Effectiveness of the Autologous Adipose Tissue Harvested With SEFFICARE Method for Treatment of DFU Minor Amputation

Diabetic Foot Ulcer Clinical Trial

— SEFFIDiFA  

Official title:

Autologous Adipose Tissue Harvested With Superficial Enhanced Fluid Fat Injection (SEFFICARE) Method for Treatment of Diabetic Foot Ulcer Undergoing Minor Amputation (SEFFIDiFA): Proposal of Basic Research and Prospective Observational Study

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05072353
• Other study ID #: SEFFIDiFA_vers1.0
• Status: Not yet recruiting
• Phase: N/A
• Start date: December 2021
• Est. completion date: October 2024

Study information

• Verified date: September 2021
• Source: Azienda Ospedaliero-Universitaria di Modena
• Contact: Nicola Leone, MD
• Phone: +390593961225
• Email: nicola.leone.md[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Diabetic foot ulcers (DFU) are one of the complications of diabetes mellitus resulting from multiple causes such as neuropathy, ischemia, and infection that contribute to morbidity and amputation. The prevalence of DFU has been estimated to be 3 to 5 times higher than the overall population. Minor amputations (digital or transmetatarsal) are the treatment of choice in case of irreversible DFU. However, many minor amputations do not heal and require re-amputation. Improvements of healing rate after adipose stem cells (ASCs) injection through micro-fragmented autologous adipose tissue of the amputation stump following minor DFU amputation were demonstrated. The use of ASCs obtained from the superficial enhanced fluid fat injection technique (SEFFICARE) to improve the healing process after DFUs minor amputation is the object of the present study.

A single-center non-randomized prospective observational study will be performed.

The recruited patients will undergo local injection of superficial enhanced fluid fat after a lower limb minor amputation. Laboratory analysis to evaluate the composition of the tissue and stromal cell components harvested from adipose tissue with SEFFICARE system by using digital droplets PCR. These data will serve for making associations between the clinical outcome and characteristics of the cell population administered to each patient.

Description:

Diabetic foot ulcers (DFU) are one of the complications of diabetes mellitus resulting from multiple causes such as neuropathy, ischemia, and infection that contribute to morbidity and amputation. The prevalence of DFU has been estimated to be 3 to 5 times higher than the overall population. Minor amputations (digital or transmetatarsal) are the treatment of choice in case of irreversible DFU. However, many minor amputations do not heal and require re-amputation. Improvements of healing rate after adipose stem cells (ASCs) injection through micro-fragmented autologous adipose tissue of the amputation stump following minor DFU amputation were demonstrated. The use of ASCs obtained from the superficial enhanced fluid fat injection technique (SEFFICARE) to improve the healing process after DFUs minor amputation is the object of the present study.

STUDY DESIGN: Single-center non-randomized prospective observational cohort study.

TREATMENT: Local injection of superficial enhanced fluid fat after a lower limb minor amputation. Laboratory analysis to evaluate the composition of the tissue and stromal cell components harvested from adipose tissue with SEFFICARE system by using digital droplets PCR. These data will serve for making associations between the clinical outcome and characteristics of the cell population administered to each patient.

INCLUSION CRITERIA:

• type-1 and type-2 diabetes mellitus

• age >18-years

• both sexes

• chronic diabetic distal ulcers/gangrene (digital or forefoot) intended as W-grade 1 to 3 according to WifI classification;

• absence of active vascular issues or patients undergoing lower extremity revascularization to improve peripheral perfusion intended as I-grade 0 to 2 according to WIfi classification;

• absence of infection signs or presence of soft tissue infection intended as fI-grade 0 to 2 according to Wifi classification, without radiologic signs of bone infection (negative X-ray for osteolytic lesions); SAMPLE SIZE: The correct sample size was calculated considering as primary endpoint the proportion of the healing stump. The sample size was calculated with the Score Z test comparing one proportion based on literature results to a reference value. Using a significance level of 0.05, power of 0.8, setting the H0 proportion of 0.80 and the Ha of 0.6 respectively, the result was 36 subjects. An additional 10% of subjects was considered taking into account eventual drop-out during the study. The final sample size inflated to 40 patients.

