Efficacy of Adipose Tissue Derived Stem Cells for the Treatment of Diabetic Foot Ulcers

NCT ID: NCT05610865

Last Updated: 2024-12-31

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

RECRUITING

Clinical Phase

PHASE1

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-20

Study Completion Date

2025-12-31

Brief Summary

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The aim of this study is to evaluate the therapeutic efficacy of uncultured adipose derived stromal vascular fraction (SVF) and cultured adipose derived stem cells (ASCs) both supplemented with platelet rich plasma (PRP) to treat chronic diabetic foot ulcers. It will increase the pragmatic potential of both types of cells as PRP is rich in survival and chemotactic factors. Moreover, the autologous nature of the proposed study will ensure safety of its use in diabetic patients and will unveil the more effective therapeutic option for treatment of foot ulcer wounds.

Detailed Description

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Under local or general anesthesia, autologous fat will be harvested by using a manual aspiration or syringe-assisted technique. SVF and ASCs isolation from autologous lipoaspirates will be done by enzymatic digestion method (collagenase Type-1 solution for 45 minutes at 37°C). Cell quality assessment will be done prior to transplantation by trypan blue exclusion assay and total populations and fractions of cells identified by immunocytochemistry / flow cytometry. PRP will be derived by centrifugation from 50-100ml blood collected in anticoagulant carrying bag, from patient at the day of transplantation. The injection volume will depend on the wound area of each patient. 2 million cells/ 0.5 ml PRP will be mixed, transferred to 1 cc syringes and injected / cm2 intradermally at the border zone \& inside of wound surface bed.

Conditions

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Diabetic Foot Ulcer Diabetes Mellitus Diabetic Foot Diabetic Foot Infection Diabetic Foot Ulcer Neuropathic Foot Ulcer Due to Type 1 Diabetes Mellitus Foot Ulcer Due to Type 2 Diabetes Mellitus Foot Ulcer Diabetes Complications Chronic Diabetic Ulcer of Left Foot Chronic Diabetic Foot Ulcer of Right Foot

Keywords

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Stromal vascular fraction (SVF), Adipose derived stem cells (ASCs), Diabetic foot ulcer (DFU), Platelet rich plasma (PRP)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control; Standard-of-care management

Saline dressing will be done as a routine care management.

Group Type ACTIVE_COMPARATOR

Control; Standard-of-care management

Intervention Type OTHER

Patients will undergo conventional wound care management.

Only PRP injection

Only PRP will be injected at the wound site.

Group Type EXPERIMENTAL

Only PRP injection

Intervention Type BIOLOGICAL

Only PRP injected / cm2 intradermally at the border zone \& inside of wound surface bed.

PRP + SVF injection

SVF pellet mixed with PRP will be injected at the wound site after adjusting number of cells.

Group Type EXPERIMENTAL

PRP + SVF injection

Intervention Type BIOLOGICAL

Uncultured cells (SVF) along PRP were mixed, transferred to 1 cc syringes and injected / cm2 intradermally at the border zone \& inside of wound surface bed.

PRP + ASCs injection

Cultured ASCs mixed with PRP will be injected at the wound site after adjusting number of cells.

Group Type EXPERIMENTAL

PRP + ASCs injection

Intervention Type BIOLOGICAL

Cultured ASCs along PRP were mixed, transferred to 1 cc syringes and injected / cm2 intradermally at the border zone \& inside of wound surface bed.

Interventions

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Control; Standard-of-care management

Patients will undergo conventional wound care management.

Intervention Type OTHER

Only PRP injection

Only PRP injected / cm2 intradermally at the border zone \& inside of wound surface bed.

Intervention Type BIOLOGICAL

PRP + SVF injection

Uncultured cells (SVF) along PRP were mixed, transferred to 1 cc syringes and injected / cm2 intradermally at the border zone \& inside of wound surface bed.

Intervention Type BIOLOGICAL

PRP + ASCs injection

Cultured ASCs along PRP were mixed, transferred to 1 cc syringes and injected / cm2 intradermally at the border zone \& inside of wound surface bed.

Intervention Type BIOLOGICAL

Eligibility Criteria

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Inclusion Criteria

* Type 1 or Type 2 Diabetes Mellitus
* Age 20-60 years (Male/Female)
* Body mass index 20-30 kg/m2
* Suitable for liposuction
* Condition or Disease: Diabetic Neuropathy
* Wound Type: Chronic foot ulcer
* Approx. wound area: 2 cm2 - 8 cm2
* Wound Condition should be of Wagner's grade I (Limited to soft tissue)
* Duration of wound persistence: 6-24 Weeks
* Transcutaneous oxygen pressure \> 30 mmHg, and an ankle brachial pressure index \> 0.5.
* Already following an adequate off-loading method
* Provided signed informed consent

Exclusion Criteria

* Uncontrolled hyperglycemia (HbAlc \> 9%)
* Presence of severe clinical sign of infection
* Inability to tolerate off-loading, and poor prognosis diseases including malignant tumors.
* Serious chronic disease i.e hepatic, heart, renal, pulmonary diseases
* Patients with critical limb ischemia and osteomylitis
* Withdrawal of informed consent
Minimum Eligible Age

20 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Centre of Excellence in Molecular Biology, University of the Punjab, Lahore

UNKNOWN

Sponsor Role collaborator

Higher Education Commission (Pakistan)

