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Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence.

Romanelli M, Dini V, Vowden P, Agren MS - Clin Interv Aging (2008)

Bottom Line: Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes.Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins.Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in "real life" situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Pisa, Pisa, Italy. m.romanelli@med.unipi.it

ABSTRACT
Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface > or = area 10 cm2 and duration of > or = 6 months) showed that the application of amelogenin (Xelma, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in "real life" situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.

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Related in: MedlinePlus

Same lesion at 12 weeks follow up.
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fig3c: Same lesion at 12 weeks follow up.

Mentions: Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unknown etiology, although an autoimmune mechanism including immune complex-mediated neutrophilic vascular reactions has been suggested. PG is frequently associated with various diseases, but up to 50% of cases are idiopathic. It is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. There are two main types of ulcers that occur: the normal ulcerative form which occurs on the legs, and an ‘atypical’ form that is more superficial and occurs on the hands and other parts of the body. Though the etiology is not well understood, the disease is thought to be due to immune system dysfunction and, in particular, improper functioning of neutrophils. At least half of all PG patients also suffer from illnesses that affect their systemic function. Classical ulcerative PG is characterized by the appearance of nodules with pustules that enlarge and lead to chronic ulcers violaceous and undermined borders (Dini et al 2007) Amelogenin therapy has been used to treat two female patients with recalcitrant PG of the lower leg lasting an average of 11 months (Dini et al 2007a). The treatment was applied weekly under an occlusive dressing for a maximum of 8 weeks in conjunction with systemic immunosuppressive therapy before and during the topical treatment. The lesions improved, showing advances in granulation tissue formation and wound size reduction (Figures 3a-c). Additionally, pain control was reported and the therapy was well-tolerated with no adverse effects.


Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence.

Romanelli M, Dini V, Vowden P, Agren MS - Clin Interv Aging (2008)

Same lesion at 12 weeks follow up.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2546471&req=5

fig3c: Same lesion at 12 weeks follow up.
Mentions: Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unknown etiology, although an autoimmune mechanism including immune complex-mediated neutrophilic vascular reactions has been suggested. PG is frequently associated with various diseases, but up to 50% of cases are idiopathic. It is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. There are two main types of ulcers that occur: the normal ulcerative form which occurs on the legs, and an ‘atypical’ form that is more superficial and occurs on the hands and other parts of the body. Though the etiology is not well understood, the disease is thought to be due to immune system dysfunction and, in particular, improper functioning of neutrophils. At least half of all PG patients also suffer from illnesses that affect their systemic function. Classical ulcerative PG is characterized by the appearance of nodules with pustules that enlarge and lead to chronic ulcers violaceous and undermined borders (Dini et al 2007) Amelogenin therapy has been used to treat two female patients with recalcitrant PG of the lower leg lasting an average of 11 months (Dini et al 2007a). The treatment was applied weekly under an occlusive dressing for a maximum of 8 weeks in conjunction with systemic immunosuppressive therapy before and during the topical treatment. The lesions improved, showing advances in granulation tissue formation and wound size reduction (Figures 3a-c). Additionally, pain control was reported and the therapy was well-tolerated with no adverse effects.

Bottom Line: Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes.Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins.Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in "real life" situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Pisa, Pisa, Italy. m.romanelli@med.unipi.it

ABSTRACT
Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface > or = area 10 cm2 and duration of > or = 6 months) showed that the application of amelogenin (Xelma, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in "real life" situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.

Show MeSH
Related in: MedlinePlus