Human epidermal growth factor enhances healing of diabetic foot ulcers.
OBJECTIVE
To study the healing effect of recombinant human epidermal growth factor (hEGF) on diabetic foot ulcers.


METHODS
A total of 127 consecutive patients were screened and 61 diabetic subjects were recruited into this double-blind randomized controlled study. Predetermined criteria were used for diagnosis and classification of the diabetic wound. The patients were randomized into three groups. All patients attended our Diabetes Ambulatory Care Center every other week for joint consultation with the diabetologist and the podiatrist. Group 1 (control) was treated with Actovegin 5% cream (Actovegin), group 2 with Actovegin plus 0.02% (wt/wt) hEGF, and group 3 with Actovegin plus 0.04% (wt/wt) hEGF. The study end point was the complete closure of the wound. Failure to heal was arbitrarily defined as incomplete healing after 12 weeks.


RESULTS
Final data were obtained from 61 patients randomly assigned into three groups. The mean ages of the patients, wound sizes, wound duration, metabolic measurements, and comorbidities were comparable within groups, except that group 3 had more female patients. Mean follow-up for the patients was 24 weeks. Data were cutoff at 12 weeks, and results were analyzed by intention to treat. After 12 weeks, in group 1 (control) eight patients had complete healing, two patients underwent toe amputation, and nine had nonhealing ulcers. In group 2 (0.02% [wt/wt] hEGF) 12 patients experienced wound healing, 2 had toe amputations, and 7 had nonhealing ulcers. Some 20 of 21 patients in group 3 (0.04% [wt/wt] hEGF) showed complete wound healing. Healing rates were 42.10, 57.14, and 95% for the control, 0.02% (wt/wt) hEGF, and 0.04% (wt/wt) hEGF groups, respectively. Kaplan-Meier survival analysis suggested that application of cream with 0.04% (wt/wt) hEGF caused more ulcers to heal by 12 weeks and increased the rate of healing compared with the other treatments (log-rank test, P = 0.0003).


CONCLUSIONS
Our data support the contention that application of hEGF-containing cream, in addition to good foot care from a multidisciplinary team, significantly enhances diabetic foot ulcer wound healing and reduces the healing time.
Tsang
Man Wo
MW
Diabetes Ambulatory Care Center, Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China. mwtsang@ha.org.hk
Wong
Wan Keung R
WK
Hung
Chi Sang
CS
Lai
Kwok-Man
KM
Tang
Wegin
W
Cheung
Elaine Y N
EY
Kam
Grace
G
Leung
Leo
L
Chan
Chi Wai
CW
Chu
Chung Min
CM
Lam
Edward K H
EK
D017668:Age of Onset; D000368:Aged; D017719:Diabetic Foot / Q000188:drug therapy*; D004311:Double-Blind Method; D004815:Epidermal Growth Factor / Q000627:therapeutic use*; D005260:Female; D016523:Foot Ulcer / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011994:Recombinant Proteins / Q000627:therapeutic use; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*
D010919:Placebos; D011994:Recombinant Proteins; D004815:Epidermal Growth Factor