[Effect of acute aprotinin (Gordox) therapy on hemostasis in heart surgery patients, with special reference to hyperfibrinolysis]

Authors have studied the effect of Gordox-therapy on haemostasis after open heart surgery in a prospective clinical trial. Thirty seven patients (pts) undergoing cardiac surgery due to their valve disease were randomly assigned either to control-group (20 pts) or to Gordox-group (17 pts). The patients in the Gordox group were given Gordox according the following scheme: 2 M IU within 20 min. after induction of anaesthesia followed by 0.5 M IU/hour infusion until the end of the operation. One M IU also was given into the oxygenator before starting the extracorporeal circulation. The postoperative chest tube drainage was less in Gordox-group (534 +/- 260 ml vs. 987 +/- 583 ml, p less than 0.005), and donor blood and fresh frozen plasma requirement was also lower in this group (534 +/- 633 ml vs. 935 +/- 718 ml p less than 0.05; 70 +/- 153 ml vs. 211 +/- 245 ml p less than 0.05, respectively). There was no significant difference between the two groups concerning the postoperative activated partial thromboplastin time, prothrombin time, thrombin time values. The authors could document significantly higher fibrinogen concentration and significantly lower fibrinolytic activity postoperatively in the Gordox-group (p less than 0.05). Gordox therapy has advantageous effect on haemostasis after open heart surgery which can be documented both by clinical and laboratory examination.

Role of gastric juice in feedback regulation of rat pancreatic secretion by luminal proteases

The role of gastric juice in the intestine on the pancreatic secretory response to intraduodenal infusion of trypsin inhibitors or to diversion of bile and pancreatic juice from the intestine was studied in conscious rats with pylorus ligation and gastric juice drainage. In absence of gastric juice in the intestine, diversion of bile and pancreatic juice from the intestine stimulated pancreatic secretion, but the incremental protein and fluid secretory responses to diversion of bile and pancreatic juice were increased approximately 2.9-fold and 2.5-fold, respectively, by intraduodenal infusion of HCl (60 microEq/h). Intraduodenal infusion of HCl (240 microEq/h) had no effect on the pancreatic secretory response to infusion of lima bean trypsin inhibitor (20 mg). These results support the hypothesis that the inhibitory effect of atropine on the pancreatic secretory response to diversion of pancreatic juice or bile and pancreatic juice is secondary to inhibition of gastric acid secretion. The lack of effect of HCl on the pancreatic response to trypsin inhibitor contradicts the hypothesis that acid in the intestine is important or necessary for the feedback response to loss of intraluminal protease activity. It is proposed that acid in the intestine augments the pancreatic response to diversion of pancreatic juice or bile and pancreatic juice by reducing intraluminal pH and thereby inactivating residual pancreatic proteases.

[Usefulness of a protease inhibitor (urinastatin) in ARDS with infectious diseases]

The usefulness of urinastatin (UST) for adult respiratory distress syndrome (ARDS) induced by gram-negative sepsis was evaluated in clinical and experimental studies. Twelve cases of clinical septic ARDS were treated with combination therapy of UST and methylprednisolone (M-PSL). Ten out of 12 responded favorably. This result was considered to some extent to be better than that of our previous experience with single administration of M-PSL for patients with septic ARDS. Pathophysiologic experiments on UST in endotoxic status were then performed. Immediately after the intravenous administration of endotoxin to rats, serum levels of beta-glucuronidase and elastase released from PMNs were increased and pulmonary edema was observed at 48-hours after the endotoxin injection. Various degrees of pulmonary edema were also observed by the intravenous administration of beta-glucuronidase and PMNs-elastase. These changes induced by the endotoxin were significantly inhibited by the intraperitoneal administration of UST, and they were inhibited more by the combination therapy of UST and M-PSL. In an in vitro study, significantly large amounts of beta-glucuronidase and elastase were released from PMNs by incubating human PMNs with endotoxin. By adding UST to this system, the release of these PMNs proteases was inhibited. These results suggested that UST neutralizes the PMNs-elastase release in the status endotoxemics, and consequently resulted in a better prognosis in cases of septic ARDS.

