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Effectiveness of the Autologous Adipose Tissue Harvested With SEFFICARE Method for Treatment of DFU Minor Amputation (SEFFIDiFA)

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ClinicalTrials.gov Identifier: NCT05072353
Recruitment Status : Not yet recruiting
First Posted : October 8, 2021
Last Update Posted : October 8, 2021
Sponsor:
Collaborator:
University of Modena and Reggio Emilia
Information provided by (Responsible Party):
Nicola Leone, Azienda Ospedaliero-Universitaria di Modena

Brief Summary:

Diabetic foot ulcers (DFU) are one of the complications of diabetes mellitus resulting from multiple causes such as neuropathy, ischemia, and infection that contribute to morbidity and amputation. The prevalence of DFU has been estimated to be 3 to 5 times higher than the overall population. Minor amputations (digital or transmetatarsal) are the treatment of choice in case of irreversible DFU. However, many minor amputations do not heal and require re-amputation. Improvements of healing rate after adipose stem cells (ASCs) injection through micro-fragmented autologous adipose tissue of the amputation stump following minor DFU amputation were demonstrated. The use of ASCs obtained from the superficial enhanced fluid fat injection technique (SEFFICARE) to improve the healing process after DFUs minor amputation is the object of the present study.

A single-center non-randomized prospective observational study will be performed.

The recruited patients will undergo local injection of superficial enhanced fluid fat after a lower limb minor amputation. Laboratory analysis to evaluate the composition of the tissue and stromal cell components harvested from adipose tissue with SEFFICARE system by using digital droplets PCR. These data will serve for making associations between the clinical outcome and characteristics of the cell population administered to each patient.


Condition or disease Intervention/treatment Phase
Diabetic Foot Diabetic Foot Ulcer Amputation Device: SEFFICARE Not Applicable

Detailed Description:

Diabetic foot ulcers (DFU) are one of the complications of diabetes mellitus resulting from multiple causes such as neuropathy, ischemia, and infection that contribute to morbidity and amputation. The prevalence of DFU has been estimated to be 3 to 5 times higher than the overall population. Minor amputations (digital or transmetatarsal) are the treatment of choice in case of irreversible DFU. However, many minor amputations do not heal and require re-amputation. Improvements of healing rate after adipose stem cells (ASCs) injection through micro-fragmented autologous adipose tissue of the amputation stump following minor DFU amputation were demonstrated. The use of ASCs obtained from the superficial enhanced fluid fat injection technique (SEFFICARE) to improve the healing process after DFUs minor amputation is the object of the present study.

STUDY DESIGN: Single-center non-randomized prospective observational cohort study.

TREATMENT: Local injection of superficial enhanced fluid fat after a lower limb minor amputation. Laboratory analysis to evaluate the composition of the tissue and stromal cell components harvested from adipose tissue with SEFFICARE system by using digital droplets PCR. These data will serve for making associations between the clinical outcome and characteristics of the cell population administered to each patient.

INCLUSION CRITERIA:

  • type-1 and type-2 diabetes mellitus
  • age >18-years
  • both sexes
  • chronic diabetic distal ulcers/gangrene (digital or forefoot) intended as W-grade 1 to 3 according to WifI classification;
  • absence of active vascular issues or patients undergoing lower extremity revascularization to improve peripheral perfusion intended as I-grade 0 to 2 according to WIfi classification;
  • absence of infection signs or presence of soft tissue infection intended as fI-grade 0 to 2 according to Wifi classification, without radiologic signs of bone infection (negative X-ray for osteolytic lesions); SAMPLE SIZE: The correct sample size was calculated considering as primary endpoint the proportion of the healing stump. The sample size was calculated with the Score Z test comparing one proportion based on literature results to a reference value. Using a significance level of 0.05, power of 0.8, setting the H0 proportion of 0.80 and the Ha of 0.6 respectively, the result was 36 subjects. An additional 10% of subjects was considered taking into account eventual drop-out during the study. The final sample size inflated to 40 patients.

ENDPOINTS: Primary endpoint: percentage of stump healing; Secondary endpoints:

  • mean time for complete healing;
  • evaluation of risk factors afflicting healing/failure;
  • evaluation of reintervention (time elapsed since index operation, type, and indication);
  • the prevalence of peripheral diabetic polyneuropathy at baseline;
  • the percentage change in the pain score of NRS;
  • health-related quality of life evaluation, intended as changing of the SF-36 score;
  • collection of eventual adverse events related to the treatment procedure and eventual posthoc analysis.
  • evaluation of the adipose harvested tissue composition and stromal cell components STATISTICAL ANALYSIS: The categorical endpoints, i.e., the difference in the healing rate will be assessed with the chi-square test or Fisher's exact test. The continuous variables will be calculated by Kaplan-Meier curves and log-rank test. A univariate and multivariate logistic regression analysis will be applied to identify influencing factors on the categorical endpoints. To test the influence of multiple variables on continuous data, one/two-way ANOVA will be performed with Bonferroni's post-test.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Prospective cohort study
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Autologous Adipose Tissue Harvested With Superficial Enhanced Fluid Fat Injection (SEFFICARE) Method for Treatment of Diabetic Foot Ulcer Undergoing Minor Amputation (SEFFIDiFA): Proposal of Basic Research and Prospective Observational Study
Estimated Study Start Date : December 2021
Estimated Primary Completion Date : June 2022
Estimated Study Completion Date : October 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment
DFU Patients are subjected to digital or transmetatarsal amputation. The treatment is provided during the amputation surgical session according to the SEFFI technique. The SEFFICARE® system (SEFFILINE S.r.l., Via delle Lame, 98, 40122 Bologna, Italy) is a disposable commercially available device. The device is provided in a sterile bag without any drugs. The SEFFI is a 5-step technique meaning preparation, anesthesia, harvesting, washing, and fluidification. The resulting tissue (2.5 mL per syringe) is ready for grafting. The stumps are closed by primary intention following adipose tissue injection.
Device: SEFFICARE

