Collagenase for Peyronie's disease experimental studies

Abstract

This pilot study was designed to test the feasibility of using purified clostridial collagenase in the clinical management of Peyronie's disease. The basic properties of this agent are discussed. We studied its effect on Peyronie's plaque tissue by a quantitative in vitro assay utilising the liberation of free alpha-amino groups as an index of enzymatic collagenolysis. Tissue from three patients with Peyronie's disease was used. Tunica albuginea from a second group of three normal patients was studied in the same manner, and no selectivity for the collagen of Peyronie's plaques was identified. Utilising human pericardium as a uniform collagenous substrate, a simple dose-effect relationship was established, and the distribution characteristics of injected collagenase observed. Its effects on blood vessels and nerves in vivo was determined as well as the effects of collagenase on the histology of normal and diseased human tissue in vitro. A tentative dose for use in Peyronie's disease was established, which is discussed in light of existing toxicological data. The study was designed to test the feasibility of purified collagenase in the clinical management of Peyronie's disease. Data included detail plaque digestion and dose-effect relationships in vitro, as well as the histological effects on plaques, blood vessels, and nerves in vivo and in vitro. It is concluded that collagenase may warrant further clinical testing in the treatment of Peyronie's disease.

Collagenase Clostridium Histolyticum: A Review in Peyronie’s Disease

“…This selectivity results in the reduction of PD plaques without damage to surrounding elastic tissue, vascular smooth muscle or axon myelin sheaths [13][14][15]. Early clinical studies indicated the potential for CCH to be used for the treatment of patients with PD [16][17][18][19], with one phase IIb study demonstrating the benefit of penile modelling in conjunction with intralesional CCH [19].…”

Treatment of Peyronie’s Disease: 2012 Update

“…The therapeutic potential of collagenase was initially introduced more than two decades ago in both in vitro and in vivo studies by Gelbard et al [34][35][36]. Although not placebo-controlled, a recent study employing two intralesional collagenase injections over three injection cycles significantly decreased plaque size and penile curvature in men with PD [37].…”

2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

“…Use of collagenase for PD was first described by Gelbard in 1982, in which collagenase was injected into PD plaques removed from patients and studied in vitro. 33 In 1985, Gelbard performed the first human trials. 34 Intralesional collagenase injection of clostridial collagenase has demonstrated true efficacy with a significant decrease in penile curvature, plaque size and an improvement in PD symptom bother scores in multiple trials.…”