Wound Healing Clinical Trial
Official title:
A Single-arm, Observational Study to Explore and Characterize Wound Healing After Skin Punch Biopsies in Healthy Volunteers
Verified date | August 2021 |
Source | Centre for Human Drug Research, Netherlands |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The skin plays a critical role in protection where it acts as a barrier from damage and pathogens between the external and internal environments. Wounds compromise its protective role by disrupting the function and the normal structure of the skin and the underlying soft tissue. As a response to injury wound healing occurs in order to rapidly restore the defect. This process involves activation of keratinocytes, fibroblasts, endothelial cells, macrophages, and platelets and consists of multiple phases including hemostasis, inflammation, migration and cellular proliferation, and maturation and remodeling. A simplified schematic of the course of wound healing is depicted in Figure 2. Hemostasis occurs immediately after dermal injury. The inflammation phase is characterized by cellular recruitment and increased vascular permeability. The epithelization phase is achieved by proliferation of basal cells and migration of epithelial cells. The last phase is known as the maturation and remodeling phase where collagen cross-linking and remodeling, wound contraction, and repigmentation takes place. Due to the broad involvement of various cell types, extracellular matrix and many reactive molecules each phase in wound healing produces characteristic changes within the tissue. A deficiency in any part of the process can lead to delayed wound healing, abnormal scar formation or chronic wounds. To study wound healing in healthy volunteers a challenge model with skin punch biopsies has been described in literature previously. However, the characterization of this model was not performed comprehensively since advanced analysis of biopsies were omitted. Furthermore, analyses performed in previous studies only partially described wound healing processes either by insufficient time points for characterization or scarce simultaneous evaluations of multiple wound healing modalities. The overall aim of this study is to develop a standardized model to temporarily and locally induce a skin trauma to investigate wound healing and monitor wound closure. This clinical model will enable future application as proof-of-pharmacology and proof-of concept studies as well as drug profiling in early drug development programs. More specifically, the objective of the trial is to explore and characterize the induction of well-defined skin trauma and natural wound healing process over the course of the different phases using a battery of dermatological assessments after skin punch biopsies in healthy volunteers. Furthermore, safety and tolerability will be assessed. Characterization and monitoring of wound healing effects following skin punch biopsies will be performed by means of biophysical, biochemical, imaging, clinical parameters and subject reported outcomes.
Status | Completed |
Enrollment | 18 |
Est. completion date | March 23, 2018 |
Est. primary completion date | March 23, 2018 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years to 30 Years |
Eligibility | Inclusion criteria Eligible subjects must meet all of the following inclusion criteria at screening: 1. Healthy subjects, 18 to 30 years of age (inclusive). The health status is verified by absence of evidence of any clinical significant active or uncontrolled chronic disease following a detailed medical history, a complete physical examination including vital signs, blood sampling of hematology, chemistry, and virology, urinalysis, urine drug and cotinine testing, and alcohol breath testing. In the case of uncertain or questionable results, tests performed during screening may be repeated before randomization to confirm eligibility or judged to be clinically irrelevant for healthy subjects. 2. Body mass index (BMI) between 18 and 30 kg/m2, inclusive 3. Fitzpatrick Skin type I-II (Caucasian type). 4. Eligible lower back to perform biopsies (no excessive hair growth, no local skin disorder) 5. Willing to give written informed consent and willing and able to comply with the study protocol. Exclusion criteria Eligible subjects must meet none of the following exclusion criteria at screening: 1. History of pathological scar formation (keloid, hypertrophic scars) 2. Any form of body modification of the lower back hindering biopsy collection of unaltered skin (e.g. tattoos, piercings, implants) 3. Any disease associated with immune system impairment, including auto-immune diseases, HIV and transplantation patients. 