The SEFFI is a 5-step technique:

  1. Preparation: the lower/lateral abdomen is chosen as the donor site.
  2. Anesthesia: the donor site is injected with a local anesthetic.
  3. Harvesting: a 0.8 mm or 0.5 mm cannula connected to a 10-ml VacLok® syringe is used to harvest the adipose tissue. The total amount of the harvested tissue could vary from 10 to 30 mL.
  4. Washing: The syringe containing the lipoaspirate tissue is immediately filled with sterile physiological solution. After some minutes the syringes in the decanting stand will show a separation by the gravity of the tissue (top) from the physiological solution (bottom).
  5. Fluidification: the syringe containing the adipose tissue should be connected to an empty 10 ml syringe. After pushing the tissue about 3 times from one syringe to the other, a good fluidification of the tissue is obtained.

The resulting tissue (2.5 mL per syringe) is ready for grafting the amputation wound.





Primary Outcome Measures :
  1. Healing [ Time Frame: 6 months ]
    Healing was defined as complete re-epithelialization of the stump after suture removal without signs of cutaneous suffering, inflammation, infection, local swelling as determined by one investigator.


Secondary Outcome Measures :
  1. healing time change [ Time Frame: 1, 2, 3, 4, 5, 6 months ]
    mean time for complete healing

  2. risk factors afflicting healing/failure [ Time Frame: 0 month ]
    evaluation of risk factors afflicting healing/failure

  3. reintervention [ Time Frame: 6 months ]
    time elapsed since index operation, type, and indication

  4. diabetic peripheral neuropathy [ Time Frame: 0 month ]
    the prevalence of DPN (probable) at baseline

  5. health-related quality of life change [ Time Frame: 1, 2, 3, 4, 5, 6 months ]
    health-related quality of life evaluation, intended as changing of the SF-36 score

  6. adverse events related to the treatment procedure [ Time Frame: 6 months ]
    collection of eventual adverse events related to the treatment procedure

  7. amount of adipose stem cells used for grafting [ Time Frame: 1 month ]
    amount of adipose stem cells used for grafting



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • type-1 and type-2 diabetes mellitus
  • age >18-years
  • both sexes
  • chronic diabetic distal ulcers/gangrene (digital or forefoot) intended as W-grade 1 to 3 according to WifI classification;
  • absence of active vascular issues or patients undergoing lower extremity revascularization to improve peripheral perfusion intended as I-grade 0 to 2 according to WIfi classification;
  • absence of infection signs or presence of soft tissue infection intended as fI-grade 0 to 2 according to Wifi classification, without radiologic signs of bone infection (negative X-ray for osteolytic lesions);

Exclusion Criteria:

  • extensive ulcers with deep involving proximal forefoot and/or deep, full-thickness heel ulcer, with calcaneal involvement (W-grade 3 according to WifI classification);
  • active vascular issues [I-grade 3 according to Wifi classification];
  • ulcers with signs of moderate and/or severe infection (osteomyelitis and/or sepsis) [fI-grade 3 according to WifI classification];
  • severe comorbidities such as severe heart failure, liver failure, and/or psychiatric disorder;
  • previous oncological treatments (past 5 years) or ongoing and/or neoplastic lesions;
  • corticosteroid therapy;
  • coagulopathy;
  • infection of the harvesting site;
  • local anesthetic allergy;
  • immunosuppressive therapy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05072353


Contacts
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Contact: Nicola Leone, MD +390593961225 nicola.leone.md@gmail.com
Contact: Giulia Trevisi Borsari, MD +390593961225 giuliatrevisiborsari@tiscali.it

Locations
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Italy
Ospedale Civile di Baggiovara (Modena), Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia
Modena, Emilia-Romagna, Italy, 41126
Contact: Nicola Leone, MD    +390593961225    nicola.leone.md@gmail.com   
Principal Investigator: Roberto Silingardi, MD         
Principal Investigator: Manuela Simoni, MD, PhD         
Sub-Investigator: Livio Casarini, PhD         
Sub-Investigator: Carla IL Greco, MD         
Sub-Investigator: Giulia Trevisi Borsari, MD         
Sub-Investigator: Nicola Leone, MD         
Sponsors and Collaborators
Azienda Ospedaliero-Universitaria di Modena
University of Modena and Reggio Emilia
Investigators
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Principal Investigator: Roberto Silingardi, MD University of Modena and Reggio Emilia
Principal Investigator: Manuela Simoni, MD, PhD University of Modena and Reggio Emilia
Publications:

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Responsible Party: Nicola Leone, MD, Azienda Ospedaliero-Universitaria di Modena
ClinicalTrials.gov Identifier: NCT05072353    
Other Study ID Numbers: SEFFIDiFA_vers1.0
First Posted: October 8, 2021    Key Record Dates
Last Update Posted: October 8, 2021
Last Verified: September 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Diabetic Foot
Foot Ulcer
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Leg Ulcer
Skin Ulcer
Skin Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies
Foot Diseases