Dupuytren's Contracture Treated with Vitamin E

Richards, H. J.

doi:10.1136/bmj.1.4772.1328

Cited by 13 publications

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“…Treatment of DC remains problematic. A variety of non-surgical interventions, including injection of steroids [ 12 ] or gamma-interferon [ 13 ], use of creams based on vitamin E [ 14 ], dimethyl sulphoxides [ 15 ], and ultrasound therapy [ 16 ] etc. yield limited benefits.…”

Section: Introductionmentioning

confidence: 99%

Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

et al. 2012

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BackgroundDupuytren's contracture (DC) is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC.MethodsTo achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group). These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments). Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02), hierarchical clustering, concordance mapping and Venn diagram.ResultsWe found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that a collagen-rich environment differentially alters gene expression in these cells. In addition, Ingenuity pathway analysis of the specific biological pathways that differentiate DC-derived cells from carpal tunnel-derived cells has identified the potential involvement of microRNAs in this fibroproliferative disorder.ConclusionsThese data show that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected palmar fascia in DC patients are highly similar, and differ significantly from the transcriptomic profiles of fibroblasts from the palmar fascia of patients undergoing carpal tunnel release.

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Section: Introductionmentioning

confidence: 99%

Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

et al. 2012

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“…The studies comprised 20 case series [ 14 , 18 , 31 , 33 , 34 , 36 , 37 , 40 – 42 , 44 – 53 ], 6 case studies [ 30 , 32 , 35 , 39 , 43 ] with 2 by 1 author [ 30 ], and 1 cohort study [ 38 ]. Only 4 publications described results for cohorts comprising exclusively of early DD patients [ 31 , 46 , 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies related to pharmacological therapies (Table 2 ), including steroids [ 30 – 34 ], vitamin E [ 18 , 35 , 36 ], furazolidone injection [ 37 ], aminosyn [ 38 ] and hyperbaric oxygen [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies reported use of vitamin E [ 18 , 35 , 36 ]. Based on clinical findings that daily administration of 200 mg of ephynal for 20 weeks resulted in a decrease in palmar fibrosis and an increase in digital extension in 13 patients (22 hands) affected to varying degrees by DD and who had not previously had surgery [ 55 ], it was hypothesized [ 18 ] that vitamin E downregulates fibroblast activity.…”

Section: Resultsmentioning

confidence: 99%

“…A study of 63 hands [ 36 ] with early DD defined as thickening of the palmar fascia only or digital flexion deformity of 30° or less at either the MCP or interphalangeal joints reported on the efficacy of systematic vitamin E. Oral doses of 100 mg of tocopherol acetate were administered twice daily for a minimum of 3 months. No rationale for treatment was described.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of non-surgical treatments for early Dupuytren’s disease

Ball

Izadi

Verjee

et al. 2016

BMC Musculoskelet Disord

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BackgroundDupuytren’s disease is a common fibrotic disorder of the palm characterized by the development of progressive flexion deformities in the digits, leading to significant functional impairment. Surgical excision remains the most common treatment. However, this is only indicated in patients with established contractures rather than those with early disease. Early disease is generally characterized by the presence of palmar nodules with limited or no contracture of the fingers. The ideal treatment would be directed at patients with early progressive disease to prevent future deterioration. Various non-surgical treatment modalities have been described but there is currently no systematic assessment of the role and efficacy of these treatments in patients with early disease.MethodsUsing a PICOS analysis we reviewed publications of studies of patients with early disease who had received physical therapies, pharmacological treatment, or radiotherapy. Following PRISMA guidelines titles and abstract were screened using predefined criteria to identify those reporting outcomes specifically relating to the treatment of early disease. In the absence of a definition of early disease studies were included if early DD was described clinically, with digital contractures not exceeding 30°, Tubiana grades N to 1, and which reported identifiable data. Studies were excluded if data for early DD patients could not be extracted for analysis.ResultsIn this systematic review, 26 studies were identified and analyzed to evaluate the effect of pharmacological therapy (n = 11), physical therapy (n = 5) and radiotherapy (n = 10) on early Dupuytren’s disease. The studies comprised 20 case series, 1 cohort study with the remainder reporting case studies. All publications were graded level of evidence 4 or 5 assessed using the Oxford Centre for Evidence Based Medicine grading. Narrative descriptions of the data are presented.ConclusionsPhysical therapies were the most robustly assessed, using objective measures but the studies were under powered, providing insufficient evidence of efficacy. Intralesional steroid injection and radiotherapy appeared to lead to softening of nodules and to retard disease progression but lacked rigorous evaluation and studies were poorly designed. There is an urgent need for adequately powered double blinded randomized trials for this common disorder which affects 4 % of the population.Trial registrationThe protocol was registered (CRD42015008986 16 November 2015) with the PROSPERO international prospective register of systematic reviews.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1200-y) contains supplementary material, which is available to authorized users.

