Dupuytren Foundation August 2013
The Dupuytren Foundation may have seemed quiet, but there's been quite a bit of internal activity reorganizing and streamlining for the last several months. This newsletter marks a milestone of consolidating all of our electronic resources into one system, which will make it easier for you to stay in touch and easier for us to work together.

Dupuytren YouTube Channel: it's growing!
Dupuytren related videos produced by the Dupuytren Foundation now have a home: http://www.youtube.com/DupuytrenFoundation
These videos include:

• All presentations from the 2010 International Symposium on Dupuytren's Disease
• Technical videos on the treatment of Dupuytren Disease
• A new section: the Dupuytren Foundation Two Minute Video Series, which are short educational videos covering a growing range of topics relevant to Dupuytren Disease and the issues which are important in the search for a cure.

The latest addition to this collection is "Measurement of Dupuytren Disease", reviewing the problems and potential of simple measurement techniques needed to better study progress and outcomes of treatment. Explore the issue yourself with the interactive online Dupuytren Finger Angle Measurer, (works on all modern browsers other than Internet Explorer; we're working on it!).

Physical Location: We now have a home.
Timothy Eaton has generously donated use of conference and event space at Eaton Fine Art, located in historic downtown West Palm Beach, Florida: 435 Gardenia Street West Palm Beach, FL 33401.

This location will be used to host a series of support and strategic planning meetings by the Dupuytren Foundation to promote education and collaborative research toward a cure for Dupuytren Disease.

Special Thanks
Thanks to donors who continue to pave the way for Foundation work. Fundraising is critical to our ongoing goal of providing research grants supporting work to crack the Dupuytren code. Particular thanks go to my mentor, Robert W Beasley MD, whose New York based Foundation for Hand Research recently underwent dissolution and made a generous distribution of assets to the Dupuytren Foundation. Large or small, financial support is both appreciated and necessary for Dupuytren Foundation work to continue.


Charles Eaton MD

Botox and Dupuytren Disease?

Botox may have a use in the treatment of Dupuytren disease.

Right now, it's untested, but it has a scientific basis. Botox is not just the botulinium toxin. It's a biologic extract which contains a number of unique molecules. One of these is C3 transferase, an enzyme which blocks several steps in the pathway of fibrosis. Botox has been reported as a potential treatment for keloid scars and has been shown to reduce contracture, adhesions and fibrosis after experimental surgical wounds:

• Dendritic Fibroblasts in Three-dimensional Collagen Matrices 
• Novel Use of Botulinum Toxin to Ameliorate Arthrofibrosis: An Experimental Study in Rabbits 
• RAC Activity in Keloid Disease 
• Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model 
• Innovative Therapies in the Treatment of Keloids and Hypertrophic Scars 
• The actin cytoskeleton in myofibroblast differentiation: Ultrastructure defining form and driving function

There is a large clinical experience to support the use of Botox in humans for treatment of benign disease.

C3 transferase based treatment of Dupuytren disease would be directed at prevention rather than correction. Current thought is that nodules, not cords, are the main location of biologic activity which results in contractures, and nodules are a logical starting study focus.

One type of study would be treatment of patients with nodules - and then following outcomes. The problem with this is that many people with only nodules may not develop contractures for decades:

• Eighteen years follow-up study of the clinical manifestations and progression of Dupuytren’s disease

Another option for study would be to add C3 transferase treatment as an adjunct to patients who are undergoing a procedure to correct Dupuytren contracture. The advantage of this would be that patients who are treated for contracture are likely to have recurrent contracture progression in a more predictable and shorter period of time than those who simply have nodules. This would shorten the needed study time and would give more statistical validity. Selection of patients with risk factors for early recurrence (positive family history, both hands involved, onset earlier than 50 years old, knuckle pads, Ledderhose and others) would similarly improve study analysis logistics. This approach has been applied to cortisone injection and perioperative Tamoxifen with encouraging results:

• Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture:A Randomized, Controlled Study 
• Recurrence After Surgery For Dupuytren's Disease: A Randomised Controlled Trial With Double Blinding, Combining Segmental Fasciectomy With Placebo Or With Neo-Adjuvant Oral Tamoxifen

Interest in coordinating a Botox Dupuytren study may be directed to the Dupuytren Foundation: info@Dupuytrens.org

Charles Eaton MD

Articles referenced above are provided for purely educational use and as such are allowed for as fair use as defined by Title 17, Section 107 Of The Copyright Act.