wound healing presentation

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Novel Wound Healing Technology Novel Wound Healing Technology WoundCare Therapeutics Corp Dr. Pankaj Modi, PhD, MD

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Page 1: Wound Healing Presentation

Novel Wound Healing TechnologyNovel Wound Healing Technology

WoundCare Therapeutics Corp

Dr. Pankaj Modi, PhD, MD

Page 2: Wound Healing Presentation

WoundCare Therapeutics Corp. is an emerging specialty company focused on the development of a portfolio of wound management, plastic surgery and dermatological products to provide patients and consumers improved clinical outcomes. Develops high value products based on its Develops high value products based on its innovative proprietary novel trans-dermal and trans-mucosal novel trans-dermal and trans-mucosal Hydro-gel Aggregate Technologies.

Has an ‘evolving’ strategy to …Has an ‘evolving’ strategy to …Develop products in mature sectors where technologies can extend the value of Develop products in mature sectors where technologies can extend the value of existing playersexisting players

Initial focusInitial focus in Wound Healing and Dermatological Products sectors in Wound Healing and Dermatological Products sectors

License technologyLicense technology to potential partners that have means to bring products to potential partners that have means to bring products to marketto market

About WoundCare Therapeutics Corp

Page 3: Wound Healing Presentation

• Wounds may result from trauma or from a surgical incision. In addition, pressure ulcers (also known as decubitus ulcers or bed sores), a type of skin ulcer, might also be considered wounds.

• Wound healing is the process of repair that follows injury to the skin and other soft tissues.

• The capacity of a wound to heal depends in part on its depth, as well as on the overall health and nutritional status of the individual.

• Following injury, an inflammatory response occurs and the cells below the dermis (the deepest skin layer) begin to increase collagen (connective tissue) production. Later, the epithelial tissue (the outer skin layer) is regenerated.

• Dietary modifications and nutritional and herbal supplements may improve the quality of wound healing by influencing these reparative processes or by

limiting the damaging effects of inflammation.

Wound and Wound Healing

Page 4: Wound Healing Presentation

Skin: structure and function

Largest organ of the body Primary function is protective Composed of several layers

• Epidermis and Stratum Corneum• Dermis, containing the capillary network• Subcutaneous layer (hypodermis, adipose layer• All layers metabolically active and susceptible to changes

Injury to skin and underlying tissues causes wound to form

Page 5: Wound Healing Presentation

The Cell

• Repairs its self at night duringin approximately 3 hour timeperiod • Balance of time is spent indefensive mode mostlyagainst free radical damage• Cellular forces take a cell on a28 day journey in whichcellular forces survive, divide,differentiate and the die• Following the injury, the cells begin to die and depletes collagen in the deep layers to form a wound

Page 6: Wound Healing Presentation

Chronic skin wounds:Diabetic foot ulcers: $1.4 billion world wide Venous stasis ulcers: $2.9 billion Bed Sores (pressure) ulcers: $3.3 billion

Acute wounds:Severe burns: $70 millionPartial thickness burns: $160 million Trauma & surgical wounds: $1.8 billion

Types of Wounds and Market Potential

The total market for treating chronic wounds is approximately $8.5 and is expected to increase by 7-10% every year.

Page 7: Wound Healing Presentation

Wound Healing Process Sequence

Page 8: Wound Healing Presentation

Wound Healing Process (components)

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Schematic Diagram of the Phases of Wound Healing

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• Inadequate Perfusion (poor circulation)

• Inflammation

• Metabolic Diseases

• Immuno-suppression

• Connective Tissues Disorders

• Arterial and Venous insufficiency

• Neuropathy

• Infection

• Edema

• Ischemia (oxygen insufficiency)

Factors Affecting Wound Healing Process

Page 11: Wound Healing Presentation

Wound Assessment

WOUND ASSESSMENT

Lab tests:

TcPO2 Size, depth location

Wound bed:• necrosis• granulation

Surrounding skin: colour, moisture,

Wound edge

Odour or exudate

Signs of infection

Page 12: Wound Healing Presentation

• Identification of the hindrance to healing• Adequate nutritional status• Adequate perfusion and oxygenation• High quality, research-based patient and wound management• Correction of the underlying cause of the problem• Disease management

Wound Healing Requirements

Page 13: Wound Healing Presentation

Grade I – non-blanchable erythema

of intact skin. Discoloration of the

skin, warmth, oedema, induration

or hardness may also be used as

indicators in people with dark skin.

