Prevention of Recurrences in Dupuytren’s Contracture: Are We in the Right Side?

Abstract

Dupuytren contracture is a fibroproliferative disorder affecting the palm of the hand causing a sustained flexion of the fingers due to fibrous cord contracture. Collagenase clostridium histolyticum, as pharmacological treatment, achieves the selective degradation of a portion of the cord, thus enabling the affected finger’s functionality. Our hypothesis is based on a literary review looking for associations based on collagenase for the treatment of the Dupuytren’s disease. Current treatment options for Dupuytren’s are symptomatic and aim at removing part of the affected tissue to restore hand functionality. Recurrence remains the greatest challenge for achieving long-term successful treatment. The association of a hydrogel with the collagenase increases the action time of the latter. The association to a collagenase-hydrogel complex with a third drug (anti-TGFs) acting at the unstructured extracellular matrix in the proliferative phase of the response of wound healing that takes place after the administration of collagenase for direct action on the transformation of fibroblast into myofibroblast, thus resembling as far as possible the actions drugs have on cell cultures. However, in Dupuytren’s contracture, the breakage and degradation of the cord that occur with current treatment make this increase in local action time unnecessary. Combining actual treatment options in Dupuytren’s disease with a hydrogel acting as a vehicle can provide an alternative to destroy the extracellular matrix and act directly against the myofibroblast.