Suppression of dimethylhydrazine-induced carcinogenesis in mice by dietary addition of the Bowman-Birk protease inhibitor

In the present study the effect of feeding the soybean-derived Bowman-Birk protease inhibitor (BBI) on dimethylhydrazine (DHM)-induced gastrointestinal tract and liver carcinogenesis in mice was examined. In this investigation we found the addition of 0.5 or 0.1% semipurified BBI or 0.1% purified BBI to the diet of DMH-treated mice resulted in a statistically significant suppression of angiosarcomas and nodular hyperplasia of the liver and adenomatous tumors of the gastrointestinal tract. Autoclaved BBI or BBI which had its trypsin inhibitory domain specifically inactivated was found to be ineffective in suppressing the induction of these liver and gastrointestinal tract lesions. The results of this study also indicate that BBI, included as 0.5% of the diet or less, has the ability to suppress carcinogenesis with no observed adverse effects on the health of the mice.

[The effect of open heart surgery and an operation on thoracic aneurysm on organs and the prevention of an organ system failure: comparison between the group using ulinastatin and not using group]

We studied the effect of the open heart surgery and the thoracic aortic aneurysm surgery on renal, liver and respiratory function and the coagulofibrinolytic system. We also investigated as to whether ulinastatin was effective or not with regard to preventing an organ system failure. The renal function, liver function and the coagulofibrinolytic system were preserved, although there was a greater number of severe cases in the group which used ulinastatin (US group) than in the group that did not use ulinastatin (non-US group). In the US group, PaO2 did not decrease postoperatively. However, in the non-US group, PaO2 decreased significantly after the operation. The variables in relation to using ulinastatin, examined by a stepwise method, included kind of disease, emergency operation, PaO2, BUN and serum plasminogen. The multiple coefficient for these five variables was 0.623 (p less than 0.01) and the contribution was 38.8%. It was suggested that ulinastatin could prevent an organ system failure, especially respiratory failure, after open heart surgery and the thoracic aortic aneurysm surgery.

[Treatment of patients with gonarthrosis by intra-articular administration of drugs]

The effectiveness of intra-articular administration of kenalog, hydrocortisone, gordox and polyvinylpyrrolidone to patients with gonarthrosis and concurrent synovitis was studied. Kenalog and hydrocortisone were more effective than placebo, while gordox, polyvinylpyrrolidone and placebo had similar effect. Kenalog and hydrocortisone had nearly the same favourable effect in synovitis. Only one patient treated with gordox had side effects. Signs of synovitis were analysed and its most typical symptoms specified.

[Kallikrein-protease inhibitors (contrical, gordox) in the complex treatment of myocardial infarction]

One hundred and forty-nine of 199 patients with myocardial infarction (MI) were treated with varying doses of kallikrein-protease inhibitors (KPI), contrical or gordox, for 4 to 5 days as part of combined treatment. KPI added to combined treatment at early dates of MI contributed significantly to the elimination or abatement of some syndromes and complications (pain syndrome, acute circulatory insufficiency, abdominal syndromes, resorption-necrotic syndrome, etc.), improvement of the re-adaptation potential, and early recovery of myocardial metabolism, as evidenced by serial measurements of enzymemia and myoglobinemia, ECG monitoring from 12 leads, and cardiotopography from 35 leads, limiting the necrosis area and the ultimate size of myocardial damage. KPI treatment in the given doses produced no side effects.

Studies on dressings for treatment of mucous membranes of oral cavity. Part 2: Influence of hydrophilizing substances on properties of hydrogel dressings comprising Kunitz protease inhibitor

Resistance of the dressings against washing out depends upon concentrations of methylcellulose or sodium salt of carboxymethylcellulose, and upon concentrations of glycerol, 1,2-propylene glycol and polyoxyethylene glycol 400. For the determined group of dressings the ratio of washing out times in 0.9% sodium chloride solution to washing out times in distilled water remains constant. A similar relation has been observed for washing out times of the dressings in vivo compared to those in vitro in 0.9% solution of sodium chloride. The pharmaceutical availability of the Kunitz type protease inhibitor depends upon composition of the gel forming and hydrophylizing substances in the dressings. The rheological characteristics of the dressings comprise a flow limit and thixotropic properties. The initial clinical examinations proved that the dressings alleviated symptoms of paradontopathy.

