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Cevik J, Rajaram R, Pollock M, Seth I, M Rozen W. Collagenase clostridium histolyticum for Dupuytren's disease: a comprehensive systematic review and comparative analysis against percutaneous needle aponeurotomy and limited fasciectomy. J Plast Surg Hand Surg 2025; 60:27-34. [PMID: 39945007 DOI: 10.2340/jphs.v60.42750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 12/16/2024] [Indexed: 05/09/2025]
Abstract
This systematic review compared the efficacy of collagenase clostridium histolyticum (CCH) against percutaneous needle aponeurotomy (PNA) and limited fasciectomy (LF) for Dupuytren's contracture. Searches were conducted in PubMed, Embase, and Web of Science databases to March 2024. Randomised controlled trials (RCTs) were included. Primary outcomes included successful contracture correction as defined by included studies. Secondary outcomes included recurrence rates, patient-reported outcomes, and adverse events. A total of 11 studies (969 patients) were included. Meta-analysis showed no difference in efficacy between CCH and PNA (Relative Risk [RR]: 1.01, 95% Confidence Interval [CI]: 0.93-1.09). Recurrence rates were also similar (RR: 1.18, 95% CI: 0.95-1.48). Data suggested higher recurrence risk with CCH versus LF (RR: 6.84, 95% CI: 1.59-29.48). In some studies, CCH was associated with higher rates of haematoma, local pain, and oedema. CCH demonstrates comparable efficacy to PNA; however, it may have a higher risk of local complications and recurrence compared to LF. Treatment decisions should be made on a case-by-case basis.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia.
| | - Rohan Rajaram
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
| | - Michaela Pollock
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
| | - Ishith Seth
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
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Nann S, Kovoor J, Fowler J, Kieu J, Gupta A, Hewitt J, Ovenden C, Edwards S, Bacchi S, Jacobsen JHW, Harries R, Maddern G. Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses. Hand (N Y) 2024; 19:1283-1292. [PMID: 37246411 PMCID: PMC11536719 DOI: 10.1177/15589447231174175] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dupuytren disease is a common fibroproliferative disease that affects the palmar fascia of the hands. Currently, there is limited consensus regarding the optimal therapy for this condition, with treatment decisions based largely on surgeon preference. Therefore, the aim of this study was to determine which treatments are the most effective for Dupuytren disease. METHOD A systematic review and network meta-analyses were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Medline, EMBASE, and Web of Science were searched for randomized trials comparing treatments for Dupuytren disease in adults. Eligible treatments included open limited fasciectomy, collagenase injection, and percutaneous needle fasciotomy. Study selection, data extraction, and quality appraisal were performed in duplicate. The methodological quality was evaluated with the Cochrane risk-of-bias critical appraisal tool. RESULTS Eleven randomized clinical trials were included in this study. At short-term (1-12 weeks) and long-term (2-5 years) time points, fasciectomy improved contracture release more than collagenase and needle fasciotomy as inferred by a lower total passive extension deficit. However, there was no difference between the groups regarding the best possible outcome at any time point. Fasciectomy was also superior in terms of recurrence and patient satisfaction compared with collagenase and needle fasciotomy, but only at later time points. There was no difference in skin damage-related and nerve damage-related complications following fasciectomy compared with other modalities. Risk of bias was generally moderate. CONCLUSIONS Fasciectomy provides superior long-term advantages in terms of patient outcomes when compared with collagenase and needle fasciotomy. Larger trials with better blinding of outcome assessors are needed in the future.
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Affiliation(s)
- Silas Nann
- The University of Adelaide, SA, Australia
- Royal Adelaide Hospital, SA, Australia
| | - Joshua Kovoor
- The University of Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - James Fowler
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | | | - Aashray Gupta
- The University of Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Joseph Hewitt
- The University of Adelaide, SA, Australia
- Royal Adelaide Hospital, SA, Australia
| | - Christopher Ovenden
- The University of Adelaide, SA, Australia
- Royal Adelaide Hospital, SA, Australia
| | | | - Stephen Bacchi
- The University of Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | | | | | - Guy Maddern
- The University of Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
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Cates WT, Denbeigh JM, Salvagno RT, Kakar S, van Wijnen AJ, Eaton C. Inflammatory Markers Involved in the Pathogenesis of Dupuytren's Contracture. Crit Rev Eukaryot Gene Expr 2024; 34:1-35. [PMID: 38912961 DOI: 10.1615/critreveukaryotgeneexpr.2024052889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Dupuytren's disease is a common fibroproliferative disease that can result in debilitating hand deformities. Partial correction and return of deformity are common with surgical or clinical treatments at present. While current treatments are limited to local procedures for relatively late effects of the disease, the pathophysiology of this connective tissue disorder is associated with both local and systemic processes (e.g., fibrosis, inflammation). Hence, a better understanding of the systemic circulation of Dupuytren related cytokines and growth factors may provide important insights into disease progression. In addition, systemic biomarker analysis could yield new concepts for treatments of Dupuytren that attenuate circulatory factors (e.g., anti-inflammatory agents, neutralizing antibodies). Progress in the development of any disease modifying biologic treatment for Dupuytren has been hampered by the lack of clinically useful biomarkers. The characterization of nonsurgical Dupuytren biomarkers will permit disease staging from diagnostic and prognostic perspectives, as well as allows evaluation of biologic responses to treatment. Identification of such markers may transcend their use in Dupuytren treatment, because fibrotic biological processes fundamental to Dupuytren are relevant to fibrosis in many other connective tissues and organs with collagen-based tissue compartments. There is a wide range of potential Dupuytren biomarker categories that could be informative, including disease determinants linked to genetics, collagen metabolism, as well as immunity and inflammation (e.g., cytokines, chemokines). This narrative review provides a broad overview of previous studies and emphasizes the importance of inflammatory mediators as candidate circulating biomarkers for monitoring Dupuytren's disease.