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Recent Advances in Nutrition and Metabolism

Unglaub¹

1954

AMA Arch Intern Med

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A SMALL monograph entitled "Present Knowledge in Nutrition" has been published recently.1 This should prove a most useful reference ; sections dealing with calories, protein, fat, carbohydrate, minerals, and vitamins are included. VITAMIN A Cama and associates * reported further studies of the characteristics of vitamin A and related compounds. Kaiser and Kagan 6 have described a technique for the determination of vitamin A in feces.Prolonged administration of quinacrine (Atabrine) to rats was found to result in damage to the liver and impairment of the ability of this organ to store vitamin A. Absorption of vitamin A and carotene was depressed by the drug.7The administration of excessive amounts of vitamin A to rats and other animals accelerates the growth and maturation of epiphyseal cartilage cells and the remodeling process which accompanies bone growth. Such effects are suggestive of hormonal action, possibly that of the anterior pituitary. However, studies by Wolbach and Maddock 8 in hypophysectomized rats have shown that these effects occur in the absence of the pituitary and in spite of marked atrophy of the adrenal glands. Similar effects have been observed upon the addition of excessive amounts of vitamin A to the medium containing tissue culture of bone from chick embryos.9 The changes observed in tissue culture are qualitatively similar to those seen in animals made hypervitaminotic by feeding large amounts of vitamin A.f The use of tissue culture techniques appears to offer distinct advantages in the study of the effects of vitamin A upon tissues.14 An unusual case of vitamin A deficiency in a 5 J^-month-old infant was reported by Cornfeld and Cooke.15 Facial palsy and increased intracranial pressure observed in this patient might possibly be attributed to compression of tissues of the growing central nervous system by failure of normal growth of the axial skeleton, which has been observed in various mammalian species and, more recently, in the chicken and duck.| weeks. Definite beneficial effects of this therapy upon localized conjunctival thickening, blepharoconjunctivitis, and "toad skin" were observed. Follicular hyperkeratosis of the forearms persisted in five of eight patients, and improvement in dark adaptation was observed in only 4 of 17 subjects. Kaser and associates 1T reported that patients with a sprue-like syndrome showed no increase in serum vitamin A levels after oral administration of the vitamin given in either the ester or the alcohol form. Patients with chronic pancreatic disease showed no change in serum levels of the vitamin after administration of its ester form, but they were found to have an increase in serum vitamin A after administra¬ tion of the alcohol form.Steigmann and co-workers 18 confirmed the previously reported interference with absorption of vitamin A by mineral oil given close to mealtimes. However, the usual therapeutic dose (30 cc.) of the oil given at bedtime was without effect upon plasma vitamin A levels.Kagan and Kaiser 19 found high concentrations of v...

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Dupuytren's Contracture Treated with Vitamin E

Cited by 13 publications

References 1 publication

Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

Systematic review of non-surgical treatments for early Dupuytren’s disease

Recent Advances in Nutrition and Metabolism

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