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| ID | Type | Description | Link |
|---|---|---|---|
| 2021-000563-69 | EudraCT Number |
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Patient recruitment issues
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| Name | Class |
|---|---|
| European Commission | OTHER |
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A randomized, double-blind, placebo-controlled, parallel, exploratory phase 2a study to evaluate safety and biologic efficacy on wound healing of ILP100-Topical in subjects with diabetic foot ulcers during 26 weeks with a 5-year long-term follow-up period. A total of 30 subjects will be randomized to low dose of ILP100-Topical (ILP100Lo), high dose of ILP100-Topical (ILP100Hi) or Placebo according to a 1:1:1 randomization schedule.
The study will consist of a 3-weeks Screening and Run-in Phase, followed by a 5-week Treatment Phase starting from Baseline and an Assessment Phase from Week 5 to Week 26. Thereafter, the subjects will be followed yearly during 5 years in a Long-Term Safety Follow-up Phase.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ILP100Lo | Experimental | During the Treatment Phase, subjects will continue on standard of care according to the protocol and ILP100Lo (ILP100-Topical, 5x10^7 colony forming units (CFU)/cm^2) will be topically administered at two occasions on Day 1 (Baseline and Hour 2), Days 2, 3, and thereafter every second to third day until Day 31. |
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| ILP100Hi | Experimental | During the Treatment Phase, subjects will continue on standard of care according to the protocol and ILP100Hi (ILP100-Topical, 1x10^9 CFU/cm^2) will be topically administered at two occasions on Day 1 (Baseline and Hour 2), Days 2, 3, and thereafter every second to third day until Day 31. |
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| Placebo | Placebo Comparator | During the Treatment Phase, subjects will continue on standard of care according to the protocol and Placebo (ILP100 dilution buffer mixed with the activation peptide SppIP) will be topically administered at two occasions on Day 1 (Baseline and Hour 2), Days 2, 3, and thereafter every second to third day until Day 31. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ILP100-Topical (emilimogene sigulactibac) 5x10^7 CFU/cm^2 | Biological | Topical application of ILP100-Topical (emilimogene sigulactibac) at a dose of 5x10^7 CFU/cm^2 wound area. |
| Measure | Description | Time Frame |
|---|---|---|
| Compare incidence of adverse events (AEs) between treatment groups | The incidence of AEs up to Week 26 will be presented for each treatment group and by category, causality, severity and frequency. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Compare incidence of serious adverse events (SAEs) between treatment groups | The incidence of SAEs up to Week 26 will be presented for each treatment group and by category, causality, severity and frequency. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Measure | Description | Time Frame |
|---|---|---|
| Local tolerability by Investigator's assessment | Local tolerance to treatment will be assessed by the Investigator. Wound tolerability parameters will be presented in categories of appearance of inflammation, amount of exudate present, hemorrhage, presence of slough/necrotic tissue, presence of granulation tissue and hypergranulation. | Compare Investigator's local tolerability assessments up to Week 26 between the ILP100-Topical and Placebo treatment arms. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of subjects with index limb amputation and any limb amputation | The proportion of subjects with index limb amputation and any limb amputation will be calculated. | Compare at Week 26, and thereafter annually Year 1 to 5, between the ILP100-Topical and Placebo treatment arms. |
| All-cause mortality and index wound-related mortality |
Inclusion Criteria:
Signed written informed consent
Males and females aged ≥18 years
Diagnosis of diabetes mellitus type 1 or 2
HbA1c ≤ 86 mmol/mol (≤ 10%) at Screening
Subjects with at least one first time or recurrent full thickness ulcer (at or below the ankle) which fulfils all of the following criteria at Screening and at the time of Baseline:
Toe pressure ≥20 mm Hg
Expected to comply with the study procedures
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jan Apelqvist, MD/PhD | Department of Endocrinology, Skåne University Hospital, Malmö, Sweden | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Endocrinology, Skåne University Hospital | Lund | 221 85 | Sweden | |||
| Clinical Diabetes Research Unit at Uppsala University Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29432190 | Background | Vagesjo E, Ohnstedt E, Mortier A, Lofton H, Huss F, Proost P, Roos S, Phillipson M. Accelerated wound healing in mice by on-site production and delivery of CXCL12 by transformed lactic acid bacteria. Proc Natl Acad Sci U S A. 2018 Feb 20;115(8):1895-1900. doi: 10.1073/pnas.1716580115. Epub 2018 Feb 5. | |
| 30870037 | Background |
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Undecided due to ongoing development.