4. Requirement of immunosuppressive or immunomodulatory medication, including glucocorticoids, non-steroid anti-inflammatory drugs (NSAIDs), and chemotherapeutic drugs within 30 days prior to enrollment or planned to use during the course of the study. 5. Have any current and/or recurrent pathologically, clinical significant relevant skin condition. 6. Use of topical medication (prescription or over-the-counter (OTC)) within 30 days of the start of the study.in local treatment area. 7. Pregnant, a positive pregnancy test, intending to become pregnant, or breastfeeding. 8. Current smoker and/or regular user of other nicotine-containing products (e.g., patches). 9. Average consumption of more than 14 units of alcohol per week 10. Tanning due to sunbathing, excessive sun exposure or a tanning booth within 3 weeks of enrollment or planned to do so during the course of the study 11. Participation in an investigational drug or device study within 3 months prior to screening or more than 4 times a year. 12. Loss or donation of blood over 500 mL within three months prior to screening. 13. Any (medical) condition that would, in the opinion of the investigator, potentially compromise the safety or compliance of the subject or may preclude the subjects' successful completion of the clinical trial. |
Country | Name | City | State |
---|---|---|---|
Netherlands | Centre for Human Drug Research | Leiden |
Lead Sponsor | Collaborator |
---|---|
Centre for Human Drug Research, Netherlands | Maruho Co., Ltd. |
Netherlands,
Dreifke MB, Jayasuriya AA, Jayasuriya AC. Current wound healing procedures and potential care. Mater Sci Eng C Mater Biol Appl. 2015 Mar;48:651-62. doi: 10.1016/j.msec.2014.12.068. Epub 2014 Dec 19. Review. — View Citation
Greaves NS, Benatar B, Whiteside S, Alonso-Rasgado T, Baguneid M, Bayat A. Optical coherence tomography: a reliable alternative to invasive histological assessment of acute wound healing in human skin? Br J Dermatol. 2014 Apr;170(4):840-50. doi: 10.1111/bjd.12786. — View Citation
Greaves NS, Iqbal SA, Hodgkinson T, Morris J, Benatar B, Alonso-Rasgado T, Baguneid M, Bayat A. Skin substitute-assisted repair shows reduced dermal fibrosis in acute human wounds validated simultaneously by histology and optical coherence tomography. Wound Repair Regen. 2015 Jul-Aug;23(4):483-94. doi: 10.1111/wrr.12308. Epub 2015 Jul 31. — View Citation
Illigens BM, Gibbons CH. A human model of small fiber neuropathy to study wound healing. PLoS One. 2013;8(1):e54760. doi: 10.1371/journal.pone.0054760. Epub 2013 Jan 31. — View Citation
Ud-Din S, Greaves NS, Sebastian A, Baguneid M, Bayat A. Noninvasive device readouts validated by immunohistochemical analysis enable objective quantitative assessment of acute wound healing in human skin. Wound Repair Regen. 2015 Nov-Dec;23(6):901-14. doi: 10.1111/wrr.12344. Epub 2015 Nov 4. — View Citation
Ud-Din S, Perry D, Giddings P, Colthurst J, Zaman K, Cotton S, Whiteside S, Morris J, Bayat A. Electrical stimulation increases blood flow and haemoglobin levels in acute cutaneous wounds without affecting wound closure time: evidenced by non-invasive assessment of temporal biopsy wounds in human volunteers. Exp Dermatol. 2012 Oct;21(10):758-64. doi: 10.1111/exd.12005. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Biopsy biomarkers | Histology with hematoxylin and eosin (HE) staining | 3 months after end of study | |
Primary | Local skin biomarkers | Local skin biomarkers for wound healing related biomarkers (e.g. VEGF-A, TNFa, IL-8, TLSP, MMP-3, IL-4) by transdermal analysis patch (TAP) | 3 months after end of study | |
Primary | Clinical imaging | 2D photography | 3 months after end of study | |
Primary | Clinical evaluation | Erythema grading scale. Wounds are scored on the basis of redness of the wound (from better to worse: absence, mild, moderate, or severe). | 3 months after end of study | |
Primary | Skin microbiome | Skin microbiome (healthy and biopsy lesions). Collection of skin culture samples is a non-invasive procedure where a sterile polyester flock tip per site is passed along the surface of the 3 different areas. The target areas are i) regions surrounding one of the biopsy lesions on the lower back, ii) a control site of healthy, unaffected skin in proximity of a biopsy lesion and iii) a control area on the lower back with a minimum distance of 10cm from a biopsy site. The skin swab will be placed in a 2 ml lysis tube containing DNA/RNA shield to stabilize and preserve the DNA. The DNA extraction will be performed using adapted DNA extraction method based on the Zymo Research fecal DNA extraction methodology. After DNA extraction, the variable regions 3 and 4 of the 16S rRNA gene are amplified giving an amplicon of around 450 base pairs. This amplicon is analyzed by capillary systems using standard protocols. | 3 months after end of study | |
