Biofilm Modified Macrophage Phenotype and Function in Diabetic Wound Healing

NCT ID: NCT03271580

Last Updated: 2024-04-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Total Enrollment

31 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-02-01

Study Completion Date

2021-09-13

Brief Summary

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The purpose of this study is to learn more about biofilm and to see how it affects diabetic wounds. A biofilm can occur if a chronic infection causes bacteria to grow in a slime enclosed group. This grouping of bacteria is called a biofilm.

Detailed Description

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There is one study visit with a 14-week follow-up that will take place during the participants standard of care visit at the Indiana University Health Comprehensive Wound Center (CWC). The following procedures will take place once your appointment has been completed:

* Informed consent will be signed (if not previously signed)
* A hemoglobin A1c drawn will be taken by research personnel, if one has not been done within the last 90 days to check your average blood sugar level.
* An Ankle Brachial Index (ABI) will be obtained if the participant has a leg wound. This is to ensure that participants have adequate blood flow to your wound. This is a non-invasive test which measures blood pressure in both of the participants arms and ankles.
* Demographics (such as your name and address and phone number, age), medical history, current medications, current standard of care labs, and wound data (measurements, cause of the wound, wound culture, assessments, treatments, and duration) will be recorded. The participant's medical record number will also be recorded.
* A photo of the wound site will be taken.
* Wound Vac Collection - The wound vac sponge will be collected (waste by product of the therapy) by the research staff.
* An optional two 3 mm punch tissue biopsies will be obtained from the participant's provider. To perform the biopsy, the area surrounding the wound will first be numbed using a local anesthetic agent that will be injected at the wound site. Then, a pencil-like instrument will be used to remove a small, thin cylinder of tissue. Each biopsy is about the size of this dot. After the tissue is removed, a sterile gauze will be placed on the area to stop any minor bleeding that may occur. The biopsies will be looked at in the laboratory to look at the microorganisms. You will not receive the results of the completed laboratory analysis. (Note: If two biopsies cannot be obtained per your physician's discretion, only one biopsy, debridement tissue (dead tissue that is removed from your wound) or no tissue will be obtained, and/or culture swabs (your wound will be swabbed with something like a Q-tip to collect cells to test for bacteria or other organisms in the wound) will be collected to test for infection.)

During the 14-week follow-up visit, research staff will review the participant's medical chart to determine the final status of the wound. If the participant does not return to the CWC at 14 weeks, the last CWC visit will be documented as the wound check follow-up. This does not require the participant to return for an extra study visit. This information will only be collected from their medical chart if available:

* Final status of the wound (healing, not healing, healed)
* Wound data (measurements), treatments, and any standard of care labs will be obtained
* A photo of your wound from the medical chart will be obtained (if available)

Conditions

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Wound Bacterial Infections Diabetes Mellitus Infected Ulcer of Skin

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Diabetic patients infected ulcers

Diabetic patients with HbA1c\<9 with who have wound 4weeks or longer with infection with following interventions:

1. Finger prick test for HbA1c measurement
2. Punch biopsy
3. VAC sponge collection
4. Ankle brachial index

Finger prick test for HbA1c measurement

Intervention Type DIAGNOSTIC_TEST

HbA1c measurement with finger prick method

Punch Biopsy

Intervention Type PROCEDURE

Wound site will be anaesthetized, by punch biopsy tissue will be collected, wound site will be monitored for bleeding(if bleeding Cautery will be used to stop bleeding).

Vac Sponge Collection

Intervention Type OTHER

NPWT sponge which is discarded as biological waste, will be collected for wound macrophage isolation

Ankle Brachial Index

Intervention Type OTHER

Blood pressure test

Diabetic patients non infected Ulcers

Diabetic patients with HbA1c\<9 who have wound 4 weeks or longer without infection with following interventions:

1. Finger prick test for HbA1c measurement
2. Punch biopsy
3. VAC sponge collection
4. Ankle brachial index

Finger prick test for HbA1c measurement

Intervention Type DIAGNOSTIC_TEST

HbA1c measurement with finger prick method

Punch Biopsy

Intervention Type PROCEDURE

Wound site will be anaesthetized, by punch biopsy tissue will be collected, wound site will be monitored for bleeding(if bleeding Cautery will be used to stop bleeding).

