Desai Sethi Urology Institute, University of Miami, 1150 NW 14th St, Miami, FL, 33136, USA.
Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
Int J Impot Res. 2024 Sep;36(6):572-575. doi: 10.1038/s41443-023-00742-0. Epub 2023 Jul 31.
Peyronie's disease (PD) is defined by penile plaque formation and curvature causing sexual dysfunction. The only FDA-approved intralesional treatment is Collagenase Clostridium histolyticum (CCh). CCh contains two collagenases, AUX1 and AUXII, that break down the type I and type III collagen contained in plaques, leading to plaque dissolution and reduction in penile curvature. Peyronie's plaques, however, also contain fibrin and calcium, which CCh cannot digest. It is unclear if plaque calcification prevents CCh from breaking down plaques. We collected ten tissue samples: five calcified penile plaques and five control samples of corpus cavernosum. They were incubated in CCh or PBS. Soluble collagen measurements and collagen staining assays were completed to measure tissue breakdown. Calcified plaques incubated in CCh showed significantly higher levels of soluble collagen (301.07 ug ± 21.28 vs. PBS: 32.82 ug ± 3.68, p = 0.02), and significantly lower levels of collagen (type I and III) compared to tissues incubated in PBS (0.12 ± 0.08, vs. 0.44 ± 0.17, p = 0.002). When comparing different tissues (calcified vs. control) incubated in CCh and PBS solutions, there were no significant differences in collagen staining or breakdown. Although higher collagen staining was seen in the calcified group, soluble collagen showed no significant differences between control and calcified tissues in the CCh group (control: 0.08 ± 0.02 vs. calcified: 0.17 ± 0.09, p = 0.08) or the PBS group (control: 0.50 ± 0.23 vs. calcified: 0.39 ± 0.39, p = 0.23). CCh exposure led to significantly more tissue breakdown in both tissue groups when compared to PBS however, there was no significant difference in plaque digestion found between calcified and control tissue exposed to CCh or PBS. This suggests that plaque calcification does not affect the action of CCh. Further research into CCh for calcified plaques is necessary to inform clinicians as to the optimal management of this population.
佩罗尼氏病（PD）的定义是阴茎斑块形成和弯曲导致性功能障碍。唯一获得 FDA 批准的病灶内治疗方法是胶原酶溶组织梭菌（CCh）。CCh 包含两种胶原酶，AUX1 和 AUXII，可分解斑块中包含的 I 型和 III 型胶原，导致斑块溶解和阴茎弯曲减少。然而，佩罗尼氏斑块还含有纤维蛋白和钙，CCh 无法消化。目前尚不清楚斑块钙化是否会阻止 CCh 分解斑块。我们收集了 10 个组织样本：5 个钙化的阴茎斑块和 5 个对照的海绵体组织样本。它们在 CCh 或 PBS 中孵育。完成可溶性胶原测量和胶原染色测定以测量组织分解。在 CCh 中孵育的钙化斑块显示出明显更高水平的可溶性胶原（301.07μg±21.28 与 PBS：32.82μg±3.68，p=0.02），并且与在 PBS 中孵育的组织相比，胶原（I 型和 III 型）水平明显降低（0.12±0.08 与 0.44±0.17，p=0.002）。当比较在 CCh 和 PBS 溶液中孵育的不同组织（钙化与对照）时，在 CCh 和 PBS 溶液中孵育的钙化组织与对照组织之间的胶原染色或分解没有显著差异。尽管在钙化组中观察到更高的胶原染色，但在 CCh 组中，钙化组织与对照组织之间的可溶性胶原没有显著差异（对照：0.08±0.02 与钙化：0.17±0.09，p=0.08）或 PBS 组（对照：0.50±0.23 与钙化：0.39±0.39，p=0.23）。与 PBS 相比，CCh 暴露导致两组组织的组织分解明显更多，但在 CCh 或 PBS 暴露的钙化和对照组织之间，斑块消化没有发现显著差异。这表明斑块钙化不会影响 CCh 的作用。需要进一步研究 CCh 治疗钙化斑块，以便为临床医生提供有关该人群最佳治疗方法的信息。
