Therapeutic angiogenesis for wound healing

he clinical management of chronic wounds is undergoing a major paradigm shift from passive aids that prevent progression-such as dressings, strappings, cleansers, and antibiotics-to advanced modalities that control the molecular mediators of healing. Successful modalities that have emerged over the past decade include recombinant growth factors, tissue-engineered products, hyperbaric oxygen, negative pressure therapy, and electrical stimulation.(1-5) In 1997, the US Food and Drug Administration (FDA) approved the first angiogenic growth factor, becaplermin (REGRANEX((R)), Johnson & Johnson Wound Management), for the treatment of nonhealing diabetic foot ulcers. Becaplermin, also known as recombinant human platelet-derived growth factor (rhPDGF-BB), stimulates vigorous angiogenesis (granulation) in the wound bed, accelerates healing, and increases the incidence of complete wound closure.(6-8) A further recent advance has been the development of an oxidized regenerated cellulose (ORC)/collagen (PROMOGRAN((R)), Johnson & Johnson Wound Management) that protects growth factors and newly formed granulation tissue by inhibiting wound proteases.' This article reviews the role and use of becaplermin and ORC/collagen for optimizing angiogenesis in chronic wounds.