Article

Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up

Department of Surgery, Stanford University Hospitals and Clinics, Palo Alto, CA 94304, USA.
The Journal of hand surgery (Impact Factor: 1.66). 04/2010; 35(4):534-9, 539.e1. DOI: 10.1016/j.jhsa.2010.01.003
Source: PubMed

ABSTRACT Collagenase has been investigated in phase II and phase III clinical trials for the treatment of Dupuytren's disease. The purpose of this study is to report 8-year follow-up results in a subset of patients who had collagenase injection for the treatment of Dupuytren's contracture.
Twenty-three patients who participated in the phase II clinical trial of injectable collagenase were contacted by letter and phone. Eight patients were enrolled, completed a Dupuytren's disease questionnaire, and had independent examination of joint motion by a single examiner.
Eight patients completed the 8-year follow-up study: 6 had been treated for isolated metacarpophalangeal (MCP) joint contracture, and 2 had been treated for isolated proximal interphalangeal (PIP) joint contracture. Average preinjection contracture was 57 degrees in the MCP group. Average contracture was 9 degrees at 1 week, 11 degrees at 1 year, and 23 degrees at 8-year follow-up. Four of 6 patients experienced recurrence, and 2 of 6 had no evidence of disease recurrence at 8-year follow-up. Average preinjection contracture was 45 degrees in the PIP group. Average contracture was 8 degrees at 1 weeks, 15 degrees at 1 year, and 60 degrees at 8-year follow-up. Both patients experienced recurrence at 8-year follow-up. No patients had had further intervention on the treated finger in either the MCP or the PIP group. Patients subjectively rated the overall clinical success at 60%, and 88% of patients stated that they would pursue further injection for the treatment of their recurrent or progressive Dupuytren's disease.
Enzymatic fasciotomy is safe and efficacious, with initial response to injection resulting in reduction of joint contracture to within 0 degrees -5 degrees of normal in 72 out of 80 patients. Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. In addition, patient satisfaction was high.

0 Followers
 · 
166 Views
  • Source
    • "In recent years, the collagenolytic activity of these enzymes has been exploited in clinical and therapeutic applications, particularly to treat the Dupuytrens' disease [2] and various types of destructive fibrosis such as liver cirrhosis [3]. Collagenases are also used as hydrolyzing agents to obtain collagen peptides with important biological activities, among which antioxidant agents [4], functional foods to relieve memory deficits associated with aging [5] and ingredients for dietary materials and parentally-fed products [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aqueous two-phase systems (ATPS) of PEG/phosphate were used to recover collagenase from Penicillium aurantiogriseum from fermented broth. Experiments were carried out according to a 24-full factorial design using the PEG molar mass (MPEG), PEG concentration (CPEG), phosphate concentration (CPHOS) and pH as the independent variables, and the purification factor (PF), partition coefficient (K) and activity yield (Y) as the responses. All the responses increased in the top phase with increasing CPEG and CPHOS and decreasing MPEG, but the maximum value of PF (5.23) was obtained at the lowest pH (6.0), that of Y (61.68%) and K (1.52) at the highest one (8.0). The electrophoretic profile revealed that some protein contaminants were removed by the ATPS, and the extracted collagenase exhibited optimum activity at pH 8.0 and 45 °C. The proposed ATPS appears to be a promising alternative to conventional first-step operations for direct recovery of collagenase from fermented broths, yielding a concentrate enzyme solution able to effectively hydrolyze collagen.
    Biochemical Engineering Journal 06/2013; 75:64–71. DOI:10.1016/j.bej.2013.03.012 · 2.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dupuytren's disease (DD) is a common disease of the hand and is characterized by thickening of the palmar fascia and formation of tight collagenous disease cords. At present, the disease is incurable and the molecular pathophysiology of DD is unknown. Surgery remains the most commonly used treatment for DD, but this requires extensive postoperative therapy and is associated with high rates of recurrence. Over the past decades, more indepth exploration of the molecular basis of DD has raised the hopes of developing new treatment modalities. This paper reviews the clinical presentation and molecular pathophysiology of this disease, as well as current and emerging treatment. It also explores the implications of new findings in the laboratory for future treatment.
    Therapeutics and Clinical Risk Management 09/2010; 6:383-90. DOI:10.2147/TCRM.S9165 · 1.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dupuytren disease (DD) is a fibroproliferative disorder of unknown etiology that often results in shortening and thickening of the palmar fascia, leading to permanent and irreversible flexion contracture of the digits. This Review provides a detailed update of the scientific understanding of DD and its clinical management, with perspectives on emerging research and therapy. Established risk factors include genetic predisposition and ethnicity, as well as sex and age. Several environmental risk factors (some considered controversial) include smoking, alcohol intake, trauma, diabetes, epilepsy and use of anticonvulsant drugs, and exposure to vibration. DD has been variously attributed to the presence of oxygen free radicals, trauma to the palmar fascia, or aberrant immune responses with altered antigen presentation, or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD-affected tissue suggests that DD is possibly immune-related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. The mainstay of treatment is surgical release or excision of the affected palmodigital tissue, but symptoms often recur. Nonsurgical correction of DD contractures can be achieved by Clostridium histolyticum collagenase injection, although the long-term safety and recurrence rate of this procedure requires further assessment.
    Nature Reviews Rheumatology 11/2010; 6(12):715-26. DOI:10.1038/nrrheum.2010.180 · 10.25 Impact Factor