From Big Medical Encyclopedia

ENZIMOTERAPYYa (.enzy + the-rapeia treatment) — use of enzymes of an animal, bacterial or plant origin with the medical purpose.

The means containing enzymes (see) long since used in traditional medicine. It is known that for treatment of injuries of skin the Don Cossacks powdered wounds with powder of the pounded stomach of chicken, and inhabitants of the Antilles islands with the same purpose, and also applied papain (enzyme of a plant origin) to data of freckles. Implementation of fermental drugs in modern a wedge, practice was promoted by development of technology of receiving the drugs enriched with enzymes and the purified enzymes, in particular the way of receiving a natural gastric juice offered by I. P. Pavlov (see).

From the means used in E., most often apply the proteolytic enzymes (see Peptid-gid-rolazy) received from a pancreas and a mucous membrane of a stomach of mammals. They are used for the purpose of replacement therapy at insufficiency of vneshnesekretorny function of digestive glands. So, at giposek-retorny gastritises, akhiliya appoint inside a natural gastric juice, drugs of pepsin (see), abomin (see), at the digestive disturbances connected with hron. pancreatitis (see), hepatitis (see), a coloenteritis (see Enteritis), after abdominal organs operations — Pancreatinum (see), festal, panzinorm, digestal, etc.

E. it is widely applied in treatment of inflammatory and necrotic processes. Most often use trypsin (see), chymotrypsin (see), chemical opsin (see), Terrilytinum, gigro-litin. These drugs catalyze splitting of the denatured protein of necrotic sites without noticeable impact on surrounding fabrics, reduce resistance of microorganisms to antibiotics, promote an inactivation of the penicillinase (see) developed by nek-ry species of bacteria create conditions for self-cleaning of the center of an inflammation and acceleration of reparative processes. For achievement of non-political effect at treatment of purulent wounds of soft tissues (see Wounds, wounds), burns (see), decubituses (see), trophic ulcers (see) proteolytic enzymes apply locally; the patient with an empyema of a pleura (see Pleurisy) or abscess of a lung (see Lungs) trypsin or chymotrypsin enter vnutriplevralno or into an abscess cavity. At the heavy course of exudative pleurisy timely begun therapy by proteolytic enzymes prevents formation of commissures and massive fibrous unions. The patient with hron. inflammatory respiratory diseases for the purpose of fluidifying and simplification an otkhozhde-niya of a viscous phlegm these drugs appoint sometimes as supportive applications in the form of aerosols or enter intrabronkhialno (during a bronkhoskopiya) or into a trachea (via the endotracheal probe). Intramuscular administration of trypsin and chymotrypsin is applied in surgical clinic, napr, at osteomyelitis (see) and thrombophlebitises (see), in otorhinolaryngology — at chronic antritis (see), otitis (see), peritonsillar abscess (see Quinsy), in stomatology — at periodontosis (see), aphthous stomatitis (see), a desquamative glossitis (see) etc.

Soluble drugs of proteolytic enzymes are quickly inactivated by the inhibitors which are contained in blood and fabrics that reduces them to lay down. action; besides, they have the local irritating and painful action, and also can cause adverse (most often allergic) reactions. These shortcomings the immobilized enzymes — the enzymatic drugs connected to a polymeric matrix or included in liposomes are deprived. So, profezy (bacterial peptide-gidro of a manhole, immobilized on a polymeric matrix by covalent «stitching» of enzyme and polymer), applied at purulent processes, has the prolonged medical effect since the denatured protein is capable to hydrolyze continuously over 10 days, keeping up to 90% of initial activity after this term.

To peptide-gidro to manholes with narrow substrate specificity drugs of kallikrein — an andeka-lean belong (see the Pancreas, drugs), dilminat, hydrolyzing only kininogen with formation of bradikinin and other vasoactive polypeptides and having at intramuscular introduction spasmolytic and hypotensive effect. They are applied to treatment of a syndrome of Reynaud (see Reynaud a disease) and an obliterating endarteritis (see. Obliterating defeats of vessels of extremities). Preferential impact on collagenic fibers is made by the collagenase (see) applied locally at trophic ulcers, burns and freezing injuries (see). It stimulates an angenesis due to the accelerated rejection of strup and clarification of a wound with more bystry development of granulations, reduction of a wound surface and emergence of regional epithelization.

