Transport of proteases across neonatal intestine and development of liver disease in infants with alpha-1 antitrypsin deficiency

The transport of macromolecules from the intestinal lumen into the systemic circulation is considerably greater in neonatal than in adult animals. Transport of both immunoglobin and non-immunoglobulin proteins is enhanced. It is postulated that luminal enzymes are also transported into the systemic circulation of the neonate and reach the liver. In the absence of protease inhibitors, such as occurs in alpha 1-antitrypsin (alpha 1-AT) deficiency, these intestinal enzymes may cause inflammation and, eventually, fibrosis of the liver. If this hypothesis is valid, treatment with trypsin inhibitors and elemental diets until the excessive macromolecular transport across the intestine ceases may help to prevent the liver disease associated with (alpha 1-AT) deficiency.

[Use of natural kallikrein-protease inhibitors (contrical and gordox) in the therapy of acute myocardial infarct]

The paper reports on the efficacy of the protease inhibitors Contrycal and Hordox in acute myocardial infarction. The authors observed 154 patients, of whom 50 constituted the control group. They used to watch the process in the myocardium with biochemical, radioimmune and electrocardiographic methods. It was established that Contrycal (Hordox) used in the combined therapy of acute myocardial infarction during the first hours of the disease is effective.

[Treatment of acute, experimental intestinal obstruction]

The effect of antienzyme drug hordox in the complex with antioxidant tocopherol acetate (vitamin E) upon the duration of life in rats with experimental strangulating ileus was studied. Animals given this drug were found to survive approximately 27 hours longer than those of the control group.

[Effect of a number of enzyme preparations on the course of experimental parotitis]

Increase in the weight of rat parotid glands, decrease in the protein concentration and the activity of alpha-amylase with simultaneous activation of the proteolytic enzymes (caseinolytic activity at pH 7.6, activity of cathepsins at pH 5.5) were observed in pyo-traumatic parotiditis. Local administration of the protease inhibitor (contrical) or intramuscular treatment with trypsin showed the positive medical effect--decrease of the gland weight, increase in the protein concentration and in the alpha-amylase activity together with lowering in the activity of proteinases. Intramuscular administration of antimicrobic enzymes (lysozyme, RNase, DNAase) did not affect the pyo-traumatic parotiditis. Application of proteolytic enzymes or their inhibitors is recommended for clinical treatment of parotidites.

Hemorrhage induced by intrauterine devices: control by local proteinase inhibition

The intrauterine application of proteinase inhibitors, tranexaminc acid and the pancreatic trypsin inhibitor (Trasylol), reduces or eliminates menorrhagia and intermenstrual bleeding (spotting) produced by an intrauterine device (IUD). A decrease in pain and vaginal (cervical) discharge is also frequently observed. A single application is usually sufficient, more than three never being required. The effect lasts for an average of three cycles. In addition to the clinical use of these agents for the treatment of uterine hemorrhage, the slow release of proteinase inhibitors from an IUD may well be useful in minimizing its side effects without interfering with its contraceptive activity.

[New aspects in the treatment of pneumonitis (author's transl)]

Two groups of patients suffering from pneumonitis received different treatments and were compared retrospectively. The first group (38 patients) was treated with heparin and aprotinin. The overall mortality was 50 percent; of the patients who were artifically ventilated 64 percent died. The second group (60 patients) was treated with heparin, fresh-frozen plasma, nicotinic acid, methylprednisolone, and alpha-receptor blocking agents. In this group the overall mortality was 26.5 percent and the mortality among the patients who were artificially ventilated was 33 percent. These results lead the authors to feel that the treatment of pneumonitis with aprotinin is no longer indicated.

[Lumbar retroperitoneal novocaine block, antibiotics and enzyme inhibitors in acute pancreatitis]

The possibility of infusing medical drugs in fascial sheaths of the pancreas was grounded anatomically. The blockade was used in 119 patients with acute pancreatitis. The authors recommend this blockade in complex with other therapeutic measures.

