A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic Bromelain-based release

Objectives: 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. Materials and 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.