Epidermal Growth Factor is Effective in the Treatment of Diabetic Foot Ulcers: Meta-Analysis and Systematic Review

Abstract

Diabetic foot ulcers (DFUs) are one the common complications of diabetes mellitus. Many trials were performed to evaluate the effect of recombinant human epidermal growth factor (rhEGF) in healing DFUs. This meta-analysis was performed to synthesize the evidence of rhEGF treatment in DFUs in comparison to placebo. Databases included for the search were PubMed, EMBASE, the Cochrane Library, Web of Science, EBSCOhost, ScienceDirect, and Scopus (up to January 2019). The outcome of interest was the complete healing rate of DFUs. We performed random effects meta-analysis stratified by the types of administration route (intralesional injection and topical apply) by calculating the odds ratios (OR) and 95% confidence interval (95% CI). A total of six studies involving 530 patients were eligible for analysis. The combined OR (intralesional injection and topical apply) was 4.005 (95% CI: (2.248; 7.135), p < 0.001). The ORs for intralesional injection and topical application were 3.599 (95% CI: (1.213; 10.677), p = 0.021) and 4.176 (95% CI: (2.112; 8.256), p < 0.001), respectively. Statistical heterogeneity might not be important in overall treatment (I2 = 15.17, p = 0.317) and both of the subgroups (I2: 24.56, p = 0.25 and I2: 33.26, p = 0.213, respectively). Our results support the use of rhEGF in the treatment of DFUs.

Discovery of Hyperstable Noncanonical Plant-Derived Epidermal Growth Factor Receptor Agonist and Analogs

“…EGF is clinically approved in several countries for treating diabetic foot ulcers. − Chronic wounds and their attendant consequences of severe pain, amputation, and disability remain an important health concern and an increasing socio-economic burden. , At least 15% of diabetic patients will develop chronic ulcers on their feet. − The total medical cost for managing this ailment was estimated US$ 9–13 billion in the United States . In this regard, EGF, which plays important roles in proliferation, migration, and differentiation, offers promise as a therapeutic intervention for wound management .…”

Growth Factors, Reactive Oxygen Species, and Metformin—Promoters of the Wound Healing Process in Burns?

“…It can also correct the pseudo-healing of traumatic tympanic membrane perforations, after daily application over six months, to keep the membrane moist [80]. In patients with diabetic foot ulcers, parenteral administration of EGF on epithelial tissue has a positive effect on the healing process [81]. Dogan and colleagues conducted an experimental study performed on male Wistar-Albino rats divided into non-diabetic and diabetic rats and reported that EGF loaded in a gelatine-microsphere improves wound healing both in normal and diabetic rats [82].…”

Nonpharmacological Management of Diabetic Foot Ulcers: An Update

“…32 The efficacy of rhEGF for the treatment of DFUs has been also confirmed in recent meta-analyses, but the quality of evidence was low. 31,33-35…”