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This is a double-blind study, and the allocation of treatments will not be disclosed to subjects, Investigator or Independent Evaluators until database lock after all subjects (who were not withdrawn) completed Week 26.
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| ILP100-Topical (emilimogene sigulactibac) 1x10^9 CFU/cm^2 | Biological | Topical application of ILP100-Topical (emilimogene sigulactibac) at a dose of 1x10^9 CFU/cm^2 wound area. |
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| Placebo | Biological | Topical application of placebo (ILP100 dilution buffer mixed with the activation peptide SppIP). |
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| Local tolerability by Independent Assessor's assessment | Local tolerance to treatment will be assessed by the Independent Assessor. Wound tolerability parameters will be presented in categories of appearance of inflammation, amount of exudate present, hemorrhage, presence of slough/necrotic tissue, presence of granulation tissue and hypergranulation. | Compare local tolerability up to Week 26 between the ILP100-Topical and Placebo treatment arms. |
| Proportion of subjects with a local tolerability parameter Grade ≥ 2 per Investigator's Assessment | The proportion of subjects with a local tolerability parameter grade ≥ 2 will be calculated (grading system=0 to 3, where 3 is severe). Local tolerance to treatment, infection and wound healing will be assessed by the Investigator. Wound tolerability parameters include appearance of inflammation, amount of exudate present, hemorrhage, presence of slough/necrotic tissue, presence of granulation tissue and hypergranulation. | Compare the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Proportion of subjects with a local tolerability parameter Grade ≥ 2 per Independent Assessor's Assessment | The proportion of subjects with a local tolerability parameter grade ≥ 2 will be calculated (grading system=0 to 3, where 3 is severe). Local tolerance to treatment, infection and wound healing will be assessed by the Independent Assessor. Wound tolerability parameters include appearance of inflammation, amount of exudate present, hemorrhage, presence of slough/necrotic tissue, presence of granulation tissue and hypergranulation. | Compare the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Wound area reduction (percent of Baseline) | Wound area will be measured and calculated as proportion of the wound area at Baseline. Metric analyses of wound area is made on 3D models acquired up to Week 26. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Wound healing rate | Wound healing rate will be calculated as change in the wound area per week. Wound healing will be assessed by Investigators and Independent Assessor. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Proportion of subjects with ≥50% and 75% partially healed wounds | The proportion of subjects with ≥50% and 75% partially healed wounds will be calculated. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Time to partial (≥50% and 75%) and complete healing | Time to event outcomes will be evaluated using Kaplan-Meier curves. Wound healing is defined as full skin re-epithelialization without drainage or dressing requirements confirmed at two consecutive study visits 2 weeks apart. Wound healing will be assessed by Investigators and Independent Assessor. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Wound area | Wound area will be measured and calculated (cm^2). Metric analyses of wound healing, including area, are made using 3D models acquired Screening to Week 26. Wound measures will be automatically generated by a computer software and validated by the Independent Assessor. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Proportion of subjects with completely healed wounds | The proportion of subjects with completely healed wounds will be calculated. Wound healing is defined as full skin re-epithelialization without drainage or dressing requirements confirmed at two consecutive study visits 2 weeks apart. Wound healing will be assessed by Investigators and the Independent Assessor. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Proportion of subjects with recurrence of index wound | The proportion of subjects with recurrence of index wound will be calculated. For wound assessments after each index wound healing visit, it will be documented if the index wound is still healed or if any recurrence of the wound has occurred. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Proportion of subjects with new wound infections | The proportion of subjects with new wound infections will be calculated based on the Investigators evaluation of the skin, including assessing whether there are any new wound infections, at each study visit. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Days on antibiotic treatment | Days on antibiotic treatment as a percentage of days in the study up to Week 26 will be calculated for each subject. | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Change in subject-reported wound-related pain | Change in wound-related pain in the area of the index wound, as reported by subjects, using a numeric rating scale (NRS; 0-10, where 10 is the worst possible pain). | Compare ILP100-Topical and Placebo treatment arms up to Week 26 |
| Long-term incidence of AEs. | AEs and SAEs will be recorded during annual visits from Year 1 through Year 5. | Compare the ILP100-Topical and Placebo treatment arms up to Year 5 after initiation of treatment. |
| CXCL12 levels in plasma | CXCL12 levels in plasma as measured by enzyme-linked immunosorbent assay (ELISA). | Compare up to Week 16 between the ILP100-Topical and Placebo treatment arms. |
| Presence of viable L. reuteri containing the pSIP_CXCL12 plasmid in wounds | Bacteria will be collected from the wound and perilesional skin with sterile cotton swabs which will be cultured. | Compare up to Year 5 between the ILP100-Topical and Placebo treatment arms. |
Mortality data will be acquired from the patient's medical records. |
| Compare at Week 26, and thereafter annually Year 1 to 5, between the ILP100-Topical and Placebo treatment arms. |
| Quality of life assessed with Wound-Quality of Life (Wound QoL) questionnaire | Quality of life will be assessed by the subjects using the Wound-QoL questionnaire including 17 questions on impairment related to the wound, each to be answered by grades from 0-4 (0='not at all' to 4='very much') | Compare up to Week 16 between the ILP100-Topical and Placebo treatment arms. |
| Time for IMP preparation | Time needed for IMP preparation, by the study personnel, will be recorded. | Compare at Week 4 between the ILP100-Topical and Placebo treatment arms. |
| Total number of redressings, off-loading and devices used for the treatment of the index wound | Wound management will include redressing, which will be done both during home visits and study site visits, while debridement and changes of off-loading devices should only be done at study site visits. The total number of redressings, off-loading and devices used for the treatment of the index wound will be recorded. | Compare the ILP100-Topical and Placebo treatment arms during 16 weeks from baseline. |
| Wound volume | Metric analyses of wound healing, including volume, are made using 3D models acquired from Screening to Week 26. Wound measures will be automatically generated by a computer software and validated by the Independent Assessor. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Wound depth | Metric analyses of wound healing, including depth, are made using 3D models acquired from Screening to Week 26. Wound measures will be automatically generated by a computer software and validated by the Independent Assessor. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Wound volume reduction (percent of Baseline) | Reduction of wound volume (percent of Baseline) will be calculated. Metric analyses of wound healing, including volume, are made using 3D models acquired from Screening to Week 26. Wound measures will be automatically generated by a computer software and validated by the Independent Assessor. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Wound depth reduction (percent of Baseline) | Reduction of wound depth (percent of Baseline) will be calculated. Metric analyses of wound healing, including depth, are made using 3D models acquired from Screening to Week 26. Wound measures will be automatically generated by a computer software and validated by the Independent Assessor. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Analyses of predictive factors for wound healing outcome | Analyses of associations between baseline clinical (including toe pressure at Baseline and sex) and biologic characteristics (including wound size and pH) with wound healing outcomes through Week 26. A statistical regression model will be developed to predict wound healing up to Week 26 | Analyses of associations between baseline clinical and biologic characteristics and wound healing outcomes up to Week 26. |