ENDPOINTS: Primary endpoint: percentage of stump healing; Secondary endpoints:

• mean time for complete healing;

• evaluation of risk factors afflicting healing/failure;

• evaluation of reintervention (time elapsed since index operation, type, and indication);

• the prevalence of peripheral diabetic polyneuropathy at baseline;

• the percentage change in the pain score of NRS;

• health-related quality of life evaluation, intended as changing of the SF-36 score;

• collection of eventual adverse events related to the treatment procedure and eventual posthoc analysis.

• evaluation of the adipose harvested tissue composition and stromal cell components STATISTICAL ANALYSIS: The categorical endpoints, i.e., the difference in the healing rate will be assessed with the chi-square test or Fisher's exact test. The continuous variables will be calculated by Kaplan-Meier curves and log-rank test. A univariate and multivariate logistic regression analysis will be applied to identify influencing factors on the categorical endpoints. To test the influence of multiple variables on continuous data, one/two-way ANOVA will be performed with Bonferroni's post-test.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 40
• Est. completion date: October 2024
• Est. primary completion date: June 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• type-1 and type-2 diabetes mellitus

• age >18-years

• both sexes

• chronic diabetic distal ulcers/gangrene (digital or forefoot) intended as W-grade 1 to 3 according to WifI classification;

• absence of active vascular issues or patients undergoing lower extremity revascularization to improve peripheral perfusion intended as I-grade 0 to 2 according to WIfi classification;

• absence of infection signs or presence of soft tissue infection intended as fI-grade 0 to 2 according to Wifi classification, without radiologic signs of bone infection (negative X-ray for osteolytic lesions);

Exclusion Criteria:

• extensive ulcers with deep involving proximal forefoot and/or deep, full-thickness heel ulcer, with calcaneal involvement (W-grade 3 according to WifI classification);

• active vascular issues [I-grade 3 according to Wifi classification];

• ulcers with signs of moderate and/or severe infection (osteomyelitis and/or sepsis) [fI-grade 3 according to WifI classification];

• severe comorbidities such as severe heart failure, liver failure, and/or psychiatric disorder;

• previous oncological treatments (past 5 years) or ongoing and/or neoplastic lesions;

• corticosteroid therapy;

• coagulopathy;

• infection of the harvesting site;

• local anesthetic allergy;

• immunosuppressive therapy.

Related Conditions & MeSH terms

• Amputation
• Diabetic Foot
• Diabetic Foot Ulcer
• Foot Ulcer

Intervention

Device:
• SEFFICARE
The SEFFI is a 5-step technique: Preparation: the lower/lateral abdomen is chosen as the donor site. Anesthesia: the donor site is injected with a local anesthetic. Harvesting: a 0.8 mm or 0.5 mm cannula connected to a 10-ml VacLok® syringe is used to harvest the adipose tissue. The total amount of the harvested tissue could vary from 10 to 30 mL. Washing: The syringe containing the lipoaspirate tissue is immediately filled with sterile physiological solution. After some minutes the syringes in the decanting stand will show a separation by the gravity of the tissue (top) from the physiological solution (bottom). Fluidification: the syringe containing the adipose tissue should be connected to an empty 10 ml syringe. After pushing the tissue about 3 times from one syringe to the other, a good fluidification of the tissue is obtained. The resulting tissue (2.5 mL per syringe) is ready for grafting the amputation wound.

Locations

Country	Name	City	State
Italy	Ospedale Civile di Baggiovara (Modena), Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia	Modena	Emilia-Romagna

Sponsors (2)

Lead Sponsor	Collaborator
Azienda Ospedaliero-Universitaria di Modena	University of Modena and Reggio Emilia

Country where clinical trial is conducted

Italy, 

References & Publications (36)

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* Note: There are 36 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Healing	Healing was defined as complete re-epithelialization of the stump after suture removal without signs of cutaneous suffering, inflammation, infection, local swelling as determined by one investigator.	6 months
Secondary	healing time change	mean time for complete healing	1, 2, 3, 4, 5, 6 months
Secondary	risk factors afflicting healing/failure	evaluation of risk factors afflicting healing/failure	0 month
Secondary	reintervention	time elapsed since index operation, type, and indication	6 months
Secondary	diabetic peripheral neuropathy	the prevalence of DPN (probable) at baseline	0 month
Secondary	health-related quality of life change	health-related quality of life evaluation, intended as changing of the SF-36 score	1, 2, 3, 4, 5, 6 months
Secondary	adverse events related to the treatment procedure	collection of eventual adverse events related to the treatment procedure	6 months
Secondary	amount of adipose stem cells used for grafting	amount of adipose stem cells used for grafting	1 month