alpha-chymotrypsin and Burns

Tissue damage of all types, such as surgical or accidental injuries, fractures, and burns, stimulates a well-orchestrated, physiological process of healing, which ultimately leads to structural and functional restoration of the damaged tissues. The tissue repair process can be broadly divided into four continuous and overlapping phases-hemostasis and coagulation, inflammation, proliferation, and remodeling. If the process is interrupted or halted during any stage, it leads to impaired healing and formation of a chronic wound. Chronic wounds are associated with significant morbidity, mortality, and poor quality of life. Therefore, prompt and effective management of acute tissue injury is necessary to prevent it from progressing to a chronic wound. Proteolytic enzymes have been used to facilitate tissue repair since ancient times. Trypsin:chymotrypsin is an oral proteolytic enzyme preparation which has been in clinical use since the 1960s. It provides better resolution of inflammatory symptoms and promotes speedier recovery of acute tissue injury than several of the other existing enzyme preparations. This review article revisits the role and clinical utility of trypsin:chymotrypsin combination in tissue repair.. Torrent Pharmaceuticals Limited.

Topics: Burns; Chymotrypsin; Drug Combinations; Humans; Inflammation; Peptide Hydrolases; Quality of Life; Trypsin; Wound Healing; Wounds and Injuries

Topics: Anaphylaxis; Burns; Chymotrypsin; Deoxyribonucleases; Drug Eruptions; Empyema; Hemothorax; Humans; Lung Abscess; Osteomyelitis; Peptide Hydrolases; Pyoderma; Streptodornase and Streptokinase; Trypsin

Topics: Animals; Burns; Chronic Disease; Chymotrypsin; Diabetic Angiopathies; Gangrene; Humans; Injections, Intramuscular; Injections, Intravenous; Leg Ulcer; Peptide Hydrolases; Preoperative Care; Skin Ulcer; Trypsin

The present study was carried out in burn patients administered with Trypsin-Chymotrypsin (Chymoral Forte D.S.) preparation to observe if the acute-phase protein levels in the serum are modulated through the synthesis of IL-1beta and IL-6 and if the severity of the inflammatory phase could be regulated. The effects of Trypsin-Chymotrypsin preparation on the modulation of cytokine levels particularly, IL-6 and IL-1beta were analyzed in serum samples of 15 burn patients and compared with untreated controls. Significant differences in cytokine levels (P<0.05) were observed in untreated burn patients and Trypsin-Chymotrypsin preparation treated patients. There were significant variations in serum IL-6 and IL-1beta on the day of admission and post burn day 10 in treated as well as untreated burn patients. Patients with a higher percentage of total body surface area and sepsis showed a significant increase in IL-1beta and IL-6 in the serum. An increase in serum levels of both cytokines was observed on post burn day 1 and a significant decrease was observed in Trypsin-Chymotrypsin preparation treated patients on days 7 and 10. The possible role of the inflammatory cytokines in the pathophysiology of burns is discussed.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Burns; Case-Control Studies; Chymotrypsin; Drug Combinations; Female; Humans; Interleukin-1; Interleukin-6; Male; Middle Aged; Treatment Outcome; Trypsin

A study was carried out to investigate the efficacy of trypsin: chymotrypsin (Chymoral forte DS) preparation on burn patients by analysing the changes taking place in serum acute-phase proteins. Serum proteins were analysed qualitatively and quantitatively for both control and enzyme-treated groups by the methods of Western Blot, ELISA and Turbidimetric assays. Furthermore, the trypsin inhibitory capacity (TIC) of the sera was also determined. Significant differences were observed between a control group of patients and a parallel group treated with trypsin: chymotrypsin preparation. During the first phase of burn wounds an initial rise was seen in C-reactive protein, alpha 1-antitrypsin, alpha 2-macroglobulin and TIC in both the groups. In the following days, enzyme preparation inhibited the rise in C-reactive protein titres and enhanced the rise in alpha 1-antitrypsin, alpha 2-macroglobulin and TIC. The above studies clearly indicate that the changes in serum acute-phase proteins between the control and treated groups reflect the anti-inflammatory activity and hence the therapeutic efficacy of Chymoral forte DS.

