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)

Sixty-six patients with symptomatic herniated lumbar discs refractory to the usual conservative management were allocated at random into one of two treatment groups according to a double-blind protocol: 31 received chymopapain intradiscally (chemonucleolysis) and 35 received a placebo intradiscally. Symptoms remained significantly improved 1 year or more after injection for 55% of those treated with chymopapain and for 46% of those treated with placebo. The difference is not statistically significant. However, to discard chemonucleolysis on the basis of this one small clinical trial may be premature. Since continuing controversy has re-established a climate in which another double-blind study of chemonucleolysis is ethically feasible and scientifically desirable, we favor additional clinical trials under a tightly controlled protocol to help resolve the issue.
J Neurosurg 1978 Dec
PMID:Double-blind evaluation of chemonucleolysis for herniated lumbar discs. Late results. 36 87

Sequences to residue 17 have been determined for the three Papaya cysteinyl proteases, chymopapain and papaya peptidase A and B. Extensive homologies were found for these three enzymes and with papain and bromelain. These results suggest that the five sulphydryl enzymes discussed derive from a common ancestral gene.
Biochim Biophys Acta 1979 Dec 14
PMID:N-Terminal homology in three cysteinyl proteases from Papaya latex. 51 21

The authors report 66 patients with signs, symptoms, and a myelographic abnormality of herniated lumbar disc, who were not responsive to conservative treatment. The discs were injected at random with either chymopapain or a placebo. Neither patient nor surgeon knew which agent was used until after the results had been tabulated. Unless early laminectomy was necessary for intractable pain, all patients were followed for 2 months or more. There was no statistically significant difference in incidence or quality of improvement between the two groups: chymopapain was successful in 58% while placebo was successful in 49% (p = 0.15). Early results from this study indicate that most, if not all, of the putative effectiveness of chemonucleolysis probably derives from a placebo effect.
J Neurosurg 1976 Dec
PMID:Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs. Early results. 78 27

This study is based on 20 patients who underwent bone scanning before and after chemonucleolysis (CN) for a herniated lumbar disk. It shows that chymopapain, the proteolytic enzyme used for CN, does not induce early or late bone lesions of the adjacent vertebral plates. Abnormal uptake by one of the vertebral plates indicates a "chemical discitis." The pattern observed on the bone scan is different from the one presented by patients with bacterial spondylitis.
Clin Nucl Med 1990 Dec
PMID:Bone scan and chemonucleolysis. 227 34

Using magnetic resonance imaging, conventional histology, and spinal evoked potentials, the authors studied the short-term effects of chymopapain on nerve tissue in the lumbar vertebral canal region in rats. Chymopapain in different concentrations was injected into the subarachnoid space in 31 rats. As early as 20 minutes later latency changes in the evoked potentials were observed; the histologic examinations after two hours showed bleeding, swelling of the myelin, and vascular changes. Magnetic resonance imaging of the lumbar spine, performed after six hours, showed a markedly stronger signal, indicative of an intraspinal edema, as compared to the control group. The authors' studies are clear proof that changes in nerve tissue following contact with chymopapain occur considerably faster than hitherto assumed in the literature.
Z Orthop Ihre Grenzgeb 1988 Dec
PMID:[Early functional and structural changes in the nerve tissue following contact with chymopapain]. 285 34

A recognized side effect of chemonucleolysis is life-threatening anaphylaxis to chymopapain. In the clinical trials of chymopapain, 13 cases of anaphylaxis were reported in 1585 administrations (0.82%). Two patients died. Data from a postmarketing survey (48,239 questionnaires) were reviewed to identify factors influencing the incidence and severity of anaphylaxis. The results indicate the incidence of anaphylaxis decreased to 0.44% in the 1983-1984 period (126/23,736), a level significantly (P less than or equal to 0.001) below the incidence of 0.82% observed in initial clinical trials. Only three deaths from complications related to anaphylaxis occurred in approximately 75,000 administrations (producing 252 anaphylactic episodes) reported since December 1982. The prophylactic use of antihistamines and pretreatment with intravenous fluids coincide with the dramatic reduction in mortality due to anaphylaxis. However, overdiagnosis of anaphylaxis in the clinical trials and avoidance of chemonucleolysis in patients with IgE antibodies to chymopapain may account, in part, for the reduction in incidence.
Anesth Analg 1985 Dec
PMID:Decreased incidence and mortality of anaphylaxis to chymopapain. 286 10