The special place in a wedge, practice occupy enzyme fibrinolysin (see) and plasminogen activators (an urokinase, Streptokinasa and Streptodecasum, i.e. Streptokinasa immobilized on a water-soluble polisakharidny matrix) — the enzymatic drugs used for pathogenetic treatment of thromboses (see Thrombosis) and thromboembolisms (see).

Hydrolytic decomposition of inter-nucleotide bonds is catalyzed by nucleases (see) — ribonuclease and deoxyribonuclease. The antiinflammatory effect of these drugs is caused by reduction of viscosity of pus or slime, improvement of a drainage of the inflammatory center both easier and bystry removal from it patol. secret. Indications to use and ways of introduction of nucleases and proteolytic enzymes at various purulent processes are identical. The combination of trypsin or chymotrypsin to ribonuclease does not change activity of the last, but accelerates permission patol. process. As ribonuclease slows down development of the viruses containing RNA (in particular, a virus of a tick-borne encephalitis), and a deoxyribonuclease — the viruses containing DNA (e.g., adenoviruses, an influenza virus etc.), these drugs are appointed also at the corresponding diseases.

Drugs of hyaluronidase — a lidaz, a ronidaz (see an iala of a ronidaz, drugs) and a lysozyme belong to the enzymatic pharmaceuticals catalyzing hydrolytic decomposition of complex polysaccharides (see). Solution of a lidaza is applied to a softening of hems, more bystry rassasyvaniye of hematomas, by increases in mobility of joints at their contracture. Subcutaneously or method of an electrophoresis in combination with anti-inflammatory drugs it is reasonable to appoint introduction of a lidaza to a number of patients at traumatic neuritis (see) and sclerodermas (see). Whether in nek-ry cases - Dazu is used for acceleration of a resorption of the medicinal substances entered subcutaneously or intramusculary. Ronidaza is appointed only outwardly for the purpose of elimination of postburn or postoperative hems, at it is long not healing wounds, extensive hematomas of soft tissues, a contracture and rigidity of joints, in initial stages of a palmar fibromatosis (see Dyupyuitren a contracture). The lysozyme possessing the expressed bacterolytic action is applied locally or entered intramusculary at various inflammatory processes caused first of all by gram-positive microorganisms. For a rassasyvaniye of exudates and connecting fabric in orthopedic and ophthalmologic practice use lecozimum containing proteolytic enzyme papain. For the purpose of improvement of oxidizing and power processes in fabrics at a number of diseases use the drugs containing cytochrome C.

Scope of enzymotherapy extends due to production of special enzymatic drugs. Attempts of use of the immobilized enzymes at organ transplantation are made and at such hereditary pathology as a disease to Gosha (see Gosha a disease) and a disease to the Pomp (see Glikogenozi). In onkol. to practice apply asparaginase — the enzyme catalyzing splitting of the exogenous asparagine necessary for development of tumor cells (see L - Asparagine - for). At the heavy allergic reactions caused by drugs of group of penicillin intramusculary enter enzyme of the bacterial nature — a penicillinase.

Modern enzymotherapy is adjoined by use with to lay down. purpose of inhibitors of enzymes and coenzymes. From the drugs having anti-fermental activity, the basic a wedge matter: inhibitors of proteolysis — a kontrik of l, or Trasylolum (see), Gordoxum, pantripin (see), aminocaproic acid (see), Ambenum; antikholinesterazny means — physostigmine (see), prozerin (see), etc.; inhibitors of monoamine oxidase — Nialamidum (see), etc.; inhibitors of a karboangidraza — Diacarbum (see), inhibitors of xanthineoxide-zy — Allopyrinolum, anticoagulants (see).