Oral trypsin-inhibitor-induced improvement of the exocrine and endocrine pancreatic functions in alloxan diabetic rats

Studies are presented dealing with the effect on the exocrine and endocrine pancreas of long-term oral trypsin inhibitor administration to alloxan diabetic rats. Three categories of rats were used: a) normal rats, b) alloxan diabetic rats, and c) alloxan diabetic rats treated with the trypsin inhibitor. 1. The concentration of amylase in both pancreas and intestinal contents were markedly decreased in alloxan diabetic rats as compared with normal rats, whereas the concentrations of lipase and trypsin(ogen) were practically unaffected by the diabetic state. 2. Trypsin inhibitor treatment of diabetic rats enhanced the concentrations of both amylase, trypsin(ogen), and lipase in pancreas and intestinal contents when compared with untreated diabetic controls. 3. Alloxan diabetic rats treated with trypsin inhibitor displayed an increased weight gain, increased pancreatic weight, and increased pancreatic protein concentration as compared with the untreated diabetic controls. 4. Alloxan diabetic rats treated for 3 or 5 weeks with the trypsin inhibitor were found to have decreased basal blood glucose levels and an increased plasma insulin: blood glucose ratio as compared to the untreated diabetic controls. 5. There was no apparent difference in the glucose elimination rate after I.V. glucose loads in diabetic rats given trypsin inhibitor and their diabetic controls. However, the insulin secretory response to the glucose stimulus was slightly improved in the trypsin inhibitor group. 6. Alloxan diabetic rats treated with trypsin inhibitor had an increased total pancreatic insulin content compared with their diabetic controls. It is concluded that long-term daily treatment with oral trypsin inhibitor in alloxan diabetic rats increased enzyme production and secretion in the exocrine pancreas, and produced an improvement of the diabetic condition of the animals. This improvement might partly be due to an increased pancreatic content and secretion of insulin.

Carbohydrate metabolism in normal and diabetic rats following long-term oral trypsin inhibitor administration

The effect of long-term oral trypsin inhibitor administration on blood glucose, plasma insulin, liver, and muscle glycogen and glucose utilization in vitro by peripheral tissues in normal and diabetic rats was studied. In normal rats the glycogen levels in liver and muscle were increased after 3 weeks of treatment. Glucose oxidation (14CO2-production) was augmented in muscle after 3 and 8 weeks and in liver after 3 weeks. An increased 14C-incorporation into glycogen from 14C-glucose and increased glycogen concentration after incubation were found in muscle after 3 weeks. In diabetic rats the basal blood glucose was decreased after 3 and 5 weeks of treatment, and the basal plasma insulin:blood glucose ratio increased after 5 weeks. The glycogen levels were increased after 3 and 5 weeks in liver. No effect on glucose oxidation (14CO2-production) in muscle was found. The 14C-incorporation into glycogen and the total glycogen content, however, was increased in muscle after both 3 and 5 weeks. Incubation of muscle tissue with serum from normal or diabetic rats treated with oral trypsin inhibitor for 3 and 5 weeks respectively had no apparent acute effects on the glucose metabolism. It is suggested that the observed action of oral trypsin inhibitors on glucose metabolism in peripheral tissues is mediated by one or more unknown gastrointestinal factor(s).

Antiinflammatory and antiproteolytic properties of naphthlthiosemicarbazides and cyclized oxadiazoles

Eight 1-(naphth-1-ylacetyl)-4-substituted thiosemicarbazides and eight 2-(naphth-1-ylmethyl)-5-arylamino-1,3,4-oxadiazoles were synthesized and evaluated for antiinflammatory and antiproteolytic properties. All thiosemicarbazides (100 mg/kg) provided 14-43% protection against carrageenin-induced edema in rats. Cyclization of thiosemicarbazides to oxadiazoles resulted in significant reduction in the antiinflammatory activity. Some of these thiosemicarbazides also possessed low antiinflammatory activity against cotton-pellet-induced granuloma formation and formaldehyde-induced arthritis in rats. Hydrocortisone and oxyphenbutazone, used as reference drugs, exhibited greater antiinflammatory activity. All compounds possessed antiproteolytic activity. The in vitro protection of trypsin-induced hydrolysis of bovine serum albumin, unlike antiinflammatory activity, was greater with oxadiazoles (30-90%) than the precursor thiosemicarbazides (4-50%) at a final concentration of 1 mM.

The effect of oral trypsin inhibitor on pancreatic damage in the rat

A study has been made of the influence of experimentally-induced pancreatic enlargement on pancreatic damage. Soybean trypsin inhibitor was fed to rats in doses sufficient to produce pancreatic enlargement. This agent was given both before and after the production of pancreatic necrosis by oral d,1-ethionine and before the induction of pancreatitis by ligation of the pancreatico-biliary duct. Generally there was no difference between the severity of pancreatic damage in rats fed trypsin inhibitor and in those on control diets. An exception was in rats given d,1-ethionine after treatment with soybean trypsin inhibitor. In these rats histology showed a less severe form of pancreatic necrosis.