Collagenase clostridium histolyticum

Collagenase
clostridium histolyticum

Clinical data
Pregnancy cat.	B(US)
Legal status	℞ Prescription only
Routes	Intralesional injection
Identifiers
CAS number	9001-12-1 Y
ATC code	M09AB02
PubChem	SID138909
DrugBank	DB00048
Synonyms	AA4500
Chemical data
Formula	?
Mol. mass	114 kDa (AUX-I), 113 kDa (AUX-II)
N(what is this?)  clostridium histolyticum (verify)

Collagenase clostridium histolyticum is an enzyme produced by the bacterium Clostridium histolyticum that dismantles collagen. It is used as a powder-and-solvent injection kit for the treatment for Dupuytren's contracture, a condition where the fingers bend towards the palm and cannot be fully straightened. BioSpecifics Technologies developed the preparation, which is manufactured and marketed by Auxilium Pharmaceuticals and Pfizer as Xiaflex in the US and Xiapex in Europe.

Uses

In February 2010, the Food and Drug Administration of the United States approved Xiaflex for the treatment of Dupuytren's contracture.^[1][2] It is the first approved nonsurgical treatment for this condition.^[3] In a case of Dupuytren's contracture, collagen accumulates in the tendon sheathes of the hands, so that the fingers cannot be straightened. A similar phenomenon occurs in Peyronie's disease, a contracture of the penis.

Collagenase clostridium histolyticum injection for Dupuytren's contracture. Before, next day, and two weeks after first treatment

In February 2011, the European Commission's Committee for Medicinal Products for Human Use approved the product for the treatment of Dupuytren's contracture in adults with a palpable cord by 'properly trained' doctors.^[4] Pfizer was reported to be working with Europe's national medicines regulatory bodies to launch the new treatment, hoping doctors could prescribe the treatment by late 2011.^[5]

Side effects

The most common side effects include lymphadenopathy (swollen lymph nodes), itching, pain, oedema, and bleeding (for example in the form of bruises or ecchymoses). Allergic reactions are seen in less than 1% of patients.^[6]

Chemical properties

The substance is a constant mixture of two collagenases (AUX-I and AUX-II) with known amino acid sequences and a length of about 1000 amino acids each. It is prepared by anaerobic fermentation from a strain of C. histolyticum that has been known since 1950.^[7]

Pharmacology

The enzymes do not reach the bloodstream in significant amounts and are presumed to largely stay at the point of injection^[6] until they are broken down by proteases.

The two collagenases act synergistically by cleaving tropocollagen (the 'collagen molecule') at different points. AUX-I attacks the C- and N-termini, AUX-II cleaves amino acid bonds within the molecule. Small collagen fragments are broken down by both enzymes.^[7]

Interactions

No interaction studies have been conducted because the drug does not reach the bloodstream and the liver. It is theorised that drugs interfering with matrix metalloproteinases, such as tetracyclines, anthracyclines, quinolones and anthraquinone derivatives, could reduce the efficacy of the collagenases, but no clinical evidence for such an interaction has been observed.^[6]

References

1. ^ "FDA Approves Xiaflex for Debilitating Hand Condition". Food and Drug Administration. February 2, 2010. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199736.htm. Retrieved March 16, 2010. 
2. ^ Pollack, Andrew (March 15, 2010). "Triumph for Drug to Straighten Clenched Fingers". The New York Times. http://www.nytimes.com/2010/03/16/business/16hand.html. Retrieved March 16, 2010. 
3. ^ Pollack, Andrew (March 15, 2010). "Bringing Movement Back to Clenched Hands". The New York Times. http://www.nytimes.com/2010/03/16/business/16handbar.html. Retrieved March 16, 2010. 
4. ^ Xiapex: collagenase clostridium histolyticum, European Medicines Agency, Undated.Accessed: 20 March 2011.
5. ^ Xiapex (Collagenase Clostridium Histolyticum) Authorised In The European Union For Dupuytren's Contracture, Medical News Today, Bexhill-on-Sea, East Sussex, 3 March 2011.Accessed: 19 March 2011.
6. ^ ^{a b c} Haberfeld, H, ed (2009) (in German). Austria-Codex (2009/2010 ed.). Vienna: Österreichischer Apothekerverlag. ISBN 3-85200-196-X. 
7. ^ ^{a b} A. Klement (9 May 2011). "Dupuytren'sche Kontraktur erstmals medikamentös behandelbar: Xiapex" (in German). Österreichische Apothekerzeitung (10/2011): 8. 

External links

• Xiaflex.com