Krempen J F, Minnig D I, Smith B S
Clin Orthop Relat Res. 1975 Jan-Feb(106):336-49. doi: 10.1097/00003086-197501000-00046.
Chymopapain degrades the nucleus pulposus portion of the intervertebral disk of rabbits. The degradation is not grossly visible until 15 days post-injection. Depolymerization of the chondromucoprotein and decreases in the ability of a disk to imbibe fluid, is, in effect, a "chemical decompression" of the nucleur pulposus. The enzyme must come into direct contact with the chondromucoprotein complex of the disk material, and to a significant extent also must reach the area of disk material adjacent to the herniated annulus. Rapid depolymerization of the chondromucoprotein complex on a biomechanical level, and "decompression" of disk material on a biomechanical level can be correlated with relief of pain in all types of disk herniation in human beings. A primary biochemical change in the disk material would lead to a secondary decrease in inflammation if the change led to a "decompression" of the chondromucoprotein. Since the primary effect of chymopapain is on the chondromucoprotein of the disk, beneficial results would not be expected if nerve root compression is due to bony impingement or scar tissue following previous surgery. Chymopapain did not seem to possess any anti-inflammatory properties when bone was used as an irritant under a nerve root. However, this was technically difficult to evaluate and the possibility that chymopapain may also interfere with a chemical mediator of pain or interfere directly with an inflammatory reaction secondary to root compression can not be excluded.
木瓜凝乳蛋白酶可降解兔椎间盘的髓核部分。直到注射后15天，这种降解才会明显显现。软骨粘蛋白的解聚以及椎间盘吸收液体能力的下降，实际上是髓核的一种“化学减压”。该酶必须与椎间盘物质的软骨粘蛋白复合物直接接触，并且在很大程度上还必须到达与突出的纤维环相邻的椎间盘物质区域。软骨粘蛋白复合物在生物力学水平上的快速解聚以及椎间盘物质在生物力学水平上的“减压”，与人类各种类型椎间盘突出症的疼痛缓解相关。如果椎间盘物质的主要生化变化导致软骨粘蛋白“减压”，则会导致炎症的继发性减轻。由于木瓜凝乳蛋白酶的主要作用是作用于椎间盘的软骨粘蛋白，因此如果神经根受压是由于先前手术引起的骨撞击或瘢痕组织，则预期不会有有益的结果。当将骨用作神经根下方的刺激物时，木瓜凝乳蛋白酶似乎不具有任何抗炎特性。然而，这在技术上很难评估，并且不能排除木瓜凝乳蛋白酶也可能干扰疼痛的化学介质或直接干扰神经根受压继发的炎症反应的可能性。
