Dupuytren Roundtable Discussions

Here are links to two recently published roundtable discussions by experts in the field of Dupuytren's. Although these were discussions by surgeons for surgeons, they are really just conversations and quite readable. They highlight the current challenges both surgeons and their patients face with Dupuytren's disease and provide insight into future efforts to develop a biological cure.

American Association of Hand Surgeons (go to page 6): http://www.dupuytrenfoundation.org/DupPDFs/2010_AAHS.pdf

American Academy of Orthopaedic Surgeons: http://www.dupuytrenfoundation.org/DupPDFs/2011_AAOS.pdf

Coming up: What is known about Dupuytren's and Chondroitin/Glucosamine?

Dupuytren Foundation 2010 Report

It's been a busy year behind the scenes for the Dupuytren Foundation - see what we've been up to at http://conta.cc/hV1lEy

Miami Dupuytren Symposium spurs new research: Report from Dupuytren's Day at the Deutsche Gesellschaft für Handchirurgiethe (German Society for Surgery of the Hand - DGH)

Dr Wolfgang Wach reports from the DGH, Oct 7 Dupuytren Program: "I attended the Dupuytren’s day at the Nuremberg conference of German hand surgeons and the Miami Dupuytren Symposium was pretty well covered there. Bernhard Lukas gave a review of the Miami conference and the current issue of the German hand surgeons journal which was distributed at the conference also contained a 3 page summary by Bernhard Lukas and Albrecht Meinel of the Miami conference. Lawrence Hurst presented collagenase. Albrecht Meinel presented an extended version of his Miami anatomy and his splinting papers, Bernhard Lukas presented his surgery paper, Holger Erne and Bernhard Lukas gave papers on NA, Ilse Degreef presented a summary of her papers, Hans Hennies presented an update on his genomics study and mentioned that, as result of the Miami Dupuytren Symposium, the UK, the Netherlands, and the German genomics study started cooperating and are exchanging samples. Great! I also gave a little patient talk.".
The full conference program can be downloaded at http://www.dgh-kongress.de/dgh2010/Hauptprogramm_DGH2010.pdf. The DGH web site is http://www.dg-h.de. This new joint effort of researchers is a realization of a goal of the Dupuytren Foundation: to spur global collaboration to develop better treatment options for Dupuytren's; to find a cure. It is happening.

Swimming the English Channel to Support Dupuytren's Research

Surgeons and surgeons in training brave the English Channel to raise money to support hand surgery research: http://www.oxfordmail.co.uk/news/yourtown/oxford/8441861.Swimming_medics_show_surgical_spirit/ Cold! I mean ...How cool is that? Good work!

Video: I was a Teenage Myofibroblast (and I loved it!)

Before becoming the villain in Dupuytren's, the myofibroblast was really not a bad cell. What happened? What caused the change? Could it happen to you? Professor Sem Phan, Department of Pathology, University of Michigan explains almost everything in this presentation of "Mechanisms of Myofibroblast Differentiation":
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/dsPwSUDrz1Y

Funding for these and other Miami Dupuytren Symposium videos at http://dupuytrensymposium.com/program.html, is provided by the Dupuytren Foundation. Support the Dupuytren Foundation with an online donation: http://CureDup.com.

The Secret Life of Myofibroblasts: Dr. Boris Hinz reveals all!

Boris Hinz PhD, University of Toronto, Ontario, CA presents "Fundamental aspects of myofibroblast contraction." and explains how the process is both simple and complex. How do these little cells do such big things? More importantly, what steps in the process go wrong to result in Dupuytren's and what can be done to safely and simply correct this? Watch the video and see: http://www.youtube.com/user/DupuytrenFoundation#p/u/0/fvmRS3OiWic

Funding for these and other Miami Dupuytren Symposium videos at http://dupuytrensymposium.com/program.html, is provided by the Dupuytren Foundation. Support the Dupuytren Foundation with an online donation: http://CureDup.com.

