Finger Clubbing Mystery Solved, Hippocrates Nods Head in Approval

What do Hippocrates and the scientists of University of Leeds have in common? They were all equally mystified by the riddle of the seemingly unexplainable “finger clubbing” condition.

Now, where do Hippocrates and the scientists of University of Leeds differ? More than 2,000 years ago, Hippocrates died wondering what the cause of finger clubbing was; the scientists of Leeds University were able to solve the mystery.


Image: University of MiamiImage: University of Miami

Finger clubbing or digital clubbing is a condition wherein the tips of one’s fingers are abnormally swollen and somewhat spongy. While it might look funny and could be perfect when playing finger puppets, digital clubbing is a serious problem, not in and of itself, but of what it indicates. You see folks, when your fingers look like something similar to what you see on the images in this article, it means you might have a more serious condition like a gastrointestinal disease, hyperthyroidism, and in the worst case scenario, heart disease and lung cancer. Since the condition could be an indicative of a serious illness, don’t be surprised if a doctor stares at your fingers while shaking your hands—chances are the doctor isn’t checking out if you’ve had manicure lately.

So, what exactly did the Leeds scientists find out that Hippocrates wasn’t able to? First off, I think you should know that there are benign cases of clubbing wherein which the tips of one’s fingers just blow up without the link to a serious illness. Since it’s impossible to figure out the condition based on that, the scientists had to work on the not-so-benign cases of digital clubbing. What they found out was that in said cases, the patients demonstrated high levels of PGE2 or prostaglandin E2.

Prostaglandin E2 (PGE2) is a fatty compound our body produces when it suffers from internal inflammation, say from lung cancer or vascular diseases . Now, when our friend, the PGE2, has done its job, an enzyme called 15-HPGD produced in the lungs breaks these fatty molecules down. In the end, there should be no harm done and everything should be A-OK. At least in an idyllic world it should be.

In the patients examined by the scientists, it seems a genetic mutation has occurred which prevents the production of the enzyme 15-HPGD. So, no 15-HPGD, no PGE2 breakdown. In cases of lung cancer, tumors cause the overproduction of PGE2. In cases of congenital heart disease, on the other hand, the blood containing PGE2 bypasses the lung areas where the PGE2 is supposed to be broken down by the 15-HPGD enzyme. Hence, overproduction of PGE2 combined with the lack of method to break it down results to, you guessed it, finger clubbing. Hippocrates would weep in happiness!

But what is the significance of this finding exactly? For one, urine tests (for people with digital clubbing) which points to the abundance of PGE2 in one’s bloodstream could indicate a more serious illness that one might not suspect of having otherwise. Additionally, now that scientists know what’s behind finger clubbing, solutions could be suggested. In fact, even now, it seems one effective way to alleviate the pain that comes with digital clubbing is to take aspirin which is used to prevent PGE2 production. It’s a great finding, but I’m afraid Professor Bonthron from Leeds is a little too hard on himself, even saying, “Actually, when you look back, it's rather obvious. When we found this gene, everything else fell neatly into place – it was like a smack on the forehead.” Come on, doc, give yourself a pat on the back—Hippocrates would approve!

Source: University of Leeds, Chest Journal, Medterms