Transglutaminase levels in Dupuytren's disease By use of immunoperoxidase staining, tissue transglutaminase and aminopropeptide of collagen type III were localized to fibroblasts running within cords of Dupuytren's fascia. Quantitative analysis of transglutaminase revealed that activity levels were significantly higher in acutely contracting fascia than in chronic contractures. The results show that contractures in Dupuytren's fascia may be reflected by the level of transglutaminase activity in the tissue. Furthermore, it is suggested that isopeptide bond formation, involving collagen type III aminopropeptide moieties, may be the biochemical mechanism by which transglutaminase maintains the contracted state. (J HAND SURG 1991j16A:787·90.) Kenneth N. Dolynchuk, MD, PhD, fRCSC, and Norman M. Pettigrew, MbCH, FRC Path, FRCSE, Winnipeg, Manitoba Dupuytren'S disease, or contracture of the palmar fascia, has been controversial in terms of its pathogenesis and its treatment. 1-4 Brickley-Parsons et al." have shown that the collagen matrix consists of a considerable amount of collagen type III. They sug- gested that the collagen matrix is stabilized in its con- tracted state by rapid collagen remodeling after con- traction is brought about by conractile fibroblasts. It has been recently reported that tissue transglutaminase, which is abundant in contractile tissues, may cross-link extracellular wound matrix molecules such as procol- lagen type III aminopropeptide.v'" These findings lead to the question as to whether this cross-link mechanism may be maintaining the contracted state of fiber archi- tecture in Dupuytren's fascia. This work studied the localization and quantitation of transglutaminase in palmar fascia from patients with Dupuytren's disease. We found it necessary to quan- From the Departments of Surgery, Biochemistry and Molecular Bi- ology, and Pathology, Faculty of Medicine, University of Mani- toba, Winnipeg, Manitoba. Supported by the H. E. Seller's Foundation and the Department of Surgery, University of Manitoba. Received for publication June 18, 1990; accepted in revised form Nov. 2, 1990. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Kenneth N. Dolynchuk, MD, PhD, Faculty of Med- icine, Department of Biochemistry and Molecular Biology, The University of Manitoba, 770 Bannatyne Ave., Winnipeg, Manitoba R3E OW3. 3/1127067 titate the level of enzyme activity and compare it with the stage of disease, because this may relate to the degree of clinical contracture. Materials and methods Two groups of patients were studied. In the first group, 10 palmar fasciectomy specimens were taken from 7 patients with symptomatic Dupuytren's disease. These tissues contained nodular and fibrous cord struc- tures. They were stored at - 20° C until thawed and dissected carefully to study the nodules and fibrous cords separately for transglutaminase activity. In the second group, 35 specimens were harvested from 32 patients who had elective palmar fasciectomy. These tissues were stage frozen to - 70° C and stored at this temperature until thawed and carefully dissected for cord tissue, which was then analyzed both biochemi- cally and immunohistologically. Active contracture and duration of disease were noted for each operative spec- imen so that comparison of enzyme activity could be made with duration of disease and severity of contrac- ture. It was the practice of local surgeons to treat re- currence of disease only after at least 1 year had passed. It was arbitrarily decided to include recurrences with those contractures of 1 or more years' duration, while acute contractures were those of less than 1 year from onset. Biochemical analysis was carried out after thawing. Approximately 20 mg of nodular or fibrous cord tissue was weighed accurately in tared 4 ml polycarbonate tubes and homogenized in buffer containing 0.5 ml of 0.1 m tris-HCl (hydrochloric acid), pH 8.3, with 0.5% triton x-ioo and 1.0 mm dithiothreitol (DIT). The tissues were homogenized twice for 30 seconds with a THE JOURNAL OF HAND SURGERY 787