Becaplermin: recombinant platelet derived growth factor, a new treatment for healing diabetic foot ulcers

Chronic or non-healing lower extremity ulcerations in diabetics are a significant cause of morbidity and mortality, and account for a large proportion of the financial burden related to the care of diabetics. Lower extremity ulcerations develop primarily as a consequence of neuropathy and the goal in addressing any wound is to re-establish tissue integrity as soon as possible. The healing of wounds is a complex procedure involving multiple growth factors, some of which have multiple effects on different cell types, in particular, platelet derived growth factor (PDGF) is a prominent agent, active in all stages of the healing process. Becaplermin (0.01% Regranex gel) is a homodimeric protein produced by recombinant DNA technology through the insertion of the gene for the B chain PDGF into the yeast Saccharomyces cerevisiae. The biological activity of becaplermin is similar to that of indigenous PDGF-BB, specifically, the promotion of chemotactic recruitment and the proliferation of cells involved in wound repair. Becaplermin has undergone extensive animal and human studies, demonstrating that it is highly effective as an adjunctive measure for the healing of ulcerations in the feet of diabetics when used in conjunction with standard wound healing practices. Specifically these practices include the provision of a moist environment free of debris and necrotic tissue, control of infection and optimal weight displacement from the affected area. Becaplermin is safe and easy to use, being applied once-daily and at present, becaplermin is the only growth factor licensed for use in wound healing.