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Lenzi LGS, Gomes dos Santos JB, Cavalheiro RP, Mendes A, Kobayashi EY, Nader HB, Faloppa F. Alterations in the Structure, Composition, and Organization of Galactosaminoglycan-Containing Proteoglycans and Collagen Correspond to the Progressive Stages of Dupuytren's Disease. Int J Mol Sci 2024; 25:7192. [PMID: 39000302 PMCID: PMC11241189 DOI: 10.3390/ijms25137192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Dupuytren's disease (DD) is a prevalent fibroproliferative disorder of the hand, shaped by genetic, epigenetic, and environmental influences. The extracellular matrix (ECM) is a complex assembly of diverse macromolecules. Alterations in the ECM's content, structure and organization can impact both normal physiological functions and pathological conditions. This study explored the content and organization of glycosaminoglycans, proteoglycans, and collagen in the ECM of patients at various stages of DD, assessing their potential as prognostic indicators. This research reveals, for the first time, relevant changes in the complexity of chondroitin/dermatan sulfate structures, specifically an increase of disaccharides containing iduronic acid residues covalently linked to either N-acetylgalactosamine 6-O-sulfated or N-acetylgalactosamine 4-O-sulfated, correlating with the disease's severity. Additionally, we noted an increase in versican expression, a high molecular weight proteoglycan, across stages I to IV, while decorin, a small leucine-rich proteoglycan, significantly diminishes as DD progresses, both confirmed by mRNA analysis and protein detection via confocal microscopy. Coherent anti-Stokes Raman scattering (CARS) microscopy further demonstrated that collagen fibril architecture in DD varies importantly with disease stages. Moreover, the urinary excretion of both hyaluronic and sulfated glycosaminoglycans markedly decreased among DD patients.Our findings indicate that specific proteoglycans with galactosaminoglycan chains and collagen arrangements could serve as biomarkers for DD progression. The reduction in glycosaminoglycan excretion suggests a systemic manifestation of the disease.
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Affiliation(s)
- Luiz Guilherme S. Lenzi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
| | - João Baptista Gomes dos Santos
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
| | - Renan P. Cavalheiro
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
- Faculdade de Medicina ABC, Centro Universitário, Santo André 09060-870, SP, Brazil
| | - Aline Mendes
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Elsa Y. Kobayashi
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Helena B. Nader
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Flavio Faloppa
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
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Nanostring-Based Identification of the Gene Expression Profile in Trigger Finger Samples. Healthcare (Basel) 2021; 9:healthcare9111592. [PMID: 34828637 PMCID: PMC8619339 DOI: 10.3390/healthcare9111592] [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: 08/12/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Trigger finger is a common yet vastly understudied fibroproliferative hand pathology, severely affecting patients' quality of life. Consistent trauma due to inadequate positioning within the afflicted finger's tendon/pulley system leads to cellular dysregulation and eventual fibrosis. While the genetic characteristics of the fibrotic tissue in the trigger finger have been studied, the pathways that govern the initiation and propagation of fibrosis are still unknown. The complete gene expression profile of the trigger finger has never been explored. Our study has used the Nanostring nCounter gene expression assay to investigate the molecular signaling involved in trigger finger pathogenesis. We collected samples from patients undergoing trigger finger (n = 4) release surgery and compared the gene expression to carpal tunnel tissue (n = 4). Nanostring nCounter analysis identified 165 genes that were differentially regulated; 145 of these genes were upregulated, whereas 20 genes were downregulated. We found that several collagen genes were significantly upregulated, and a regulatory matrix metalloproteinase (MMP), MMP-3, was downregulated. Bioinformatic analysis revealed that several known signaling pathways were dysregulated, such as the TGF-β1 and Wnt signaling pathways. We also found several novel signaling pathways (e.g., PI3K, MAPK, JAK-STAT, and Notch) differentially regulated in trigger finger. The outcome of our study helps in understanding the molecular signaling pathway involved in the pathogenesis of the trigger finger.
