Burns, Second Degree Burn, Wounds and Injuries
Conditions
Keywords
4-aminopyridine, 4-AP, Burns, Second degree burn, Wounds
Brief summary
Many patients suffer from traumatic burns and current treatments do not increase the regenerative potential of either skin grafts or the remaining uninjured skin. There is a need to develop treatments to accelerate and improve healing of burn injuries. More research is needed to evaluate the role of 4-AP, a promising new agent with an excellent safety profile, on wound and burn healing. The investigational treatment will be used to test the hypothesis that 4-AP accelerates burn healing in traumatically burned patients.
Detailed description
Burn treatment has not appreciably changed in decades. Most treatments focus on infection prevention and control, as well as fluid management. This is because burns are universally infected with bacteria allowed to infiltrate deeper tissues by the absence of a skin barrier. If bacteria can now get into these tissues, the problem is only made worse by the large amount of hydration that now can get out into the environment from the open wound. Desiccation sets in with deeper tissues losing fluids. This renders tissue significantly more susceptible to further infection, as dry tissues are less perfused and less capable of fighting infectious insults. Desiccation also robs burned patients of fluids vital to sustain cardiopulmonary function. Without skin, patients essentially lose fluids and cannot perfuse even the most vital organs with time. Research in the field focuses on preventing complications and temporizing these two factors. No regenerative treatments are currently offered to accelerate wound healing, and few investigative treatments are ready for translation to human trials. Most of the pipelines for future treatment involve long development timelines and still focus chiefly on infection control instead of driving tissue to regenerate and heal faster. A significant gap is the need for a regenerative burn treatment that can be trialed while still allowing the use of current protocols. An adjuvant regenerative burn treatment is needed. The purpose of this study is to evaluate the role of local 4-aminopyridine (4-AP) on the treatment of burn wounds to accelerate healing.
Interventions
DRUGDrug: 4-Aminopyridine
Active study drug
OTHERPlacebo
Placebo comparator
Sponsors
John Elfar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Masking description
Subjects in both aims will be assigned to Group A or Group B using a randomization scheme. Each study participant for each aim is randomly assigned to either treatment or placebo using permuted block randomization.
Intervention model description
This is a double-blind, randomized, placebo-controlled trial design.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Injured (burned) adults with a maximum severity of second-degree burns. * Burns involving at least 6cm2 of skin area * Acute burns within 7 days of injury * Cognitive ability to evaluate burn healing, report sensory and motor deficit during examination. * Adults aged 18-80 * Ability to give written informed consent. * Capable of safely coming in for follow up visits on all scheduled appointments.
Exclusion criteria
* History of multiple sclerosis, stroke or any other diagnosed neurological disorder * History of hypersensitivity to AMPYRA® or 4-aminopyridine * Current use of aminopyridine medications, including other compounded 4-AP * Suspected renal impairment based on the Choyke questionnaire. * History of difficult compliance with timely follow up * Patients outside the age range * Unable to provide informed consent. * Patients with a known history of a seizure disorder (4-AP overdose can, in selected cases, result in limited seizure activity). * Patients with a concomitant traumatic brain injury. * Patients unable to communicate. * Patients unwilling to complete the study requirements. * Patients currently taking organic cat-ion transporter 2 (OCT2) inhibitors, e.g. Cimetidine. * Pregnancy, breastfeeding or incarcerated individuals. * Non-English speaking * Patients unable or unwilling to take calibrated (with gauge) photographs of their wounds
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Healing rate | 12 months | Each subject will undergo detailed fiducial-marking augmented macroscopic imaging to determine baseline burn area measurement. These measurements will be repeated at each follow up study visit to assess healing rate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Skin-graft rate | 12 months | Skin-graft rate (failure of healing) |
| Scar formation | 12 months | Scar formation will be measured by the Patient and Observer Scar Assessment Scale (POSAS). Each item of the POSAS is rated on a 10-point score with total scores ranging from 6 to 60 with higher scores indicating increase severity of symptoms. These measurements will be repeated at each follow up study visit. |
| Scar sensitivity | 12 months | Scar sensitivity will be measured by the Patient and Observer Scar Assessment Scale (POSAS). Each item of the POSAS is rated on a 10-point score with total scores ranging from 6 to 60 with higher scores indicating increase severity of symptoms. These measurements will be repeated at each follow up study visit to assess healing rate. |
Countries
United States
Contacts
CONTACTCarly J Deal, MPH
CONTACTVeronica Rangel, BS
PRINCIPAL_INVESTIGATORJohn Elfar, MD
University of Arizona
Outcome results
None listed