Modified Platform Trial Evaluating PpLHACM and SOC Versus SOC Alone in the Treatment of Nonhealing DFUs

Inclusion Criteria:

1. At least 18 years of age or older.

2. Diagnosis of type 1 or 2 Diabetes mellitus.

3. At randomization subjects must have a target ulcer with a minimum surface area of 0.7 cm^2 and a maximum surface area of 5.0 cm^2 measured post debridement.

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

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

6. The target ulcer must be Wagner 1 or 2 grade, extending at least through the dermisor subcutaneous tissue and may involve the muscle provided it is below the medialaspect of the malleolus. The ulcer may not include exposed tendon or bone.

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

8. Ankle-Brachial Index (ABI) between 0.7 and ≤ 1.3;

9. Toe-Brachial Index (TBI) ≥ 0.6;

10. Transcutaneous Oxygen Measurement (TCOM) ≥ 40 mmHg;

11. Pulse Volume Resistance (PVR): biphasic.

12. If the potential subject has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will bedesignated as the target ulcer.

13. Target ulcers located on the plantar aspect of the foot must be offloaded for atleast 14 days prior to enrollment.

14. The potential subject must consent to using the prescribed offloading method for theduration of the study.

15. The potential subject must agree to attend the weekly study visits required by theprotocol.

16. The potential subject must be willing and able to participate in the informedconsent process.

Exclusion Criteria:

1. The potential subject is known to have a life expectancy of < 6 months.

2. The potential subject's target ulcer is not secondary to diabetes.

3. The target ulcer is infected or there is cellulitis in the surrounding skin.

4. The target ulcer exposes tendon or bone.

5. There is evidence of osteomyelitis complicating the target ulcer.

6. There is an infection in the target ulcer or in a remote location that requiressystemic antibiotic therapy.

7. The potential subject is receiving immunosuppressants (including systemiccorticosteroids at doses greater than 10 mg of prednisone per day or equivalent) orcytotoxic chemotherapy or is taking medications that the PI believes will interferewith wound healing (e.g., biologics).

8. The potential subject is taking hydroxyurea.

9. The potential subject has applied topical steroids to the ulcer surface within onemonth of initial screening.

10. The potential subject with a previous partial amputation on the affected foot thatresults in a deformity that impedes proper offloading of the target ulcer.

11. The potential subject has glycated hemoglobin (HbA1c) greater than or equal to 12%within 3 months of the initial screening visit.

12. The surface area of the target ulcer has reduced in size by more than 20% in the 2weeks prior to the initial screening visit ("historical" run-in period). MolecuLightImaging Device is not required for measurements taken during the historical run-inperiod (e.g., calculating surface area using length X width is acceptable).

13. The surface area measurement of the Target ulcer decreases by 20% or more during the 2-week screening phase: the 2 weeks from the initial screening visit (S1) to theTV-1 visit during which time the potential subject received SOC.

14. The potential subject has an acute Charcot foot, or an inactive Charcot foot, whichimpedes proper offloading of the target ulcer.

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

16. The potential subject has end stage renal disease requiring dialysis.

17. Participation in a clinical trial involving treatment with an investigationalproduct within the previous 30 days.

18. A potential subject who, in the opinion of the investigator, has a medical orpsychological condition that may interfere with study assessments.

19. The potential subject was treated with hyperbaric oxygen therapy (HBOT) or aCellular, Acellular, Matrix-like Product (CAMP) in the 30 days prior to the initialscreening visit.

20. The potential subject has a malnutrition indicator score <17 as measured on the MiniNutritional Assessment.

21. A subject has a wound with active or latent infection is excluded.

22. A subject with a disorder that would create unacceptable risk of post-operativecomplications is excluded.

23. A subject with a known sensitivity to aminoglycoside antibiotics is excluded.