| Analyses of predictive factors for occurence of AEs | Analyses of associations between baseline clinical (including toe pressure at Baseline and sex) and biologic characteristics (including wound size and pH) with AEs. A statistical regression model will be developed to predict the AE outcome up to Week 26 | Analyses of associations between baseline clinical and biologic characteristics and occurence of AEs up to Week 26. |
| Analyses of scar area | Scar area will be measured for the index wound using 3D models generated from superimposing 2D images and infrared scanning of the topography of the wound and perilesional skin acquired at the study visits. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Analyses of scar volume | Scar volume will be measured for the index wound using 3D models generated from superimposing 2D images and infrared scanning of the topography of the wound and perilesional skin acquired at the study visits. | Compare between the ILP100-Topical and Placebo treatment arms up to Week 26. |
| Change from Baseline in level of wound pH | Change from Baseline in level of wound pH will be measured on exuding wounds (at the discretion of the Investigator) at selected timepoints just prior to IMP administration using sterile litmus paper strips. | Compare at Weeks 1, 4, 5, 8 and 16 between the ILP100-Topical and Placebo treatment arms. |
| Change from Baseline in local blood flow in wound area measured with Laser Speckle Contrast Analysis | Change from Baseline in local blood flow around the index wound will be addressed by non-invasive imaging using Laser Speckle Contrast Analysis (LASCA) where each wound and surrounding skin will be recorded for at least one minute of stable recording at selected timepoints in the study. | Compare ILP100-Topical and Placebo treatment arms up to Week 16 |
| Pathogenic wound bacteria characterization upon clinically defined or suspicions of wound infection | Characteristics of ILP100 will be addressed by collecting bacteria from the wound with sterile cotton swabs which will be cultured. | Compare species of infection-causing wound pathogens up to Week 26 between the ILP100-Topical and Placebo treatment arms. |
| Wound microbiome profile, including presence and proportion of wound pathogenic bacteria | The impact of ILP100 on the wound microbiome composition will be assessed from wounds swabs identified by sequencing bacterial 16S ribosomal ribonucleic acid (rRNA) genes. | Compare the microbiome profile up to Week 16 between the ILP100 and Placebo treatment arms. |
| Presence of anti-drug antibodies (ADA) to CXCL12 and the activation peptide SppIP up to Year 5 | The development of anti-drug antibodies (ADAs, to CXCL12 and SppIP) as measured by electrochemiluminescence immunoassay (ECLIA). | Compare presence of ADA up to Year 5 between the ILP100-Topical and Placebo treatment arms. |
| Analysis of L. reuteri containing the pSIP_CXCL12 plasmid in blood, feces, and perilesional skin | Shedding to the external environment will be measured in feces and water lock samples collected at the sites. The method will determine the number of live L. reuteri R2LC containing pSIP_CXCL12 in the samples. Used dressings will also be collected for shedding analyses of L. reuteri R2LC containing the pSIP_CXCL12 plasmid. | Analyses of presence of L. reuteri containing the pSIP_CXCL12 plasmid up to Year 5. |
| Uppsala |
| Sweden |
| Ohnstedt E, Lofton Tomenius H, Vagesjo E, Phillipson M. The discovery and development of topical medicines for wound healing. Expert Opin Drug Discov. 2019 May;14(5):485-497. doi: 10.1080/17460441.2019.1588879. Epub 2019 Mar 14. |
| 35213962 | Background | Ohnstedt E, Lofton Tomenius H, Frank P, Roos S, Vagesjo E, Phillipson M. Accelerated Wound Healing in Minipigs by On-Site Production and Delivery of CXCL12 by Transformed Lactic Acid Bacteria. Pharmaceutics. 2022 Jan 19;14(2):229. doi: 10.3390/pharmaceutics14020229. |
| ID | Term |
|---|---|
| D017719 | Diabetic Foot |
| ID | Term |
|---|---|
| D003925 | Diabetic Angiopathies |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D016523 | Foot Ulcer |
| D007871 | Leg Ulcer |
| D012883 | Skin Ulcer |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D048909 | Diabetes Complications |
| D003920 | Diabetes Mellitus |
| D004700 | Endocrine System Diseases |
| D003929 | Diabetic Neuropathies |
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