The role of collagenase ointment in acute burns: a systematic review and meta-analysis

Pham, Christopher H; Collier, Zachary J; Fang, Mike; Howell, Anna C.; Gillenwater, T Justin

doi:10.12968/jowc.2019.28.sup2.s9

Cited by 21 publications

(8 citation statements)

References 23 publications

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“…As we collate these results, we have begun the process of elucidating the positive outcomes from previous clinical publications. Treatment with collagenase resulted in reduced time to complete debridement and trajectory for healing potential [25,[58][59][60]. In tandem, collagenase treatment allowed for earlier cellular influx throughout the interstitial space and vascular perfusion.…”

Section: Discussionmentioning

confidence: 99%

Clostridium Collagenase Impact on Zone of Stasis Stabilization and Transition to Healthy Tissue in Burns

Frederick

Bearden

Jovanovic

et al. 2021

IJMS

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Clostridium collagenase has provided superior clinical results in achieving digestion of immediate and accumulating devitalized collagen tissue. Recent studies suggest that debridement via Clostridium collagenase modulates a cellular response to foster an anti-inflammatory microenvironment milieu, allowing for a more coordinated healing response. In an effort to better understand its role in burn wounds, we evaluated Clostridium collagenase’s ability to effectively minimize burn progression using the classic burn comb model in pigs. Following burn injury, wounds were treated with Clostridium collagenase or control vehicle daily and biopsied at various time points. Biopsies were evaluated for factors associated with progressing necrosis as well as inflammatory response associated with treatment. Data presented herein showed that Clostridium collagenase treatment prevented destruction of dermal collagen. Additionally, treatment with collagenase reduced necrosis (HMGB1) and apoptosis (CC3a) early in burn injuries, allowing for increased infiltration of cells and protecting tissue from conversion. Furthermore, early epidermal separation and epidermal loss with a clearly defined basement membrane was observed in the treated wounds. We also show that collagenase treatment provided an early and improved inflammatory response followed by faster resolution in neutrophils. In assessing the inflammatory response, collagenase-treated wounds exhibited significantly greater neutrophil influx at day 1, with macrophage recruitment throughout days 2 and 4. In further evaluation, macrophage polarization to MHC II and vascular network maintenance were significantly increased in collagenase-treated wounds, indicative of a pro-resolving macrophage environment. Taken together, these data validate the impact of clostridial collagenases in the pathophysiology of burn wounds and that they complement patient outcomes in the clinical scenario.

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Section: Discussionmentioning

confidence: 99%

Clostridium Collagenase Impact on Zone of Stasis Stabilization and Transition to Healthy Tissue in Burns

Frederick

Bearden

Jovanovic

et al. 2021

IJMS

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“…During burn healing, native and denatured collagen in necrotic tissue need to be removed. In this framework, using collagenases, in particular CCH, can help to heal the wound and to minimize pain without increasing the risk of infection [63,64] (Table 1).…”

Section: Extracellular Matrix Disordersmentioning

confidence: 99%

Enzyme Therapy: Current Challenges and Future Perspectives

Fuente

Lombardero²,

Gómez-González

et al. 2021

IJMS

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In recent years, enzymes have risen as promising therapeutic tools for different pathologies, from metabolic deficiencies, such as fibrosis conditions, ocular pathologies or joint problems, to cancer or cardiovascular diseases. Treatments based on the catalytic activity of enzymes are able to convert a wide range of target molecules to restore the correct physiological metabolism. These treatments present several advantages compared to established therapeutic approaches thanks to their affinity and specificity properties. However, enzymes present some challenges, such as short in vivo half-life, lack of targeted action and, in particular, patient immune system reaction against the enzyme. For this reason, it is important to monitor serum immune response during treatment. This can be achieved by conventional techniques (ELISA) but also by new promising tools such as microarrays. These assays have gained popularity due to their high-throughput analysis capacity, their simplicity, and their potential to monitor the immune response of patients during enzyme therapies. In this growing field, research is still ongoing to solve current health problems such as COVID-19. Currently, promising therapeutic alternatives using the angiotensin-converting enzyme 2 (ACE2) are being studied to treat COVID-19.

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“…The only such product with Food and Drug Administration approval in the USA is clostridial collagenase ointment (CCO) (Santyl). There is evidence for CCOs’ positive effect on burn wounds [ 12 ]. The findings suggest that CCO can be used to debride burn wounds with less pain and nursing labor than traditional therapy with other silver-impregnated products.…”

Section: Different Sources Of Enzymesmentioning

confidence: 99%

Historical Perspectives on the Development of Current Standards of Care for Enzymatic Debridement

2020

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Background and Objective: The use of plant-based products for burn treatment dates back to 1600 BC. Enzymatic debridement, which can be achieved as non-surgical or conservative debridement, has recently gained increasing attention. Several reviews have been published thus far. However, there has been no historical article including the achievements of the last 20 years, and this is the first review to present the achievements made in the field of enzymatic debridement in the last 20 years. This study aimed to present a historical overview of the development of enzymatic debridement until the present day. Methods: Enzymes from bacteria and plants were initially used for full-thickness burn treatment; however, they did not gain attention. Papain-derived products were the first plant-based products used for enzymatic debridement. Sutilains gained broad use in the 70s and 80s but came off market in the 1990s. Bromelain has been used for burn treatment owing to its strong debriding properties. NexoBrid™ is used as a minimally invasive approach for enzymatic debridement of deep dermal burns. However, its use has been limited due to commercially available bromelain and the presence of four distinct cysteine proteinases. NexoBrid™ involves faster eschar removal together with reduced blood loss, leading to improved long-term outcomes. However, research on nonoperative enzymatic debridement of burns has taken decades and is still ongoing. Results: Overall, the results of our study indicate that necrectomy, which has been used for a long time, remains the standard of care for burns. However, enzymatic debridement has several advantages, such as faster eschar removal, reduced blood loss, and reduced need for skin grafting, especially in cases of facial and hand burns. Enzymatic debridement cannot replace surgical intervention, as the enzyme only works on the surface of the eschar. Enzymatic debridement is not recommended in the early phase of scald burns. Conclusions: Enzymatic debridement has become an integral part of burn therapy and the standard of care in specific burn centers.

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The role of collagenase ointment in acute burns: a systematic review and meta-analysis

Cited by 21 publications

References 23 publications

Clostridium Collagenase Impact on Zone of Stasis Stabilization and Transition to Healthy Tissue in Burns

Clostridium Collagenase Impact on Zone of Stasis Stabilization and Transition to Healthy Tissue in Burns

Enzyme Therapy: Current Challenges and Future Perspectives

Historical Perspectives on the Development of Current Standards of Care for Enzymatic Debridement

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