1
|
Maruccia M, Tedeschi P, Sisto F, Converti I, Giudice G, Elia R. Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique. Arch Plast Surg 2024; 51:295-303. [PMID: 38737838 PMCID: PMC11081731 DOI: 10.1055/s-0043-1775882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/15/2023] [Indexed: 05/14/2024] Open
Abstract
Background Dupuytren's disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique. Methods From 2016 to 2020, 52 patients suffering from Dupuytren's contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions-five levels index were systematically scored before each surgical intervention and reevaluated after 24 months. Results Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase Clostridium histolyticum ). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55-130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0-12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85-96 degrees) and 82.7 ± 2.5 degrees (80-87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered ( p < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint. Conclusion The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren's contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.
Collapse
Affiliation(s)
- Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Tedeschi
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Sisto
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Ilaria Converti
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
2
|
Larocerie-Salgado J, Davidson J, Fenton P. Nonoperative Treatment of Dupuytren's Contracture: The Use of Ultrasound Imaging to Assess Efficacy. J Hand Microsurg 2024; 16:100003. [PMID: 38854375 PMCID: PMC11127546 DOI: 10.1055/s-0042-1748780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective We have used ultrasound imaging technology to objectively demonstrate changes in the degree and quality of diseased fascia in patients with Dupuytren's disease treated nonoperatively with therapeutic splinting and tissue mobilization. Materials and Methods Measurement of active proximal interphalangeal and metacarpophalangeal joint extension along with ultrasound elastography imaging of the fascia was performed prior to, and 6 months after, the initiation of therapy. Results Improvement in active joint extension over the course of therapy was associated with a consistent decrease in the radiologic dimensions of the diseased fascia in combination with qualitative changes in its composition. Conclusion The use of a simple orthosis and soft tissue mobilization techniques have a quantifiable effect on the degree of deformity and the quantity and quality of contracted fascia in Dupuytren's disease, and would appear to have a role in the management of mild to moderate presentations of the disease when enzymatic or surgical interventions may not be practical.
Collapse
Affiliation(s)
| | - John Davidson
- Division of Plastic Surgery, Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Paul Fenton
- Department of Radiology, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Soreide E, Murad MH, Denbeigh JM, Lewallen EA, Dudakovic A, Nordsletten L, van Wijnen AJ, Kakar S. Treatment of Dupuytren's contracture: a systematic review. Bone Joint J 2018; 100-B:1138-1145. [PMID: 30168768 DOI: 10.1302/0301-620x.100b9.bjj-2017-1194.r2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aims Dupuytren's contracture is a benign, myoproliferative condition affecting the palmar fascia that results in progressive contractures of the fingers. Despite increased knowledge of the cellular and connective tissue changes involved, neither a cure nor an optimum form of treatment exists. The aim of this systematic review was to summarize the best available evidence on the management of this condition. Materials and Methods A comprehensive database search for randomized controlled trials (RCTs) was performed until August 2017. We studied RCTs comparing open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase clostridium histolyticum (CCH) with placebo, and CCH with PNA, in addition to adjuvant treatments aiming to improve the outcome of open fasciectomy. A total of 20 studies, involving 1584 patients, were included. Results PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH. Conclusion Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.
Collapse
Affiliation(s)
- E Soreide
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA and Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - J M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - E A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA and Department of Biological Sciences, Hampton University, Hampton, Virginia, USA
| | - A Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - L Nordsletten
- Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - A J van Wijnen
- Department of Orthopedic Surgery and Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - S Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Vesper US, Mehling IM, Arsalan-Werner A, Sauerbier M. [Primary intervention in Dupuytren's disease]. DER ORTHOPADE 2017; 46:336-341. [PMID: 28243691 DOI: 10.1007/s00132-017-3395-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Partial aponeurectomy as the state-of-the-art treatment in Dupuytren's disease is indicated when minimally invasive forms of treatment, such as needle aponeurotomy or percutaneous collagenase injection, are not possible due to the advanced stage of the disease or the morphology of the contracture. Even in earlier stages of Dupuytren disease partial aponeurectomy has advantages in comparison to minimally invasive forms of treatment. These advantages are lower recurrence rates as well as less persistent residual contractures, especially in the proximal interphalangeal joint.
