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Evaluating The Efficacy Of A Keratin Graft In Treating Non-Healing Diabetic Foot Ulcers

Primary Purpose

Ulcer Healing, Diabetic Foot Ulcer

Status
Active
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
human keratin graft
Sponsored by
ProgenaCare Global, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ulcer Healing focused on measuring Diabetic Foot Ulcer, Wound Care

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Diagnosis of type 1 or 2 diabetes mellitus Target diabetic foot ulcer with a minimum surface area of 1.0 cm^2 and a maximum surface area of 20.0 cm^2 measured post-debridement with photographic planimetry. Target ulcer must have been present for a minimum of 4 weeks and maximum of 52 weeks of standard of care prior to initial screening Target ulcer must be located on the foot with at least 50% of its area below the malleolus Target ulcer must be full thickness on the foot or ankle that does not probe to bone Adequate circulation in the affected foot documented within 3 months of initial screening visit, as determined by one of the following: transcutaneous oximetry measurement (TCOM) greater or equal to 30 mmHg, ankle-brachial index (ABI) between 0.7 and 1.3, biphasic pulse volume recording (PVR), toe-brachial index (TBI) greater than 0.6, or arterial Doppler ultrasound evaluating for biphasic dorsalis pedis and posterior tibial vessels at the ankle level If subject has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will be designated as the target ulcer Target ulcers on the plantar aspect of the foot must be offloaded for at least 14 days prior to randomization Subject must consent to using the prescribed off-loading method for the duration of the study Subject must agree to attend weekly study visits required by the protocol Subject must be willing and able to participate in the informed consent process Exclusion Criteria: Subjects known to have a life expectancy of < 6 months Infection of the target ulcer or cellulitis in the surrounding skin Presence of osteomyelitis or exposed bone, or wounds that probe to bone or joint capsule on investigator's exam or radiographic evidence Infection in the target ulcer requiring systemic antibiotic therapy Subjects receiving immunosuppressants (including systemic corticosteroids > 10 mg Prednisone per day or equivalent) or cytotoxic chemotherapy Topical application of steroids to the ulcer surface within one month of initial screening Subjects with previous partial amputation on the affected foot that impedes proper offloading of the target ulcer Subjects with a glycated hemoglobin (HbA1c) greater than or equal to 13% taken at or within 3 months of the initial screening visit Subjects with a serum creatinine level ≥ 3.0mg/dL within 6 months of randomization Surface area of the target ulcer reduces in size by more than 30% in the two weeks between the initial screening and randomization during which they are subject to standard of care Subjects with acute or inactive Charcot foot that impedes proper offloading of the target ulcer Women who are pregnant or considering becoming pregnant within the next 6 months Subjects with end stage renal disease requiring dialysis Subjects who participated in a clinical trial involving treatment with an investigational product within the previous 30 days Subjects who, in the opinion of the investigator, have a medical or psychological condition that may interfere with study assessments Subjects treated with hyperbaric oxygen therapy or a cellular and/or tissue product (CTP) in the 30 days prior to the initial screening visit

Sites / Locations

  • Doctors Research Network
  • Foot and Ankle Specialists of the Mid-Atlantic (FASMA)
  • Foot and Ankle Specialists of the Mid-Atlantic (FASMA)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Weekly Human Keratin Graft Application

Bi-Weekly Human Keratin Graft Application

Arm Description

Patients randomized into this arm will receive standard of care (offloading, debridement, and three-layer outer dressing) with the test material, the human keratin graft, reapplied weekly to the target wound.

Patients randomized into this arm will receive standard of care (offloading, debridement, and three-layer outer dressing) with the test material, the human keratin graft, reapplied every other week to the target wound.

Outcomes

Primary Outcome Measures

Wound Closure
The proportion of subjects that achieve complete closure of the target wound with each treatment.

Secondary Outcome Measures

Time to Wound Closure
The time required for target ulcers to achieve complete closure with each treatment.
Wound Area Change
The change in target wound area between treatment visits.
Change in Peripheral Neuropathy
Changes in peripheral neuropathy of the foot with the target ulcer between treatment visits, assessed by the standard 10-point Semmes-Weinstein monofilament exam.
Change in Wound Pain
Changes in pain in the target ulcer assessed by the numerical pain rating scale from 0 (no pain) to 10 (worst pain possible).
Change in Quality of Life
Changes in patient quality of life relating to their wound using the wound quality of life assessment with 17 questions answered on a scale of 0 ("not at all") to 4 ("very much").

