Factor de crecimiento epidérmico, innovación y seguridad

doi:10.1016/j.medcli.2014.09.012

Medicina Clínica

Volume 145, Issue 7, 5 October 2015, Pages 305-312

https://doi.org/10.1016/j.medcli.2014.09.012 Get rights and content

Resumen

El recombinant human epidermal growth factor (rhEGF, «factor de crecimiento epidérmico recombinante humano bioidéntico»), disponible en concentraciones y pureza aptas para uso terapéutico, dispone de formulaciones estables en el tiempo. Hay evidencias de efectos terapéuticos beneficiosos en diversas enfermedades y lesiones de la piel (heridas, cicatrices, queloides, dermatitis o alopecia por radiación o por quimioterápicos, hiperpigmentaciones posinflamación o daño causado por la edad), e igualmente puede ser considerado para el tratamiento de algunas afecciones de la mucosa orofaríngea y digestiva alta (aftosis, fístulas faríngeas, mucosas esofágica y gástrica) o para lesiones corneales y conjuntivales.

El rhEGF no muestra efectos secundarios o colaterales en humanos ni en animales de experimentación, evidenciando una óptima tolerabilidad y seguridad.

La formulación magistral otorga versatilidad, individualización, personalización, estabilidad molecular, seguridad y efectividad en condiciones idóneas, evidenciando una buena capacidad de penetración en el tejido, tanto en piel intacta como sobre lesiones cutáneas que exponen los planos inferiores a la superficie.

Se pueden considerar los compuestos con rhEGF para la prevención o tratamiento de diversas afecciones y enfermedades cutáneas o mucosas a través de preparados de formulación magistral.

Abstract

Bioidentical recombinant human epidermal growth factor (rhEGF) is available in concentrations and purity suitable for therapeutic use in long time stable formulations. Beneficial effects in several skin pathologies and lesions have been reported (traumatic and surgical wound healing, laser induced wounds, abnormal scars, keloids, radiation or chemotherapy induced dermatitis, post inflammatory hyperpigmentation or for skin aging damage repairing) and also may be considered for the treatment of several oropharingeal and high gastroesophageal tract mucosa diseases (mouth sores, pharyngeal fistulas, ulcers), and several corneal or conjunctive mucosa lesions.

rhEGF has not shown any important side or collateral effects in humans or in laboratory experimentation animals, showing optimal tolerability and safety with continuous use for months.

Compounding gives advantages of versatility, individualization, personalization, molecular stability, safety and effectiveness in ideal conditions, showing good tissue penetration, both on intact skin and skin lesions that expose the lower planes to the surface.

rhEGF compounds can be considered for prevention or as a treatment of diverse skin and mucosa diseases and conditions through compounding preparations.

Section snippets

Introducción

La investigación traslacional en biotecnología y la recombinación genética con Escherichia coli permiten disponer de recombinant human epidermal growth factor (rhEGF, «factor de crecimiento epidérmico recombinante humano bioidéntico») heterólogo purificado y en concentraciones precisas y estables, permitiendo su uso experimental y clínico; el conocimiento preciso de sus mecanismos de acción define sus indicaciones clínicas.

El epidermal growth factor (EGF, «factor de crecimiento epidérmico») es

Factor de crecimiento epidérmico, estructura y bioquímica

Stanley Cohen y Rita Levi-Montalcini recibieron el Premio Nobel de Medicina en 1986 por el descubrimiento de la estructura peptídica del EGF, cuya existencia era conocida anteriormente. El EGF promueve el crecimiento, la proliferación, la diferenciación y la supervivencia celulares² mediante el ligando con su receptor de membrana (EGFR, del inglés epidermal growth factor receptor,)³.

El EGF, presente en plaquetas, macrófagos y fluidos como orina, saliva, leche y plasma⁴, es un polipéptido (6.045

Heridas y úlceras cutáneas

La curación de heridas comprende 3 fases sucesivas (inflamación, proliferación y remodelado), que implican la participación de múltiples tipos celulares. Factores de crecimiento como el EGF intervienen en los procesos involucrados en la curación de la herida: expresión proteica, producción enzimática, división, diferenciación, proliferación celular y angiogénesis, degradación de la matriz extracelular y quimiotactismo para la intervención de células inflamatorias y fibroblastos⁶. Su alteración

Formas de prescripción: formulación magistral

El EGF, en galénicas y dosis adecuadas, ha mostrado estabilidad y efectividad clínica sin efectos secundarios ni colaterales de importancia en afecciones de piel y mucosas, en prevención primaria y como tratamiento, con indicaciones en diversas especialidades (Dermatología, Cirugía, Oftalmología, Digestología, Otorrinolaringología, Medicina Estética, Regenerativa, etc.) (tabla 1)⁵⁸.

