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Estudos

EPIFACTOR?

Bioestimula??o epitelial

DESCRI??O

Subst?ncia ativa bioid?ntica de natureza pept?dica (Epidermal Grow Factor-EGF), sH-Oligopept?dio 1, com elevada concentra??o de ?cidos graxos oleico e linoleico, que mimetiza o componente de mesmo nome EGF no organismo humano; sua cadeia, composta por 53 amino?cidos, ? obtida por processo biotecnol?gico de fermenta??o, atrav?s da bact?ria E.coli.

MECANISMO DE A??O

Epifactor? atua atrav?s da sua afinidade com os receptores de EGF, ou seja, o EGFR que est?o presentes na epiderme, derme e matriz de fol?culos pilosos. A uni?o de Epifactor? com EGFR induz a atividade da tirosinaquinase, que inicia uma cascata de a??es resultando em uma grande sucess?o de trocas bioqu?micas em toda a c?lula, onde entre essas trocas, pode-se destacar a prolifera??o de queratin?citos, com aumento de sua ades?o e mobilidade, ativa??o da funcionalidade do fibroblasto, aumentando a produ??o de col?geno, ?cido hialur?nico e elastina, e indu??o da angiog?nese. Assim, estimula a express?o g?nica (up-regulation), a capacidade de recupera??o cut?nea pela prolifera??o dos fibroblastos, atenua os sinais do envelhecimento cut?neo, regenera cicatrizes e contribui com tratamentos a laser, Luz Intensa Pulsada (LIP), peeling e implantes, drug delivery, entre outros. A recomenda??o t?pica de Epifactor? pode ser vari?vel a depender da base e posologia (ex: BB Blur 30g em p?s procedimentos est?ticos, base Adimax? 250g em p?s cir?rgicos e Aristoflex? 150g para feridas de meia perna).

INDICA??ES

P?s-laser/Peeling/implantes; Pr? procedimentos e cirurgias (prepara??o cut?nea); Regenera??o cut?nea em cicatrizes, feridas e queimaduras; Preven??o de queloides e melhora de les?es de acne; Preven??o e tratamento de estrias; Anti aging em geral.

DOSE USUAL

Recomenda??o t?pica de 0,004 mg de Epifactor?.

SUGEST?ES DE F?RMULAS

Epifactor?............................................. 0,004 mg Serum qsp .................................................... 30 g

Modo de uso: aplica??o imediata p?s procedimento.

Indica??o: otimiza??o de cicatriza??o cut?nea.

Epifactor?............................................. 0,004 mg Adimax qsp................................................... 30 g

Modo de uso: aplicar 2 vezes ao dia, por 30 dias.

Indica??o: tratamento e preven??o de queloides, cicatriza??o de feridas.

PRINCIPAIS REFER?NCIAS

SCHOUEST, J.M.; LUU, T.K.; MOY, R.L. Improved texture and appearance of human facial skin after daily topical application of barley produced, synthetic, human-like epidermal growth factor (EGF) serum. J Drugs Dermatol. V. 11, n. 5, p. 613-620, May 2012. Dispon?vel em: < (2012)>. Acesso em: 16 de novembro de 2015, ?s 18:12.

NIIYAMA, H.; KUROYANAGI, Y. Development of novel wound dressing composed of hyaluronic acid and collagen sponge containing epidermal growth factor and vitamin C derivative. J Artif Organs. V. 17, n.1, p. 81-87, Mar. 2014. Dispon?vel em: (2014)++egf. Acesso em: 16 de novembro de 2015, ?s 18:18.

EPIFACTOR?

ESTUDOS CL?NICOS

Improved texture and appearance of human facial skin after daily topical application of barley produced, synthetic, human-like epidermal growth factor (EGF) serum

A three month, open-label, single center study was conducted to determine whether a uniquely derived serum containing barley bioengineered, human-like epidermal growth factor protein could improve visible signs of photodamage and aging in facial skin. Twenty-nine females, aged 39 to 75 years, with mild to severe, fine and course rhytids, photodamage, and pigmentation were enrolled. Subjects then applied the treatment serum per the prescribed protocol twice-daily for 3 months, in addition to the use of a basic sunscreen and facial cleanser. In-person clinical evaluations and subject self-assessment questionnaires were administered at each follow up visit. In addition, clinical photography was completed at baseline, and each subsequent visit. Clinical evaluations showed statistically significant improvement in the appearance of fine lines and rhytids, skin texture, pore size, and various dyschromatic conditions apparent within the first month of use, and continuing improvement trends for the duration of the study. The treatment serum was well tolerated with minimal treatment-related complications reported throughout. Efficacy of this novel serum and treatment protocol resulted in meaningful improvements in photodamage and visible signs of aging.