Studies on dressings for mucosa of oral cavity. Part 1: Influence of hydrophilizing substances on xerogel properties of dressings comprising Kunitz protease inhibitor

2% methylcellulose gel solutions containing Kunitz protease inhibitor and increasing concentrations of glycerol or 1,2-propylene glycol were spread on semipermeable membrane. After evaporation of water from the gel solutions, dressings consisting of 1 or 2 mg of methylcellulose have been prepared. In these dressings, the ratio of hydrophilizing agent to methylcellulose ranged from 0.5:1 to 8:1. The thickness of the dressings is proportional to methylcellulose and hydrophilizing substance concentration/cm2 surface area. Water diffusion rates fo the dressings are similar and concentrations of hydrophilizing agent per surface unit area have not significant influence on the process. Kunitz protease inhibitor is liberated in two stages and follows first order reaction kinetics in dependence upon the hydrophilizing agent used. With the dressings, containing 100 micrograms inhibitor/cm2, peridontosis was treated within 2 weeks without any irritating effects on gingival mucosa.

Suppression of experimental autoimmune encephalomyelitis by the oral administration of myelin basic protein

The oral administration of myelin basic protein (MBP) to Lewis rats prior to an encephalitogenic challenge resulted in total inhibition or a significant delay in the onset of experimental autoimmune encephalomyelitis (EAE). In vitro lymphocyte proliferative responses to MBP were significantly decreased in MBP-fed rats when compared with vehicle-fed controls. Suppression of EAE and in vitro proliferative responses to MBP were observed to be antigen specific, since oral feeding of a control protein exerted no suppressive effect. Moreover, the specificity of MBP-induced oral tolerance was shown to be species specific, since feeding guinea pig MBP (GPMBP) or human MBP (HuMBP) induced protection only against a GPMBP or HuMBP challenge, respectively. Conversely, Lewis rats could not be orally tolerized to the self antigen rat MBP.

The effect of fasting on enzyme levels in the enlarged and involuting rat pancreas

1. The effect on pancreatic digestive enzyme levels of fasting and changes from a diet containing trypsin inhibitor (raw soya-bean flour, RSF) to diets free of trypsin inhibitor (heated soya-bean flour, HSF, or commercial rat chow) was studied in rats for up to 7 d. 2. In RSF-fed rats killed without fasting, enzyme levels were low, but after fasting for 24 h before killing there was a marked increase in all enzyme levels. Histological studies showed that pancreatic acinar cells from RSF-fed rats killed without fasting were devoid of zymogen granules, but following a 24 h fast there was a marked accumulation of zymogen granules which extend into the basal cytoplasm. Fasting either produced no change or a fall in enzyme levels in rats fasted after feeding HSF or chow continuously. 3. If animals fed on RSF were changed to HSF and either fed or fasted for 24 h up to the time of killing there was an increase in amylase (EC 3.2.1.1), trypsin (EC 3.4.21.4), lipase (triacylglycerol lipase; EC 3.1.1.3) and protein 1 d after the change, followed by a fall over the next 6 d to levels similar to those seen in rats fed on HSF continuously. 4. Animals changed from RSF to chow showed similar effects as far as trypsin, lipase and protein were concerned, but amylase rose, to reach the level seen in rats fed on chow continuously (about ten times that seen in soya-bean-fed rats), after 2 d. 5. These results suggest that in the rats fed on RSF, pancreatic enzyme synthesis is rapid but secretion is equally rapid and intracellular enzyme levels are low. When these animals are fasted or changed to a diet free of trypsin inhibitor the rate of secretion falls but the high rate of synthesis continues for at least 24 h and enzymes accumulate in the pancreas. In studies of pancreatic enzyme levels in rats fed on trypsin inhibitor the extent of fasting before killing the animal is therefore an important variable. Such animals should probably not be fasted before study.

