Keloid Clinical Trial
Official title:
The Safety of Topically Delivered FS2 in Humans. Phase 1 Clinical Trial
Background Scarring typically occurs after trauma, burn injury or surgery. Hypertrophic
scarring presents as raised, red and itchy lesions which variably respond to various
treatment modalities, such as corticosteroids, pressure garments, laser therapy, the use of
silicone sheets and radiotherapy.
Kynurenine, or "Fibrostop 1" (FS1), and its further breakdown products, such as kynurenic
acid, or "Fibrostop 2" (FS2), are endogenous products found in many systems and have shown
potential in reducing scar formation in animal studies.
The aim of study is to evaluate the safety and tolerability of FS2 cream applied to the skin
of healthy human subjects.
Scarring typically occurs after trauma, burn injury or surgery. Hypertrophic scars (scars
with excessive amounts of a protein called collagen) and keloids (hypertrophic scars that
grow beyond the boundaries of the original wound) are types of abnormal scarring that are
termed "dermal fibroproliferative disorders" - disorders of abnormal growth of fibrous
tissue in the dermis, a layer in normal skin. These disorders present as raised, red and
itchy lesions which variably respond to various treatment modalities, such as
corticosteroids, pressure garments, laser therapy, the use of silicone sheets and
radiotherapy. Surgical excision of hypertrophic scars or keloids often leads to recurrence
resulting in cosmetic deformities and contractures.
In a previous study involving a hypertrophic scar rabbit model, it was found that collagen
deposition could be reduced by increasing the activity of a molecule called MMP-1 (matrix
metalloproteinase 1), an enzyme inside body cells. The investigators also know from the
investigators previous work that a molecule called kynurenine, a breakdown product of
amino-acids, can reduce collagen deposition and possibly stimulate MMP production.
Kynurenine is a breakdown product (catabolite) of the essential amino acid tryptophan used
in the production of niacin - an organic compound and essential human nutrient found in
food. Kynurenine is made by the enzyme indoleamine 2,3-dioxygenase (IDO) which is found in
many tissues in response to activation of the immune systen, and also by the enzyme
tryptophan dioxygenase, which is found in the liver. Kynurenine is further converted to
kynurenic acid, or "Fibrostop 2" (FS2), carry out many functions in the body, including
dilating blood vessels during inflammation and regulating the immune response.
The investigators have hypothesized that improved healing outcomes in the investigators
rabbit model were due to kynurenine and by-products stimulating MMP, which in turn acted on
cells (fibroblasts) to reduce collagen production. This hypothesis lead to a study
investigating the effects of topical 0.5% kynurenine cream treatment on MMP-1 and MMP-3
expression in fibrotic rabbit ear wound model. The results showed marked improvement in scar
formation suggesting the possible use of kynurenine as an anti-fibrogenic treatment against
scarring.
Toxicity, pharmacodynamic, and pharmacokinetic data has been completed, and the
investigators institution is now preparing to conduct its first Phase I clinical trial. The
investigators objective is to evaluate the safety and tolerability of topically applied FS2
in healthy human subjects by conducting a double-blinded acute and chronic sensitivity study
involving patch testing.
;
Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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