Therapies that we are considering as research or experimental

N-Acetyl-L-Cysteine (NAC, also marketed under other brand names)

NAC has been in use for decades for treating immune and respiratory deficiencies. To our knowledge it is available in the U.S. as nutritional supplement. Research indicates that NAC might also slow down or stop growth of Dupuytren tissue: Juergen Kopp et al. "N-Acetyl-L-Cysteine abrogates fibrogenic properties of fibroblasts isolated from Dupuytren's disease by blunting TGF-β signalling" J. Cell. Mol. Med. 10 (2006) pp. 157-165. Abstract and full article: NAC_link.

Above study is a laboratory study on Dupuytren cells, not a clinical study on patients. Yet this study indicates the possibility of NAC "providing a basis for a therapeutic strategy in Dupuytren's disease and other fibroproliferative disorders." Since publication of this study NAC has also been tested on patients (orally applied, typically 600 mg/day; private communication, not published). While the total number of patients is still too low for reliable statistics, first results seem promising, e.g. to avoid extension of Dupuytren to other areas after surgery or, in one case, a significant reduction of Ledderhose nodules.

Should this turn out a successful therapy it might eventually support other therapies. Effectiveness and long term effects need still to be researched and we would caution taking high dose antioxidants like NAC over a long period of time, like years (see e.g. JAMA_antioxidants ).

As no clinical data have been published yet (and probably won't be published because Juergen Kopp has moved on to another clinic and assignment) Dupuytren Society as an inital assessment collected data from patients who have taken or are taking NAC. For results see NAC data collection by Dupuytren Society.

For more details on NAC, including brand names, see wiki_NAC.

Combination of NAC with ACE inhibitors

It has been proposed to combine NAC and ACE inhibtors to reduce recurrence after surgery of Dupuytren's contracture: K. Knobloch et al. "Antifibrotic medication using a combination of N-acetyl-L-cystein (NAC) and ACE inhibitors can prevent the recurrence of Dupuytren’s disease" Medical Hypotheses 73 (2009) p 659–661 abstract . To our knowledge this is only a propsal, we are not aware of any clinical results (status Sept 2010).

 

Laser therapy

Laser therapy is occasionally applied to Ledderhose (we are not aware of its application to Dupuytren). Doubts have been raised regarding the effectiveness of laser therapy but we know of Ledderhose patients that were satisfied and the nodules were successfully reduced in size. The outcome might, besides others, depend on the type of laser and is probably best for small nodules, i.e. in the initial stage of the disease. As no generally accepted statistics have been published so far, we consider this therapy for Ledderhose as still experimental.

  
 

Antiestrogen (Tamoxifen)

So far research seems to be restricted mostly to laboratory conditions, and Tamoxifen cannot be viewed as a proven therapy. "Tamoxifen, by neutralizing or downregulating TGF_2, may prove to be a method to manipulate and control Dupuytren’s contracture in the clinical setting. Eventually, through further clinical investigation, it may be possible to halt or even reverse this progressive and debilitating disease." Cited from M. A. Kuhn, X. Wang,  W. G. Payne, F. Ko, and M. C. Robson, Tamoxifen Decreases Fibroblast Function and Downregulates TGF_2 in Dupuytren’s Affected Palmar Fascia, Journal of Surgical Research 103 (2002) p 146–152. - In the mean time the relevance of TGF_2 has been questioned: R. Tse, J. Howard, Y. Wu, and B.S. Gan "Enhanced Dupuytren’s disease fibroblast populated collagen lattice contraction is independent of endogenous active TGF-β2". BMC Musculoskelet Disord 5 (2004) p 41-48 full_article.

In high-risk, aggressive cases Tamoxifen has been tried in combination with segmental surgery and results. A randomized trial showed improved results of the surgical outcome when Tamoxifen was applied as adjuvant oral therapy Degreef_Miami2010.

 

5-Fluorouracil

Lab experiments showed that 5-fluorouracil caused a dose-dependent, selective, and specific decrease in collagen production by Dupuytren's fibroblasts. "The clinical implication is that 5-fluorouracil could possibly reduce extracellular matrix production and therefore reduce recurrence of Dupuytren's disease of the hand." NW Bulstrode et al. "5-Fluorouracil Selectively Inhibits Collagen Synthesis" Plastic & Reconstructive Surgery 116 (2005) p 209-221 abstract. - Yet a small clinical trial with 15 patients did not exhibit specific advantages of topical treatment with 5-fluorouracil: NW Bullstrode at al. "A prospective randomised clinical trial of the intra-operative use of 5-fluorouracil on the outcome of Dupuytren’s disease" J Hand Surg [Br] 29 (2004) p 18-21 abstract. - See also Sandra Kraljevic Pavelic et al. "Screening of potential prodrugs on cells derived from Dupuytren's disease patients" Biomedicine and Pharmacotherapy (in press) abstract.

 

Mechanical treatment / massaging

Two patients independently reported that intense massaging of their cords and nodules with a ball (wooden or plastic) over months eventually seemed to remove the Dupuytren tissue. In one case this observation was confirmed by a doctor. We don't know how that worked and whether it would work for other patients. This is far from being a therapy but we consider it worth mentioning.

 

Diet

Various diets have been proposed to reduce or stop tumor growth. Most famous are possibly those based on the Warburg hypothesis. Otto Heinrich Warburg, Nobel laureate in medicine in 1931, observed that cancer cells get their energy mainly from glucose rather than by absorbing molecular oxygen from the blood, which is what normal cells do. He suggested that this faulty respiration causes cells to become cancerous (Warburg biography and wiki_article). Later research built on his thesis (Warburg revisited, Science_article) and very recently results from University of Jena, Germany, confirmed his theory (Jena_article_in_German).

Also proposed are low or zero carbohydrate diets (e.g. Wolfgang Lutz' "Living without Bread"). Recently a phase 1 study on the effect of a low carb diet on cancer had been started at a German hospital at Wuerzburg but is now on hold due to low funding (Time article on low carb study). 

Some patients report successful reduction of Dupuytren nodules after 6 months of vegetarian, no alcohol, no coffee diet. - John reports on Gort's Health Forum complete remission after going onto a diet of whole plant foods. - A female patient in our German forum tried a diet strictly avoiding progesterone to reduce the growth of breast cancer and observed a positive effect on Dupuytren nodules and cords. The diet she had used was a vegetarian one, additionally avoiding milk products (vegan diet).

Other diets e. g. suggest a high intake of antioxidants, e.g. a patient reported that his Dupuytren nodules significantly decreased when he eat excessive amounts of tomatoes during the harvest period. The effect might be due to the high lycopene (antioxidant) content of tomatoes. Similarly, taking NAC seems to reduce growth rates and soften cords.

So far reports of successful diets provide only anecdotal evidence, no sound statistics and no comparison to control groups. We therefore consider diets as experimental and remind patients that diets may have severe side effects.

 

Page last modified: 09/02/2010