Primary | Biopsy biomarkers | Immunohistochemistry with wound healing related biomarkers (e.g. CD31, collagen I, collagen III, aSMA, fibronectin) | 3 months after end of study | |
Primary | Biopsy biomarkers | RNA-seq or qRT-PCR for wound healing related biomarkers (e.g. VEGFa, TGFß1, TGFß2, TGFß3, PDGF, CTGF, TNF, IL-1B, IL-4, GM-CSF, IL-6, IL-10, MMP1, MMP3, OSM, LOX) | 3 months after end of study | |
Primary | Clinical imaging | 3D photography | 3 months after end of study | |
Primary | Clinical imaging | Thermography | 3 months after end of study | |
Primary | Clinical imaging | Laser speckle contrast imaging (LSCI) | 3 months after end of study | |
Primary | Clinical imaging | Trans epidermal water loss (TEWL) | 3 months after end of study | |
Primary | Clinical imaging | Colorimetry | 3 months after end of study | |
Primary | Clinical evaluation | Red-Yellow-Black (RYB) wound assessment scale. Wounds are scored based on the color of the wound bed (from healthy to least healthy: red, yellow, or black). The least healthy color is chosen in multi-color wounds. Furthermore, a humidity subscale (dry, humid, or wet) is added to further classify the health status of the wounds. | 3 months after end of study | |
Primary | Clinical evaluation | POSAS. The observer scale of the POSAS consists of six items (vascularity, pigmentation, thickness, relief, pliability and surface area). All items are scored on a scale ranging from 1 ('like normal skin') to 10 ('worst scar imaginable'). The sum of the six items results in a total score of the POSAS observer scale. Categories boxes are added for each item:
Vascularity category: pale, pink, red, purple, mix Pigmentation category: hypo, hyper, mix Thickness category: thicker, thinner Relief category: more, less, mix Surface area category: expansion, contraction, mix Furthermore, an overall opinion is scored on a scale ranging from 1 to 10. All parameters are preferably compared to normal skin on a comparable anatomic location. |
3 months after end of study | |
Secondary | Adverse events (AEs) | Adverse events | 3 months after end of study | |
Secondary | Local tolerance | Erythema grading scale. Wounds are scored on the basis of redness of the wound (from better to worse: absence, mild, moderate, or severe). | 3 months after end of study | |
Secondary | Local tolerance | Red-Yellow-Black (RYB) wound assessment scale. Wounds are scored based on the color of the wound bed (from healthy to least healthy: red, yellow, or black). The least healthy color is chosen in multi-color wounds. Furthermore, a humidity subscale (dry, humid, or wet) is added to further classify the health status of the wounds. | 3 months after end of study | |
Secondary | Local tolerance | POSAS. The observer scale of the POSAS consists of six items (vascularity, pigmentation, thickness, relief, pliability and surface area). All items are scored on a scale ranging from 1 ('like normal skin') to 10 ('worst scar imaginable'). The sum of the six items results in a total score of the POSAS observer scale. Categories boxes are added for each item:
Vascularity category: pale, pink, red, purple, mix Pigmentation category: hypo, hyper, mix Thickness category: thicker, thinner Relief category: more, less, mix Surface area category: expansion, contraction, mix Furthermore, an overall opinion is scored on a scale ranging from 1 to 10. All parameters are preferably compared to normal skin on a comparable anatomic location. |
3 months after end of study | |
Secondary | Local tolerance | NRS pruritus and pain. The pruritus and pain NRS are single-question assessment tools that are used to assess the subject's worst itch and pain in the previous time interval. Subjects will be asked the following question; "on a scale of 0 - 100, with 0 being no itch, and 100 being the worst itch imaginable, how would you rate your average degree of itch of all biopsy sites combined experienced during the previous time interval?" and "on a scale of 0 - 100, with 0 being no pain, and 100 being the worst pain imaginable, how would you rate your average degree of pain of all biopsy sites combined experienced during the previous time interval?" | 3 months after end of study |
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