Collapse
Affiliation(s)
- U S Vesper
- Abteilung für Plastische-, Hand- und Rekonstruktive Chirurgie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland.
| | - I M Mehling
- Abteilung für Plastische-, Hand- und Rekonstruktive Chirurgie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| | - A Arsalan-Werner
- Abteilung für Plastische-, Hand- und Rekonstruktive Chirurgie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| | - M Sauerbier
- Abteilung für Plastische-, Hand- und Rekonstruktive Chirurgie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland
| |
Collapse
|
5
|
Brauns A, Van Nuffel M, De Smet L, Degreef I. A clinical trial of tension and compression orthoses for Dupuytren contractures. J Hand Ther 2017; 30:253-261. [PMID: 28236563 DOI: 10.1016/j.jht.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized clinical trial on 2 patient groups with Dupuytren's disease. INTRODUCTION Despite an unpredictable outcome, surgery remains an important treatment for Dupuytren's disease. Orthotic devices are a controversial noninvasive treatment method to influence the myofibroblasts in the nodules. PURPOSE OF THE STUDY To detect how much improvement 2 types of orthotic device (tension and compression) as only treatment intervention can provide on a Dupuytren's contracture. Is a compression orthosis better than a tension orthosis? METHODS Thirty patients with measurable flexion contractures of the fingers were identified. Both primary and recurrence cases were included. Patients were randomized in 2 groups of 15 patients. One group had a standard tension orthosis (Levame), the other group a newly designed silicon compression orthotic device. Patients were instructed to wear the orthotic devices 20 hours a day during 3 months. Data were collected at first visit and after 3 months of orthotic treatment. Primary outcomes were active extension deficit of each joint and total active extension (TAE) of the digit. Secondary outcome was patient satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10 points) were recorded at the start and after 3 months. RESULTS Flexion contracture was reduced at least 5 degrees in all patients. After 3 months, TAE was significantly reduced in both groups (both P < .001).The mean change in TAE was 32.36° in the tension group and 46.47° in the compression group. Although reduction of TAE deficit was bigger in the compression group, this difference was not statistically significant (P = .39). VAS scale of esthetics and functionality was significantly increased in both treatment groups. The functional VAS scale after 3 months was 11% higher in the compression group than in the tension group (P = .03). A major complication of a tension orthotic is skin ulcers. DISCUSSION Too much tension may cause myofibroblast stimulation and disease progression, whereas continuous limited tension can improve flexion contractures. The idea of a compression device is based on the treatment concept of hypertrophic burn scars. CONCLUSION Tension and compression orthotic devices can be used as a nonoperative treatment of Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed. LEVEL OF EVIDENCE I (Randomized controlled trial, Therapeutic study).
Collapse
Affiliation(s)
- Annelien Brauns
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium.