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Doan KT, Kshetri P, Attamakulsri N, Newsome DR, Zhou F, Murray CK, Chen WR, Xu G, Vaughan MB. The Effect of Chitosan Derivatives on the Compaction and Tension Generation of the Fibroblast-populated Collagen Matrix. Molecules 2019; 24:molecules24152713. [PMID: 31357389 PMCID: PMC6696429 DOI: 10.3390/molecules24152713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023] Open
Abstract
Fibrotic diseases, such as Dupuytren's contracture (DC), involve excess scar tissue formation. The differentiation of fibroblasts into myofibroblasts is a significant mechanism in DC, as it generates tissue contraction in areas without wound openings, leading to the deposition of scar tissue, and eventually flexing one or more fingers in a restrictive fashion. Additionally, DC has a high recurrence rate. Previously, we showed that N-dihydrogalactochitosan (GC), an immunostimulant, inhibited myofibroblast differentiation in a DC fibroblast culture. Our goal of this study was to expand our previous study to include other DC and normal cell lines and other chitosan derivatives (GC and single-walled carbon nanotube-conjugated GC) to determine the specific mechanism of inhibition. Derivative-incorporated and vehicle control (water) anchored fibroblast-populated collagen matrices (aFPCM) were used to monitor compaction (anchored matrix height reduction) using microscopy and optical coherence tomography (OCT) for six days. Fibroblasts were unable to compact chitosan derivative aFPCM to the same extent as vehicle control aFPCM in repeated experiments. Similarly, chitosan derivative aFPCM contracted less than control aFPCM when released from anchorage. Proliferative myofibroblasts were identified by the presence of alpha smooth muscle actin via myofibroblast proliferative assay. In all tested conditions, a small percentage of myofibroblasts and proliferative cells were present. However, when aFPCM were treated with transforming growth factor-beta 1 (TGF-β1), all tested samples demonstrated increased myofibroblasts, proliferation, compaction, and contraction. Although compaction and contraction were reduced, there was sufficient tension present in the chitosan derivative aFPCM to allow exogenous stimulation of the myofibroblast phenotype.
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Affiliation(s)
- K Tu Doan
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Biology, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Pratiksha Kshetri
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Biology, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Natthapume Attamakulsri
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Biology, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Derek R Newsome
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Biology, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Feifan Zhou
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Engineering and Physics, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Cynthia K Murray
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Mathematics and Statistics, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Wei R Chen
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Engineering and Physics, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Gang Xu
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
- Department of Engineering and Physics, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA
| | - Melville B Vaughan
- Center for Interdisciplinary Biomedical Education and Research (CIBER), College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA.
- Department of Biology, College of Mathematics and Science, University of Central Oklahoma, 100 N. University Drive, Edmond, OK 73034, USA.
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Multiple Recurrences in Aggressive Forms of Dupuytren's Disease-Can Patients Benefit from Repeated Selective Fasciectomy? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1247. [PMID: 28280681 PMCID: PMC5340496 DOI: 10.1097/gox.0000000000001247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022]
Abstract
Background: In Dupuytren’s disease (DD), limited fasciectomy is the mainstay of surgical therapy in patients at risk of contractures and disease recurrences. New minimally invasive treatments such as injection of collagenase clostridium histolyticum have evolved as a common tool for the preliminary treatment of Dupuytren’s contractures. However, recurrences and their therapy remain controversial. In this study, we evaluate the benefit of repeated limited fasciectomy in patients with aggressive forms of the disease and multiple recurrences of contractures. Methods: We evaluated the outcome of 16 patients undergoing limited fasciectomy 3 or more times on a single hand. Results: Postoperatively, 10 of 13 (76.9%) patients were satisfied with the clinical result after the last operation; 10 of 12 (83.3%) patients would choose to have their surgery repeated, if so needed. The mean improvement of proximal interphalangeal joint range of motion was 59.2 degrees (SD 26.8) and 86.2% (SD 19.9). There were no severe complications after treatment within the observed time period. Conclusions: Our findings demonstrate that patients with recurrence of contractures after multiple previous treatments in aggressive forms of DD can benefit from surgical intervention. In conclusion, repeated limited fasciectomy remains indicated in patients after previous surgeries with DD.
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Abstract
BACKGROUND This study was designed to provide comparative information on the safety and efficacy of injection with collagenase clostridium histolyticum (CCH) and fasciectomy for patients with Dupuytren's contracture (DC). METHODS A single-center, retrospective, observational, longitudinal chart review was conducted of 25 patients treated with CCH injections and 21 patients undergoing fasciectomy. Patients were assessed at 1 week, monthly for 3 months and then yearly for a minimum of 2 years after treatment for changes in contracture and range of motion, time to return to work/normal activities, patient satisfaction, and Disabilities of Arm, Shoulder and Hand (DASH) score. RESULTS Post-procedure follow-up averaged 32 months for the injection group compared with 39 months for fasciectomy group. For the CCH group, the mean postinjection contracture was 3.6° for the metacarpophalangeal and 17.5° for the proximal interphalangeal joints compared with 3.7° and 8.1° in the fasciectomy group, respectively. Patients treated with injections returned to normal activities after a mean of 1.9 days compared with 37.4 days for fasciectomy patients (p < 0.0001). DASH scores for 13 CCH and 15 fasciectomy patients were obtained. The mean DASH score was significantly lower in the injection group in the first 3 months (p < 0.01). At the 2-year follow-up visit, patients were satisfied with their outcomes following either treatment (92 % and 96 % of CCH and fasciectomy patients, respectively). CONCLUSION CCH injections are safe and effective and may be a viable alternative to fasciectomy for treating DC. It also allows earlier return to work and daily activities.