La escasa estabilidad del EGF en medios aptos para su almacenaje y comercialización más allá de 3 meses hizo

Conclusiones

El rhEGF ha sido probado con éxito en humanos y en animales de experimentación, evidenciando eficacia como prevención primaria o tratamiento de diversas enfermedades y complicaciones de la piel (heridas traumáticas o quirúrgicas, heridas por láser, cicatrices anómalas, dermatitis o alopecia por radiación o por quimioterápicos, hiperpigmentaciones posinflamación o para la reparación del daño causado por la edad) y de mucosas (corneal, conjuntiva y orofaríngea, en aftas orales, fístulas faríngeas

Financiación

Para la redacción de la presente revisión no se ha recibido financiación por parte de organismos oficiales.

Conflicto de intereses

El Dr. Jordi Esquirol Caussa es asesor ocasional de Fagron Ibérica S. A. U. sin remuneración, coordinador de Investigación en el Servei Universitari de Recerca en Fisioteràpia en las Escuelas Universitarias Gimbernat (adscritas a la Universitat Autònoma de Barcelona) y médico asistencial en el Hospital Quirón Teknon de Barcelona.

La Dra. Elisabeth Herrero es coordinadora de la Unidad de Medicina Preventiva y médico especialista en Medicina Familiar y Comunitaria de Àptima (Terrassa, Barcelona) y

Agradecimientos

Agradecemos a Fagron Ibérica S. A. U. su colaboración científica para la obtención de información pertinente a esta revisión.

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Revisión de evidencia y opciones terapéuticas del factor de crecimiento epidérmico recombinante humano bioidéntico (rhEGF) en úlceras vasculares. El rhEGF ha evidenciado eficacia, tolerabilidad y seguridad, considerándose tratamiento adyuvante o emergente en guías de práctica clínica basadas en la evidencia. Se dispone de rhEGF mediante formulación magistral, asegurando estabilidad, efectividad y seguridad, permitiendo la individualización (adición de principios activos, cambios de galénica). Los compuestos con rhEGF mediante formulación magistral pueden considerarse indicados en el tratamiento de úlceras vasculares.
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RevisiónFactor de crecimiento epidérmico, innovación y seguridadEpidermal growth factor, innovation and safety

Resumen

Abstract

Section snippets

Introducción

Factor de crecimiento epidérmico, estructura y bioquímica

Heridas y úlceras cutáneas

Formas de prescripción: formulación magistral

Conclusiones

Financiación

Conflicto de intereses

Agradecimientos

Atherosclerosis

J Biol Chem.

J Surg Res.

J Dermatol Sci.

J Dermatol Sci.

Am J Pathol.

J Pharm Sci.

J Biol Chem.

Eur J Med Chem.

Profiling and metaanalysis of epidermal keratinocytes responses to epidermal growth factor

BMC Genomics.

Review of epidermal growth factor receptor biology

Int J Radiat Oncol Biol Phys.

Epidermal growth factor and epidermal growth factor signaling attenuate laser-induced melanogenesis

Dermatol Surg.

Robbins and Cotran pathologic basis of disease

Nobel Lecture 1986. Epidermal growth factor

The modern approach to wound treatment

Med Pregl.

Growth factors in lung development and disease: Friends or foe?

Respir Res

Iodine in evolution of salivary glands and in oral health

Nutr Health.

Epidermal growth factor immunoreactive material in the central nervous system: Location and development

Science.

Recombinant growth factor mixtures induce cell cycle progression and the upregulation of type i collagen in human skin fibroblasts, resulting in the acceleration of wound healing processess

Int J Mol Med.

The epidermal growth factor receptor is a regulator of epidermal complement component expression and complement activation

J Immunol.

Effects of human epidermal growth factor gene-transfected mesenchymal stem cells on fibroblast migration and proliferation

Cell Prolif.

Epidermal EGFR controls cutaneous host defense and prevents inflammation

Sci Transl Med.

EGFR signaling and drug discovery

Oncology.

Efectores metabólicos y nutricionales asociados a la terapia biologica del cancer

Nutr Hosp.

The epidermal growth factor receptor increases cytokine production and cutaneous inflammation in response to ultraviolet irradiation

ISRN Dermatol.

Effects of the basic fibroblast growth factor and its anti-factor in the healing and collagen maturation of infected skin wound

Acta Cir Bras.

Human epidermal growth factor enhances healing of diabetic foot ulcers

Diabetes Care.

Epidermal growth factor in the treatment of diabetic foot ulcers: An update

Perspect Vasc Surg Endovasc Ther.

Role of epidermal growth factor in healing of diabetic foot ulcers

Indian J Surg.

Topical application of epidermal growth factor accelerates wound healing by myofibroblast proliferation and collagen synthesis in rat

J Vet Sci.

Revisión
Factor de crecimiento epidérmico, innovación y seguridadEpidermal growth factor, innovation and safety