Kastenbauer E R, Hochgesand K, Hochstrasser K, Tappermann G
Laryngol Rhinol Otol (Stuttg). 1975 Jul;54(7):604-11.
Proteolytic enzymes such as pepsine or papaine are able to split IgG antibodies into large fragments in vitro. These immunoglobulin fragments (IgG, IgA, IgM) were now detected in vivo from the purulent secretions of cholesteatoma, chronic otitis media and radical mastoid cavities. During chronic otitis media the intact immunoglobulins are split due to the proteolytic activity of neutral proteinases. These fragments were qualitatively and quantitatively investigated by means of various immunological procedures. After the immunoelectrophoretic separation of the purulent middle-ear-secretions and after diffusion against anti-IgG-, anti-IgA- and anti-IgM- serum double precipitate lines could be observed especially in middle-ear-secretion with a bacterial flora of pseudomonas aeruginosa (pyocyanea) and of the proteus-providencia-group. This was the first proof of the presence of split products of the immunoglobulins. The exact demonstration of these split products could be carried out by gel-filtration and fractionation of the intact and split immunoglobulins. During chronic otitis media intact immunoglobulins are split by leucocytic and extracellular bacterial proteinases into fragments of different molecular weight. The most malignant extracellular proteinases with the greatest proteolytic activity against intact immunoglobulins are the bacterial proteinases of pseudomonas aeruginosa. These proteinases can not be inhibited by the other serum proteinaseinhibitors except for alpha-2-macroglobulin of the human blood serum. This inhibitor has a very high molecular weight so that we can not find it in a higher concentration in the middle-ear-secretion. We can liberate this inhibitor by injuring the blood vessels during a tympanoplasty. In this way we get an inhibitory effect against these proteinases and combined with an appropriate antibiotic therapy we can cure a chronic otitis media.
诸如胃蛋白酶或木瓜蛋白酶之类的蛋白水解酶在体外能够将IgG抗体裂解为大片段。现在在体内从胆脂瘤、慢性中耳炎和根治性乳突腔的脓性分泌物中检测到了这些免疫球蛋白片段（IgG、IgA、IgM）。在慢性中耳炎期间，完整的免疫球蛋白由于中性蛋白酶的蛋白水解活性而被裂解。通过各种免疫学方法对这些片段进行了定性和定量研究。在脓性中耳分泌物进行免疫电泳分离后，与抗IgG、抗IgA和抗IgM血清进行扩散后，尤其在具有铜绿假单胞菌（绿脓杆菌）和变形杆菌-普罗威登斯菌群的中耳分泌物中可以观察到双沉淀线。这是免疫球蛋白裂解产物存在的首个证据。这些裂解产物的确切证明可以通过对完整和裂解的免疫球蛋白进行凝胶过滤和分级分离来实现。在慢性中耳炎期间，完整的免疫球蛋白被白细胞和细胞外细菌蛋白酶裂解为不同分子量的片段。对完整免疫球蛋白具有最大蛋白水解活性的最具危害性的细胞外蛋白酶是铜绿假单胞菌的细菌蛋白酶。除了人血清中的α-2-巨球蛋白外，这些蛋白酶不能被其他血清蛋白酶抑制剂抑制。这种抑制剂分子量非常高，因此我们在中耳分泌物中无法发现其高浓度存在。我们可以在鼓室成形术中通过损伤血管来释放这种抑制剂。通过这种方式我们获得了针对这些蛋白酶的抑制作用，并且结合适当的抗生素治疗我们可以治愈慢性中耳炎。
