a Prospective, Multicenter, Randomized Controlled Trial, With a Non-randomized Sentinel Cohort, Evaluating the Efficacy of Bioxheal, a Single-layer Placental-derived Biologic in Nonhealing Diabetic Foot Ulcers (AB BIOH - DFU)

October 14, 2026 updated by: Applied Biologics, LLC

a Randomized Controlled Multicenter Clinical Trial, Evaluating the Efficacy of a Single Layer Placental-based Biologic and Standard of Care Versus Standard of Care Alone in the Management of Nonhealing Diabetic Foot Ulcers.

BIOxHEAL is an investigational placental-derived biologic being evaluated for the treatment of nonhealing diabetic foot ulcers. Adults with type 1 or type 2 diabetes who have a diabetic foot ulcer that has not healed with standard wound care may be eligible to participate. Participants in the randomized phase are assigned by chance in a 2:1 ratio to receive either BIOxHEAL administered topically in combination with standard of care (SOC), or SOC alone. Treatment is administered once weekly for up to 12 weeks or until complete ulcer closure. The primary objective is to evaluate whether BIOxHEAL plus SOC increases the proportion of target ulcers achieving complete closure at Week 12 compared with SOC alone.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Phase 3, multicenter, prospective, open-label, randomized controlled study conducted at up to 30 U.S. clinical centers. A non-randomized sentinel cohort (5 completed participants required, with up to 10 participants enrolled) will first receive BIOxHEAL plus SOC to assess early safety. Following DSMB review and FDA authorization to proceed, 243 participants will be randomized 2:1 to BIOxHEAL plus SOC or SOC alone, with randomization stratified by baseline ulcer area and ulcer duration. BIOxHEAL is administered topically once weekly for up to 12 weeks or until complete ulcer closure. Complete closure is confirmed approximately 2 weeks later. Participants are subsequently followed for 3 months.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
253

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • United States
    • Ohio
      • Boardman, Ohio, United States, 44512
        • Recruiting
        • NOMS Ankle and Foot Care Center
        • Contact:
          • Lawrence DiDomenico, DPM
          • Phone Number: 330-953-3222
          • Email: ld5353@aol.com

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

Participants must be at least 18 years of age or older. Participants must have a diagnosis of type 1 or 2 diabetes mellitus. At randomization (or enrollment for the sentinel cohort), participants must have a target ulcer with a minimum surface area of 1.0 cm2 and a maximum surface area of 25.0 cm2 measured post debridement.

The target ulcer must have been present for a minimum of 4 weeks and a maximum of 52 weeks of standard of care prior to the initial screening visit.

The target ulcer must be located on the foot with at least 50% of the ulcer below the malleolus.

The target ulcer must be Wagner Grade 1 extending at least through the dermis or subcutaneous tissue.

The affected limb must have adequate perfusion confirmed by vascular assessment. Any of the following methods performed within 3 months of the first screening visit are acceptable:

ABI greater than or equal to 0.7 and less than or equal to 1.3 TBI greater than or equal to 0.6 TCOM greater than or equal to 40 mmHg Arterial Doppler ultrasound with biphasic dorsalis pedis and posterior tibial vessels at the level of the ankle on the extremity where the index ulcer is located If the participant has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will be designated as the target ulcer.

The participant must consent to using the prescribed offloading method for the duration of the study.

The participant must agree to attend the weekly study visits required by the protocol.

The participant must be willing and able to participate in the informed consent process.

The participant must have a suitable living environment to manage prescribed offloading and wound care management.

Exclusion Criteria:

Known life expectancy of less than 6 months. Target ulcer is not secondary to diabetes. Wagner Grade 2 to 5 ulcers. Target ulcer is infected, or there is cellulitis in the surrounding skin.

Evidence of osteomyelitis complicating the target ulcer, based on clinical assessment supported by at least one of the following:

Imaging (for example, plain radiography, MRI, or nuclear medicine study) consistent with osteomyelitis Positive bone culture Abnormal inflammatory markers (for example, ESR, CRP) in conjunction with clinical signs highly suggestive of osteomyelitis per Investigator judgment - Documentation of the basis for diagnosing or excluding osteomyelitis must be available in the participant's source documents Infection in the target ulcer or in a remote location that requires systemic antibiotic therapy.

Receiving immunosuppressants (including systemic corticosteroids at doses greater than 10 mg of prednisone per day or equivalent) or cytotoxic chemotherapy.

Topical application of steroids to the ulcer surface within one month of initial screening.

Previous partial amputation on the affected foot, if the resulting deformity impedes proper offloading of the target ulcer.

Glycated hemoglobin (HbA1c) greater than or equal to 12% within 3 months of the initial screening visit.

The surface area of the target ulcer has reduced in size by more than 40% between Screening Visit 1 and Treatment Visit 1 during the protocol-defined screening period.

Acute Charcot foot, or an inactive Charcot foot, that impedes proper offloading of the target ulcer.

Women who are pregnant or considering becoming pregnant within the next 6 months.

Male or female participants who are unwilling or unable to comply with the required contraceptive measures for the duration of study participation.

End stage renal disease requiring dialysis. Serum creatinine level greater than 3.0 mg/dL. Aspartate aminotransferase (AST, GOT) and/or alanine aminotransferase (ALT, GPT) greater than 3 times the upper limit of normal.

A medical or psychological condition that, in the opinion of the investigator, may interfere with study assessments.

Treated with hyperbaric oxygen therapy or a Cellular and/or Tissue Product (CTP) in the 30 days prior to the initial screening visit.

