Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up
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.
[Show abstract] [Hide abstract] ABSTRACT: This work presents the development of a new bioactive material for wound therapeutics which may play a dual role of modulate metallo proteinases activity while prevents infection blocking out pathogenic microorganisms and foreign materials. A CGP/PVA film was activated by covalent immobilization of trypsin. Results from biocompatibility test revealed that PDL fibroblasts grown on the surface of CGP/PVA and the high amount of viable cells proved absence of cytotoxicity. Trypsin immobilized onto CGP/PVA film remained 100% active after 28 days stored dried at room temperature. In addition, CGP/PVA-trypsin film could be used for 9 cycles of storage/use without loss of activity. After immobilization, trypsin retained its collagenolytic activity, indicating this material as a promising material for wound dressing applications. Copyright © 2015 Elsevier Ltd. All rights reserved.
- "The successful immobilization of trypsin confers to CGP/PVAtrypsin possible biomedical applications. In recent years, the collagenolytic enzymes has been exploited in clinical and therapeutic applications as agents for remodeling tissues as well as to treat the Dupuytren's disease and various types of destructive fibrosis (Lima et al., 2013; Watt, Curtin, & Hentz, 2010; Yuan et al., 2012). Results from collagenolytic activity of CGP/PVA-trypsin showed that immobilized trypsin maintained the hydrolytic activity toward collagen (Fig. 6). "
[Show abstract] [Hide abstract] ABSTRACT: Generally speaking, the excessive expression of myofibroblasts is associated with excessive collagen production. One exception is seen in patients and animal models of Ehlers-Danlos syndrome type IV in which the COL3A1 gene mutation results in reduced collagen III but with concurrent increased myofibroblast expression. This paradox has not been examined with the use of external drugs/modalities to prevent hypertrophic scars. In this paper, we injected the rabbit ear wound model of hypertrophic scarring with two doses of a protein called nAG, which is known to reduce collagen expression and to suppress hypertrophic scarring in that animal model. The higher nAG dose was associated with significantly less collagen III expression and concurrent higher degree of myofibroblast expression. We concluded that collagen III content of the extracellular matrix may have a direct or an indirect effect on myofibroblast differentiation. However, further research is required to investigate the pathogenesis of this paradoxical phenomenon.
- "For example, Dupuytren's cords are now being treated with direct injection of collagenase . Collagenases will breakdown collagen within the cords and this allows the surgeon to break the cord by hyperextending the fingers . Recurrence of cord contracture  and extensive deep tissue scarring  are well-known complications of this management approach. "
[Show abstract] [Hide abstract] ABSTRACT: Background This review article critically examines the current literature for Dupuytren's disease. Methods Five procedures are considered: dermofasciectomy, limited fasciectomy, segmental aponeurectomy, needle aponeurotomy, and collagenase injection. Studies regarding the efficacy of these treatments focus primarily on the initial degree of correction, rate of recurrence, and complications. Results No one treatment has been declared superior and substantial controversy exists. Comparison between studies has been hampered by the absence of uniform definitions for clinical success and measurable disease progression. Traditional post-operative care includes formal therapy and night splinting, but recent studies have questioned the value of these adjuncts. Conclusion The extent of involvement at which the surgeon should intervene was previously well accepted by convention, but as the paradigm shifts towards less invasive procedures, treatment may be offered at an earlier stage. Future research should be structured to recognize the value-based decision making used by patients when selecting treatment.
- "Previous clinical successes recurred 35 % overall, 27 % at MP and 56 % at PIP. Previous clinically unsuccessful CCH patients progressed 50 % overall, 38 % at MP and 62 % at PIP. Eight-year follow-up was obtained for six MP joints (57° pre-injection, 11° at 1 year, 23° at 8 years) and two PIP joints (45° pre-injection, 15° at 1 year, 60° at 8 years) . A randomized, placebo-controlled, double-blind study of 35 patients resulted in up to three CCH injections being administered to 16 MP joints overall (12/14 "primary" cases initially corrected to within 5° of full extension from a contracture of 51°) and 14 PIP joints overall (9/9 "primary" cases initially corrected to within 5° of full extension from a contracture of 46°) . "