Dupuytren's disease cords are weakened ex vivo by injection of recombinant collagenase G - A proof-of-concept study.

OBJECTIVES: Dupuytren's disease is a fibroproliferative disorder that is characterized by collagen-rich cords that cause progressive flexion contractures. Collagenase from Clostridium histolyticum is an established nonsurgical therapy. Herein, we evaluated whether a recombinant form of collagenase G (ColG), expressed in Escherichia coli, weakens Dupuytren's cords ex vivo. METHODS: Cords from Dupuytren's disease patients were excised during surgery. Using a 30G needle, 0.5 mL of 4 mg/ml ColG or phosphate buffer Saline (PBS) was injected into the cord center. Samples were incubated in saline at 37 °C and mounted via size-1 Prolene Krackow sutures on an Instron tensile testing system. Force vs. displacement curves were recorded. RESULTS: Six cords from five patients were tested (ColG n = 4; PBS n = 2). Representative force-displacement curves showed a reduced slope and lower peak force prior to rupture in ColG-treated samples compared with vehicle. The mean maximum rupture force was lower with ColG than with PBS (0.047 kN vs 0.069 kN), corresponding to ~32% reduction in the force required to tear the cord in this series. CONCLUSIONS: Recombinant ColG weakens the tensile strength of Dupuytren's cords ex vivo, consistent with potent collagenolytic activity. These proof-of-concept pilot data support further studies to define dose-response, optimize formulation and exposure time, and evaluate safety and clinical performance relative to current collagenase-based treatments.