| Eligibility |
Inclusion Criteria:
1. Patient is between 18 and 80 years of age
2. Patients with Type I or Type II diabetes with a glycosylated hemoglobin (HbA1c) of =
12 %, obtained at enrollment or within 30 days prior to study enrollment
3. Patients who have a wound defined as diabetic foot ulcer present for = 4 weeks
4. Foot ulcer Wagner grade I - II or ARMSTRONG grade I-A (superficial, non-infected,
non-ischemic wound not involving tendon, capsules, or bone) or II-A (non-infected,
non-ischemic wound penetrating to tendon or capsule but not to the bone or joint)
5. Estimated foot ulcer surface area between = 0.8 cm2 and = 8 cm2 as measured at day of
randomization assessed using the eKare imaging and measurement device
6. A patient with more than one diabetic foot ulcer may be included in the study but only
one ulcer will be selected for the investigational treatment based on Investigator
judgment as far as the ulcer meets the inclusion criteria (the largest ulcer fitting
the inclusion criteria will be selected as index ulcer)
7. Wound area has not changed by more than 30 % between screening visit and randomization
visit (at least 14 days)
8. Adequate arterial blood perfusion measured on the leg with treated wound (ABI [ankle
brachial index] =0.5 [the lowest ABI measured value will be used as reference], or toe
pressure > 40 mmHg, or tcPO2 > 40 mmHg) within the past 6 months including patients
with mild to moderate peripheral arterial disease (Fontaine Stage I and II)
9. Patient must adhere to off-loading of the ulcer area (in mobile patients adherence to
off-loading footwear during the study is mandatory)
10. Patient is able to give written informed consent prior to study start and to comply
with the study requirements
11. Women of childbearing potential agree using adequate birth control methods during the
study
Exclusion Criteria:
1. History of anaphylaxis, known hypersensitivity to sodium alginate, propylene glycol,
methylene-blue or chicken-egg
2. Target ulcer is over a deformity (such as Charcot deformity) that interferes with
off-loading based on investigator's opinion
3. Index wound duration of > 3 years without intermittent healing
4. Clinical evidence of ulcer bed infection or patients requiring intravenous (IV)
antibiotics to treat the index wound infection at time of randomization
5. Current evidence of osteomyelitis, cellulitis, or other evidence of infection
including pus drainage from the wound site, or documented history of osteomyelitis at
the target wound location during the 8 weeks preceding the screening visit
6. Major uncontrolled medical disorder(s) such as severe uncontrolled leg edema,
concurrent medication, or other issue that renders the patient unsuitable for
participation in the study, including but not limited to: comorbid condition with an
estimated life expectancy of = 12 months, hemoglobin A1c (Hba1c) > 12 % at screening,
patients on dialysis, patients with severe pulmonary (requiring home oxygen,
uncontrolled COPD Gold III/ IV) or cardiovascular conditions (heart failure NYHA IV,
uncontrolled hypertension systolic BP by repeated measurement > 180 mmHg)
7. Raynaud disease or any other severe peripheral microvascular disease, current
diagnosis of vasculitis
7a. Patients with PAD who
- have not been assessed by vascular imaging as per standard of care or
- have acute peripheral artery occlusion of the index extremity or
- have PAD Fontaine Stage III and IV or
- have PAD with planned revascularization during the upcoming 6 months or
- had Angioplasty for re-perfusion in the lower extremity with target ulcer during 3
months preceding the screening visit
8. Dermatologic comorbid disease (e.g. pyoderma gangrenosum, vasculopathy or
vasculitic ulcers), history of Systemic Lupus Erythematosus with elevated anti-DNA
antibody titers, Buerger's disease (thromboangiitis obliterans)
9. Patient currently treated for an active malignant disease or prior diagnosis of an
active malignant disease who is disease free for less than 1 year. Treatment with
anticancer therapy (chemotherapy, immunotherapy, radiotherapy, targeted therapy or
gene therapy) within 3 months before the first administration of investigational
product or at any time during the study.
10. Patient with history of malignancy within the wound; history of radiation therapy
to the wound region
11. Patients who have undergone wound treatments with growth factors, dermal
substitutes, or other biological therapies within the last 30 days or during the study
12. Patients who received oral or parenteral corticosteroids, immunosuppressants, or
cytotoxic agents within 30 days preceding the first study drug administration, or plan
to use these medications during the study period
13. Patients who are pregnant or breastfeeding
14. Mental condition rendering the patient (or the patient's legally acceptable
representative[s]) unable to understand the nature, scope and possible consequences of
the study
15. Patients who are incarcerated, including prisoners or patients compulsorily
detained for treatment of either a psychiatric or physical (e.g. infectious disease)
illness
16. Therapy with another investigational agent within thirty days of screening, or
during the study
17. Patients who are considered by the investigator to have a significant disease,
which can impact the study; patients who are considered not suitable for the study by
the investigator
18. Employee at the study site, spouse/partner or relative of any study staff (e.g.
investigator, sub-investigators, or study nurse) or relationship to the sponsor
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