| | - Maarten Van Nuffel
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
| | - Luc De Smet
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
| | - Ilse Degreef
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
| |
Collapse
|
6
|
Schaffer TC, Schaffer MC. Disorders of the Upper Extremity. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Chakrabarty S, Foderingham N, O’Hara H. Selected Disorders of the Musculoskeletal System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Zhou C, Liu F, Gallo PH, Baratz ME, Kathju S, Satish L. Anti-fibrotic action of pirfenidone in Dupuytren's disease-derived fibroblasts. BMC Musculoskelet Disord 2016; 17:469. [PMID: 27835939 PMCID: PMC5106805 DOI: 10.1186/s12891-016-1326-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dupuytren's disease (DD) is a complex fibro-proliferative disorder of the hand that is often progressive and eventually can cause contractures of the affected fingers. Transforming growth factor beta (TGF-β1) has been implicated as a key stimulator of myofibroblast activity and fascial contraction in DD. Pirfenidone (PFD) is an active small molecule shown to inhibit TGF-β1-mediated action in other fibrotic disorders. This study investigates the efficacy of PFD in vitro in inhibiting TGF-β1-mediated cellular functions leading to Dupuytren's fibrosis. METHODS Fibroblasts harvested from (DD) and carpal tunnel (CT)- tissues were treated with or without TGF-β1 and/or PFD and were subjected to cell migration, cell proliferation and cell contraction assays. ELISA; western blots and real time RT-PCR assays were performed to determine the levels of fibronectin; p-Smad2/Smad3; alpha-smooth muscle actin (α-SMA), α2 chain of type I collagen and α1 chain of type III collagen respectively. RESULTS Our results show that PFD effectively inhibits TGF-β1-induced cell migration, proliferation and cell contractile properties of both CT- and DD-derived fibroblasts. TGF-β1-induced α-SMA mRNA and protein levels were inhibited at the higher concentration of PFD (800 μg/ml). Interestingly, TGF-β1 induction of type I and type III collagens and fibronectin was inhibited by PFD in both CT- and DD- derived fibroblasts, but the effect was more prominent in DD cells. PFD down-regulated TGF-β1-induced phosphorylation of Smad2/Smad3, a key factor in the TGF-β1 signaling pathway. CONCLUSION Taken together these results suggest the PFD can potentially prevent TGF-β1-induced fibroblast to myofibroblast transformation and inhibit ECM production mainly Type I- and Type III- collagen and fibronectin in DD-derived fibroblasts. Further in-vivo studies with PFD may lead to a novel therapeutic application in preventing the progression or recurrence of Dupuytren's disease.
Collapse
Affiliation(s)
- Chaoming Zhou
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Fang Liu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Phillip H. Gallo
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Mark E. Baratz
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Sandeep Kathju
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Latha Satish
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
- Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, Scaife Hall, S685.2, Pittsburgh, PA 15261 USA
| |
Collapse
|
9
|
Anderson ER, Ye Z, Caldwell MD, Burmester JK. SNPs previously associated with Dupuytren's disease replicated in a North American cohort. Clin Med Res 2014; 12:133-7. [PMID: 24573701 PMCID: PMC4317152 DOI: 10.3121/cmr.2013.1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Dupuytren's disease is a progressive fibrosis of the hand that often results in debilitating flexion contractures. Its etiology is not completely understood but likely involves both genetic and environmental factors. A recent study performed in Europe identified DNA variants that associate with Dupuytren's disease. Given the likelihood for genetic variation among populations, we planned to validate the genetic variants identified by this study in a North American population. METHODS In the Marshfield Clinic's Personalized Medicine Research Project, 296 cases with Dupuytren's disease were identified and matched 3-to-1 to controls without Dupuytren's disease. Clinical data were abstracted from the electronic medical record. The top 12 single nucleotide polymorphisms (SNPs) from the European study were selected and tested in a multiplex assay using the MassArray Analyzer 4 (Sequenom, Inc., San Diego, CA). Differences in allele frequency were determined, and variants with a P value of <0.004 were considered significant. RESULTS We replicated 5 of the 12 SNPs previously reported to be associated with Dupuytren's disease. CONCLUSION Our findings support a role for the Wnt signaling pathway in the development of Dupuytren's disease, and suggest that further study of this pathway may result in early diagnosis and non-surgical treatments for Dupuytren's disease.
Collapse
Affiliation(s)
| | - Zhan Ye
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Michael D Caldwell
- Department of General Surgery, Director of Wound Healing Program, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - James K Burmester
- Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| |
Collapse
|
10
|
Gajendran VK, Hentz V, Kenney D, Curtin CM. Multiple collagenase injections are safe for treatment of Dupuytren's contractures. Orthopedics 2014; 37:e657-60. [PMID: 24992063 DOI: 10.3928/01477447-20140626-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases.
