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Cold Intolerance Following Collagenase Clostridium histolyticum Treatment for Dupuytren Contracture: A Molecular Mechanism
1886
LETTERS TO THE EDITOR
FIGURE 1: A A 32-year-old male patient with proximal one-third scaphoid nonunion presenting with stage I scaphoid nonunion advanced collapse wrist. B Five-year follow-up radiograph depicting union of the scaphoid and distal radius osteotomy and widening of the radioscaphoid joint. (Reproduced with permission from Malizos KN, Koutalos A, Papatheodorou L, Varitimidis S, Kontogeorgakos V, Dailiana Z. Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse. J Hand Surg Am. 2014;39(5):872e879. Copyright Ó 2014 ASSH.1)
Faculty of Medicine, University of Thessalia Biopolis, Larissa, Greece http://dx.doi.org/10.1016/j.jhsa.2014.06.023 REFERENCES 1. Malizos KN, Koutalos A, Papatheodorou L, Varitimidis S, Kontogeorgakos V, Dailiana Z. Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse. J Hand Surg Am. 2014;39(5):872e879.
2. Giannikas AC, Papachristou G. Wedge osteotomy of the lower end of the radius in the treatment of painful pseudarthrosis of the carpal scaphoid bone. Clin Orthop Relat Res. 1989;(246):16e21. 3. Kam B, Topper SM, McLoughlin S, Liu Q. Wedge osteotomies of the radius for Kienböck’s disease: a biomechanical analysis. J Hand Surg Am. 2002;27(1):37e42. 4. Garcia-Elias M. Understanding wrist mechanics: a long and winding road. J Wrist Surg. 2013;2(1):5e12. 5. Salva-Coll G, Garcia-Elias M, Hagert E. Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg. 2013;2(2):136e140. 6. Braga-Silva J, Román JA, Padoin AV. Wrist denervation for painful conditions of the wrist. J Hand Surg Am. 2011;36(6):961e966.
Cold Intolerance Following Collagenase Clostridium histolyticum Treatment for Dupuytren Contracture: A Molecular Mechanism To the Editor: We read with great interest the letter by King and Belcher entitled “Cold Intolerance Following Collagenase Clostridium histolyticum Treatment for Dupuytren Contracture.”1 The authors had no explanation for collagenase C histolyticumeinduced cold intolerance. We would like to expand on the discussion by introducing the route through which collagenase C histolyticum can cause cold intolerance. Recent studies showed that physiologic imbalance between matrix metalloproteinase and their natural inhibitors can cause increased synthesis of collagen, leading to active Dupuytren disease.2 Wilkinson et al3 showed increased expression of matrix metalloproteinase as a biomarker of disease progression. Produced by bacterium C histolyticum, collagenase is related functionally to matrix metalloproteinase. J Hand Surg Am.
r
Collagenase C histolyticum, which is used for treatment of Dupuytren contracture, degrades the extracellular matrix through increased matrix metalloproteinase activity.4 Transient receptor potential channels have an essential role in cold intolerance. Transient receptor potential channels, which contribute to cold intolerance in the skin, are a mediator of matrix metalloproteinase.5,6 Therefore, this important mechanism should be considered a possible explanation for collagenase C histolyticumeinduced cold intolerance. We believe that this attempt to enlighten researchers about the molecular mechanism of collagenase C histolyticumeinduced cold intolerance could stimulate a multiplicity of laboratory and later clinical investigations, leading to better treatment for patients experiencing this disease. Vol. 39, September 2014
1887
LETTERS TO THE EDITOR
Hamid Namazi, MD Zahra Majd, MD Department of Orthopaedic Surgery Shiraz University of Medical Sciences Shiraz, Iran http://dx.doi.org/10.1016/j.jhsa.2014.04.046 REFERENCES 1. King ICC, Belcher HJCR. Cold intolerance following collagenase Clostridium histolyticum treatment for Dupuytren contracture. J Hand Surg Am. 2014;39(4):808e809. 2. Ulrich D, Hrynyschyn K, Pallua N. Matrix metalloproteinases and tissue inhibitors of metalloproteinases in sera and tissue of patients with Dupuytren’s disease. Plast Reconstr Surg. 2003;112(5):1279e1286. 3. Wilkinson JM, Davidson RK, Swingler TE, et al. MMP-14 and MMP2 are key metalloproteases in Dupuytren’s disease fibroblast-mediated contraction. Biochim Biophys Acta. 2012;1822(6):897e905. 4. Edkins TJ, Koller-Eichhorn R, Alhadeff JA, Mayer U, Faust H, Del Tito BJ. Assessment of potential cross-reactivity of human endogenous matrix metalloproteinases with collagenase Clostridium histolyticum antibodies in human sera obtained from patients with Dupuytren’s contracture. Clin Vaccine Immunol. 2012;19(4):562e569. 5. Kambiz S, Duraku LS, Holstege JC, Hovius SE, Ruigrok TJ, Walbeehm ET. Thermo-sensitive TRP channels in peripheral nerve injury: a review of their role in cold intolerance. J Plast Reconstr Aesthet Surg. 2014;67(5):591e599. 6. Lee YM, Kim YK, Kim KH, Park SJ, Kim SJ, Chung JH. A novel role for the TRPV1 channel in UV-induced matrix metalloproteinase (MMP)-1 expression in HaCaT cells. J Cell Physiol. 2009;219(3):766e775.
