Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.22.6 (chymopapain)
 407 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The DATTA panelists did not achieve a definitive consensus on the use of chymopapain chemonucleolysis for a protruding lumbar disk contained by the annulus. Concerns about safety, especially the risk of anaphylaxis and the risk of damage to the spinal cord, were frequent. The effectiveness of this procedure for this indication was also questioned by many of the panelists. The panel did agree that chemonucleolysis is unacceptable as either safe or effective for use in patients with a herniated lumbar disk that is extruding nucleus pulposus through the annulus. Accordingly, diagnostic imaging of any suspect disk must be performed before chemonucleolysis can be deemed appropriate for any individual patient. Current imaging techniques are not infallible and cannot confer an absolute sense of security when seeming to indicate a nonextruded protruding disk.
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PMID:Diagnostic and therapeutic technology assessment. Chemonucleolysis for herniated lumbar disk. 229 58

The proteolytic specificities of chymopapain and papaya proteinase omega were investigated by using the alpha-chains of manatee and mole haemoglobin, whose primary structures are known, as substrates. The resulting peptides from each enzymatic cleavage were isolated by gel filtration on Sephadex G-25, followed by reversed-phase HPLC of the separated peaks and, in some cases, further purified by preparative thin-layer electrophoresis. The purified peptides were then identified on the basis of their amino-acid composition. The proteolytic specificities of chymopapain and papaya proteinase omega, deduced from the experimental cleavage patterns, are compared to that of papain. As in the case of papain, the specificity-determining factor is the amino-acid residue of the substrate that will be bound in subsite S2 (the next but one from the scissible bond). Aromatic residues in this position, preferred by papain, are not important for chymopapain and papaya proteinase omega. Cleavages preferentially occur when S2 is occupied by leucine, valine or threonine. For chymopapain, proline in position S2 also causes cleavage.
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PMID:The thiol proteinases from the latex of Carica papaya L. IV. Proteolytic specificities of chymopapain and papaya proteinase omega determined by digestion of alpha-globin chains. 268

The effect of diatrizoate on the chronic toxicity of chymopapain in the epidural space was studied. Chymopapain was injected epidurally into four monkeys; chymopapain plus diatrizoate meglumine, into four. In 3 months, neither group developed significantly more arachnoiditis than a control group of animals that had received epidural injections of physiologic saline. No synergistic effect of chymopapain and diatrizoate on the meninges was detected.
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PMID:Synergy of chymopapain and diatrizoate studied in an experimental model. 270 13

Epidural adhesions were discovered in seven of nine patients undergoing surgery for failed chymopapain chemonucleolysis. Clinically the adhesions were very vascular, prolific and adherent to the nerve root, dura and the porieties. The histological composition was similar to the normal tissues of the epidural space from the post-mortem controls and also to adhesions discovered at surgery in a non-injected patient, except that there was an increase in fibrous tissue, which was poorly cellular. There was no evidence of an inflammatory infiltrate. Such adhesions may partly explain the failure of chemonucleolysis and prejudice the success of surgery by potentiating further adhesion formation.
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PMID:Epidural adhesions after chymopapain chemonucleolysis. 281 Jan 89

The marginal band is a bundle of microtubules residing at the periphery of nucleated erythrocytes of nonmammalian vertebrates and some invertebrates. Marginal bands from erythrocytes of the newt (Notopthalmus viridescens) were isolated from the cells as intact structures by treatment with detergent and either mild protease or high salt. Isolated bands were subjected to mechanical testing by stretching the band between a glass microhook and a calibrated glass fiber. The deflection of the fiber provided a measure of the force on the band. The flexural rigidity of the band was determined from measurements of the band deformation as a function of applied force. Bands isolated with either of two proteases (pepsin or elastase) or with high salt exhibited elastic behavior with a flexural rigidity of approximately 9.0 X 10(-12) dyn.cm2. Treatment of bands with chymopapain caused an increase in band rigidity and inelastic behavior. Estimates of the contribution of the band to cellular rigidity are made based on the measurements of the structural properties of the isolated band. The band provides the cell with a large resistance to indentations at the rim and to large extensions, while maintaining a high degree of flexibility in small extensions or flexure.
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PMID:Flexural rigidity of marginal bands isolated from erythrocytes of the newt. 271 74