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Liu W, O’Gorman DB, Gan BS. Operative trends and physician treatment costs associated with Dupuytren's disease in Canada. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 21:229-33. [PMID: 24497764 PMCID: PMC3910518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine treatment trends and costs associated with Dupuytren's disease (DD) in Canada. METHODS Data regarding fasciectomies, fasciotomies and digit amputations performed for DD from 2005 to 2010 were extracted from the Canadian Institute for Health Information database. The data were analyzed according to year, sex and five-year age groups. The estimated annual physician reimbursement costs for DD in Ontario were calculated using Ontario Health Insurance Plan billing information and the 2010 Physician Schedule of Benefits. RESULTS The number and rate of fasciectomies remained stable from 2005 to 2009 (mean of 4067 and 1.24 per 10,000, respectively), but increased in the 2009/2010 fiscal year (to 4458 and 1.32 per 10,000). The number of fasciotomies increased from 133 in 2005/2006 to 201 in 2008/2009, but dropped to 183 in 2009/2010. The mean number of amputations remained stable (12 procedures).The ratio of males to females undergoing fasciectomies remained stable (4:1). The highest rate of fasciectomies was performed for the age groups 65 to 69 years and 70 to 74 years. Estimated mean physician remuneration for DD in Ontario remained stable ($3.2 million per annum). DISCUSSION The results regarding patient demographics are comparable with results from previous literature. There was a trend toward an increasing number of fasciectomies and fasciotomies annually, with fasciotomies increasing faster than fasciectomies, which is reflective of the aging population and the recent attention to fasciotomies in the literature. The present study was the first to investigate treatment trends and physician reimbursement costs for the management of DD in Canada.
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Affiliation(s)
- Wendy Liu
- The Roth | McFarlane Hand and Upper Limb Centre, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
| | - David B O’Gorman
- The Roth | McFarlane Hand and Upper Limb Centre, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
- Departments of Surgery, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
- Biochemistry, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
| | - Bing Siang Gan
- The Roth | McFarlane Hand and Upper Limb Centre, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
- Departments of Surgery, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
- Medical Biophysics, University of Western Ontario, St Joseph’s Health Centre, London, Ontario
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Coleman S, Gilpin D, Tursi J, Kaufman G, Jones N, Cohen B. Multiple concurrent collagenase clostridium histolyticum injections to Dupuytren's cords: an exploratory study. BMC Musculoskelet Disord 2012; 13:61. [PMID: 22540636 PMCID: PMC3409044 DOI: 10.1186/1471-2474-13-61] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 04/27/2012] [Indexed: 12/13/2022] Open
Abstract
Background Dupuytren’s contracture (DC) is a progressive fibroproliferative disorder characterized by development of nodules and collagen cords within the palmar fascia of the hand. Collagenase clostridium histolyticum (CCH) is currently approved in adults with DC for the nonsurgical treatment of a single palpable cord during a 30-day treatment cycle. This open-label pilot study was designed to examine the safety, efficacy, and multiple-dose pharmacokinetics of injecting two cords (affected joints) with multiple doses of CCH concurrently into the same hand in subjects with DC and multiple contractures. Methods Twelve subjects with DC were enrolled, each with ≥3 contractures caused by palpable cords. Efficacy assessments were taken 30 days after treatment and adverse events (AEs) were recorded throughout. In the first treatment period, all subjects were injected with a single dose of CCH (0.58 mg) into a single cord. The same subjects entered a second treatment period 30 days later, where two different cords (affected joints) were injected concurrently on the same hand. A finger extension procedure was performed 24 hours after each administration of CCH to disrupt the enzymatically weakened cord. Results For metacarpophalangeal (MP) joints, mean contracture reduction per joint treated was 29.0 ± 20.7 degrees following single injection vs 30.3 ± 10.9 degrees per treated joint following multiple injections. For proximal interphalangeal (PIP) joints, mean reduction in contracture was 30.7 ± 21.1 and 22.1 ± 4.9 degrees per treated joint, respectively, for the two periods. All patients (100%) were either “quite satisfied” or “very satisfied” following either treatment cycle. The most common treatment-related AEs were edema peripheral, contusion, and pain in the treated extremity; the differences in severity for local effects of the injections were minimal between treatment periods. No serious treatment-related AEs or systemic complications were reported. Conclusion These results provide preliminary evidence that two cords (affected joints) can be treated concurrently with CCH with similar efficacy and safety as cords treated individually in a sequential fashion. Multiple concurrent injections would eliminate the 30-day wait between single treatments and allow for rapid and effective treatment of patients with multiple affected joints, a significant advantage for both patient and physician. Trial registration Australian New Zealand Clinical Trials Registry #ACTRN12610001045000.
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Affiliation(s)
- Stephen Coleman
- Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia.
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