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Affiliation(s)
- William T Cates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Janet M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Andre J van Wijnen
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
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The Role of Stem Cells in Dupuytren's Disease: A Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1777. [PMID: 29922559 PMCID: PMC5999435 DOI: 10.1097/gox.0000000000001777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 12/13/2022]
Abstract
The pathogenesis of Dupuytren’s disease (DD) remains unclear although there is increasing evidence supporting the role of stem cells in this and other fibrotic conditions. This review examines the role of DD tissue-associated embryonic stem cells (ESCs) and mesenchymal stem cells (MSCs), and circulating fibrocytes and circulating MSCs, in the biology of DD. It is exciting to infer that dysfunction of an upstream ESC-like population within the affected tissue leads to the downstream development and proliferation of aberrant myofibroblasts through a putative MSC intermediate. This ESC-like population may be a potential novel therapeutic target through modulation of the renin-angiotensin system. Furthermore, circulating CD34+ fibrocytes and MSCs either derived from the bone marrow, peripheral blood cells, or DD-associated ESC-like population, may serve as potential additional extra-palmar reservoirs that undergo endothelial-to-mesenchymal transition, eventually giving rise to the aberrant myofibroblasts. Further studies examining the relative roles of these stem cells and the precise regulatory pathways that govern them may lead to novel therapy that targets these populations.
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Tan K, Brasch HD, van Schaijik B, Armstrong JR, Marsh RW, Davis PF, Tan ST, Itinteang T. Expression and Localization of Cathepsins B, D, and G in Dupuytren's Disease. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1686. [PMID: 29616179 PMCID: PMC5865920 DOI: 10.1097/gox.0000000000001686] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/05/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pathogenesis of Dupuytren's disease (DD) remains unclear. An embryonic stem cell (ESC)-like population in the endothelium of the microvessels around tissues that expresses components of the renin-angiotensin system (RAS) has been reported. This study investigated if this primitive population expresses cathepsins B, D, and G, that contribute to RAS bypass loops. METHODS 3,3-Diaminobenzidine immunohistochemical (IHC) staining for cathepsins B, D, and G was performed on sections of formalin-fixed paraffin-embedded DD cords (n = 10) and nodules (n = 10). Immunofluorescence IHC staining was utilized to demonstrate co-expression of these cathepsins with ESC markers. Protein and gene expression of these cathepsins was investigated in snap-frozen DD cords (n = 3) and nodules (n = 3) by Western blotting and NanoString analysis, respectively. Enzymatic activity of these cathepsins was investigated by enzymatic activity assays. RESULTS 3,3-Diaminobenzidine IHC staining demonstrated expression of cathepsins B, D, and G in DD cords and nodules. Gene expression of cathepsins B, D, and G was confirmed by NanoString analysis. Western blotting confirmed expression of cathepsins B and D, but not cathepsin G. Immunofluorescent IHC staining demonstrated high abundance of cathepsins B and D on the OCT4+/angiotensin converting enzyme+ endothelium and the smooth muscle layer of the microvessels. Cathepsin G was localized to trypase+ cells within the stroma in DD cords and nodules with limited expression on the microvessels. Enzyme activity assays demonstrated functional activity of cathepsins B and D. CONCLUSIONS Cathepsins B, D, and G were expressed in the DD tissues, with cathepsins B and D localized to the primitive population in the endothelium of the microvessels, whereas cathepsin G was localized to phenotypic mast cells, suggesting the presence of bypass loops for the RAS.