Topics: Acute-Phase Proteins; Adult; Anti-Inflammatory Agents, Non-Steroidal; Blood Protein Electrophoresis; Blotting, Western; Burns; Chymotrypsin; Drug Combinations; Electrophoresis, Polyacrylamide Gel; Enzyme-Linked Immunosorbent Assay; Humans; Middle Aged; Trypsin

This study was mainly aimed to investigate the efficacy of trypsin:chymotrypsin to elicit anti-oxidant properties. In our earlier studies it was observed that the enzyme preparation exhibited an anti-inflammatory action as there was a remarkable reduction in oedema formation and tissue destruction. This led to further study on the amount of lipid peroxidation products formed and the levels of enzymatic and non-enzymatic anti-oxidants and relative trace element contents of copper, selenium, iron and zinc during administration of the enzyme preparation. Decreased formation of lipid peroxidation products was observed in treated group in comparison with the untreated group. Higher levels of enzymatic anti-oxidants mainly super oxide dismutase, catalase, glutathione peroxidase and glutathione-s-transferase and non-enzymatic antioxidant namely ceruloplasmin persisted for a longer period of time in the treated group than in the untreated group. No statistical significance was observed in non-enzymatic antioxidants viz. ascorbic acid and tocopherol levels in both the groups. Increased serum copper and selenium levels in the treated group could be related to higher levels of the ceruloplasmin and glutathione peroxidase observed in the treated group. The above studies support the finding that treatment with the enzyme preparation reduced tissue destruction leading to decreased formation of free radicals and subsequent effective scavenging of free radicals by the higher levels of enzymatic and non-enzymatic anti-oxidants.

Topics: Adult; Burns; Ceruloplasmin; Chymotrypsin; Female; Follow-Up Studies; Free Radicals; Glutathione Peroxidase; Humans; Lipid Peroxidation; Male; Middle Aged; Oxidative Stress; Trace Elements; Treatment Outcome; Trypsin; Vitamins

The levels of 12 serum proteins including 'acute-phase reactants', immunoglobulins and albumin were measured in 20 patients suffering from thermal burns. The acute-phase reactants: C-reactive protein, alpha-l antitrypsin, alpha-l antichymotrypsin, haptoglobin and orosomucoid, all increased in concentration. Highest levels, which showed significant correlations with injury severity, occurred at 6-8 days post-burn. The levels of albumin, alpha-l lipoprotein and transferrin were decreased. The immunoglobulins IgG, IgA and IgM showed an initial decrease followed by a steady return to normal levels. Four patients, of whom three died, developed serious sepsis. The levels of alpha-l antichymotrypsin and C-reactive protein were much higher in patients with sepsis than in those without sepsis. The highest levels occurred during and often before the episode of sepsis was clinically evident. The immunoglobulins especially IgG and IgA were lower in those patients who developed sepsis than in those who did not. The results suggest that the serum levels of either C-reactive protein or alpha-l antichymotrypsin could be used both as an aid to diagnosis of sepsis and also to monitor the effect of therapy.

Topics: Adult; Aged; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Blood Proteins; Burns; C-Reactive Protein; Chymotrypsin; Female; Haptoglobins; Humans; Immunoglobulins; Lipoproteins, HDL; Male; Middle Aged; Orosomucoid; Sepsis; Serum Albumin; Transferrin

Topics: Adolescent; Adult; Aged; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Blood Proteins; Burns; Chymotrypsin; Female; Glucagon; Humans; Hydrocortisone; Male; Middle Aged; Serum Albumin; Time Factors; Transferrin

Protease-S was extracted from thermally injured rat skin, and partially purified by column chromatography using Sephadex G-50, CM-Sephadex (A-50), Sephadex G-75 gel filtration. The optimum pH of this enzyme was 8.6--8.8, and the molecular weight determined by Sephadex G-75 gel filtration was approximately 30 000. This enzyme is active on the N-acetyl-L-tyrosine ethyl ester, N-succinyl-L-phenylalanine-p-nitroanilide (of chymotrypsin substrate) but not N-tosyl-L-arginine methyl ester, N-benzoyl-L-arginine-p-nitroanilide. Also, protease-S was completely inhibited by diisopropylfluorophosphate (1 mM) or phenylmethylsulfonylfluoride (10 micrometer), and N-tosyl-L-phenylalanine chloromethylketone (1 mM). These results are very similar to those obtained with bovine chymotrypsin. But the enzyme is not identical with the chymotrypsin-like proteases in mast cells and leukocyte granules. When proteases-S was measured during the inflammatory reaction in vivo, maximal activity was found after 8 h, at the end of inflammation.