Full Information

First Posted
March 9, 2023
Last Updated
August 21, 2023
Sponsor
ProgenaCare Global, LLC
Collaborators
Professional Education and Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT05797285
Brief Title
Evaluating The Efficacy Of A Keratin Graft In Treating Non-Healing Diabetic Foot Ulcers
Official Title
A Randomized Clinical Pilot Evaluating The Efficacy For Two Application Regimens Of A Unique Keratin Based Graft In The Treatment Of Non-Healing Diabetic Foot Ulcers
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 28, 2023 (Actual)
Primary Completion Date
November 2023 (Anticipated)
Study Completion Date
November 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ProgenaCare Global, LLC
Collaborators
Professional Education and Research Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
The goal of this clinical pilot is to collect patient outcome data on a commercially available, keratin-based skin substitute matrix: ProgenaMatrix®. In this trial, two groups of patients with diabetic foot ulcers (DFUs) will be randomized to receive treatment with ProgenaMatrix applied either weekly or bi-weekly to the target wound. Researchers will compare how weekly or bi-weekly application of ProgenaMatrix affects the healing of DFUs. The primary questions to be answered are: How many patients achieve wound closure in 12 weeks with ProgenaMatrix treatment? And What is the change in wound area during the trial in each group?
Detailed Description
ProgenaMatrix® is a human keratin graft that is 510K approved for application on diabetic foot wounds and has been shown in case studies and clinical practice to assist in wound healing . Additionally, a study published by Tang and Kirsner showed that keratin stimulates human keratinocyte migration and types IV and VII collagen expression. Therefore, based on this early promising data, a larger pilot is necessary to further validate these results and identify the likelihood of wound healing with weekly versus bi-weekly application. For consistency, one type of wound will be studied in this trial and DFU's have been chosen as they are some of the most common wounds seen in the wound clinics. The purpose of this clinical evaluation is to collect patient outcome data on a commercially available 510K FDA cleared synthetic, absorbable skin substitute matrix. The commercially available product is ProgenaMatrix® Advanced Wound Graft and consists of Human Keratin Matrix. In this trial, two groups of subjects with diabetic foot ulcers (DFUs), will receive standard of care (SOC) treatment for their condition. Half of the patients will be randomized to a 510K FDA cleared ProgenaMatrix® applied weekly and the other half will be randomized to a 510K FDA cleared ProgenaMatrix® applied bi-weekly (i.e., once every two weeks).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ulcer Healing, Diabetic Foot Ulcer
Keywords
Diabetic Foot Ulcer, Wound Care