[Effect of soybean trypsin inhibitor and chicken ovomucoid on the immunogenic and sensitizing properties of various dietary proteins]

Adult male guinea pigs were sensitized by intragastric administration of bovine serum albumin (BSA) and chick ovalbumin (OA) and their mixtures with soybean Kunitz trypsin inhibitor (SBTI) and chick ovomucoid (OM). Sensitization of the animals was evaluated by the anaphylactic shock reaction and also by the levels of serum specific IgG antibodies against BSA and OA as measured in the solid phase radioimmunoassay. The experiment revealed pronounced desensitizing properties of SBTI combined both with OA and BSA. OM produced no effect on the animal sensitization caused by OA and enhanced the BSA-induced sensitization. The results obtained demonstrate the necessity of differential approach to the evaluation of the action of varying trypsin inhibitors on food sensitization.

31P-NMR studies of energy metabolites in rat pancreas treated with trypsin inhibitor

The energy metabolites and the composition of rat pancreas treated with trypsin inhibitor (T.I.) were investigated. T.I. treatment significantly induced the hypertrophy of pancreatic acinar cells and the increase in the amylase and sialic acid contents. However, when the pancreas was perfused by control solution or the solution containing acetylcholine (10(-7) M), the 31P-NMR spectra of energy metabolites in the pancreas treated with T.I. were similar to those of normal rats.

[Hyperthermic effect of a trypsin inhibitor in rats and rabbits]

The influence of intraventricular and intravenous administration of trypsin inhibitor (from soya-bean) on the body temperature was studied in experiments on unanesthetized rats and rabbits. It was established that the substance provoked a steady and prolonged hyperthermia in rats and rabbits, attenuated by pre-administration of sodium salicylate. Hyperthermia was accompanied by a significant decrease in the content of PGE2 in the hypothalamus. The results suggest than inhibition of certain trypsin-like serine proteases in thermoregulatory centres may be one of the factors responsible for the development of fever.

Partially purified white bean amylase inhibitor reduces starch digestion in vitro and inactivates intraduodenal amylase in humans

Whether commercial, bean-derived alpha-amylase inhibitor preparations failed to decrease starch digestion in humans because of insufficient antiamylase activity, destruction by gastrointestinal secretions, or decreased activity in the presence of starch is unknown. We used a simple partial purification procedure to markedly concentrate the inhibitor (sixfold to eightfold by total protein content, and 30-40-fold by dry weight). Compared with a commercial preparation and crude bean extract, this partially purified inhibitor inactivated intraduodenal, intraileal, and salivary amylase in vitro faster and more completely (p less than 0.001); its specific activity was not affected by exposure to gastric juice and was only minimally reduced by duodenal juice. Whereas the rate of amylase inhibition by inhibitor was markedly slowed in the presence of nondietary liquid starch, dietary solid starch had only a minimal effect. Consequently, the partially purified inhibitor had no effect on liquid starch digestion, but decreased in vitro digestion of dietary starch in a dose-dependent manner (p less than 0.001). Perfusion of the partially purified inhibitor (2.0, 3.5, or 5.0 mg/ml at 5 ml/min) into the duodenum of humans rapidly inhibited greater than 94%, greater than 99%, or greater than 99.9% of intraluminal amylase activity. We conclude that commercial amylase inhibitors failed to decrease starch digestion in vivo mainly because they have insufficient antiamylase activity. However, a partially purified inhibitor with increased specific activity is stable in human gastrointestinal secretions, slows dietary starch digestion in vitro, rapidly inactivates amylase in the human intestinal lumen, and, at acceptable oral doses, may decrease intraluminal digestion of starch in humans. Such an inhibitor therefore deserves study.

