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Intralesional rhEGF
Epidermal Growth Factor
Epidermal Growth Factor (EGF) is a 53 amino acid polypeptide isolated for the first time from mice submaxillary glands. It stimulates fibroblasts, keratinocytes, and vascular endothelial cells proliferation that improve high quality new granulation tissue and wound healing. The healing mechanism starts with the coupling of EGF with specific receptors located on the cellular membrane.
EGF receptors are glycoproteins with an extracellular binding domain, a transmembrane region, and a cytoplasmic portion with tyrosine kinase activity. EGF receptors are expressed on most human cell types including those that play critical roles in wound repair such as fibroblasts, endothelial cells, and keratinocytes.
Rationale of EGF use to treat Diabetic Foot Ulcers
- Impairment of healing in diabetic patients, associated with a relative deficit of growth factors (EGF among them).
- Role of EGF in stimulating not only angiogenesis but also cell division, differentiation, and migration in damaged tissues and wounds.
Intralesional injection
- The availability of the growth factor at wound surface is limited.
- Bacterial biofilm is a physical barrier that limits and negatively impacts healing medications with cell receptors.
- The wound area is rich in acute proteases that can quickly degrade any added healing medication.
- Cells at the deep tissue layer are richer in EGF receptors when compared with epidermal and surface cell tissues.