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
In this trial, two groups of subjects with diabetic foot ulcers (DFUs), will receive standard of care (SOC) treatment for their condition. The study has two phases: a 14-day screening phase to determine eligibility, and a 13-week treatment phase. Half of the patients will be randomized to a 510K FDA cleared ProgenaMatrix applied weekly and the other half will be randomized to a 510K FDA cleared ProgenaMatrix applied bi-weekly (i.e., once every two weeks). SOC includes offloading the DFU with controlled ankle movement (CAM) boots or total contact casting, appropriate sharp or surgical debridement, and wound care covering with ProgenaMatrix followed by a padded 3-layer dressing of 4x4 gauze, soft roll, and compressive wrap.
Masking
None (Open Label)
Masking Description
The treatments in this study will not be masked. Assessment of the primary study objective (wound closure) will be overseen by an adjudication panel of at least two wound care experts to reduce bias.
Allocation
Randomized
Enrollment
26 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Weekly Human Keratin Graft Application
Arm Type
Experimental
Arm Description
Patients randomized into this arm will receive standard of care (offloading, debridement, and three-layer outer dressing) with the test material, the human keratin graft, reapplied weekly to the target wound.
Arm Title
Bi-Weekly Human Keratin Graft Application
Arm Type
Experimental
Arm Description
Patients randomized into this arm will receive standard of care (offloading, debridement, and three-layer outer dressing) with the test material, the human keratin graft, reapplied every other week to the target wound.
Intervention Type
Device
Intervention Name(s)
human keratin graft
Other Intervention Name(s)
ProgenaMatrix
Intervention Description
The intervention to be applied is an advanced wound care matrix composed of human keratin to be applied at two different treatment frequencies.
Primary Outcome Measure Information:
Title
Wound Closure
Description
The proportion of subjects that achieve complete closure of the target wound with each treatment.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Time to Wound Closure
Description
The time required for target ulcers to achieve complete closure with each treatment.
Time Frame
From date of randomization until date of documented wound closure, assessed up to 12 weeks
Title
Wound Area Change
Description
The change in target wound area between treatment visits.
Time Frame
From date of randomization until date of documented wound closure or study conclusion, whichever comes first, assessed up to 12 weeks
Title
Change in Peripheral Neuropathy
Description
Changes in peripheral neuropathy of the foot with the target ulcer between treatment visits, assessed by the standard 10-point Semmes-Weinstein monofilament exam.
Time Frame
From date of randomization until date of documented wound closure or study conclusion, whichever comes first, assessed up to 12 weeks
Title
Change in Wound Pain
Description
Changes in pain in the target ulcer assessed by the numerical pain rating scale from 0 (no pain) to 10 (worst pain possible).
Time Frame
From date of randomization until date of documented wound closure or study conclusion, whichever comes first, assessed up to 12 weeks
Title
Change in Quality of Life
Description
Changes in patient quality of life relating to their wound using the wound quality of life assessment with 17 questions answered on a scale of 0 ("not at all") to 4 ("very much").
Time Frame
From date of first screening until date of documented wound closure or study conclusion, whichever comes first, assessed up to 15 weeks
Other Pre-specified Outcome Measures:
Title
Presence of Cellulitis and Infection
Description
Difference in number of participants presenting with cellulitis and/or infection in or around the target ulcer between treatment groups.
Time Frame
12 weeks
Title
Number of Adverse Events Observed
Description
The number and type of adverse events observed during the study.
Time Frame
15 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of type 1 or 2 diabetes mellitus Target diabetic foot ulcer with a minimum surface area of 1.0 cm^2 and a maximum surface area of 20.0 cm^2 measured post-debridement with photographic planimetry. Target ulcer must have been present for a minimum of 4 weeks and maximum of 52 weeks of standard of care prior to initial screening Target ulcer must be located on the foot with at least 50% of its area below the malleolus Target ulcer must be full thickness on the foot or ankle that does not probe to bone Adequate circulation in the affected foot documented within 3 months of initial screening visit, as determined by one of the following: transcutaneous oximetry measurement (TCOM) greater or equal to 30 mmHg, ankle-brachial index (ABI) between 0.7 and 1.3, biphasic pulse volume recording (PVR), toe-brachial index (TBI) greater than 0.6, or arterial Doppler ultrasound evaluating for biphasic dorsalis pedis and posterior tibial vessels at the ankle level If subject has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will be designated as the target ulcer Target ulcers on the plantar aspect of the foot must be offloaded for at least 14 days prior to randomization Subject must consent to using the prescribed off-loading method for the duration of the study Subject must agree to attend weekly study visits required by the protocol Subject must be willing and able to participate in the informed consent process Exclusion Criteria: Subjects known to have a life expectancy of < 6 months Infection of the target ulcer or cellulitis in the surrounding skin Presence of osteomyelitis or exposed bone, or wounds that probe to bone or joint capsule on investigator's exam or radiographic evidence Infection in the target ulcer requiring systemic antibiotic therapy Subjects receiving immunosuppressants (including systemic corticosteroids > 10 mg Prednisone per day or equivalent) or cytotoxic chemotherapy Topical application of steroids to the ulcer surface within one month of initial screening Subjects with previous partial amputation on the affected foot that impedes proper offloading of the target ulcer Subjects with a glycated hemoglobin (HbA1c) greater than or equal to 13% taken at or within 3 months of the initial screening visit Subjects with a serum creatinine level ≥ 3.0mg/dL within 6 months of randomization Surface area of the target ulcer reduces in size by more than 30% in the two weeks between the initial screening and randomization during which they are subject to standard of care Subjects with acute or inactive Charcot foot that impedes proper offloading of the target ulcer Women who are pregnant or considering becoming pregnant within the next 6 months Subjects with end stage renal disease requiring dialysis Subjects who participated in a clinical trial involving treatment with an investigational product within the previous 30 days Subjects who, in the opinion of the investigator, have a medical or psychological condition that may interfere with study assessments Subjects treated with hyperbaric oxygen therapy or a cellular and/or tissue product (CTP) in the 30 days prior to the initial screening visit
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David G Armstrong, DPM,MD,PhD
Organizational Affiliation
University of Southern California
Official's Role
Study Chair
Facility Information:
Facility Name
Doctors Research Network
City
Miami
State/Province
Florida
ZIP/Postal Code
33143
Country
United States
Facility Name
Foot and Ankle Specialists of the Mid-Atlantic (FASMA)
City
Frederick
State/Province
Maryland
ZIP/Postal Code
21703
Country
United States
Facility Name
Foot and Ankle Specialists of the Mid-Atlantic (FASMA)
City
Salem
State/Province
Virginia
ZIP/Postal Code
24153
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

Evaluating The Efficacy Of A Keratin Graft In Treating Non-Healing Diabetic Foot Ulcers

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