A new bromelain-based enzyme for the release of Dupuytren’s contracture
نویسندگان
چکیده
OBJECTIVES Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren's cords. MATERIALS AND METHODS Specially prepared medical grade IBS was injected into fresh Dupuytren's cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system. RESULTS We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases. CONCLUSIONS These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren's contracture.Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016;5:175-177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.
منابع مشابه
Palmar fasciectomy after collagenase Clostridium histolyticum injection for Dupuytren’s contracture: A case report.
We present a case of successful salvage fasciectomy after initial collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren’s contracture. We did not find any remarkable scarring around the Dupuytren’s cord and nodule three and a half years after the initial CCH injection. Pathological findings revealed the previously ruptured cord and partial continuity of the collage...
متن کاملThe role of static night splinting after contracture release for Dupuytren’s disease. A preliminary recommendation based on clinical cases. Albrecht Meinel Recommendations for using a static night splint after surgery are as old as the literature on Dupuytren’s. The coachman,
Recommendations for using a static night splint after surgery are as old as the literature on Dupuytren’s. The coachman, M. Demarteau, who was treated with fasciotomy by Dupuytren in his famous lecture of December 1831, afterwards wore a night splint „for another month and an excellent result was achieved“ (D. Elliot, 1990). Yet firm data on the effectiveness of static or dynamic splinting is s...
متن کاملBasic Thoughts on Dupuytren’s Contracture
Dupuytren’s contracture has been known as such for nearly 200 years. It is a common disease in certain areas of the world. Patients suffering from the disease can have normal life expectancy. The natural course of the disease should be well known. However, our understanding of Dupuytren’s has grown little in the last 100 years despite the fact that it is easy to observe and over the years has b...
متن کاملARTICLE IN PRESS FEEDBACK INHIBITION OF HIGH TGF-b 1 CONCENTRATIONS ON MYOFIBROBLAST INDUCTION AND CONTRACTION BY DUPUYTREN’S FIBROBLASTS
Myofibroblasts and TGF-b1 are implicated in Dupuytren’s contracture. Transforming growth factor b1(TGF-b1) (1–10 ng/ml) increases myofibroblast induction in Dupuytren’s fibroblasts and contraction in a collagen model. However, higher doses (20–30 ng/ml) inhibit contraction in dermal fibroblasts. We hypothesized higher doses of TGF-b1 would inhibit induction of myofibroblasts and contraction by ...
متن کامل