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Serwanja J, Wieland AC, Haubenhofer A, Brandstetter H, Schönauer E. A conserved strategy to attack collagen: The activator domain in bacterial collagenases unwinds triple-helical collagen. Proc Natl Acad Sci U S A 2024; 121:e2321002121. [PMID: 38593072 PMCID: PMC11032491 DOI: 10.1073/pnas.2321002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Bacterial collagenases are important virulence factors, secreted by several pathogenic Clostridium, Bacillus, Spirochaetes, and Vibrio species. Yet, the mechanism by which these enzymes cleave collagen is not well understood. Based on biochemical and mutational studies we reveal that collagenase G (ColG) from Hathewaya histolytica recognizes and processes collagen substrates differently depending on their nature (fibrillar vs. soluble collagen); distinct dynamic interactions between the activator and peptidase domain are required based on the substrate type. Using biochemical and circular dichroism studies, we identify the presumed noncatalytic activator domain as the single-domain triple helicase that unwinds collagen locally, transiently, and reversibly.
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Affiliation(s)
- Jamil Serwanja
- Department of Biosciences and Medical Biology, Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
- Center for Tumor Biology and Immunology (CTBI), Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
| | - Alexander C. Wieland
- Department of Biosciences and Medical Biology, Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
- Center for Tumor Biology and Immunology (CTBI), Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
| | - Astrid Haubenhofer
- Department of Biosciences and Medical Biology, Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
- Center for Tumor Biology and Immunology (CTBI), Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
| | - Hans Brandstetter
- Department of Biosciences and Medical Biology, Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
- Center for Tumor Biology and Immunology (CTBI), Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
| | - Esther Schönauer
- Department of Biosciences and Medical Biology, Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
- Center for Tumor Biology and Immunology (CTBI), Paris-Lodron University of Salzburg, SalzburgA-5020, Austria
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Larson H, Warner J, Savage J, Kohler T, Ziegelmann M, Trost L. Changes in Point of Maximal Curvature During Collagenase Clostridium Histolyticum Injections for Peyronie's Disease. Urology 2024; 184:122-127. [PMID: 38061610 DOI: 10.1016/j.urology.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To determine change in the point of maximal curvature (POMC) during Collagenase Clostridium histolyticum (CCH) injections for Peyronie's disease (PD). METHODS A prospective database has been maintained of all men undergoing CCH injections since March 2014. For the current study, data were abstracted on the POMC with each curve assessment and correlated with demographic and clinical factors. Maximal changes were defined as the largest change in POMC from baseline. RESULTS Six hundred and eighteen men underwent ≥1 series of CCH, with 313 having a baseline and subsequent POMC measurements available. Median baseline curvature was 60.0° and POMC 2.8 cm. Among 189 men who were satisfied or completed 8 CCH injections, the median improvement in penile curvature was -27.5° (40.9%). The median maximal change in POMC during CCH treatment was 1.0 cm (interquartile range, 0.5, 1.8). Overall, 55.6% had changes in POMC of ≥1 cm, 23.6% ≥2 cm, 8.9% ≥3 cm, and 3.8% ≥4 cm. Multivariate logistic regression identified ventral curvature as a predictor of larger change in POMC, after controlling for other variables. Study limitations included the observational, non-randomized study design and potential for intra- and inter-individual measurement variability. Strengths are the inclusion of an all-comer population, large series, prospective database, and routine objective assessments. CONCLUSION Approximately half of men with PD undergoing CCH experience ≥1 cm of change in POMC during the treatment course, with nearly 1/4 experiencing ≥2 cm. Findings suggest that patients may benefit from repeat curvature assessments with each CCH series to optimize accuracy of drug administration.
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Affiliation(s)
| | | | | | | | | | - Landon Trost
- Brigham Young University, Provo, UT; Male Fertility and Peyronie's Clinic, Orem, UT; Mayo Clinic, Rochester, MN; CURE PD, Orem, UT.