Three hundred thirty-five patients with herniated lumbar intervertebral discs were injected with chymopapain. The overall success rate was 76%. The success rate was higher for private insurance patients (89%) than for Worker's Compensation patients (66%). There were no serious complications and patients spent fewer days in the hospital and returned to work faster than patients with laminectomies. Chemonucleolysis is an excellent alternative to open surgery for treatment of a herniated lumbar disc, especially if patients are selected carefully and good technique is strictly followed.
Clin Orthop Relat Res 1987 Dec
PMID:Chemonucleolysis as an alternative to laminectomy for the herniated lumbar disc. Experience with patients in a private orthopedic practice. 296 Apr 77

Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.
Orthopedics 1988 Dec
PMID:Evaluation and treatment of chemonucleolysis failures. 323 75

A follow-up of 1289 chemonucleolyses performed on 1141 patients and a questionnaire answered by 80% of these patients shows that some conditions hitherto held to be contraindications can be questioned: chemonucleolysis performed in cases of disk herniations with spinal stenosis can produce very good results. A second chemonucleolysis with chymopapain at a later date is possible. In patients who have previously undergone surgery on the same disk, chemonucleolysis offers good chances of improvement in the event of a reherniation.
Z Orthop Ihre Grenzgeb 1988 Dec
PMID:[Chemonucleolysis--with extended indications. 4 years clinical experience]. 324 82

We investigated the effect of proteolytic enzyme treatment on the course of passive Heymann nephritis (PHN). PHN was induced by intravenous injection of Heymann antibody into Sprague Dawley rats. Protease-treated rats received intraperitoneal chymopapain and subtilisin. In rats given subnephritogenic doses of Heymann antibody (5 or 10 mg, insufficient to cause proteinuria), glomerular immune deposits were assessed by immunofluorescence and electron microscopy. In rats given 5 mg Heymann antibody and treated with protease in the heterologous phase of the disease (days 1-7), fewer animals were positive for rabbit IgG and rat IgG, as determined by immunofluorescence on day 12, compared with controls (p less than 0.01). Rats given 10 mg Heymann antibody and treated on days 1-5 were less frequently positive for rabbit IgG on day 5 than controls (p less than 0.05). When treatment was given on days 6-12 (autologous phase), fewer rats had glomerular rabbit and rat IgG compared with controls (p less than 0.025). Protease treatment of rats given nephritogenic doses of Heymann antibody (greater than or equal to 40 mg, causing proteinuria) did not result in significant differences in immunofluorescence deposits. However, protease treatment significantly reduced the number of electron dense deposits at all doses of antibody (p less than 0.01). Furthermore, rats given 60 mg Heymann antibody followed by enzyme treatment in the heterologous phase (days 1-7) or throughout the autologous phase (days 6-18) had significantly reduced protein excretion during the autologous phase compared with control rats (p less than 0.05). After onset of significant proteinuria on day 15 in rats given 40 mg Heymann antibody and treated from day 15 until day 25, there was significantly less (p less than 0.05) proteinuria on days 21-22 and 24-25 than in control rats; thus, enzymes could reverse proteinuria. In normal rats, administration of proteases did not have significant effects on urinary protein excretion, serum creatinine, or renal morphology, nor did protease affect anti-rabbit IgG antibody production in rats injected with Heymann antibody. The overall results indicate that proteolytic enzyme treatment can prevent or remove glomerular immune deposits and can prevent or reverse proteinuria.
J Exp Med 1986 Dec 01
PMID:Proteolytic enzyme treatment reduces glomerular immune deposits and proteinuria in passive Heymann nephritis. 353 93


1 2 3 4 Next >>