Dupuytren's vs. Burns! Video: Dr. Paul Zidel at the 2010 Miami Dupuytren Symposium

Dr. Paul Zidel, Chief, Hand Surgery, Maricopa Medical Center, Phoenix, Arizona, presents a thought provoking comparison of two different yet similar conditions in "Dupuytren's versus burn scar contracture"
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/uR5OcoIKfOI
Hypertrophic scars, Ledderhose disease, burn scars, keloid scars, desmoid tumors, pulmonary fibrosis, arteriosclerosis and other abnormal fibrosing conditions share some of the same complex biology as Dupuytren's. Answers found for one condition may apply to others - there are many stones yet unturned in the path to find a cure for Dupuytren's. Support the effort at http://CureDup.com

Video: Professor Millesi at the Miami Dupuytren's Symposium

Professor Hanno Millesi of the Millesi Center in Vienna, chairman of the 1983 Dupuytren's Meeting in Vienna, presents "Changes of the visco-elastic properties of the palmar fascia as pathogenetic basis of Dupuytren's Disease": http://www.youtube.com/user/DupuytrenFoundation#p/u/0/vRc9XFBOVTk. The more one investigates, the deeper the mystery of Dupuytren's becomes. The legendary Dr. Millesi explores the chicken and egg aspect of the mechanics of Dupuytren's.
These and other videos are archived at http://dupuytrensymposium.com/program.html and are made possible through funding by the Dupuytren Foundation. Please support further research and education by giving to the Dupuytren Foundation at http://CureDup.com

Dr. Paul Werker presents at the 2010 Dupuytren Symposium

Paul Werker MD PhD, Professor and Head of the Department of Plastic Surgery, Groningen University Medical Center Groningen, NL presents: Management of soft tissue contractures: a surgical perspective. See the video at http://www.youtube.com/user/DupuytrenFoundation#p/u/0/fHoOhGlsgDU. This and other video presentations from the 2010 International Symposium on Dupuytren's Disease, are being added to http://dupuytrensymposium.com/program.html. This symposium was made possible through funding from the Dupuytren Foundation. Join the effort to find a cure by making a donation to support research, education and global collaboration through the Dupuytren Foundation: http://CureDup.com.

Video: Dr. Osterman at the 2010 Miami Dupuytren Symposium

The latest installment of video presentations archived from the Miami Dupuytren Symposium features Dr. Lee Osterman, Professor of Hand/Orthopedic Surgery at the Thomas Jefferson University in Philadelphia, PA. Dr. Osterman's entertaining presentation highlights the complex background of efforts to understand and treat Dupuytren's Disease. See "Cline’s contracture: Dupuytren was a thief. A history of surgery for Dupuytren’s contracture." at http://www.youtube.com/user/DupuytrenFoundation#p/u/0/iOd0iZNbM_w. If you missed or had audio difficulties with previously posted symposium videos, check http://dupuytrensymposium.com/program.html for updated versions and new releases.

Video: Dr. Wolfgang Wach at the 2010 Dupuytren Symposium

Dr. Wolfgang Wach, founder of the Dupuytren Society (http://www.dupuytren-online.info/), discusses the development, value and future of the Dupuytren Society in this video from the 2010 International Symposium on Dupuytren's Disease. The Dupuytren Society is the largest, most visited patient oriented Dupuytren's resource on the internet. http://www.youtube.com/watch?v=F_8did7Pr78

Video Presentations of the 2010 Miami Dupuytren Symposium on YouTube

The Miami Dupuytren Symposium was very exciting. Presentations were recorded on video, and are finally making their way through post processing to be available on line. Free. For you - courtesy of the Dupuytren Foundation. These will be released weekly. Each presentation is at least 15 minutes, and most will take some time to digest, so get comfortable, and get to know the people who are working around the world to find a cure for Dupuytren's and related conditions.

The first video is the introductory and welcoming remarks by Dr. Charles Eaton.
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/E4qAoklf4sE

Enjoy!

Stony Brook Dupuytren Symposium

I had the opportunity to attend the Stony Brook Dupuytren Symposium April 17. This was a real treat, featuring a faculty of well known authorities on Dupuytren's. The volcanic ash European flight difficulties prevented attendance of only one speaker. The symposium covered a range of topics and in addition provided an in depth tour of the use of collagenase injection for Dupuytren's from the initial concept, through proof of concept in laboratory tests and then clinical trials, to clinical application, indications and issues. This is a monumental achievement for Drs. Hurst and Badalamente, and a testimony to their insight and persistence. Plans were also discussed to jointly present the materials from the Stony Brook and the upcoming Miami Dupuytren Symposium (http://www.DupuytrenSymposium.com) together as one book, to be published by the American Society for Surgery of the Hand (http://www.assh.org). What a promising year for Dupuytren's!