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Dullea A, Khodamoradi K, Campbell K, Ghomeshi A, Ramasamy R, Ziegelmann M, Masterson T. In vitro efficacy of intralesional Collagenase Clostridium Histolyticum for the treatment of calcified Peyronie's disease plaques. Int J Impot Res 2023:10.1038/s41443-023-00742-0. [PMID: 37524836 DOI: 10.1038/s41443-023-00742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
Peyronie's disease (PD) is defined by penile plaque formation and curvature causing sexual dysfunction. The only FDA-approved intralesional treatment is Collagenase Clostridium histolyticum (CCh). CCh contains two collagenases, AUX1 and AUXII, that break down the type I and type III collagen contained in plaques, leading to plaque dissolution and reduction in penile curvature. Peyronie's plaques, however, also contain fibrin and calcium, which CCh cannot digest. It is unclear if plaque calcification prevents CCh from breaking down plaques. We collected ten tissue samples: five calcified penile plaques and five control samples of corpus cavernosum. They were incubated in CCh or PBS. Soluble collagen measurements and collagen staining assays were completed to measure tissue breakdown. Calcified plaques incubated in CCh showed significantly higher levels of soluble collagen (301.07 ug ± 21.28 vs. PBS: 32.82 ug ± 3.68, p = 0.02), and significantly lower levels of collagen (type I and III) compared to tissues incubated in PBS (0.12 ± 0.08, vs. 0.44 ± 0.17, p = 0.002). When comparing different tissues (calcified vs. control) incubated in CCh and PBS solutions, there were no significant differences in collagen staining or breakdown. Although higher collagen staining was seen in the calcified group, soluble collagen showed no significant differences between control and calcified tissues in the CCh group (control: 0.08 ± 0.02 vs. calcified: 0.17 ± 0.09, p = 0.08) or the PBS group (control: 0.50 ± 0.23 vs. calcified: 0.39 ± 0.39, p = 0.23). CCh exposure led to significantly more tissue breakdown in both tissue groups when compared to PBS however, there was no significant difference in plaque digestion found between calcified and control tissue exposed to CCh or PBS. This suggests that plaque calcification does not affect the action of CCh. Further research into CCh for calcified plaques is necessary to inform clinicians as to the optimal management of this population.
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Affiliation(s)
- Alexandra Dullea
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA
| | - Kajal Khodamoradi
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA
| | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA
| | | | - Thomas Masterson
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA.
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Khooblall P, Bole R, Lundy SD, Bajic P. Expanded Utilization of Intralesional Therapies for Treatment of Peyronie's Disease. Res Rep Urol 2023; 15:205-216. [PMID: 37366388 PMCID: PMC10290860 DOI: 10.2147/rru.s386340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose In this narrative review we explore additional indications for which intralesional collagenase Clostridium histolyticum (CCH) injection therapy may be used, in addition to those utilized in the IMPRESS trials. The goal is to provide updated assessment of available intralesional therapies and justify whether to expand clinical indications based on advancements over the last decade. Results Patients receiving CCH in the acute phase of PD have shown significant improvement in penile curvature - which may be even more significant than reported due to progressive curvature over the longitudinal course of injection therapy. Across studies, patients with ventral plaques achieved the greatest curvature improvement (~30°) compared to PD patients with dorsal or lateral plaques. Patients with curvature > 90° have been minimally documented. However, the concept of patients with higher degree of curvature achieving more significant degrees of improvement prevails across studies. Studies including PD patients with volume loss deformities or indentation(s) focus on curvature improvement and do not gauge improvement in these girth loss or indentation features specifically. PD patients with calcification may benefit from CCH, however, critical analysis of included study designs and results compared to placebo do not lend for strong support of CCH in PD at this time. Conclusion Based on the most recent research, the use of CCH in the acute phase of PD and patients with ventral penile plaques may be effective and safe. The limited available research on the efficacy of CCH on calcified plaque(s) and curvature greater than 90° is promising, however, more research is needed to ensure safety and success in this patient cohort. Finally, the current literature continues to show the use of CCH is not effective in PD patients with volume loss, indentation, or hourglass deformity. When expanding the use of CCH to patients not originally included in the IMPRESS trials, providers must prioritize minimizing chances of potential injury to urethral tissue. Finally, further investigation is required to determine whether CCH has utility for curvature greater than 90° or calcified plaques, although the limited available literature is promising.
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Affiliation(s)
- Prajit Khooblall
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Raevti Bole
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Scott D Lundy
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Petar Bajic
- Cleveland Clinic, Center for Men’s Health, Glickman Urological and Kidney Institute, Cleveland, OH, USA
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