Trypsin Therapy in Pulmonary Diseases, 1955–1960

Abstract

The role of trypsin as a therapeutic modality for the treatment of inflammation and edema, to liquefy purulent debris and inspissated thick, viscid mucus, has been established.'@5 Clinical observations described6 to document the efficacy of buccally administered trypsin tablets, given in conjunction with intramuscular trypsin, for the rapid control of the signs and symptoms of respiratory infections. Liquefication of sputum and rapid dimunition of cough were observed3 in patients with acute and chronic bronchitis and bronchial asthma following the use of intramuscular trypsin. It has been reported'3 that treatment with intramuscular trypsin, given simultaneously with antibiotics, effected a clinical cure within a period varying from three to six weeks in cases of tuberculous lymphad enitis and bone tuberculosis (sternum and first rib). The author con cluded that trypsin, given simultaneously with antituberculosis drugs and antibiotics, appears to be the treatment of choice in tuberculosis lymphadenitis and secondary sinuses, or bone tuberculosis. After two months of combined treatment with trypsin and antituber culosis drugs and antibiotics, there was a complete resolution of the pul monary lesion in a patient with miliary tuberculosis and tuberculous meningitis. This result prompted the suggestion'4 that trypsin in sesame oil be considered as an adjunct to antituberculosis drugs and antibiotics in the management of miliary and meningeal tuberculosis. Our interest in the proteolytic enzymes was initiated in 1955. With passage of time, new pharmaceutical forms of crystalline trypsin were developed in an endeavor to promote patient cooperation. Our studies started with crystalline trypsin in sesame oil (Parenzyme). In 1957, we used buccal tablets of crystalline trypsin (Parenzyme B); in 1958-59, trypsin in aqueous solution (Parenzyme A) and finally in 1959 an enteric coated tablet of trypsin for oral administration (Orenzyme). We will present our experiences with the various available forms of trypsin along with our results in four groups of patients.