Grade II – partial-thickness skin loss

involving epidermis, dermis or both.

The ulcer is superficial and presents

clinically as an abrasion or blister.

Grade III – full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia

Grade IV – extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures with or without full thickness skin loss.

Classifying wounds: Grading by tissue Involvement

Page 14: Wound Healing Presentation

Describes the type of material presentIn the base of the wound:

• Slough (yellow)• Necrotic tissue (black)• Infected tissue (green)• Granulating tissue (red)• Epithelialising (pink)

Clinical Appearance

Page 15: Wound Healing Presentation

• Wound assessment charts• Frequency of assessment• Wound dimensions• Photography• Treatment plan • Change therapy• Assessment of Diabetes• Life style changes• Monitoring nutrition intake

Monitoring healing progress

Page 16: Wound Healing Presentation

The purpose of dressings:• To aid debridement• To remove excess exudate• To control bleeding• To protect a wound• To support healing

The ideal dressing• A dressing that creates the optimum environment• Wound debridement• Wound cleansing• Protect and heal

Dressing choice

Page 17: Wound Healing Presentation

Traditional wound dressings includes;• Various cloth and fiber materials as exudates absorbents,such as cotton pads

• Limited absorbency

• Requires frequent changing

• Limited ability to preserve sterility

• Scabs that form as the wounds heal tend to stick to thedressings which can be painful and interfere with healing.

Limitations of Traditional Dressings

Page 18: Wound Healing Presentation

• Advanced polymer technology• Non-adherent wound contact layer• Highly absorptive• Semi-permeable (allows oxygen transport)• Adhesive and non-adhesive layers• Environment for autolysis to debride sloughy or necrotic wounds• Occlusive --> hypoxic environment to encourage angiogenesis• Provides needed oxygen to cells to promote faster and effective healing• Waterproof

Need for Novel Dressing Technology to Promote Faster and Effective Healing

Page 19: Wound Healing Presentation

• The novel Breathable Hydrogel Nano Particles Technology utilizes a method of tissue super-oxygenation that provides oxygen to the tissues to aid in the faster healing and cells revitalization process.

• Oxygen is provided to the tissue through microscopic bubbles and is present at the concentration that is found in the blood.

• The oxygen in the micro-bubbles can be transported through the skin when placed in contact with the skin.

• Such treatment increases the oxygen level in the interstitial fluids of the sub-epithelial and dermal tissues and is immediately available to the oxygen depleted cells, thereby inducing more rapid healing.

• This procedure is clinically proven for the treatment of sepsis and help in healing the bedsores, skin lacerations, burns related infections and aid in the prevention of gangrene formation.

WoundCare Therapeutics Technology

Page 20: Wound Healing Presentation

• Forms a film in situ sealing the wound and allowing conformation to irregular wound surfaces• Adheres to the wound but does not harm the healing tissue• The dressing is moisture vapor and oxygen permeable• The dressing releases the oxygen to the tissues• Maintains sterility for longer time duration• Substantially decreases the need for multiple dressing changes• Active healing agents can be trapped between the nano-particles to control the release of these actives to promote wound healing

Attributes of the novel Breathable Hydro-gel Technology

Page 21: Wound Healing Presentation

Oxygenated Vasodialtor Hydrogel LayerTop fibrous porous layer

Elastomeric Bottom Layer with Adhesive

Wound Healing Bandage Actual Oxygenating Vasodilator Hydrogel Layer

Page 22: Wound Healing Presentation

Animal Studies; Study # 1 Mouse Footpad Model to Evaluate the Effectiveness of Novel Wound Dressing Treatment

Materials and Methods Mice. Male Swiss-Webster mice weighing approximately 20g Groups of 30 mice were wounded on the posterior tarsus of both feet by 5mm incision \ between the Achilles tendon and the external finger. The wounds were measured by a subjective scoring system (accepted wound healing rating system) on a scale of 5 to 0. 5 is open and totally unhealed; 4 is a small slit; 3 is a closed wound with a scab; 2 is a closed wound with scab shed; 1 is a healed wound with a visible scar; 0 is a healed wound and no visible scar.

Page 23: Wound Healing Presentation

Treatments

The wound healing test bandage containing HA was made using the medical grade HA and Collagen and elastin with rapid acting topical anesthetics and combination of vasodilator and oxygen generator (WondCare Therpeutic’s proprietary formulation) under sterile conditions.

