Diabetic Foot Ulcer Clinical Trial
Official title:
Prospective, Multicenter, Single-blind, Randomized, Controlled Clinical Trial on Safety and Efficacy of a Novel Topical Formulation Containing Erythropoietin for the Treatment of Diabetic Foot Ulcers
Remedor has developed a patented technology (RMD-G1), which comprises erythropoietin (EPO) as
the active pharmaceutical ingredient (API) in a carbopol-based hydrogel with an FN matrix.
RMD-G1 was designed to maintain EPO stability and activity over long periods and to optimize
the administration of EPO onto the wound bed.
RMD-G1 is indicated for treating DFUs in adult patients with diabetes mellitus and aims to
accelerate the healing of diabetic foot ulcers. RMD-G1 is an adjunct treatment, and not a
substitute for good diabetic wound care, which includes initial debridement, wound cleansing,
pressure relief, and infection control. In this trial, RMD-G1 is applied daily onto a clean
wound at 0.25g per sq. cm. wound surface. After its application, the wound will be covered
with a dressing in order to prevent leakage of the hydrogel and contamination of the wound
area.
Delayed healing of a neuroischaemic diabetic foot ulcer (DFU) has been related to prolonged
local inflammatory response, an unstable provisional matrix, increased degradation of the
extracellular matrix, lack of growth factors and their receptors that are crucial for
healing, fibroblast dysfunction, impaired neovascularization, increased oxidative stress, and
cellular apoptosis in the wound bed, all of which collectively hinder re-epithelialisation
and wound closure.
Erythropoietin (EPO) is an approved drug which is widely used for treating anaemia. EPO is a
well-known glycoprotein hormone, which is primarily produced by the tubular cells of the
kidney. EPO is widely known for regulating the red blood cell mass by stimulating
differentiation and proliferation of precursor cells and hindering apoptosis of erythroid
cells in the bone marrow. Millions of people have received EPO since its market approval by
the US Food and Drug Administration in 1989 as a treatment of anaemia in patients with
chronic kidney disease and later on as a treatment for chemotherapy-associated anaemia. There
is growing evidence that both systemic administration and topical EPO application to skin
wounds in animals with experimentally-induced diabetes mellitus (DM) and in patients with DM
accelerates the healing of these wounds. This accelerated wound healing is mediated by EPO
because it concomitantly suppresses the inflammatory response and apoptosis and stimulates
angiogenesis, re-epithelialization, and collagen deposition.
Growing studies in experimental healthy and diabetic animals have demonstrated that systemic
or topical treatment with EPO onto acute and chronic wounds and burns is safe and effective.
Recently, the molecular mechanisms of EPO action in wound repair have been elucidated. EPO
acts on all cutaneous cells that are involved in the wound healing process by promoting
cellular differentiation and proliferation, exerting cytoprotective actions, and inhibiting
inflammation and apoptosis due to the presence of EPO receptors in these cells [Hamed et al.
2014].
The aim of this multicenter, single-blind, randomized, controlled clinical trial is to
evaluate the safety and efficacy of topical RMD-G1 treatment for DFUs. This study is an
exploratory proof-of-concept study on RMD-G1 treatment for DFU.
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