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

True sciatica, and the back pain associated with it, are symptoms stemming from a common anatomical lumbar distortion--compression of a spinal nerve root. Two therapeutic approaches have evolved: surgical laminectomy and discectomy for relief of compression of a lumbar nerve root; and chemonucleolysis, a tissue modification technique using the intradiscal injection of the proteolytic enzyme chymopapain. Chemonucleolysis has been demonstrated to have a successful outcome at the 75% level in 6 weeks and at the 80% level in 6 months. Lumbar microdiscectomy appears to be 85% effective at 3 months.
Todays OR Nurse 1991 Sep
PMID:Sciatica management: chemonucleolysis vs. surgical discectomy. 192 1

The effect of externally applied spinal loads on facet mechanics before and after facet capsulectomy and disc alteration was investigated. Four control and four chymopapain-treated specimens were tested. Facet load and resultant load location were determined in the unaltered state, after facet capsulectomy, and after discectomy using a newly developed, noninvasive measurement technique. Resultant contact load locations shifted in a predictable manner. Caudal shift in contact locations occurred with chymopapain treatment or discectomy but was variable with capsulectomy. Facet load changed with applied load magnitude and direction; no significant change was noted after intradiscal chymopapain, discectomy, or capsulectomy. The significance of the lack of force change with disc narrowing is unknown. Perhaps, observed facet degeneration results from a change in the joint motion and contact location rather than change in facet load.
Spine (Phila Pa 1976) 1990 Sep
PMID:Facet loads in the canine lumbar spine before and after disc alteration. 225 91

We carried out a randomized comparison study with 69 patients, one group of whom had been operated on (41) and the other group treated by chemonucleolysis with chymopapain (25) in order to arrive at an objective picture of the latter recently much criticised method. 88% of the patients who were treated with chymopapain showed lasting success, and almost 90% of the operated patients are also in a good condition. In our opinion, complications can be avoided and the patient can be spared a surgical operation by the correct choice of patients and proper performance of the method in standby anaesthesia. This justifies the performance of chemonucleolysis with chymopapain.
Neurochirurgia (Stuttg) 1990 Sep
PMID:[Chemonucleolysis with chymopapain in lumbar disk hernia. Randomized comparative study with operated patients]. 226 6

Proteoglycans were extracted from nuclease-digested sonicates of 10(9) rat basophilic leukemia (RBL-1) cells by the addition of 0.1% Zwittergent 3-12 and 4 M guanidine hydrochloride and were purified by sequential CsCl density gradient ultracentrifugation, DE52 ion exchange chromatography, and Sepharose CL-6B gel filtration chromatography under dissociative conditions. Between 0.3 and 0.8 mg of purified proteoglycan was obtained from approximately 1 g initial dry weight of cells with a purification of 200-800-fold. The purified proteoglycans had a hydrodynamic size range of Mr 100,000-150,000 and were resistant to degradation by a molar excess of trypsin, alpha-chymotrypsin, Pronase, papain, chymopapain, collagenase, and elastase. Amino acid analysis of the peptide core revealed a preponderance of Gly (35.4%), Ser (22.5%), and Ala (9.5%). Approximately 70% of the glycosaminoglycan side chains of RBL-1 proteoglycans were digested by chondroitinase ABC and 27% were hydrolyzed by treatment with nitrous acid. Sephadex G-200 chromatography of glycosaminoglycans liberated from the intact molecule by beta-elimination demonstrated that both the nitrous acid-resistant (chondroitin sulfate) and the chondroitinase ABC-resistant (heparin/heparan sulfate) glycosaminoglycans were of approximately Mr 12,000. Analysis of the chondroitin sulfate disaccharides in different preparations by amino-cyano high performance liquid chromatography revealed that 9-29% were the unusual disulfated disaccharide chondroitin sulfate di-B (IdUA-2-SO4----GalNAc-4-SO4); the remainder were the monosulfated disaccharide GlcUA----GalNAc-4-SO4. Subpopulations of proteoglycans in one preparation were separated by anion exchange high performance liquid chromatography and were found to contain chondroitin sulfate glycosaminoglycans whose disulfated disaccharides ranged from 9-49%. However, no segregation of subpopulations without both chondroitin sulfate di-B and heparin/heparan sulfate glycosaminoglycans was achieved, suggesting that RBL-1 proteoglycans might be hybrids containing both classes of glycosaminoglycans. Sepharose CL-6B chromatography of RBL-1 proteoglycans digested with chondroitinase ABC revealed that less than 7% of the molecules in the digest chromatographed with the hydrodynamic size of undigested proteoglycans, suggesting that at most 7% of the proteoglycans lack chondroitin sulfate glycosaminoglycans.(ABSTRACT TRUNCATED AT 400 WORDS)
J Biol Chem 1985 Sep 15
PMID:Purification and characterization of protease-resistant secretory granule proteoglycans containing chondroitin sulfate di-B and heparin-like glycosaminoglycans from rat basophilic leukemia cells. 241 30