In Reply: We thank Drs Namazi and Majd for their interest in the case reports of cold intolerance after treatment with collagenase Clostridium histolyticum (CCH). Their added discussion of the role of matrix metalloproteinases in the development of cold intolerance is thought-provoking but speculative. Cold intolerance is a well-recognized albeit illunderstood response to trauma that is thought to be vasomotor in origin.1 Its occurrence after treatment
may therefore have been a response to the notable inflammation caused by the injection of CCH as well as subsequent manipulation. An alternative hypothesis is that structural damage may occur if arterial vessel wall collagen is exposed to high volumes of collagenase.2 Although CCH has limited activity against type IV collagen,3,4 a constituent of the basement membrane (ie, blood vessels), it has activity against type I and III collagen present in vessel walls.5 The explanation for this complication may therefore be more prosaic than suggested in the letter by Drs Namazi and Majd. Clinicians should nonetheless be mindful of this potential complication after administration of CCH for the treatment of Dupuytren contracture. Ian C. C. King, MA, MBBS Harry J. C. R. Belcher, MS Department of Plastic and Reconstructive Surgery Queen Victoria Hospital East Grinstead, UK http://dx.doi.org/10.1016/j.jhsa.2014.06.024 REFERENCES 1. Nylander G, Nylander E, Lassvik C. Cold sensitivity after replantation in relation to arterial circulation and vasoregulation. J Hand Surg Br. 1987;12(1):78e81. 2. Spiers JD, Ullah A, Dias JJ. Vascular complication after collagenase injection and manipulation for Dupuytren’s contracture. J Hand Surg Eur Vol. 2014;39(5):554e556. 3. Badalamente MA, Hurst LC. Enzyme injection as a nonoperative treatment for Dupuytren’s disease. Drug Delivery. 1996;3(1): 35e40. 4. Rydevik B, Ehira T, Linder L, Olmarker K, Romanus M, Branemark PI. Microvascular response to locally injected collagenase: an experimental investigation in hamsters and rabbits. Scand J Plast Reconstr Hand Surg. 1989;23(1):17e21. 5. Gelbard MK, Walsh R, Kaufman JJ. Collagenase for Peyronie’s disease experimental studies. Urol Res. 1982;10(3):135e140.
Secondary Block Failure for Upper Extremity Surgery: Less Is Not More To the Editor: We write regarding the article by Ahsan and colleagues.1 When doing a continuous brachial plexus block, we place a catheter with ultrasound or nerve stimulator guidance on 1 of the 5 roots or 1 of the 3 trunks, in the case of interscalene block. A catheter can also be placed on 1 of the 6 divisions or 3 cords in the case of supra- or infraclavicular block and on 1 of the 7 peripheral nerves in the case of axillary block. However, the logic of the Hilton law of anatomy2 survives the test of time. It states that a nerve that J Hand Surg Am.
