title: A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release.
abstract: OBJECTIVE
  Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren's cords.
  
  
  METHODS
  Specially prepared medical grade IBS was injected into fresh Dupuytren's cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system.
  
  
  RESULTS
  We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases.
  
  
  CONCLUSIONS
  These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren's contracture.Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016;5:175-177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.
authors.affiliation: Orthopaedic Department, Central Emek Hospital, Afula, Israel guytalr@bezeqint.net.
authors.forename: G
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Orthopaedic Department, Central Emek Hospital, Afula, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Rinott
authors.affiliation: Orthopaedic Department, Central Emek Hospital, Afula, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Wolovelsky
authors.affiliation: Orthopaedic Department, Central Emek Hospital, Afula, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Rosenberg
authors.affiliation: Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Shoham
authors.affiliation: Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Rozen
keywords: Bromelain; Collagenase; Dupuytren’s contracture; Enzyme; Fasciotomy