The bandage applied to the wound area after thorough cleaning of the wound with IPA with gentle rubbing. The bandage was secured on to the skin with the help of adhesive strips.

The comparator was regular dressing bandage which most clinics use regularly on the surgical wounds.

Page 24: Wound Healing Presentation

Day 0 Day 3 Day 5 Day 7

Control 47.9 ± 6.1 ** 43.3 ± 6.5 39.8 ± 7.5 33.8 ± 6.9 % Change (9.54 ± 6.3) (16.9 ± 8.3) (29.4 ± 7.6)

Wound Healing 84.4 ±8.5 28.3 ± 7.3 19.6 ± 7.7 9.6 ± 7.1 Dressing (41.5 ± 5.3) (59.6 ± 5.7) (80.2 ± 5.8)

* mean values for wounds on day one had no statistically significant differences ** values are mean ± SE of estimated wound area and range of estimated wound area (cm or mm)

Epithelial damage (before)Punch Biopsy

After treatment with Novel Bandage- 72 hrs

RESULTS

Page 25: Wound Healing Presentation

Animal Study # 2; Novel Formulation with PDGF and BFGF Proteins in Removal of Scar Formation in a Rabbit Ear Excessive Scar Model

Excessive cutaneous scarring in the form of hypertrophic scars and keloids is an area of unmet clinical need and continues to pose significant functional, cosmetic, and psychological problems .

Pre-surgical and surgical procedures. Rabbits were anesthetized. Three 8-mm wounds were created with a trephine in the ventral surface of each rabbit ear to the depth of the cartilage. The cartilage and overlying skin were removed from each wound. In dermal repair investigations, all wounds were covered with a commonly used occlusive dressing.

Reconstituted PDGF-BFGF was diluted in sterile PBS diluent to the final working concentrations and mixed with the novel formulation. Eight (8) rabbits were treated with the novel formulation and 6 were treated with the placebo which did not contain any actives but only the vehicle.

Scar thickness of each wound was measured with a micrometer at Day post-wounding and continued twice weekly thereafter until sacrifice at Day 28 or 29. Gross appearance of an elevated rabbit ear wound section with trichrome staining

Page 26: Wound Healing Presentation

Treatments # Rabbits Treated Healed Unhealed % improvements

After 4 weeks Scar Scar Lightness Lightness

Formulation+PDGF 14 11 3 79% healed

Control 14 5 9 35% healed

(control) showing little collagen and tissues after 4 weeks

Active treatment showing substantial collagen and tissues after 4 weeks

Results

Page 27: Wound Healing Presentation

Human Study Study to Evaluate the Safety and Efficacy of Novel Hydrogel Dressings with Recombinant Human BFGFactor in Healing Diabetic Foot Ulcers

Aim The aim of the study was to evaluate the efficacy and safety of rhEGF or BFGF hydro- gel applied topically in patients with Grade I or II (Wagner’s classification) diabetic foot ulcers and to compare the time required for complete healing of the ulcer in the test group and control group.

Inclusion criteria. Target ulcers were no less than 2 cm2 and no more than 50 cm2 in area. Patients were expected to be available for the 15 week study period and had to be able to adhere to the treatment regimen. Healthy men or women between the ages of 38 and 65 years at the time of consent were included. Included patients had controlled diabetes mellitus (type 1 and 2) and foot ulcers. Ulcers that remained open without healing for more than 2–3 weeks (irrespective of the ambulatory treatment administered) were included. Patients had to have ankle brachial index (ABI) readings of ≥ 0.75.

Study Medication The active drug was formulated using the novel hydro-gel formulation with rhEGF+HA with collagen and topical anesthetics; the placebo did not include the active ingredients.

Page 28: Wound Healing Presentation

Wound Measurements Wound healing typically has been expressed as a change in area over time. Wound measurements were divided into 3 major groups: ruler-based assessment schemes, transparency tracings, and optical methods.

Skin biopsy Skin biopsy was done at baseline and after treatment to evaluate the degree of healing.

Drug Administration The study drugs were administered by topical application as per the procedure set forth in the study protocol. The visit at Day 0 constituted the study medication administration day. The test group received Novel formulation of rhEGF and the control group received placebo (without ant actives and were maintained on antibiotics mainly). The study drug was provided in a gel base to allow for even application (topically) on the ulcer using a sterile cotton swab. This was done twice daily until the wound healed or until the end of Week 15, whichever was earlier.

