The purpose of this study is to test the efficacy of an oral, nutrient intervention containing the bioactive components of fish oil to promote healing of chronic venous leg ulcers (CVLUs) by reducing the chronic inflammation at wound sites that prevents healing progression. If this systemic, nutrient intervention is found to alter the microenvironment of CVLUs, the science of wound healing and care of patients with CVLUs will be vastly improved.
The pathogenesis of CVLU involves high numbers of activated polymorphonuclear leukocytes (PMN) that are associated with persistent inflammation in the wound bed. The proposed research is to test the efficacy of an oral, nutrient intervention containing the bioactive components of fish oil (eicosapentaenoic acid - EPA + docosahexaenoic acid - DHA) to assuage PMN activity and promote healing. The study plans to include 248 successive eligible adults ≥ 55 years of age with CVLUs who continue to receive standard care at two university out-patient wound clinics. Participants will be randomized to 2 groups: 12 weeks of daily oral therapy with EPA+DHA (1.87 g/d of EPA + 1.0 g/d of DHA) or daily oral therapy with placebo. At 0, 4, 8 and 12 weeks, across the 2 groups, three specific aims will be pursued: Aim 1. Compare levels of EPA+DHA-derived lipid mediators, and inflammatory cytokines in blood and CVLU fluid. Subaim 1a. Compare inflammatory cytokine gene expression by PMNs in blood (neutrophils and monocytes). Aim 2. Compare PMN activation (blood, CVLU fluid), and PMN-derived protease levels (CVLU fluid). Aim 3. Compare reduction in wound area, controlling for key factors known to affect healing, and determine relationships with lipid mediators, cytokines and PMN activation. Subaim 3a. Compare frequency of CVLU recurrence and levels of study variables in blood between 2 subgroups within the EPA+DHA group with healed CVLUs (after 3 additional months of EPA+DHA therapy versus placebo therapy beyond Week 12 time point). Subaim 3b. Compare the symptom of pain at all time points and quality of life at first and last study visits across the 2 groups and 2 subgroups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
296
The Ohio State University College of Nursing
Columbus, Ohio, United States
Change in EPA+DHA-derived lipid mediators
plasma and wound fluid levels of EPA+DHA-derived lipid mediators of inflammation
Time frame: 0, 4, 8 and 12 weeks
Change in inflammatory cytokines
plasma and wound fluid levels of pro- and anti-inflammatory cytokines
Time frame: 0, 4, 8 and 12 weeks
Change in polymorphonuclear leukocyte (PMN) activation
blood and wound fluid levels of PMN activation
Time frame: 0, 4, 8 and 12 weeks
Change in PMN-derived proteases
wound fluid levels of PMN-derived proteases
Time frame: 0, 4, 8 and 12 weeks
Change in reduction in wound area
reduction in wound area measured in cm2
Time frame: 0, 4, 8 and 12 weeks
inflammatory cytokine gene expression
inflammatory cytokine gene expression by neutrophils and monocytes from blood
Time frame: 0, 4, 8 and 12 weeks
recurrence of chronic venous leg ulcers
frequency of recurrence of chronic venous leg ulcers after healing
Time frame: 3 months beyond Week 12 time point in participants whose leg ulcers have healed by Week 12
Change in symptom of pain
pain related to venous leg ulcer measured using the Venous Clinical Severity Score (VCSS)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 0, 4, 8 and 12 weeks (and at 3 month timepoint beyond Week 12 in participants in extended study - with healed leg ulcers by Week 12)
quality of life using the VEINES-QOL/Sym questionnaire
quality of life related to venous leg ulcer measured using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire
Time frame: 0, 12 weeks ((and at 3 month timepoint beyond Week 12 in participants in extended study - with healed leg ulcers by Week 12)