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
Spine (Phila Pa 1976) 1989 Sep
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.
Anaesthesia 1989 Sep
PMID:Anaphylactoid reaction to chymopapain. 239 12

In a comparative study 71 patients were treated by intradiscal injection of collagenase and 93 patients by chymopapain injections. Indication, technique of injection and post-injection treatment were based on uniform criteria and followed standardised procedure. In practically all cases, monosegmental injections were performed almost exclusively in the last two discs of the lumbar vertebral column; in cases where the x-ray and clinical findings were unequivocal, the injections were performed at one level of the lumbar vertebral column. After collagenase injection, patients suffered more from low back pain, needed higher doses of strong analgesics, and had a longer hospital stay. Results after one year were almost equal with success rates of 75% (chymopapain) and 72% (collagenase). In each group about three-quarters of the patients with unsatisfactory results were operated on.
Neurochirurgia (Stuttg) 1986 Sep
PMID:[Experiences with intradisk injection treatment with chymopapain and collagenase]. 302 39

With chymopapain at a concentration of 10 mg/ml, the authors skin tested 540 chemonucleolysis candidates; six were positive, and 534 were negative. None of the positive patients received therapeutic injections of chymopapain. There were no instances of unequivocal anaphylaxis to chymopapain in the patients with negative skin tests treated with chymopapain. When this 0% incidence of systemic reactions in skin test negative patients is compared with the historical rate of 1%, this difference is statistically significant (p less than 0.05). Restriction of chymopapain treatment to patients with negative prick tests can reduce the incidence of systemic reactions.
Clin Orthop Relat Res 1988 Sep
PMID:Prevention of chymopapain anaphylaxis by screening chemonucleolysis candidates with cutaneous chymopapain testing. 340 65

Allergic reaction following chemonucleolysis with chymopapain is responsible for half of all known complications of this treatment. Although the incidence of allergic reactions is comparatively low one should not underestimate the danger involved. If chemonucleolysis is performed under local anaesthesia, the risk of an anaphylactic reaction is reduced. If no pre-operative test methods are available, the patient risk can be considerably lessened by suitable premedication and by keeping anti-allergics within easy reach during intradiscal therapy. Exclusion of patients who have a previous history of allergy from chemonucleolysis will not result in additional safety. The specificity of the serological tests is very high, but their sensitivity and reliability in respect of prediction of an allergic reaction with positive or negative test result is comparatively low. They take up a lot of time (24 hours) and require skilled personnel trained in laboratory chemistry. The chymopapain prick test is simple to perform and the result of the test rapidly available (15 minutes). The danger of allergic reactions to the prick test itself is negligibly small, as experience has shown. At the present time no comparative tests are available between serological tests and skin tests in a large group of patients, so that we can say something about the reliability only on the basis of empirical data. Of the 352 test-negative patients investigated so far, none had an allergic immediate reaction to chymopapain. Even if we take the possibility of false positive skin tests into consideration, we believe that it would not be appropriate with a positive skin test to perform chemonucleolysis.
Neurochirurgia (Stuttg) 1986 Sep
PMID:[Incidence and prevention of allergic reactions following chemonucleolysis with chymopapain]. 349 35

With Magnetic Resonance Imaging (MRI) it is possible to monitor the changes in water content of the nucleus pulposus after intradiscal injection of chymopapain. In this prospective study the changes that occurred in 20 patients undergoing single-level chemonucleolysis were monitored. A constant pattern of gradual reduction of nuclear signal was seen in all cases. Complete loss of signal took at least 6 weeks and corresponded to the maximum reduction in disc space height. Seventeen patients were scanned at more than 1 year after treatment. Of these, 13 had been treated by chemonucleolysis alone. No significant return of signal from the nucleus pulposus was noted despite a slight reconstitution in disc space height. Chymopapain produced irreversible changes analogous to gross premature disc degeneration. No similar changes were noted in a control group of 12 patients (31 discs) undergoing diagnostic discography without injection of the enzyme.
Spine (Phila Pa 1976) 1987 Sep
PMID:The long-term effect of chemonucleolysis on the intervertebral disc as assessed by magnetic resonance imaging. 368 22


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