Vac Sponge Collection

Intervention Type OTHER

NPWT sponge which is discarded as biological waste, will be collected for wound macrophage isolation

Ankle Brachial Index

Intervention Type OTHER

Blood pressure test

Interventions

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Finger prick test for HbA1c measurement

HbA1c measurement with finger prick method

Intervention Type DIAGNOSTIC_TEST

Punch Biopsy

Wound site will be anaesthetized, by punch biopsy tissue will be collected, wound site will be monitored for bleeding(if bleeding Cautery will be used to stop bleeding).

Intervention Type PROCEDURE

Vac Sponge Collection

NPWT sponge which is discarded as biological waste, will be collected for wound macrophage isolation

Intervention Type OTHER

Ankle Brachial Index

Blood pressure test

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Age 18 and above years old
2. Willing and able to provide informed consent
3. Willing and able to comply with protocol instructions, including biopsies and study visits
4. Diabetics with an open wound
5. Receiving Negative Wound Pressure Therapy (NPWT)

Exclusion Criteria

1. Inadequate arterial supply, as evidenced by any of the following (for wounds below the knee):

1. TcOM \< 30mmHg
2. ABI \< 0.7
3. TBI \< 0.6
2. Women who are pregnant
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Indiana University

OTHER

Sponsor Role lead

Responsible Party

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Dr. Sashwati Roy

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sashwati Roy, PhD

Role: PRINCIPAL_INVESTIGATOR

Indiana University

Locations

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IU Health Methodist Hospital

Indianapolis, Indiana, United States

Site Status

Davis Heart and Lung Institute

Columbus, Ohio, United States

Site Status

The Ohio State University Hospital East

Columbus, Ohio, United States

Site Status

Comprehensive Wound Care Centers, The Ohio State University Hospital

Columbus, Ohio, United States

Site Status

Martha Morehouse Medical Plaza

Columbus, Ohio, United States

Site Status

Countries

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United States

References

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Breen JD, Karchmer AW. Staphylococcus aureus infections in diabetic patients. Infect Dis Clin North Am. 1995 Mar;9(1):11-24.

Reference Type BACKGROUND
PMID: 7769212 (View on PubMed)

Davis SC, Martinez L, Kirsner R. The diabetic foot: the importance of biofilms and wound bed preparation. Curr Diab Rep. 2006 Dec;6(6):439-45. doi: 10.1007/s11892-006-0076-x.

Reference Type BACKGROUND
PMID: 17118226 (View on PubMed)

James GA, Swogger E, Wolcott R, Pulcini Ed, Secor P, Sestrich J, Costerton JW, Stewart PS. Biofilms in chronic wounds. Wound Repair Regen. 2008 Jan-Feb;16(1):37-44. doi: 10.1111/j.1524-475X.2007.00321.x. Epub 2007 Dec 13.

Reference Type BACKGROUND
PMID: 18086294 (View on PubMed)

Hanke ML, Angle A, Kielian T. MyD88-dependent signaling influences fibrosis and alternative macrophage activation during Staphylococcus aureus biofilm infection. PLoS One. 2012;7(8):e42476. doi: 10.1371/journal.pone.0042476. Epub 2012 Aug 3.

Reference Type BACKGROUND
PMID: 22879997 (View on PubMed)

Hanke ML, Heim CE, Angle A, Sanderson SD, Kielian T. Targeting macrophage activation for the prevention and treatment of Staphylococcus aureus biofilm infections. J Immunol. 2013 Mar 1;190(5):2159-68. doi: 10.4049/jimmunol.1202348. Epub 2013 Jan 30.

Reference Type BACKGROUND
PMID: 23365077 (View on PubMed)

Neut D, Tijdens-Creusen EJ, Bulstra SK, van der Mei HC, Busscher HJ. Biofilms in chronic diabetic foot ulcers--a study of 2 cases. Acta Orthop. 2011 Jun;82(3):383-5. doi: 10.3109/17453674.2011.581265. Epub 2011 May 11. No abstract available.

Reference Type BACKGROUND
PMID: 21561305 (View on PubMed)

Zhao G, Usui ML, Lippman SI, James GA, Stewart PS, Fleckman P, Olerud JE. Biofilms and Inflammation in Chronic Wounds. Adv Wound Care (New Rochelle). 2013 Sep;2(7):389-399. doi: 10.1089/wound.2012.0381.

Reference Type BACKGROUND
PMID: 24527355 (View on PubMed)

Other Identifiers

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1808802536

Identifier Type: -

Identifier Source: org_study_id

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