Bacterial collagenases and their clinical applications.

Clostridium histolyticum cultures secrete a specific collagenase which can be precipitated from the medium in relatively large amounts. The enzyme is a metalloproteinase capable of cleaving native collagen types I, II, III, IV and V. In addition to being a valuable tool in the laboratory the bacterial collagenase has found clinical applications in the treatment of third degree burns and decubitus, diabetic or arterial ulcers. Several cases of successful topical use of the crude enzyme in an ointment base are illustrated. More recently direct injection of a highly purified form of the enzyme has been proposed in the treatment of herniated discs and keloids and as an adjunct in vitrectomy. Preliminary results of the two latter interventions are described.