6 Pharmacologic Properties of Chymopapain

Gesler, R. M.

doi:10.1097/00003086-196911000-00007

Cited by 33 publications

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“…Therefore the evaluation of principles could be useful also for enzymes other than Discase| (e.g., Nucleolysin). This paper will not deal with the biochemical and pharmacological basis of discolysis, which is sufficiently reported in the literature (Branemark et al 1969, Garwin et al 1965, Gesler 1969, Jansen et al 194I, Shealy 1967, Stern 1969 Smith 1967, Tsaltas 1958). From the same reason it seems unnecessary to describe the technique of discolysis.…”

Section: Introductionmentioning

confidence: 99%

Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis)

Loew

Kivelitz

1982

Acta neurochir

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An analysis is given of a series of 25 patients suffering from lumboischialgic pain of different causes, which have been treated by discolysis. Literature reports are taken into consideration. As a result of analysis, the following statements seem justified: In no kind of lumbar disc prolapse are the results of discolysis superior to those of modern operative treatment. Discolysis results are indisputably worse in cases with the usual operative indication, which consists of neurological deficit and large disc prolapse. Favourable results by discolysis can be obtained in cases with disc protrusion or small prolapse, but these cases can mostly be cured also by consequent conservative treatment. Contraindications are marked neurological deficit, demonstration of a large disc prolapse by contrast methods, Verbiest's stenosis of the lumbar spinal canal, low back pain and ischialgia without possible proof of a disc protrusion, cases with low back pain as the main or only feature, spondylolisthesis. Disc prolapse recurrences after discolysis often occur about one month afterwards. Structural instability at this stage is likely. Therefore, as with postoperative treatment, it is advisable to avoid major physical stress for the first weeks after discolysis. Major complications after discolysis are possible, and have occurred. Because discolysis offers no real advantages but some shortcomings compared to conservative treatment for disc protrusions, and to operative treatment in real disc prolapses, its justification seems more than questionable.

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Section: Introductionmentioning

confidence: 99%

Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis)

Loew

Kivelitz

1982

Acta neurochir

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“…This mechanism decreases the water-binding capacity of the polysaccharide side chains. 14,29,60,64 The pressure in the disc is lowered, so the disc protrusion decreases, which relieves the tension on the nerve root. 66 The effect of chemonucleolysis can be demonstrated by the aspiration of a milky fluid from the disc immediately after injection.…”

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Five-Year Results From Chemonucleolysis With Chymopapain or Collagenase

Wittenberg

Oppel²,

Rubenthaler³

et al. 2001

Spine

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“…Substantial clinical and experimental evidence indicates that chymopapain, a potent proteolytic enzyme, catalyzes a rapid reduction in the viscosity and molecular weight of the water-insoluble component of the nucleus pulposus, both in vitro and in vivo. 5,20,22,53,54,59 It is generally assumed that the enzymatic degradation and subsequent remodeling of the disc carti-lage results in an "internal decompression" of the nerve root and the cauda equina, thereby affording symptomatic relief for the patient with discogenic lumbar radiculopathy. 30,59 However, radiological studies suggest that the size and configuration of the offending disc herniation are not altered acutely by the intradiscal injection of chymopapain.…”

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confidence: 99%

Chymopapain-induced reduction of proinflammatory phospholipase A2 activity and amelioration of neuropathic behavioral changes in an in vivo model of acute sciatica

Sawin¹,

Traynelis²,

Rich³

et al. 1997

Journal of Neurosurgery

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The mechanism of action underlying chymopapain (Chymodiactin) chemonucleolysis remains obscure. Radiographic studies suggest that chymopapain does not alter disc fragment size acutely; nonetheless, patients often report symptom resolution within a few days, even hours, of treatment. The authors postulate that, in addition to its chemonucleolytic action, chymopapain may possess antiinflammatory properties. To test this hypothesis, the authors assessed the ability of chymopapain to modulate the activity of the proinflammatory enzyme phospholipase A2 (PLA2) and to ameliorate behavioral changes associated with inflammatory neuropathy in an in vivo model of sciatica. Thirty-nine male Fischer rats were randomly assigned to one of three treatment groups: 1) saline, 2) betamethasone, or 3) chymopapain. All of the rats underwent unilateral sciatic nerve ligation with loose chromic gut suture to induce inflammatory mononeuropathy. The animals were tested for thermal and mechanical hyperalgesia on Days 0 (preoperation), 7 (pretreatment), and 14 (prior to death). Three animals were killed on Day 0 to determine the baseline PLA2 activity within unmanipulated rat sciatic nerves. On Day 7, three animals from each group were killed to assess PLA2 activity prior to treatment. The remainder were given a single infusion of saline, betamethasone (0.3 mg/kg), or chymopapain (100 pKat U) around the inflamed nerve. On Day 14, the remaining animals were killed and their sciatic nerves were removed. The tissue was homogenized and the PLA2 activity was determined using [14C]arachidonate-labeled Escherichia coli phospholipid membrane as a substrate. Lipids were extracted and separated by thin-layer chromatography. All animals developed behavioral changes consistent with inflammatory mononeuropathy 24 to 72 hours postoperatively; these included gait disturbance, flexion deformity, and hyperalgesia of the involved hindlimb. The degree of mechanical and thermal hyperalgesia was comparable between groups at Day 7. By Day 14, the thermal hyperalgesia had resolved; the mechanical hyperalgesia was less evident in the betamethasone- and chymopapain-treated groups than in the saline-treated controls (p = 0.003; saline- vs. chymopapain-treated groups p = 0.004; saline- vs. betamethasone-treated groups p = 0.008). The mean PLA2 activity at baseline (Day 0) was 11.6 +/- 4.9 nmol phospholipid hydrolyzed per minute per milligram of protein. The PLA2 activity at Day 7 was 74.4 +/- 18.2 (ligated side) and 21.2 +/- 11.7 (nonligated side). At Day 14, PLA2 activity was reduced in the chymopapain- (47.8 +/- 12.3) and betamethasone- (39.7 +/- 9.5) treated groups compared with the saline control group (62.3 +/- 11.2), (saline- vs. chymopapain-treated groups p < 0.05; saline- vs. betamethasone-treated groups p < 0.01). The PLA2 activity in nonligated specimens was 18.6 +/- 10.1. These data indicate that chymopapain exhibits antiinflammatory properties in vivo, reducing PLA2 activity and ameliorating mechanical hyperalgesia in this model of inflammatory sciatic n...

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6 Pharmacologic Properties of Chymopapain

Cited by 33 publications

References 0 publications

Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis)

Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis)

Five-Year Results From Chemonucleolysis With Chymopapain or Collagenase

Chymopapain-induced reduction of proinflammatory phospholipase A2 activity and amelioration of neuropathic behavioral changes in an in vivo model of acute sciatica

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