Collapse
|
11
|
Abstract
Bacterial collagenases are metalloproteinases involved in the degradation of the extracellular matrices of animal cells, due to their ability to digest native collagen. These enzymes are important virulence factors in a variety of pathogenic bacteria. Nonetheless, there is a lack of scientific consensus for a proper and well-defined classification of these enzymes and a vast controversy regarding the correct identification of collagenases. Clostridial collagenases were the first ones to be identified and characterized and are the reference enzymes for comparison of newly discovered collagenolytic enzymes. In this review we present the most recent data regarding bacterial collagenases and overview the functional and structural diversity of bacterial collagenases. An overall picture of the molecular diversity and distribution of these proteins in nature will also be given. Particular aspects of the different proteolytic activities will be contextualized within relevant areas of application, mainly biotechnological processes and therapeutic uses. At last, we will present a new classification guide for bacterial collagenases that will allow the correct and straightforward classification of these enzymes.
Collapse
Affiliation(s)
- Ana Sofia Duarte
- a Department of Biology and Cesam , University of Aveiro, Campus Universitario de Santiago , Aveiro , Portugal
| | - Antonio Correia
- a Department of Biology and Cesam , University of Aveiro, Campus Universitario de Santiago , Aveiro , Portugal
| | - Ana Cristina Esteves
- a Department of Biology and Cesam , University of Aveiro, Campus Universitario de Santiago , Aveiro , Portugal
| |
Collapse
|
12
|
Kang YM, Choi YR, Yun CO, Park JO, Suk KS, Kim HS, Park MS, Lee BH, Lee HM, Moon SH. Down-regulation of collagen synthesis and matrix metalloproteinase expression in myofibroblasts from Dupuytren nodule using adenovirus-mediated relaxin gene therapy. J Orthop Res 2014; 32:515-23. [PMID: 24293067 DOI: 10.1002/jor.22535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 11/09/2013] [Indexed: 02/04/2023]
Abstract
Dupuytren's disease is a fibroproliferative connective tissue disorder characterized by contracture of the palmer fascia of the hand. Relaxin (RLN) is a multifunctional factor which contributes to the remodeling of the pelvic ligament by inhibiting fibrosis and inflammatory activities. The aim of this study was to investigate the effect of the RLN gene on the inhibition of fibrosis in myofibroblastic cells. Myofibroblast cells with adenovirus LacZ (Ad-LacZ) as a marker gene or adenovirus relaxin (Ad-RLN) as therapeutic gene showed transgene expressions in beta-galactosidase assay and Western blot analysis. Myofibroblastic cells with Ad-RLN demonstrated a 22% and 48% reduction in collagen I and III mRNA expressions respectively, a 50% decrease in MMP-1, 70% decrease in MMP-2, 80% decrease in MMP-9, and a 15% reduction in MMP-13 protein expression compared with cultures with viral control and saline control. In addition, myofibroblastic cells with Ad-RLN showed a 40% decrease in TIMP 1 and a 15% increase in TIMP 3 protein expression at 48 h compared to cultures with viral control and saline control. Also, myofibroblastic cell with Ad-RLN demonstrated a 74% inhibition of fibronectin and a 52% decrease in total collagen synthesis at 48 h compared with cultures with viral control and saline control. In conclusion, the RLN gene render antifibrogenic effect on myofibroblastic cells from Dupuytren's nodule via direct inhibition of collagen synthesis not through collagenolytic pathway such as MMP-1, -13, TIMP 1, and 3. Therefore relaxin can be an alternative therapeutic strategy in initial stage of Dupuytren's disease by its antifibrogenic effect.
Collapse
Affiliation(s)
- Young-Mi Kang
- BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Disorders of the Upper Extremity. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Selected Disorders of the Musculoskeletal System. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|