The palmar fascia in Duputren’s contracture does not contract like a muscle: it’s more like the effect of an army of tiny rachets. Adjacent parallel strands of collagen are grabbed by myofibroblasts, which then shorten (“crimp”) lengthwise, pulling the strands to overlap more and more, and then gluing these strands together with crosslinks. Crimp, lock, crimp, lock, shortening the fabric in one direction. Crimping is accomplished by the action of one type of smooth muscle actin (SMA) inside myofibroblast cells. This study looks at the presence of SMA in Dupuytren’s tissues, and suggests that one of the five types of platelet derived growth factor, PDGF-BB, might be used to selectively block SMA and prevent contracture:
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