Stretching, Myofibroblasts and Dupuytren's

How, and why, does Dupuytren's disease actually contract? What is the physical mechanism? What provokes it? There is a genetic risk, but genes don't provide the entire script, otherwise Dupuytren's contractures should be symmetric, the same problem developing at the same time in the same way in both hands, but that's not what happens: usually, contractures in one hand are different in time and space than the other hand. Why? One explanation is that Dupuytren's is both biological and mechanical, and that physical forces somewhat influence the process. One way to study the big picture is to look at the little picture: what happens inside Dupuytren cells in response to physical forces? This is an active and exciting area of research. Myofibroblasts are the contracting cells producing Dupuytren's and other fibrotic contractures. Myofibroblasts respond to stretching by first relaxing and then pulling against the line of pull. This process is the subject of ongoing studies. In "Stretch-activated force-shedding, force recovery, and cytoskeletal remodeling in contractile fibroblasts" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2008_Nekouzadeh.pdf), researchers used a laboratory model to demonstrate fibroblast reactions to stretch. Stretching cells initially tears the scaffolding inside cells, which is made of the protein actin. This releases tension, but also provokes the cells to pull back in two phases. The first phase starts within seconds ("Rapid Active Response"), the second after a few minutes ("Gradual Active Response"). These responses show the cell repairing the torn proteins. Other responses follow, modifying the collagen matrix outside the cells. The result? The more you pull, the more Dupuytren's pulls back. This is the type of data we need to move past what would seem to make sense, but is probably exactly wrong (pulling and stretching your fingers back to keep them from contracting) to an effective treatment, a cure.

Personal experiences with Xiaflex and Needle Aponeurotomy

Xiaflex is now available, and is generating reports by both traditional writers and self published social media authors. There are now two minimally invasive treatments for contractures due to Dupuytren's disease - Xiaflex injection and needle aponeurotomy - with relative advantages and disadvantages of each. The following video was made by a Dupuytren's patient, documenting experience with needle aponeurotomy: http://www.youtube.com/watch?v=lGD9RjmFBzo. Another person's documentary experience with Xiaflex, also with videos, is posted here: http://bit.ly/9RhqQA. Their experiences were different, but both are satisfied with their results. Every hand is different and no one treatment works for everyone, but it's great that there are new options to choose from to buy time while researchers work for a cure. The Dupuytren Foundation is actively recruiting volunteers and fund raising options to develop better treatments - and eventually a cure. Support the effort. Make a difference. http://www.DupuytrenFoundation.org

Red wine and yellow curry to prevent Dupuytren's?

Could a yellow curry dinner and a glass of red wine be good for Dupuytren's? Possibly. Dupuytren's is a fibrotic condition, something it shares with other disorders. There is a great deal of ongoing research into the biology of fibrosis and its possible treatment. Two studies suggest that diet may have an helpful influence on excessive fibrosis, at least in special circumstances. In "Protective Effects Of Curcumin Against Amiodarone-Induced Pulmonary Fibrosis In Rats" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2003_Punithavathi.pdf), researchers found a protective effect against lung fibrosis of curcumin, found in turmeric, the spice which gives the yellow color to curry and yellow rice. Another group reported in "Ochratoxin A–Induced Renal Cortex Fibrosis and Epithelial-to-Mesenchymal Transition: Molecular Mechanisms of Ochratoxin A-Injury and Potential Effects of Red Wine" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2005_Gagliano.pdf) a protective effect of red wine against kidney fibrosis. These studies were performed on rats, testing against drugs known to cause fibrosis, which is a bit of a stretch to to Dupuytren's, but it's a start, if you are a rat, and possibly if you are human. Simple options are often the best. Keep looking for a cure!

The earliest case of Dupuytren's? You'll never guess where.