r
innervates muscles that move a joint or innervate the skin that overlies a joint will also innervate that joint. For surgery on any major joint of the upper limb, therefore, we need to block the entire brachial plexus for complete analgesia. The primary block is done by placing a large volume of a high-concentration local anesthetic agent through a needle or catheter on 1 of the plexus elements, the local anesthetic that diffuses to the axons owing to the high-concentration gradient blocks all of the plexus elements, and the Hilton law is satisfied. By the next day, however, with the lowVol. 39, September 2014
LETTERS TO THE EDITOR
FIGURE 1: A A 32-year-old male patient with proximal one-third scaphoid nonunion presenting with stage I scaphoid nonunion advanced collapse wrist. B Five-year follow-up radiograph depicting union of the scaphoid and distal radius osteotomy and widening of the radioscaphoid joint. (Reproduced with permission from Malizos KN, Koutalos A, Papatheodorou L, Varitimidis S, Kontogeorgakos V, Dailiana Z. Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse. J Hand Surg Am. 2014;39(5):872e879. Copyright Ó 2014 ASSH.1)
Faculty of Medicine, University of Thessalia Biopolis, Larissa, Greece http://dx.doi.org/10.1016/j.jhsa.2014.06.023 REFERENCES 1. Malizos KN, Koutalos A, Papatheodorou L, Varitimidis S, Kontogeorgakos V, Dailiana Z. Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse. J Hand Surg Am. 2014;39(5):872e879.
2. Giannikas AC, Papachristou G. Wedge osteotomy of the lower end of the radius in the treatment of painful pseudarthrosis of the carpal scaphoid bone. Clin Orthop Relat Res. 1989;(246):16e21. 3. Kam B, Topper SM, McLoughlin S, Liu Q. Wedge osteotomies of the radius for Kienböck’s disease: a biomechanical analysis. J Hand Surg Am. 2002;27(1):37e42. 4. Garcia-Elias M. Understanding wrist mechanics: a long and winding road. J Wrist Surg. 2013;2(1):5e12. 5. Salva-Coll G, Garcia-Elias M, Hagert E. Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg. 2013;2(2):136e140. 6. Braga-Silva J, Román JA, Padoin AV. Wrist denervation for painful conditions of the wrist. J Hand Surg Am. 2011;36(6):961e966.
Cold Intolerance Following Collagenase Clostridium histolyticum Treatment for Dupuytren Contracture: A Molecular Mechanism To the Editor: We read with great interest the letter by King and Belcher entitled “Cold Intolerance Following Collagenase Clostridium histolyticum Treatment for Dupuytren Contracture.”1 The authors had no explanation for collagenase C histolyticumeinduced cold intolerance. We would like to expand on the discussion by introducing the route through which collagenase C histolyticum can cause cold intolerance. Recent studies showed that physiologic imbalance between matrix metalloproteinase and their natural inhibitors can cause increased synthesis of collagen, leading to active Dupuytren disease.2 Wilkinson et al3 showed increased expression of matrix metalloproteinase as a biomarker of disease progression. Produced by bacterium C histolyticum, collagenase is related functionally to matrix metalloproteinase. J Hand Surg Am.
r
Collagenase C histolyticum, which is used for treatment of Dupuytren contracture, degrades the extracellular matrix through increased matrix metalloproteinase activity.4 Transient receptor potential channels have an essential role in cold intolerance. Transient receptor potential channels, which contribute to cold intolerance in the skin, are a mediator of matrix metalloproteinase.5,6 Therefore, this important mechanism should be considered a possible explanation for collagenase C histolyticumeinduced cold intolerance. We believe that this attempt to enlighten researchers about the molecular mechanism of collagenase C histolyticumeinduced cold intolerance could stimulate a multiplicity of laboratory and later clinical investigations, leading to better treatment for patients experiencing this disease. Vol. 39, September 2014
1887
LETTERS TO THE EDITOR
Hamid Namazi, MD Zahra Majd, MD Department of Orthopaedic Surgery Shiraz University of Medical Sciences Shiraz, Iran http://dx.doi.org/10.1016/j.jhsa.2014.04.046 REFERENCES 1. King ICC, Belcher HJCR. Cold intolerance following collagenase Clostridium histolyticum treatment for Dupuytren contracture. J Hand Surg Am. 2014;39(4):808e809. 2. Ulrich D, Hrynyschyn K, Pallua N. Matrix metalloproteinases and tissue inhibitors of metalloproteinases in sera and tissue of patients with Dupuytren’s disease. Plast Reconstr Surg. 2003;112(5):1279e1286. 3. Wilkinson JM, Davidson RK, Swingler TE, et al. MMP-14 and MMP2 are key metalloproteases in Dupuytren’s disease fibroblast-mediated contraction. Biochim Biophys Acta. 2012;1822(6):897e905. 4. Edkins TJ, Koller-Eichhorn R, Alhadeff JA, Mayer U, Faust H, Del Tito BJ. Assessment of potential cross-reactivity of human endogenous matrix metalloproteinases with collagenase Clostridium histolyticum antibodies in human sera obtained from patients with Dupuytren’s contracture. Clin Vaccine Immunol. 2012;19(4):562e569. 5. Kambiz S, Duraku LS, Holstege JC, Hovius SE, Ruigrok TJ, Walbeehm ET. Thermo-sensitive TRP channels in peripheral nerve injury: a review of their role in cold intolerance. J Plast Reconstr Aesthet Surg. 2014;67(5):591e599. 6. Lee YM, Kim YK, Kim KH, Park SJ, Kim SJ, Chung JH. A novel role for the TRPV1 channel in UV-induced matrix metalloproteinase (MMP)-1 expression in HaCaT cells. J Cell Physiol. 2009;219(3):766e775.
