Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.22.25 (chymopapain)
 430 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chymopapain chemonucleolysis is now used extensively in this country to treat lumbar disk herniation. Despite increasing experience in patient selection, there continue to be patients who do not respond to treatment and require diagnostic reevaluation. Interpretation of postchemonucleolysis computed tomographic (CT) scans in these patients requires a knowledge of the CT changes that normally occur after treatment with chemonucleolysis. To define these temporal changes, a prospective CT evaluation was performed of 29 treated interspaces in 26 patients who returned for routine postchemonucleolysis follow-up. Despite a successful clinical response in 17 of 21 patients, changes in the size, location, shape, homogeneity, and density of the disk herniation were uncommon at the 6 week follow-up. In 24 treated interspaces, the most common changes at 6 week CT follow-up were the development of vacuum phenomenon in three (12.5%) and a slight decrease in the size of two (8.3%) disk herniations. A successful response was noted in 17 of 21 patients scanned at 6 month follow-up, with five (22.7%) of 22 injected interspaces exhibiting vacuum phenomenon and 13 (59.1%) interspaces showing an observable decrease in the size of the disk herniation. Early improvement of sciatica after chemonucleolysis often occurs without a change in the size of the disk herniation and may be mediated by chymopapain-induced disk-space narrowing. Continued improvement may be accompanied by both a decrease in the disk height and a reduction in the size of the disk protrusion.
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PMID:Chymopapain chemonucleolysis: CT changes after treatment. 389 61

Chemonucleolysis with chymopapain (Chymodiactin, Discase) bears the risk of unpredictable anaphylactic reactions. The rate of anaphylaxis is reported to be between 0.35% and 1.5%. Serological in vitro tests such as RAST (radio-allergo-sorbent test) or ChymoFAST (fluorescent allergo-sorbent test) are used to determine increased specific immunoglobulin E antibody titers against chymopapain in patients submitted to chemonucleolysis. Alternatively, skin prick tests have also been applied in clinical trials. A skin prick test including Discase, Chymodiactin, and Solutrast 250 M, which is a radiopaque dye, has been performed in a total of 257 patients; 222 patients were tested before, and 35 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3%-3.3% had positive skin tests. After chemonucleolysis, the overall allergy rate to chymopapain increased to 42.9%. Positive skin reactions seem to be time-dependent--between the 3rd and 12th weeks after chemonucleolysis, more than 70% of the patients had positive skin tests. There was no correlation between a history of previous allergy and the skin test result. Patients with positive skin tests should be excluded from chemonucleolysis. This procedure increases the safety for patients submitted to chemonucleolysis. No anaphylactic reaction has been observed hitherto in more than 350 patients who were treated with the intradiskal injection of chymopapain after a negative skin prick test.
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PMID:Skin testing for chymopapain allergy in chemonucleolysis. 394 10

Chymopapain injected into the intervertebral disc space (chemonucleolysis) has been used clinically in patients with disc disease with success. Neurosurgical complications secondary to the procedure have, however, been reported. In this study, the authors have investigated the possible neurotoxic effect of chymopapain on the peripheral nerve in rat and primate models. While the extrafascicular injection caused no nerve fiber damage, the intrafascicular injection caused dose-related nerve fiber damage in both species.
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PMID:Peripheral nerve injury by chymopapain injection. 632 41

A double-blind, randomized trial was conducted to compare the efficacy of intradiskal injection of chymopapain (Chymodiactin) with injection of placebo in patients with a herniated lumbar disk. Patients were randomly assigned to either placebo or drug regimens and followed up for six months. The primary measure of performance was agreement by patient and surgeon that further intervention was not necessary. At any time that patient and investigator agreed that treatment had failed, the patient was classified as a failure and the treatment code was broken. Of 53 placebo-treated patients, 31 failed by this criterion. Of 55 drug-treated patients, 15 failed. Placebo-treated patients who failed were allowed to receive drug treatment, and 29 (91%) of 32 were treated successfully. This study demonstrates that chymopapain is more effective than placebo for treatment of patients with a herniated lumbar disk.
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PMID:Safety and efficacy of chymopapain (Chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomized, double-blind study. 634 32