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Affiliation(s)
- Kirin Tan
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Helen D. Brasch
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Bede van Schaijik
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - James R. Armstrong
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Reginald W. Marsh
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Paul F. Davis
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Swee T. Tan
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Tinte Itinteang
- From the Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand; and University of Auckland, Auckland, New Zealand
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Zhou C, Hovius SER, Pieters AJ, Slijper HP, Feitz R, Selles RW. Comparative Effectiveness of Needle Aponeurotomy and Collagenase Injection for Dupuytren's Contracture: A Multicenter Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1425. [PMID: 29062633 PMCID: PMC5640330 DOI: 10.1097/gox.0000000000001425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the efficacy of collagenase clostridium histolyticum (CCH) injections has been demonstrated by randomized clinical trials, the relative effectiveness of CCH remains uncertain. Our aim was to compare the outcomes of CCH with those of percutaneous needle aponeurotomy (PNA) in daily clinical practice. METHODS We analyzed data from patients undergoing PNA or CCH between 2011 and 2014 at 7 practice sites in the Netherlands. We examined the degree of improvement in contracture and adverse effects at 6-12 weeks after surgery or the last injection. Additionally, we invited patients to complete the Michigan Hand Questionnaire before and at 6-12 months follow-up. To minimize the risk of bias, we used propensity score matching. RESULTS Among 130 matched patients (93% Tubiana I or II) undergoing PNA (n = 46) and CCH (n = 84), improvement in contracture was similar: 26 degrees (65% improvement from baseline) for PNA versus 31 degrees (71%) for CCH for affected metacarpophalangeal joints (P = 0.163). This was 16 degrees (50% improvement) versus 17 degrees (42%) for affected proximal interphalangeal joints (P = 0.395), respectively. No serious adverse effects occurred in either of the 2 treatment groups. Of the mild adverse effects, only skin fissures and sensory disturbances were seen in both groups. Through 1-year follow-up, patients reported similar improvements in the overall Michigan Hand Questionnaire score (PNA 5.3 points versus CCH 4.9 points; P = 0.912). CONCLUSIONS In patients with mild contractures (Tubiana I or II), CCH was as effective as PNA in reducing contractures. Both treatments were safe and improved hand function to a similar extent in daily practice.
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Affiliation(s)
- Chao Zhou
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Steven E. R. Hovius
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Adriana J. Pieters
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm P. Slijper
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Reinier Feitz
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ruud W. Selles
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
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Riester SM, Arsoy D, Camilleri ET, Dudakovic A, Paradise CR, Evans JM, Torres-Mora J, Rizzo M, Kloen P, Julio MKD, van Wijnen AJ, Kakar S. RNA sequencing reveals a depletion of collagen targeting microRNAs in Dupuytren's disease. BMC Med Genomics 2015; 8:59. [PMID: 26446724 PMCID: PMC4597401 DOI: 10.1186/s12920-015-0135-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/20/2015] [Indexed: 01/08/2023] Open
Abstract
Background Dupuytren’s disease is an inherited disorder in which patients develop fibrotic contractures of the hand. Current treatment strategies include surgical excision or enzymatic digestion of fibrotic tissue. MicroRNAs, which are key posttranscriptional regulators of genes expression, have been shown to play an important regulatory role in disorders of fibrosis. Therefore in this investigation, we apply high throughput next generation RNA sequencing strategies to characterize microRNA expression in diseased and healthy palmar fascia to elucidate molecular mechanisms responsible for pathogenic fibrosis. Methods We applied high throughput RNA sequencing techniques to quantify the expression of all known human microRNAs in Dupuytren’s and control palmar fascia. MicroRNAs that were differentially expressed between diseased and healthy tissue samples were used for computational target prediction using the bioinformatics tool ComiR. Molecular pathways that were predicted to be differentially expressed based on computational analysis were validated by performing RT-qPCR on RNA extracted from diseased and non-diseased palmar fascia biopsies. Results A comparison of microRNAs expressed in Dupuytren’s fascia and control fascia identified 74 microRNAs with a 2-fold enrichment in Dupuytren’s tissue, and 32 microRNAs with enrichment in control fascia. Computational target prediction for differentially expressed microRNAs indicated preferential targeting of collagens and extracellular matrix related proteins in control palmar fascia. RT-qPCR confirmed the decreased expression of microRNA targeted collagens in control palmar fascia tissues. Discussion Control palmar fascia show decreased expression of mRNAs encoding collagens that are preferentially targeted by microRNAs enriched in non-diseased fascia. Thus alterations in microRNA regulatory networks may play an important role in driving the pathogenic fibrosis seen in Dupuytren’s disease via direct regulatory effects on extracellular matrix protein synthesis. Conclusion Dupuytren’s fascia and healthy palmar fascia can be distinguished by unique microRNA profiles, which are predicted to preferentially target collagens and other extracellular matrix proteins. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0135-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scott M Riester
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Diren Arsoy
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Emily T Camilleri
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Christopher R Paradise
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jared M Evans
- Department of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA.
| | | | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Peter Kloen
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | | | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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