OTHER

Sponsor Role collaborator

Jinnah Burn and Reconstructive Surgery Centre, Lahore

OTHER_GOV

Sponsor Role collaborator

University of the Punjab

OTHER

Sponsor Role lead

Responsible Party

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Azra Mehmood

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Azra Mehmood, PhD

Role: PRINCIPAL_INVESTIGATOR

Center of Excellence in Molecular Biology (CEMB, University of the Punjab, Lahore

Sheikh Riazuddin, PhD

Role: STUDY_DIRECTOR

Jinnah Burn and Reconstructive Surgery Center (JB&RSC), Lahore

Locations

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Stem Cell Laboratory, Jinnah Burn and Reconstructive Surgery Center (JB&RSC)

Lahore, Punjab Province, Pakistan

Site Status RECRUITING

Countries

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Pakistan

Central Contacts

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Azra Mehmood, PhD

Role: CONTACT

Phone: +92-333-4107008

Email: [email protected]

Amna Arif, M.Phil.

Role: CONTACT

Phone: +92-333-4161068

Email: [email protected]

Facility Contacts

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Dr. Moazzam Nazeer Tarar, Plastic Surgeon MBBS/ FRCS

Role: primary

References

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Shao S, Pan R, Chen Y. Autologous Platelet-Rich Plasma for Diabetic Foot Ulcer. Trends Endocrinol Metab. 2020 Dec;31(12):885-890. doi: 10.1016/j.tem.2020.10.003. Epub 2020 Nov 13.

Reference Type BACKGROUND
PMID: 33199085 (View on PubMed)

Nolan GS, Smith OJ, Heavey S, Jell G, Mosahebi A. Histological analysis of fat grafting with platelet-rich plasma for diabetic foot ulcers-A randomised controlled trial. Int Wound J. 2022 Feb;19(2):389-398. doi: 10.1111/iwj.13640. Epub 2021 Jun 24.

Reference Type BACKGROUND
PMID: 34169656 (View on PubMed)

Carstens MH, Quintana FJ, Calderwood ST, Sevilla JP, Rios AB, Rivera CM, Calero DW, Zelaya ML, Garcia N, Bertram KA, Rigdon J, Dos-Anjos S, Correa D. Treatment of chronic diabetic foot ulcers with adipose-derived stromal vascular fraction cell injections: Safety and evidence of efficacy at 1 year. Stem Cells Transl Med. 2021 Aug;10(8):1138-1147. doi: 10.1002/sctm.20-0497. Epub 2021 Apr 7.

Reference Type BACKGROUND
PMID: 33826245 (View on PubMed)

Qin HL, Zhu XH, Zhang B, Zhou L, Wang WY. Clinical Evaluation of Human Umbilical Cord Mesenchymal Stem Cell Transplantation After Angioplasty for Diabetic Foot. Exp Clin Endocrinol Diabetes. 2016 Sep;124(8):497-503. doi: 10.1055/s-0042-103684. Epub 2016 May 24.

Reference Type BACKGROUND
PMID: 27219884 (View on PubMed)

Han SK, Kim HR, Kim WK. The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: a pilot study. Wound Repair Regen. 2010 Jul-Aug;18(4):342-8. doi: 10.1111/j.1524-475X.2010.00593.x. Epub 2010 May 11.

Reference Type BACKGROUND
PMID: 20492632 (View on PubMed)

Didangelos T, Koliakos G, Kouzi K, Arsos G, Kotzampassi K, Tziomalos K, Karamanos D, Hatzitolios AI. Accelerated healing of a diabetic foot ulcer using autologous stromal vascular fraction suspended in platelet-rich plasma. Regen Med. 2018 Apr;13(3):277-281. doi: 10.2217/rme-2017-0069. Epub 2018 May 1.

Reference Type BACKGROUND
PMID: 29715071 (View on PubMed)

Prakasam N, Prabakar MS, Reshma S, Loganathan K, Senguttuvan K. A clinical study of platelet rich plasma versus conventional dressing in management of diabetic foot ulcers. International Surgery Journal. 2018 Sep 25;5(10):3210-6.

Reference Type BACKGROUND

Alvaro-Afonso FJ, Sanz-Corbalan I, Lazaro-Martinez JL, Kakagia D, Papanas N. Adipose-Derived Mesenchymal Stem Cells in the Treatment of Diabetic Foot Ulcers: A Review of Preclinical and Clinical Studies. Angiology. 2020 Oct;71(9):853-863. doi: 10.1177/0003319720939467. Epub 2020 Jul 29.

Reference Type BACKGROUND
PMID: 32723090 (View on PubMed)

Khan A, Junaid N. Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings. J Pak Med Assoc. 2017 Dec;67(12):1818-1824.

Reference Type BACKGROUND
PMID: 29256523 (View on PubMed)

Yin S, Yang X, Bi H, Zhao Z. Combined Use of Autologous Stromal Vascular Fraction Cells and Platelet-Rich Plasma for Chronic Ulceration of the Diabetic Lower Limb Improves Wound Healing. Int J Low Extrem Wounds. 2021 Jun;20(2):135-142. doi: 10.1177/1534734620907978. Epub 2020 Mar 4.

Reference Type BACKGROUND
PMID: 32131655 (View on PubMed)

Other Identifiers

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CEMB-SC02

Identifier Type: -

Identifier Source: org_study_id