A case of Dupuytren's contracture has been discovered dating back nearly three thousand years. The Monthemhat Project, a multinational Egyptology group, recently published an analysis of 18 mummies from the Third Intermediate Period from the Luxor Cachette, and report the diagnosis of Dupuytren's contracture involving the left hand of one of the mummies. The full report, "Estudio Antropológico, Paleopatológico Y Radiológico De Las Momias Localizadas En El Almacen Número 4 De La Casa Americana (El Asasif, Luxor, Egypt): Proyecto Monthemhat 2009" is available here: http://www.dupuytrenfoundation.org/DupPDFs/2009_garciaguixe.pdf. The Third Intermediate Period refers to the time in Ancient Egypt from the death of Pharaoh Ramesses XI in 1070 BC to the foundation of the Twenty-Sixth Dynasty by Psamtik I in 664 BC. If this is true, this identifies a case of Dupuytren's nearly two thousand years before the previously earliest reports of Dupuytren's in Orkney and Iceland in the 12th and 13th centuries. The question is: were the Egyptians the secret ancestors of the Vikings?

Dupuytren's or palmar fasciitis?

Dupuytren's isn't the only problem which can affect the fascia of the palm. Inflammation of the palmar fascia (palmar fasciitis) may be due to less common problems, and differs from typical Dupuytren's in that it is usually painful. The difference between Dupuytren's and palmar fasciitis is similar to the difference between Ledderhose disease and plantar fasciitis - they are completely different problems which happen to affect the same stucture. Palmar fasciitis may be part of a syndrome associated with arthritis, as reported in "Idiopathic Palmar Fasciitis with Polyarthritis Syndrome" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2006_Sung.pdf), a problem following trauma as discussed in this hand surgery book exerpt (text: http://bit.ly/9Srduf) or part of a paraneoplastic syndrome associated with malignancy as reported in "Palmar fasciitis and polyarthritis as a paraneoplastic syndrome associated with tubal carcinoma: a case report" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2004_Denschlag.pdf). Fortunately or not, Dupuytren's is much more common than any of these conditions, but it is important to keep these in the list of possible diagnoses when evaluating a case of Dupuytren's which doesn't fit the typical picture.

Metalloproteinases and Dupuytren's

A better understanding of the biology of metalloproteinases may lead to new treatment options for Dupuytren's. Metalloproteinases (MMPS) are a group of enzymes in our bodies which break down certain proteins, including collagen. MMPS are blocked by tissue inhibitors of metalloproteinases (TIMPS). MMPS and TIMPS balance each other: imbalances have been implicated in conditions of excess collagen, as seen in Dupuytren's, or inadequate collagen leading to rotator cuff tears. The article "Metalloproteinases and their inhibitors—diagnostic and therapeutic opportunities in orthopedics" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2009_Pasternak.pdf) is a clearly written and thorough review of the topic and its implications for Dupuytren's and other conditions. MMPs are involved in the biology of inflammation and wound healing, which overlaps the cell biology of Dupuytren's. The authors note "In view of the strong hereditary component and a predilection for men in Dupuytren’s disease, it is interesting to note that TIMP-1 is located on the X-chromosome." It may not be that a man's Y chromosome puts him at special risk, but that a woman's X chromosome offers her special protection. In addition to involvement with Dupuytren's, MMPs and TIMPs appear to play key roles in unrelated disorders including arthritis, degenerative disk disease, tendinitis, fracture healing and other conditions. Inroads made in understanding their role in Dupuytren's are likely to benefit people suffering from other conditions - an added incentive to work for a cure.

Stony Brook Dupuytren Symposium

What a year for Dupuytren's! Xiaflex is FDA approved, the 2010 International Symposium on Dupuytren's Disease http://www.DupuytrenSymposium.com is coming up May 22,23 in Miami, and now Stony Brook University Medical Center Department Of Orthopaedics has announced its Dupuytren’s Disease Symposium Saturday, April 17th, 2010 in Stony Brook, New York. The program flier is http://sbumc.informatics.sunysb.edu/sbumcfiles/Dupuytrens%20brochure.pdf. The program lists an international faculty and reviews Dupuytren's biology in addition to a spectrum of management options to straighten fingers bent by Dupuytren's. The Stony Brook Symposium will be a perfect complement to the Miami Symposium's goals of presenting new research and establishing a coalition to work toward a cure for Dupuytren's disease and related conditions.