In Reply: We thank Drs Namazi and Majd for their interest in the case reports of cold intolerance after treatment with collagenase Clostridium histolyticum (CCH). Their added discussion of the role of matrix metalloproteinases in the development of cold intolerance is thought-provoking but speculative. Cold intolerance is a well-recognized albeit illunderstood response to trauma that is thought to be vasomotor in origin.1 Its occurrence after treatment
may therefore have been a response to the notable inflammation caused by the injection of CCH as well as subsequent manipulation. An alternative hypothesis is that structural damage may occur if arterial vessel wall collagen is exposed to high volumes of collagenase.2 Although CCH has limited activity against type IV collagen,3,4 a constituent of the basement membrane (ie, blood vessels), it has activity against type I and III collagen present in vessel walls.5 The explanation for this complication may therefore be more prosaic than suggested in the letter by Drs Namazi and Majd. Clinicians should nonetheless be mindful of this potential complication after administration of CCH for the treatment of Dupuytren contracture. Ian C. C. King, MA, MBBS Harry J. C. R. Belcher, MS Department of Plastic and Reconstructive Surgery Queen Victoria Hospital East Grinstead, UK http://dx.doi.org/10.1016/j.jhsa.2014.06.024 REFERENCES 1. Nylander G, Nylander E, Lassvik C. Cold sensitivity after replantation in relation to arterial circulation and vasoregulation. J Hand Surg Br. 1987;12(1):78e81. 2. Spiers JD, Ullah A, Dias JJ. Vascular complication after collagenase injection and manipulation for Dupuytren’s contracture. J Hand Surg Eur Vol. 2014;39(5):554e556. 3. Badalamente MA, Hurst LC. Enzyme injection as a nonoperative treatment for Dupuytren’s disease. Drug Delivery. 1996;3(1): 35e40. 4. Rydevik B, Ehira T, Linder L, Olmarker K, Romanus M, Branemark PI. Microvascular response to locally injected collagenase: an experimental investigation in hamsters and rabbits. Scand J Plast Reconstr Hand Surg. 1989;23(1):17e21. 5. Gelbard MK, Walsh R, Kaufman JJ. Collagenase for Peyronie’s disease experimental studies. Urol Res. 1982;10(3):135e140.
Secondary Block Failure for Upper Extremity Surgery: Less Is Not More To the Editor: We write regarding the article by Ahsan and colleagues.1 When doing a continuous brachial plexus block, we place a catheter with ultrasound or nerve stimulator guidance on 1 of the 5 roots or 1 of the 3 trunks, in the case of interscalene block. A catheter can also be placed on 1 of the 6 divisions or 3 cords in the case of supra- or infraclavicular block and on 1 of the 7 peripheral nerves in the case of axillary block. However, the logic of the Hilton law of anatomy2 survives the test of time. It states that a nerve that J Hand Surg Am.
r
innervates muscles that move a joint or innervate the skin that overlies a joint will also innervate that joint. For surgery on any major joint of the upper limb, therefore, we need to block the entire brachial plexus for complete analgesia. The primary block is done by placing a large volume of a high-concentration local anesthetic agent through a needle or catheter on 1 of the plexus elements, the local anesthetic that diffuses to the axons owing to the high-concentration gradient blocks all of the plexus elements, and the Hilton law is satisfied. By the next day, however, with the lowVol. 39, September 2014