Topics: Animals; Burns; Chymotrypsin; Endopeptidases; Kinetics; Rats; Skin; Substrate Specificity

A procedure for adsorbing enzymes from the human burn wound onto solid sheets of substrate is described. Using this technique, low levels of enzyme activity with chymotrypsin-like specificity can be demonstrated in the wound approximately 2 weeks after injury. This activity disappears at about 5 weeks after the burn. The enzyme activity corresponds with the clinical experience for the time course of natural loss of the burn eschar. A trypsin-like enzyme of very low level activity is present in the wound. No collagenase was detected in the human burn wound. Preliminary evidence shows an additional leucine-specific enzyme in the human burn wound. A more detailed analysis of enzymes in the human burn wound should permit the development of a useful artificial debriding agent. Presently these preparations must be used with caution.

Topics: Adolescent; Bandages; Burns; Child; Chymotrypsin; Debridement; Granulation Tissue; Humans; Microbial Collagenase; Peptide Hydrolases; Skin; Time Factors; Trypsin; Wound Healing

Topics: Adolescent; alpha 1-Antitrypsin; Alpha-Globulins; Blood Proteins; Burns; C-Reactive Protein; Calcium; Child; Child, Preschool; Chymotrypsin; Complement Inactivator Proteins; Complement System Proteins; Humans; Infant; Infant, Newborn; Macroglobulins; Phagocytosis; Protease Inhibitors; Protein Binding; Trypsin Inhibitors

Topics: Anti-Bacterial Agents; Arteriosclerosis; Burns; Chymotrypsin; Debridement; Deoxyribonucleases; Endarteritis; Enzyme Therapy; Female; Humans; Male; Nervous System Diseases; Skin Transplantation; Streptodornase and Streptokinase; Streptokinase; Transplantation, Autologous; Trypsin; Ulcer; Varicose Ulcer; Veins; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Ambulatory Care; Burns; Carbuncle; Chymotrypsin; Female; Furunculosis; Humans; Leg Ulcer; Male; Middle Aged; Minor Surgical Procedures; Paronychia; Peptide Hydrolases; Wound Infection

Topics: Adult; Animals; Burns; Chymotrypsin; Contusions; Edema; Fracture Fixation; Fractures, Bone; Hemarthrosis; Hematoma; Humans; Joint Dislocations; Methocarbamol; Phenylbutazone; Rats; Skin Transplantation; Wound Healing; Wounds and Injuries

Topics: Burns; Chymotrypsin; Drug Combinations; Hematologic Tests; Humans; Trypsin

Topics: Burns; Chymotrypsin; Drug Combinations; Hematologic Tests; Trypsin

Topics: Anti-Inflammatory Agents; Arthritis; Body Temperature; Burns; Chymotrypsin; Infrared Rays; Oxyphenbutazone; Photography; Skin; Sprains and Strains; Thermography; Wound Healing; Wounds and Injuries

Topics: Burns; Chymotrypsin; Drug Therapy; Foot Diseases; Gangrene; Humans; Leg Ulcer; Pressure Ulcer; Trypsin

Topics: Burns; Chymotrypsin; Hematologic Tests

Topics: Alkalies; Blood Transfusion; Burns; Burns, Chemical; Burns, Inhalation; Chymotrypsin; Debridement; First Aid; Humans; Oxygen; Plasma Substitutes; Skin Transplantation

Topics: Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Blood Platelets; Burns; Chymotrypsin; Coagulants; Drug Combinations; Ethyl Biscoumacetate; Fibrinogen; Humans; Orthopedics; Thrombelastography; Trypsin

Topics: Blood Coagulation; Blood Platelets; Burns; Chymotrypsin; Coagulants; Drug Combinations; Fibrinogen; Hemostatics; Humans; Pharmacology; Thrombelastography; Trypsin