Randomized trial and local biological effect of autologous platelets used as adjuvant therapy for chronic venous leg ulcers.
OBJECTIVE
Platelet products have been proposed as adjuvant therapy for wound healing. We undertook this study to determine the healing effect of topically applied frozen autologous platelets (FAP) on chronic venous ulcers, compared with effect of placebo, and whether use of topical FAP modifies local expression of vascular endothelial growth factor (VEGF), keratinocyte growth factor (KGF), interleukin 8 (IL-8), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in wound fluid.


METHODS
This randomized, placebo-controlled, double-blind trial was carried out in institutional practice, with ambulatory patients with proved chronic venous leg ulcers. In all patients, whole venous blood was drawn for preparation of FAP. FAP or normal saline solution was applied three times per week for up to 12 weeks, together with hydrocolloids and standardized compression bandages. Leg ulcer surface was assessed with numerical pictures. IL-8, VEGF, KGF, and TIMP-1 levels were determined (enzyme-linked immunosorbent assay) in wound fluid after each 4 weeks of treatment.


RESULTS
Fifteen patients were randomized into two groups with comparable leg ulcer characteristics. Mean percent reduction in ulcer area was 26.2% in the FAP group versus 15.2% in the placebo group (P =.94). One ulcer in each group was completely healed at study end. Levels of TIMP-1 increased significantly during FAP treatment. IL-8 concentration was significantly lower in wound fluid of healing ulcers than in the fluid of nonhealing ulcers, in both FAP and placebo groups. Growth factor levels were not modified with FAP treatment.


CONCLUSIONS
Topical autologous platelets have no significant adjuvant effect on healing of chronic venous leg ulcers and increased wound fluid TIMP-1 concentration. Ulcer healing is associated with a decrease in wound fluid IL-8.
Senet
Patricia
P
Institut de Rercherche sur la Peau, Paris, France.
Bon
François-Xavier
FX
Benbunan
Marc
M
Bussel
Annette
A
Traineau
Richard
R
Calvo
Fabien
F
Dubertret
Louis
L
Dosquet
Christine
C
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000502:physiology*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D051523:Fibroblast Growth Factor 7; D005346:Fibroblast Growth Factors / Q000378:metabolism; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D016209:Interleukin-8 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism; D014647:Varicose Ulcer / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D014945:Wound Healing / Q000502:physiology*
C496453:FGF7 protein, human; D007155:Immunologic Factors; D016209:Interleukin-8; D019715:Tissue Inhibitor of Metalloproteinase-1; D042461:Vascular Endothelial Growth Factor A; D051523:Fibroblast Growth Factor 7; D005346:Fibroblast Growth Factors