Development of novel wound dressing composed of hyaluronic acid and collagen sponge containing epidermal growth factor and vitamin C derivative

This study was designed to investigate the potential of a wound dressing composed of hyaluronic acid (HA) and collagen (Col) spongy sheet containing epidermal growth factor (EGF) and vitamin C derivative (VC). High-molecularweight HA aqueous solution, hydrolyzed low-molecular-weight HA aqueous solution and heat-denatured Col aqueous solution were mixed, followed by freeze-drying to obtain a spongy sheet. Cross-linkage between Col molecules was induced by UV irradiation of the spongy sheet (C-wound dressing). In a similar manner, three types of spongy sheet containing EGF (EGF-wound dressing), containing VC (VC-wound dressing) or containing EGF and VC (EGF?VCwound dressing) were prepared by freeze-drying the mixed solution containing the specified components. Cytokine production by fibroblasts was assessed in a wound surface model using a fibroblast-incorporating Col gel sheet (cultured dermal substitute; CDS). CDS was elevated to the air-medium interface, onto which each wound dressing was placed and cultured for 7 days. Fibroblasts in CDS covered with EGF-wound dressing released 3.6 times more VEGF and 3.0 times more HGF, as compared with the C-wound dressing. Fibroblasts in CDS covered with EGF?VCwound dressing released 4.2 times more VEGF and 6.0 times more HGF, as compared with the C-wound dressing. The efficacy of these wound dressings was evaluated in animal tests using diabetic mice. Each wound dressing was applied to a full-thickness skin defect on the dorsal area measuring 1.5 ? 2.0 cm. After 1 week of application, wound conditions were evaluated histologically. The EGF?VC-wound dressing more effectively promoted granulation tissue formation associated with angiogenesis, as compared with other wound dressings.

Wound repair by bone marrow stromal cells through growth factor production

We have previously shown that treatment with bone marrow stromal cells (BMSCs) augments the healing of fascial wounds in the rat. However, the biochemical mechanism by which BMSCs improve wound healing was not investigated. Growth factors have been shown to play a key role in repairing damaged tissue. In this study, we investigated whether BMSCs are capable of producing growth factors that play a critical role in healing of the damaged tissue. Growth factor expression in BMSCs stimulated with pro-inflammatory cytokines or wound superfusate was measured by RT-PCR and growth factor-specific quantitative sandwich enzyme-linked immunosorbent assay (ELISA). RT-PCR analysis demonstrated that BMSCs are capable of expressing transforming growth factor beta-1 (TGF-beta1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) plateletderived growth factor (PDGF), keratinocyte growth factor (KGF), fibroblast growth factor (FGF), and hepatocyte growth factor (HGF) constitutively or upon stimulation with LPS, IL-1alpha, or TNF-alpha. Quantitative analysis of growth factor production by ELISA showed that BMSCs do not secrete TGF-beta1, EGF or VEGF in response to uninjured fascia tissue superfusate; however, production of these growth factors is significantly increased when cells

were stimulated with wound tissue superfusate. The ability of wound to stimulate growth factor production in BMSCs could be detected as early as day 1 and lasted through day 7 after wounding. Thus, growth factor production by BMSCs in response to wound microenvionment suggests that BMSCs might augment wound healing through the responsive secretion of growth factors that enhance angiogenesis and promote wound repair.

Em um estudo cl?nico, foi avaliada a efic?cia de Epifactor? comparado ao placebo na atividade regeneradora da barreira cut?nea p?s-laser CO2 fracionado. Observaram-se par?metros de tempo de reepiteliza??o, vermelhid?o e irrita??o cut?nea. O estudo evidenciou que o uso do Epifactor? n?o impediu os benef?cios do laser CO? fracionado; pelo contr?rio, contribuiu para a efic?cia do tratamento. Concluiu-se uma melhora mais r?pida na regenera??o da pele, menos eritema e maior conforto para o paciente no tempo de repouso.

Refer?ncia de dados baseada em estudos do pr?prio fornecedor.

