Chlorin E6 gel plus red‑light treatment for diabetic foot ulcers

Single-Centre, Open-labeled, Randomized, Phase IIb and Phase III Clinical Studies to Evaluate the Safety, Tolerability, and Efficacy of Chlorin E6 (Gel Formation) as a Photosensitizing Agent for the Management of Diabetic Foot Ulcers With Photodynamic Therapy.

This study will test whether applying a Chlorin E6 gel to chronic diabetic foot ulcers and illuminating them with red light helps them heal faster and reduce infection in adults with diabetes.

Quick facts

• Phase: Phase 3
• Study type: Interventional
• Enrollment: 300 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: United Medical and Dental College (Academic / other)
• Drugs / interventions: chemotherapy, radiation
• Locations: 1 site (Karachi, Sindh)
• Trial ID: NCT07488247 on ClinicalTrials.gov

What this trial studies

This is a single‑center, open‑label, randomized Phase IIb/III study of topical Chlorin E6 gel used with photodynamic therapy (PDT) in adults with diabetic foot ulcers. The gel (1% W/V, dosed at 1.0 mg/cm²) is applied to the ulcer for 30 minutes, rinsed, then illuminated with red light (660–670 nm) at 100 J/cm² for about 11 minutes, with a second illumination if needed; standard wound care including debridement, targeted antibiotics, and glucose management is provided to all participants. The Phase IIb portion enrolled 30 participants and the Phase III portion plans to enroll 300 participants, with each participant followed for about three months. Primary outcomes include safety, wound healing rates and bacterial eradication, and secondary outcomes include recurrence and limb amputation rates within six months.

Who should consider this trial

Good fit: Adults (≥18 years) with diabetes who have a chronic foot ulcer of at least 4 weeks' duration, wound surface area 0.5–20 cm², ABI 0.7–1.2, and reasonably controlled blood glucose (HbA1c <12%, random glucose <350 mg/dL) are the intended participants.

Not a fit: Patients with active sepsis, severe peripheral arterial disease (ABI <0.7), very large or extremely long‑standing ulcers outside the size/duration limits, or unstable medical conditions are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, the treatment could speed ulcer healing, lower infection rates, and reduce the risk of amputations for people with diabetic foot ulcers.

How similar studies have performed: Small studies and case series of photodynamic therapy for infected wounds have shown promising antimicrobial and healing effects, but large randomized trials in diabetic foot ulcers remain limited.

Eligibility criteria

Inclusion Criteria:

1. Patients with diagnosis of Diabetes mellitus, with diabetic foot ulcer.
2. Males and females subject of age 18 years and above.
3. HbA1c of less than 12% and random blood sugars of less than 350 mg/dl.
4. Vitally stable patient with no clinical signs of sepsis, a qSOFA (quick Sepsis-Related Organ Failure Assessment) score of \<2.
5. ABI (Ankle Brachial Index) 0.7 to 1.2.
6. Lower extremity ulcer of more than 30 days duration and less than 2 years duration.
7. Total wound surface area between 0.5 to 20 cm.
8. Deep wounds extending up to muscles (University of Texas Grade \& Stage 1A, 1B, 2A \& 2B) will be included.
9. Patients giving written informed consent to participate in the study after a full understanding of the implications and constraints of the study protocol.
10. Understand the content of the ICF, and voluntarily sign the ICF (If the participant is unable to sign the ICF on his/her own due to illiteracy, an impartial witness is needed).
11. The subject can understand the research process and is willing and able to comply with all research proposals and other requirements of the study.
12. Able to cooperate to complete the scheduled follow-ups till the end of the study

Exclusion Criteria:

1. The vital signs or physical examination are clinically significantly abnormal as determined by the investigators in screening.
2. A history of severe allergy (including drugs, vaccines, and foods) or allergy to any component of the experimental product.
3. Subjects diagnosed with a serious disease, congenital malformation or chronic disease (including but not limited to serious: respiratory disease, cardiovascular disease, serious cerebrovascular disease, kidney disease, serious or uncontrollable diabetes, autoimmune disease, thrombocytopenic purpura, thalassemia, malignant tumor, hereditary allergic constitution, etc.) that may interfere with the conduct or completion of the study;
4. Participating in or planning to participate in other clinical trials (drugs or vaccines) within 3 months prior to participating in this study;
5. Other circumstances considered by the investigator as inappropriate to participate in the study.
6. Vitally unstable patients with clinical signs and symptoms of sepsis, qSOFA score ≥2.
7. More than 2 ulcers in the foot and leg.
8. Deep wounds extending into bone (UoT Criteria any Grade stage C \& D, Grade 3).
9. Subjects with moderate to severe obstruction on ABI (\<0.7 or \>1.3).
10. Patients with HbA1c more than 12% and random blood sugar of more than 350 mg /dl.
11. Subjects with evidence of cardiac disease or heart failure on ECG or echocardiography
12. Patients with eGFR (Estimated Glomerular Filtration Rate) of less than 60 ml/min/1.73 m2.
13. Pregnant or breast-feeding females or women of childbearing potential not using contraception.
14. Hypersensitivity to investigational product/Chlorophyll-driven compounds.
15. Diagnosed case of porphyria.
16. Ophthalmological disease requiring slit-lamp examination or Yag-laser within the next 30 days or anti-VEGF therapy/injection.
17. Patients who do not give written informed consent
18. Subjects unable or unwilling to meet protocol requirements.
19. Ulcer of non-diabetic etiology, such as venous, arterial, and burn wounds
20. Ulcer is less than 3 cm in distance from any other ulcer on the same extremity.
21. Ulcer presents with any of the following: osteomyelitis, exposed bone or gangrene.
22. Ulcer surface area has decreased \> 40% between screening and at randomization (visit 1) as assessed by the imaging system
23. Has medically documented history of HIV
24. Has severe protein malnutrition as defined by Serum Albumin \< 2.5 g/dL.
25. Has serum aspartate aminotransferase (AST, SGOT, GOT) or serum alanine aminotransferase (ALT, SGPT, GPT) levels greater than twice the upper limit of normal
26. Has a medically documented or self-reported history, within the previous 12 months from date of screening visit, of alcohol or substance abuse.
27. Has received previous treatment with the following during the 60 days prior to screening: immunosuppressive agents, radiation, chemotherapy, growth factors at the site of the Ulcer, split- or full-thickness skin graft at the site of the Ulcer, biologically active (or engineered) cellular or acellular product(s) at the site of the study ulcer, investigational drug or device
28. Has ESR \> 70 mm/h and CRP \> 100 mg/L at time of screening

Where this trial is running

Karachi, Sindh

• Creek General Hospital — Karachi, Sindh, Pakistan (Recruiting)

Conditions Diabetic Foot Ulcer; DFU; PDT; Photodynamic Therapy; Chlorin E6; Phase IIB of Chlorin E6; Chlorin E6 Gel