Use of enzymes for treatment of diseases of an organ of sight. The first messages on use of enzymes in ophthalmology (at treatment of inflammatory and dystrophic diseases of a cornea of trypsin) appeared in the 40th. In 1958 chymotrypsin was applied to a zonulo-lysis (fusion of fibers of a tsin-new sheaf) at extraction of a cataract (see the Cataract). Further the number of the proteolytic enzymes applied in ophthalmology increased, and in a crust, time in addition to proteinases, proteolytic, use drugs of hyaluronidase, begin to apply the immobilized enzymes, and also activators and inhibitors of enzymes.

Indications to E. in ophthalmology the damages of an eye and the fabrics surrounding it which are followed by scarring are (cicatricial changes a century, a stenosis of slezootvodyashchy ways, etc.); inflammatory diseases of an eyeglobe — a keratitis (see), a uveitis (see), complicated by formation of commissures, and especially an iridocyclitis (see) with the organization of back synechias, formation of membrane structures in a vitreous (see); tapetoretinalny dystrophy (see); hemorrhages on Wednesdays and covers of an eyeglobe — a hyphema (see), a hemophthalmia (see), retinal hemorrhages, etc. At operative measures enzymes use for a lysis of a tsinnovy sheaf and the prevention of growth of an epithelium of the front capsule of a crystalline lens at extraction of a cataract, for improvement of passability of drainage system of an eye at primary glaucoma (see).

The choice of fermental drug for treatment of diseases of eyes is defined by specificity of their action, a stage of development patol. process and pharmacokinetics of fermental drugs.

From the main ways of administration of fermental drugs, in addition to intramuscular and intravenous, in ophthalmology use instillations of solutions in a conjunctival sac, a subconjunctiva lny, parabulbar and retrobulbar injections, intraocular injections (in an anterior chamber of an eye, in a vitreous), and also fermental physical therapy in the form of an electrophoresis, a fonoforez and a magnetophoresis.

Complications E. can be caused by the increased individual sensitivity to fermental drug and its adverse action at nek-ry combinations patol. processes (e.g., a vitreous hemorrhage and increase in intraocular pressure, a recurrent hemophthalmia against the background of a diabetic retinopathy, etc.). At instillation of enzymes in a conjunctival sac the allergic reaction which is shown an itch, reddening and a chemosis is possible. At administration of fermental drugs in a vitreous reaction of a ciliary body in the form of an easy pericorneal injection of an eyeglobe, adjournment of powdered precipitated calcium superphosphates on a back surface of a cornea, emergence of a phenomenon of Tyndall is, as a rule, noted (see Biomicroscopy of an eye). These side effects eliminate with purpose of antihistamines — Dimedrol (see), Suprastinum (see Chloropyraminum), instillation of midriatik, napr, Scopolaminum (see) and corticosteroids — a hydrocortisone (see), dexamethasone (see) etc.

See also Enzymes.

Bibliogrvolf M. and Ransber-g e r To. Treatment by enzymes, the lane with English, M., 1976, bibliogr.; Clinical pharmacology, under the editorship of V. V. Za-kusov, page 421, M., 1978; M and r d and -

sh e in S. R. Enzymes as medicines, Zhurn. Vsesoyuz. chemical about-va of D. I. Mendeleyev, t. 18, No. 2, page 137, 1973; Starkov G. L. and With and - in and N y x V. I. Fermentoterapiya in ophthalmology, Kemerovo, 1977; Chazov E. I., Gundorova R. A. and Romashchenko A. D. The immobilized Streptokinasa (Streptodecasum) in treatment of intraocular hemorrhages, Vestn. oftalm., No. 4, page 61, 1982;

Enzyme therapy in genetic diseases, ed. by R. J. Desnick, Baltimore, 1980; Urokinase: basic and clinical aspects, ed. by P. M. Man-nucci a. A. D’ Angelo, L. a. o., 1982.

V. D. Topolyansky; G. M. Laryukhina (oft.).,