Mini Nutritional Assessment (MNA) screening score below 12.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Sentinel Cohort: BIOxHEAL + SOC

Non-randomized sentinel cohort (5 completed participants required, up to 10 enrolled). Participants receive BIOxHEAL administered topically once weekly plus SOC for up to 12 weeks or until complete ulcer closure, to assess early safety before the randomized phase.
Other: Standard of Care

Protocol-defined standard of care (SOC) for diabetic foot ulcers, performed at each study visit: wound cleansing with sterile saline, sharp debridement as clinically indicated, a non-adherent silicone primary dressing with an absorbent secondary dressing to maintain a moist wound environment, offloading for plantar and pressure-bearing ulcers (Foot Defender boot, Total Contact Cast, or Medical Monitor-approved equivalent), and diabetes education and nutritional support, including smoking cessation counseling for current smokers.

Biological: BIOxHEAL (human amniotic membrane allograft)

BIOxHEAL is an investigational, sterile, single-use biologic derived from human amniotic membrane. BIOxHEAL is administered topically to the target ulcer once weekly in combination with protocol-defined standard of care for up to 12 weeks or until complete ulcer closure. Each unit is individually packaged for single-patient, one-time use.
Active Comparator: Randomized: SOC Alone

Participants randomized 2:1 to receive protocol-defined SOC alone, with weekly treatment visits for up to 12 weeks or until complete ulcer closure, with closure confirmed approximately 2 weeks later.
Other: Standard of Care

Protocol-defined standard of care (SOC) for diabetic foot ulcers, performed at each study visit: wound cleansing with sterile saline, sharp debridement as clinically indicated, a non-adherent silicone primary dressing with an absorbent secondary dressing to maintain a moist wound environment, offloading for plantar and pressure-bearing ulcers (Foot Defender boot, Total Contact Cast, or Medical Monitor-approved equivalent), and diabetes education and nutritional support, including smoking cessation counseling for current smokers.
Experimental: Randomized: BIOxHEAL + SOC

Participants randomized 2:1 to receive BIOxHEAL administered topically once weekly plus SOC for up to 12 weeks or until complete ulcer closure, with closure confirmed approximately 2 weeks later.
Biological: BIOxHEAL (human amniotic membrane allograft)

BIOxHEAL is an investigational, sterile, single-use biologic derived from human amniotic membrane. BIOxHEAL is administered topically to the target ulcer once weekly in combination with protocol-defined standard of care for up to 12 weeks or until complete ulcer closure. Each unit is individually packaged for single-patient, one-time use.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Proportion of target ulcers with complete wound closure at Week 12
Time Frame: Baseline to Week 12

Complete closure is defined as 100% epithelialization, assessed by the Investigator and confirmed by blinded, independent wound evaluators. Compared between BIOxHEAL plus standard of care and standard of care alone.
Baseline to Week 12

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Proportion of target ulcers with complete wound closure at Week 8
Time Frame: Baseline to Week 8.

Complete closure is defined as 100% epithelialization, assessed by the Investigator and confirmed by blinded, independent wound evaluators. Compared between BIOxHEAL plus standard of care and standard of care alone.
Baseline to Week 8.
Proportion of participants with treatment-emergent adverse events (TEAEs), serious adverse events (SAEs) and adverse events of special interest (AESIs)
Time Frame: From first treatment through the end of follow-up (at least 3 months after complete wound healing, or after Visit 13 if not healed), assessed up to approximately 6 months

Number and proportion of participants with TEAEs, including SAEs and AESIs. Compared between BIOxHEAL plus standard of care and standard of care alone.
From first treatment through the end of follow-up (at least 3 months after complete wound healing, or after Visit 13 if not healed), assessed up to approximately 6 months
Mean change in Wound Quality-of-Life (wQOL) score from baseline to Week 12
Time Frame: Baseline to 12 weeks

Change in wQOL questionnaire score. Compared between BIOxHEAL plus standard of care and standard of care alone.
Baseline to 12 weeks
Proportion of participants with major and minor lower extremity amputations, and number and frequency of amputations
Time Frame: From first treatment through the end of the follow-up period, assessed up to approximately 6 months

Number and frequency of major and minor lower extremity amputations occurring during the study period.
From first treatment through the end of the follow-up period, assessed up to approximately 6 months
Proportion of participants with completely closed diabetic foot ulcers at any time during the study
Time Frame: From first treatment until complete wound closure (100% epithelialization) is first confirmed, assessed up to approximately 6 months

Complete closure is defined as 100% epithelialization, assessed by the Investigator and confirmed by blinded, independent wound evaluators. Compared between BIOxHEAL plus standard of care and standard of care alone.
From first treatment until complete wound closure (100% epithelialization) is first confirmed, assessed up to approximately 6 months

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Number of sentinel cohort participants with treatment-emergent adverse events (TEAEs), serious adverse events (SAEs) and adverse events of special interest (AESIs) during the treatment period
Time Frame: From first treatment through the end of the treatment period (up to 12 weeks)

Early safety assessment in the non-randomized sentinel cohort, in which all participants receive BIOxHEAL plus standard of care. Safety data from the first 5 participants who complete the treatment period are reviewed by the DSMB and the FDA before randomization begins. The DSMB monitors for risks associated with tissue-based products, including localized inflammatory responses, graft rejection, or unexpected infections.
From first treatment through the end of the treatment period (up to 12 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Applied Biologics, LLC

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Study Director: Charles Zelen, DPM, Professional Education & Research Institute (PERI)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 8, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 25, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 30, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 1, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 16, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 14, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AB BIOH-26-001 Protocol v4.0
  • IND 32533 (Other Identifier: FDA)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

There is currently no plan to make individual participant data (IPD) available to other researchers. The Sponsor will consider reasonable requests for de-identified data after completion of the study and regulatory review, subject to participant privacy protections and applicable agreements.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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