

  16. Day 1 Day 21

  17. Day 1 Day 30

  18. Day 1 Day 14

  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. Thank You !

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