Influence of several plant and animal proteins on rat pancreas

Twelve different plant and animal proteins were fed to rats for 4 weeks. Trypsin inhibitor (TI) content of the diet was significantly correlated with (although not directly related in all cases to) pancreas weights and with the pancreatic biochemical parameters that indicate hypertrophy. In vitro, but not in vivo, digestibility was correlated with the TI content of the diet. Quantity of DNA per gram pancreas was not found to be related to TI content. A second experiment compared graded levels of TI from raw or heated soy flour and soy protein isolate (SPI). The SPI diet produced higher relative pancreas weights per TIU than did the flour diets. Two commercial SPI's were fed as is or autoclaved in a third experiment. Autoclaving to very low TI values made no improvement in weight gain or pancreatic parameters measured, indicating that there may be a threshold level of TI below which rat pancreata do not respond, and that other factors in SPI are responsible for the slight pancreatic enlargement seen with SPI compared to casein.

Effects on the monkey, pig and rat pancreas of soy products with varying levels of trypsin inhibitor and comparison with the administration of cholecystokinin

Raw and heated soy flour and casein diets were compared in rats, pigs, and monkeys with respect to growth, pancreatic changes, fecal trypsin, and nitrogen digestibility. Cholecystokinin injection was compared to feeding raw soy flour and casein in rats and casein in pigs. Several soy protein preparations were fed to rats and monkeys. Neither raw soy flour nor any other soy product produced pancreatic enlargement in pigs or monkeys. Casein and heated soy flour performed similarly. By comparison, other effects of raw soy flour were as follows. Growth was depressed 60% in rats and 84% in pigs, but not at all in monkeys. Nitrogen digestibility was depressed 5, 45, and 9% in rats, pigs, and monkeys, respectively. Pancreatic DNA, RNA, and protein levels were unchanged in monkeys fed raw soy flour. In rats, RNA per milligram pancreas was increased 40%, in pigs 20%. Pancreatic protein was decreased 7% in pigs and increased 47% in rats. Changes in pancreatic trypsin, chymotrypsin, lipase, and amylase were dissimilar in the three species. Fecal trypsin was elevated 300-400% in rats, and decreased approximately 50% in pigs and monkeys. Cholecystokinin injections in pigs and rats produced changes both quantitatively and qualitatively different from those seen with raw soy flour. Feeding of heated soy flour or soy protein isolates was comparable to feeding casein in all three species, and produced no deleterious effects.

[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.

[Complex treatment of pancreatic necrosis]

The experience in the treatment of 1800 patients with acute pancreatitis is described. Destructive forms were found in 36% of cases during the last five years. The main methods of treatment and the mortality rate following the methods used are analyzed. The authors believe cytostaticotherapy with the infusion of 5-phthoruracil into the celiac artery and forced diuresis with the infusion of fluids into the celiac artery to be the most perspective methods. The use of the above methods decreased the lethality in destructive forms to 8,3%. The intraaretrial infusion of 5-phthoruracil with antibiotics allowed coping processes of the pancreatic tissue autolysis and avoiding broad sequestration and severe suppurative complications of pancreatitis.

Myelin basic protein treatment of experimental allergic encephalomyelitis in monkeys

Treatment of experimental allergic encephalomyelitis (EAE) in two strains of monkeys with large amounts of myelin basic basic protein (BP) fails unless an adjunct is also used. In both strains the adjunct by itself is more effective than BP by itself, but in the one strain which could be investigated sufficiently, the combination can be made almost totally effective in reversing EAE. The adjunct varies with the strain of monkey, an antibiotic in Macaca mulatta and a steroid in Macaca fascicularis. Similar adjunctive treatments should be considered in the management of multiple sclerosis, for EAE remains one of the best studied models.

Effects of oral administration of trypsin inhibitor and repeated injections of pancreozymin on the insulin and glucagon contents of rat pancreas

Rats were given soybean trypsin inhibitor or repeatedly injected with pancreozymin (daily 40 I.D.U./kg) for 7 days, and the insulin and glucagon contents of the pancreas were measured. The insulin and glucagon contents were markedly increased after these treatments and this effect was especially conspicuous after injections of large doses (daily 120 I.D.U.) of depot-type pancreozymin. Insulin content thus reached 1.9 times, and glucagon content 2.4 times as much in control values. This result is compatible with our previous histological finding that not only the exocrine pancreas but also islet cells undergo the trophic effect of endogenous and exogenous pancreozymin.