Pulmonary alveolar proteinosis. Remission after therapy with trypsin and chymotrypsin

Review on the recent progress in the development of fluorescent probes targeting enzymes

Enzymes are very important for biological processes in a living being, performing similar or multiple tasks in and out of cells, tissues and other organisms at a particular location. The abnormal activity of particular enzyme usually caused serious diseases such as Alzheimer's disease, Parkinson's disease, cancers, diabetes, cardiovascular diseases, arthritis etc. Hence, nondestructive and real-time visualization for certain enzyme is very important for understanding the biological issues, as well as the drug administration and drug metabolism. Fluorescent cellular probe-based enzyme detectionin vitroandin vivohas become broad interest for human disease diagnostics and therapeutics. This review highlights the recent findings and designs of highly sensitive and selective fluorescent cellular probes targeting enzymes for quantitative analysis and bioimaging.

Perspective on chymotrypsin detection

Chymotrypsin is one of the most extensively known proteases participating in the pathogenesis of various diseases, which can be used in drug discovery and clinical diagnosis.

A non-peptide NIR fluorescent probe for detection of chymotrypsin and its imaging application

A novel non-peptide NIR fluorescent probe for the detection of chymotrypsin and its imaging application.

Therapy options in pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis is a rare condition characterized by the accumulation of lipoproteinaceous material within the airspaces, resulting in impaired gas transfer, and clinical manifestations ranging from asymptomatic to severe respiratory failure. To the best of the authors' knowledge, there are only a few conditions whose natural history has been so dramatically changed by the influence of advances in basic science, clinical medicine, and translational research in therapeutic approaches. Whole-lung lavage is the current standard of care and it plays a critical role as a modifier factor of the natural history of proteinosis. That notwithstanding, the identification of autoantibodies neutralizing granulocyte-macrophage colony-stimulating factor in serum and lung of patients affected by the form of proteinosis previously referred to as idiopathic, has opened the way to novel therapeutic options, such as supplementation of exogenous granulocyte-macrophage colony-stimulating factor, or strategies aimed at reducing the levels of the autoantibodies. The aim of this paper is to provide an updated review of the current therapeutic approach to proteinosis.

Bronchoalveolar lavage with trypsin in pulmonary alveolar proteinosis

Two cases of pulmonary alveolar proteinosis were treated with bronchoalveolar lavage (BAL) via a fibreoptic bronchoscope. Additional clinical improvement was seen when trypsin was added to the lavage fluid. Analysis of effluents in the BAL fluid showed marked reduction of protein constituents with clinical improvement after treatment with trypsin in the lavage. BAL with trypsin was well tolerated.

Pulmonary alveolar proteinosis: successful treatment with aerosolized trypsin

A 37 year old man with pulmonary alveolar proteinosis and severe pulmonary physiologic impairment was treated empirically for 12 months with continuous oxygen, intermittent positive pressure breathing and aerosolized saline solution, heparin and acetylcysteine. Because of progression of disease, he was treated with aerosolized trypsin in a dose of 100,000 U twice daily for six months. This treatment was associated with dramatic symptomatic, chest roentgenographic and pulmonary physiologic improvement that has lasted for two and a half years without remission. The absence of adverse effects of trypsin aerosol allowed its administration in the patient's home. It is suggested that the preferred initial therapy for symptomatic alveolar proteinosis is aerosolized trypsin.