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Advanced therapies are needed because standard topical therapies are often ineffective or yield only short-term wound healing. Thus, we are testing a new oral therapy containing the bioactive elements of fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for targeting and reducing the high numbers of activated polymorphonuclear leukocytes (PMN) in wound microenvironments that keep CVLUs \u201ctrapped\u201d in a chronic inflammatory state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This double-blind RCT will include 248 eligible adults \u2265 55\u2009years of age with CVLUs receiving standard care at a large Midwest outpatient wound clinic. Participants are randomized to two groups: 12\u2009weeks of daily oral therapy with EPA\u2009+\u2009DHA (1.87\u2009g\/day of EPA\u2009+\u20091.0\u2009g\/day of DHA) or daily oral therapy with placebo. At 0, 4, 8, and 12\u2009weeks, across the two groups, we are pursuing three specific aims: Aim 1. Compare levels of EPA\u2009+\u2009DHA-derived lipid mediators, and inflammatory cytokines in blood and wound fluid; Subaim 1a. Compare inflammatory cytokine gene expression by PMNs in blood; Aim 2. Compare PMN activation in blood and wound fluid, and PMN-derived protease levels in wound fluid; Aim 3. Compare reduction in wound area, controlling for factors known to impact healing, and determine relationships with lipid mediators, cytokines, and PMN activation. Subaim 3a. Compare frequency of CVLU recurrence and levels of study variables in blood between the randomly assigned two subgroups (continuing EPA\u2009+\u2009DHA therapy versus placebo therapy beyond week 12) within the EPA\u2009+\u2009DHA group with healed CVLUs after 3\u2009months of therapy. Subaim 3b. Compare symptoms of pain at all time points and quality of life at first and last time points across the two groups and two subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This trial will provide new evidence about the effectiveness of EPA\u2009+\u2009DHA oral therapy to target and reduce excessive PMN activation systemically and locally in patients with CVLUs. If effective, this therapy may facilitate healing and thus be a new adjunct treatment for CVLUs in the aging population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03576989\">NCT03576989<\/jats:ext-link>\n                      ; Registered on 13 June 2018.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-019-3970-7","type":"journal-article","created":{"date-parts":[[2020,1,16]],"date-time":"2020-01-16T08:04:49Z","timestamp":1579161889000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Impact of omega-3 fatty acid oral therapy on healing of chronic venous leg ulcers in older adults: Study protocol for a randomized controlled single-center trial"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3089-4928","authenticated-orcid":false,"given":"Jodi C.","family":"McDaniel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Rausch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alai","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,16]]},"reference":[{"key":"3970_CR1","doi-asserted-by":"publisher","first-page":"3S","DOI":"10.1016\/j.jvs.2014.04.049","volume":"60","author":"TF O\u2019Donnell","year":"2014","unstructured":"O\u2019Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. 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