Effectiveness of Epidermal Growth Factor Loaded Carboxymethylcellulose (EGF-CMC) Hydrogel in Biofilm Formation in Wounds of Diabetic Patients: A Randomized Clinical Trial

Abstract

Diabetic patients frequently develop wounds, which can be colonized by bacteria, mainly Staphylococcus aureus and Pseudomonas aeruginosa, with the ability to form biofilms. This study aimed to evaluate the colonization and biofilm formation of Staphylococcus aureus and Pseudomonas aeruginosa in chronic wounds of diabetic patients treated with a bioactive dressing (EGF-CMC), which consisted of a 2% carboxymethylcellulose (CMC) hydrogel loaded with epidermal growth factor (EGF). This randomized clinical trial was conducted with 25 participants: 14 treated with EGF-CMC hydrogel and 11 treated with CMC hydrogel for 12 weeks. Participants with type 2 diabetes mellitus were selected. All had diabetic foot ulcers or chronic venous ulcers. Swab collections were performed on weeks 1, 6, and 12. The laboratory analyses included the identification of strains, microbial quantification, virulence gene investigation, and the evaluation of biofilm formation. In total, 13 S. aureus strains and 15 P. aeruginosa strains were isolated. There were no statistically significant differences regarding bacterial loads and virulence genes. However, EGF-CMC-hydrogel-treated wounds were colonized by strains with lower biofilm formation abilities. The probability of isolating biofilm-producing strains from CMC-hydrogel-treated wounds was 83% greater than the probability of isolating biofilm-producing strains from EGF-CMC-treated wounds.

Innovative Functional Biomaterials as Therapeutic Wound Dressings for Chronic Diabetic Foot Ulcers

“…In addition, good biocompatibility with L929 fibroblasts was observed, as well as enhanced cell adhesion and proliferation, thus underlining the potential of this hybrid composite scaffold as an attractive wound dressing [ 65 ]. Furthermore, a randomized clinical trial conducted by Pessanha et al demonstrated the effects of a CMC hydrogel loaded with epidermal growth factor (EGF) on biofilm formation in the wounds of patients with DM [ 66 ]. Despite no differences in overall bacterial loads and virulense genes, they revealed that the loaded hydrogels were colonized by bacterial strains that presented lower biofilm formation capacities [ 66 ].…”

“…Furthermore, a randomized clinical trial conducted by Pessanha et al demonstrated the effects of a CMC hydrogel loaded with epidermal growth factor (EGF) on biofilm formation in the wounds of patients with DM [ 66 ]. Despite no differences in overall bacterial loads and virulense genes, they revealed that the loaded hydrogels were colonized by bacterial strains that presented lower biofilm formation capacities [ 66 ].…”

Antibacterial and Antibiofilm Potential of Bacterial Cellulose Hydrogel Containing Vancomycin against Multidrug-Resistant Staphylococcus aureus and Staphylococcus epidermidis

“…Its formation on wound surfaces hampers antibiotic penetration, consequently impeding wound healing. Research indicates that hydrogel can enhance the healing trajectory and management of wounds afflicted by MDR bacteria, particularly those loaded with antibiotics [7][8][9][10].…”

Wound Gel with Antimicrobial Effects Based on Polyvinyl Alcohol and Functional Aryloxycyclotriphosphazene

“…Covalently cross-linked polymers obtained through the Diels-Alder reaction [14], non-covalently cross-linked non-toxic cryogels of chitosan and polyvinyl alcohol [15], gum arabic cryogels [16], nanofibers based on biodegradable poly-ε-caprolactone, and poly-Llactide obtained via centrifugal spinning or electrospinning [17][18][19][20][21] have been used as gels to prepare wound dressings. Hydrogels based on carboxymethyl cellulose [22] and its combination with carbomer 940 [23], carboxymethyl chitosan [24,25], and chitosan with bacterial cellulose [26] are used to treat chronic wounds and burns.…”