Efficacy of topical application of beta urogastrone (recombinant human epidermal growth factor) in Wagner's Grade 1 and 2 diabetic foot ulcers: Comparative analysis of 50 patients

Introduction: Diabetes mellitus is growing at epidemic proportions world wide and associated with this is an increase in incidence of diabetic foot ulcers. For better understanding and ease of management, diabetic foot ulcer severity is often classified using the Wagner system. In recent times, various treatment modalities have been put to test for getting early wound healing, including growth factors like human epidermal growth factor.Materials and methods: The present study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana. The patients were divided into two groups of 25 patients each. Group 1 was the study group and patients in this group received topical application of beta urogastrone (rhEGF) gel. Group 2 was the control group and patients in this group received betadine dressing. The patients were followed up after every two weeks for eight weeks.RESULTS:The age and sex were comparable in both groups. Mode of onset was either spontaneous or posttraumatic or following debridement. Initially in group A, 12 patients each had serous and seropurulent discharge respectively. I patient did not have any discharge. In group B, 15 patients had sero purulent discharge, 9 patients had serous discharge and 1 patient had purulent discharge. Initially, 13 patients in group A and 15 patients in group B had granulation tissue. Mean size at the beginning of the study in-group A was 19.56 sq cm and 21.20 sq cm in group B. Two patients from group A had incomplete healing at the end of the study as compared to 14 patients from group B. Conclusions:The application of rhEGF shortens the wound healing time significantly and the mean closure was significantly higher in the EGF group compared with placebo.

Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis Growth factor (GF) therapy has shown promise in treating a variety of refractory wounds. However, evidence supporting its routine use in burn injury remains uncertain. We performed this systematic review and meta-analysis assessing randomised controlled trials (RCTs) to investigate efficacy and safety of GFs in the management of partialthickness burns. Electronic searches were conducted in PubMed and the Cochrane databases. Endpoint results analysed included wound healing and scar formation. Thirteen studies comprising a total of 1924 participants with 2130 wounds (1131 GF receiving patients versus 999 controls) were identified and included, evaluating the effect of fibroblast growth factor (FGF), epidermal growth factor (EGF) and granulocytemacrophage-colony stimulating factor (GM-CSF) on partial-thickness burns. Topical application of these agents significantly reduced healing time by 5?02 (95% confidence interval, 2?62 to 7?42), 3?12 (95% CI, 1?11 to 5?13) and 5?1 (95% CI, 4?02 to 6?18) days, respectively, compared with standard wound care alone. In addition, scar improvement following therapy with FGF and EGF was evident in terms of pigmentation, pliability, height and vascularity. No significant increase in adverse events was observed in patients receiving GFs. These results suggested that GF therapy could be an effective and safe add-on to standard wound care for partial-thickness burns. High-quality, adequately powered trials are needed to further confirm the conclusion.

REFER?NCIAS

SCHOUEST, J.M.; LUU, T.K.; MOY, R.L. Improved texture and appearance of human facial skin after daily topical application of barley produced, synthetic, human-like epidermal growth factor (EGF) serum. J Drugs Dermatol. V. 11, n. 5, p. 613-620, May 2012. Dispon?vel em: < (2012)>. Acesso em: 16 de novembro de 2015, ?s 18:12. NIIYAMA, H.; KUROYANAGI, Y. Development of novel wound dressing composed of hyaluronic acid and collagen sponge containing epidermal growth factor and vitamin C derivative. J Artif Organs. V. 17, n.1, p. 81-87, Mar. 2014. Dispon?vel em: (2014)++egf. Acesso em: 16 de novembro de 2015, ?s 18:18. LIU, Y. et. al. Wound repair by bone marrow stromal cells through growth factor production. J Surg Res. V. 136, n. 2, p. 336-341, Dec 2006 Dispon?vel em:< (2006)++egf>. Acesso em: 16 de novembro de 2015, ?s 18:25. Refer?ncia de dados baseada em estudos do pr?prio fornecedor. SINGLA, S. Et. al. Efficacy of topical application of beta urogastrone (recombinant human epidermal growth factor) in Wagner's Grade 1 and 2 diabetic foot ulcers: Comparative analysis of 50 patients. J Nat Sci Biol Med. v. 5, n. 2, p. 273-277, Jul 2014. Dispon?vel em:< >. Acesso em: 04 de janeiro de 2016, ?s 14:23. ZHANG, Y. et. al. Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis. Int Wound J 2014. Dispon?vel em: < >. Acesso em: 04 de janeiro de 2016, ?s 14:29.

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