Chemonucleolysis is a promising alternative to open surgical treatment of a herniated lumbar disc. The technique involves injecting chymopapain into the disc under fluoroscopic control. Chymopapain is specific for chondromucoprotein in cartilage. The results of chemonucleolysis in 100 patients are reported; the procedure was successful in 83 percent. This closed procedure has a success rate comparable to that of surgery, but has a lower morbidity, is less costly and is more acceptable to patients.
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PMID:Chemonucleolysis of herniated lumbar discs. 634 48

Chymopapain has been approved for intradiscal injection in the United States and is expected to be used in approximately 100,000 patients per year. The need to identify the population at risk for anaphylaxis is obvious. Both in vivo and in vitro methods are available for measurement of IgE against chymopapain. This is a report of two cases of chymopapain allergy. One case discusses a 25-year-old woman who had rhinitis, asthma, and urticaria associated with occupational health hazards who was rejected for chemonucleolysis. The other case describes a 59-year-old man who had a predictably severe anaphylactic reaction to chymopapain and responded to treatment with epinephrine. Both patients had IgE antibody against chymopapain.
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PMID:Chymopapain allergy: case reports and identification of patients at risk for chymopapain anaphylaxis. 638 Aug 59

Postmarketing surveillance data on 29,075 patients who received Chymodiactin (Smith Laboratories' formulation of chymopapain) intradiscal injections for a herniated lumbar intervertebral disc are summarized and tabulated. The serious adverse reactions reported include death, anaphylaxis, paraplegia, and discitis. Similar problems also have been reported for Discase (Baxter-Travenol's formulation of chymopapain). Of 11 deaths reported following Chymodiactin administration, only 3 appear to be related to the drug or procedure. Two of these three were due to anaphylaxis and the third to bacterial discitis with resultant meningitis. Paraplegia appeared to be primarily due to needle trauma or injection of contrast agent and enzyme into the subarachnoid space. Careful patient selection and needle placement are essential for avoiding serious problems.
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PMID:Chymodiactin postmarketing surveillance. Demographic and adverse experience data in 29,075 patients. 638 53

This study describes the changes in chymopapain-specific IgE antibody levels in patients following chemonucleolysis with Chymodiactin. Using the ChymoFAST method, chymopapain-specific IgE values were studied in 91 patients prior to and for 2 months post-Chymodiactin chemonucleolysis. A total of 8.8% (17/91) developed IgE levels greater than or equal to 0.06 IU/ml. Those patients with detectable IgE levels prior to chemonucleolysis were more likely than those with nondetectable preinjection levels (36.4% versus 4%) to develop chymopapain-specific IgE levels greater than or equal to 0.06 IU/ml.
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PMID:Chymopapain-induced hypersensitivity following chemonucleolysis. 639 Jul 23

Chymopapain (EC 3.4.22.6) was purified from commercially available spray-dried latex of papaya (Carica papaya) fruit by (NH4)2SO4 fractionation and fast protein chromatography on the Mono S cation-exchange column. Multiple forms of chymopapain separated chromatographically were shown to be immunologically identical. A major form was isolated and found to be homogeneous by several criteria, and fully active, and its N-terminal amino acid was identified as tyrosine. Latex from fresh unripe papaya fruit contained predominantly one form of chymopapain, and it is concluded that chymopapain is a single enzyme distinct from the other cysteine proteinases of C. papaya latex.
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PMID:Chymopapain. Chromatographic purification and immunological characterization. 643 89

Seventy-seven patients treated by chymopapain and laminectomy were compared before, and 6 and 14 weeks after, treatment. A standardized, multidimensional scale of low back pain providing scores on 7 independent dimensions of sensory and affective discomfort and one measure of intensity were used. Fourteen weeks after surgery, patients treated by chymopapain were functioning as well as those treated by laminectomy. Major differences, however, characterized the course of recovery. Chymopapain produced rapid change, which was maintained over the 3 1/2-month period. Healing following laminectomy was slower, but the end results were essentially the same. These findings, using sophisticated measurement techniques, support previous research suggesting that chymopapain is an effective alternative to laminectomy in the treatment of lumbar disk disease.
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PMID:A comparison of patients treated by chymopapain and laminectomy for low back pain using a multidimensional pain scale. 644 50


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