Photography Measuring wound area using tracings of photographs has the advantage of avoiding direct contact with the wound. The photographs were arranged sequentially according to patient visits, and healing progress was monitored throughout the study process.

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Treatments No of Patients Healed Unhealed % improvement

(12 weeks period)

Placebo (control) 30 4 25 13% healed Novel formulation +rhEGF 30 27 3 90% healed

# of weeks of Formulation+RhEGF Placebo Treatment Improvements (healed) Improvements (healed) 3 (30) 7 (23%) 1 (3%) 6 (30) 13 (43%) 2 (7%) 12 (30) 21 (70%) 2 (7%) 24 (30) 27 (90%) 4 (13%)

Results

Page 30: Wound Healing Presentation

Results This study established the safety and efficacy of the novel rhEGF formulated gel and found that the gel healed diabetic foot ulcers faster than the placebo.

This study advocates the use of novel formulation of growth factor therapy in chronic wounds, such as diabetic foot ulcers, where healing of the ulcer is a major hindrance.

Growth factor therapy would lead to prevention of leg amputations and would serve as a major treatment therapy to facilitate faster healing of chronic wounds and, thereby, wound closure.

This novel formulation can also be helpful in treatment of other non-diabetic hard heal wounds, surgical wounds, minor burns and abrasions injuries.

Page 31: Wound Healing Presentation

Human Study # 2 Management of Pain in Acute and Chronic Wounds:Improvement in Quality of Life

Aim: This study was conducted to assess the efficacy of the novel topical wound healing therapy and improvements in various parameters related to pain in patients with acute and chronic wounds.

Patients and Methods The study was conducted in the wound clinic of a university hospital. It involved 50 patients suffering from acute (duration <6 weeks) and chronic wounds (duration >6 weeks) who visited the once a week clinic on a particular day. Patients responded to questions related to wound pain such as the onset, location, type, and intensity using visual analogue and verbal reporting scales. Responses to statements regarding aggravating and relieving factors and overall impact of pain on quality of life were obtained using a 5-points scale where 5 = painful (very dependent life style because of pain and movement restriction) and 1 = almost no pain

The study group comprised 37 (74%) men and 13 (26%) women ranging in age from 7 to 74 years. Trauma was the leading cause of wounds (33, 66%) and the majority of wounds occurred in lower limbs (n = 39, 78%). Of the 50 patients studied, pain was present in 46 (92%).

Page 32: Wound Healing Presentation

Treatment Plan All patients were given treatment with the novel wound healing dressing which contained topical anesthetics of require strength and potency along with the wound healing medications to reduce or eliminate the pain within few minutes of application of the drug (cream with dressing).

All patients received treatment once a day as the daily in clinic visit to clean and examination of their wounds and pain management. Nurses applied the bandages on the wounds after proper cleaning of the wounds with antiseptic solutions.

All patients after the application of the novel dressing were asked to rate their pain after 30 min of their treatment on scales consisting of;

5 = severe excruciating4 = very painful3 = moderate pain al pain (very mild and of short duration) 2= mild pain1= occasional 0= no pain

Page 33: Wound Healing Presentation

Chronic Wound # of Patients Pain score # of Treatments % improvements Pain n=33 (score=4.3) 15 days 87%, score=1.4

Acute Wound Pain n=17 (score=4.5) 15 days 93%, score=1.2

Thus, the novel hydro-gel growth factor formulation with topical anesthetic combination not only helped in reducing the pain and improvement in the quality of life but also aided in healing the wound faster than the traditional therapies.

Results

Page 34: Wound Healing Presentation

• Forms a film in situ sealing the wound and allowing conformation to irregular wound surfaces• Adheres to the wound but does not harm the healing tissue• The dressing is moisture vapor and oxygen permeable• Oxygen is provided to the tissue through microscopic bubbles and Hydro-gel matrix• The oxygen in the micro-bubbles can be transported through the dressing in to the skin• The dressing releases the oxygen to the tissues• Maintains sterility for longer time duration• Substantially decreases the need for multiple dressing changes Provides faster healing and cells revitalization process• The dressing provides pain relief on contact• Clinically proven for the treatment of sepsis and in healing the bedsores, skin lacerations, burns related infections and aid in the prevention of gangrene formation.

Conclusions

Page 35: Wound Healing Presentation

Thank You