From 1983 to 1987, 100 consecutive patients with lumbar herniated nucleus pulposus were treated with either chymopapain chemonucleolysis (51 patients) or surgical discectomy (49 patients). The chymopapain-treated group was followed for an average of 16 months and the surgically treated group was followed for an average of 12 months. All patients had to be candidates for both procedures and were grouped for therapy based on their preference. The groups were similar in military duty status, history, age, gender, duration and character of symptoms, physical findings, and computed tomography/myelogram results. Satisfactory outcomes were achieved in 40 of 51 (78%) chymopapain-treated patients and in 39 of 49 (80%) surgically treated patients. Seventy-eight percent of the chymopapain group and 79% of the surgery group ultimately returned to full military duty. Of the nine initial chymopapain failures, eight were successfully treated with surgical discectomy. There were fewer complications, 4% versus 10%, in the chymopapain group. The authors now consider chemonucleolysis as the final conservative measure prior to surgery, rather than an alternative to surgical discectomy.
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PMID:Chymopapain chemonucleolysis versus surgical discectomy in a military population. 274 57

Measurements of the area of the intervertebral disc space were made, over a period of 400 days or more, in 16 patients who underwent chemonucleolysis and 20 patients after nucleotomy. The superimpositioning method of measurement used is based on a determination of fixed points and it has a high level of reproducibility. We have measured areas which differ from volumes in only a single dimension, but which show good correlation compared with measurement of intervertebral disc space heights alone. After both chemonucleolysis and nucleotomy, narrowing of the intervertebral disc space occurs up to the 50th day, after which there is a highly significant difference: the intervertebral disc space height increases after chemonucleolysis, and continues to decrease after nucleotomy. It is concluded that the enzymatic effect of chymopapain on the nucleus pulposus produces a gain in disc substance after chemonucleolysis, whereas nucleotomy is associated with a loss of substance.
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PMID:Quantitative measurement of disc space area before and after chemonucleolysis and nucleotomy. 274 21

The prognostic significance of gravity-induced trunk list and cross leg pain was investigated in 113 patients who had root tension signs from a lumbar disc lesion. Cross leg pain, (a positive contralateral straight leg raising sign) and list was associated with poor prognosis for conservative management. There was a high incidence of disc sequestration and extrusion in the operated patients with cross leg pain. It was concluded that cross leg pain is probably a contraindication to chymopapain injections, and the surgeon should be aware of the possibility of a migrated disc fragment during operation on patients with cross leg pain.
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PMID:Cross leg pain and trunk list. 274 74

The role of antibiotics in the treatment of iatrogenic discitis remains controversial. This study was carried out to assess the ability of cephazolin (a first-generation cephalosporin) to penetrate the intervertebral disc and to establish the role of intravenous antibiotics in the prevention and treatment of iatrogenic discitis. Six sheep had 1 g of intravenous antibiotic administered between 30 minutes and 120 minutes before being killed. Two adjacent lumbar intervertebral discs were harvested and assayed for antibiotic concentration. Cephazolin could only be detected in the animals killed at 30 minutes. Intravenous cephazolin was administered 30 minutes before bacterial inoculation in 46 discs of nine sheep. In five animals, the bacterial suspension contained radiographic contrast and, in four sheep, reconstituted chymopapain. No evidence of discitis was found at any level at death. Eight sheep were treated with intravenous cephazolin commencing 1, 2, or 3 weeks after bacterial intradiscal inoculation and for periods of up to 21 days. All discs developed discitis, and the lesions appeared to be similar, irrespective of time between inoculation and the commencement, duration, and dosage of antibiotic therapy. Our study supports the use of a suitable broad-spectrum antibiotic during any surgical procedure that invades the intervertebral disc. Antibiotics, however, are unable to arrest the progression of discitis once it is established
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PMID:Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. 278 8

Chymopapain is a proteolytic enzyme used in the chemonucleolysis of the herniated nucleus pulposus of lumbar intervertebral discs. It causes rapid hydrolysis of the noncollagenous polypeptides that maintain the tertiary structure of the chondromucoprotein of the nucleus pulposus. We report here an anaphylactoid reaction after the intervertebral injection of chymopapain.
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PMID:Anaphylactoid reaction to chymopapain. 239 12


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