The holy grail of treating Dupuytren’s contracture is “disease modification”: how to stop progression or recurrence in a safe, nontoxic way? Three articles hint at the tantalizing possibility of the use of Botox (botulinum toxin) for Dupuytren’s. Botox includes two classes of enzymes which affect two different biologic systems. The first enzyme, which made Botox popular, is the neurotoxin which blocks nerve signals and paralyzes muscles. The second, lesser known component is C3 transferase exonzyme, which is fascinating and completely different. C3 transferase exonzyme affects a variety of cell-cell and cell-matrix interactions involved in fibrosis. Keloid scars show increased activity in the specific pathways affected by C3 transferase exonzyme http://www.dupuytrenfoundation.org/DupPDFs/2008_Witt.pdf and botox is being reported as a treatment for keloid scars. Experimentally, botox has been shown to reduce contracture, adhesions and fibrosis after surgical wounds http://www.dupuytrenfoundation.org/DupPDFs/2009_Lee.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2007_Namazi.pdf. Could Botox be the magic bullet for Dupuytren’s?
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