Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease).
Dupuytren's disease is a connective tissue disorder of the hand causing excessive palmar fascial fibrosis with associated finger contracture and disability. The aetiology of the disease is heterogeneous, with both genetic and environmental components. The connective tissue is abnormally infiltrated by myofibroblasts that deposit collagen and other extracellular matrix proteins. We describe the clinical profile of Dupuytren's disease along with current therapeutic schemes. Recent findings on molecular and cellular parameters that are dysregulated in Dupuytren's disease, which may contribute to the onset of the disease, and the role of resident inflammation promoting fibrosis, are highlighted. We review recent literature focusing on non-myofibroblast cell types (stem cell-like cells), their pro-inflammatory and pro-fibrotic role that may account for abnormal wound healing response.
Department of Urology, Leiden University Medical Center, Albinusdreef 2, Leiden, ZA 2333 The Netherlands ; Urology Research Laboratory, Department of Urology and Department of Clinical Research, University of Bern, Murtenstrasse 35, Bern, 3008 Switzerland.
S
S
Karkampouna
Department of Plastic Surgery, Rode Kruis Ziekenhuis, Vondellaan 13, Beverwijk, 1942 LE The Netherlands.
M
M
Kreulen
Department of Plastic Reconstructive and Hand Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam, 1100 DD The Netherlands.
M C
MC
Obdeijn
Department of Orthopedic Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam, 1100 DD The Netherlands.
P
P
Kloen
Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands.
A L
AL
Dorjée
Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands ; Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
F
F
Rivellese
Institute of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK.
A
A
Chojnowski
Biomedical Research Centre, School of Biological Sciences, University of East Anglia, Norwich, UK.
I
I
Clark
Department of Urology, Leiden University Medical Center, Albinusdreef 2, Leiden, ZA 2333 The Netherlands ; Urology Research Laboratory, Department of Urology and Department of Clinical Research, University of Bern, Murtenstrasse 35, Bern, 3008 Switzerland.
Marianna
M
Kruithof-de Julio
Contracture; Dupuytren’s; Fibrosis; Inflammation; Regeneration