[Enzymatic mechanism of otosclerosis. Action of NaF]

The authors present the conclusions they reached after more than four years of multiple correlations made from february 1976 to september 1980. 648 perilymph samples were selected from a total number of 811 samples taken during stapedectomies on otosclerotic patients. These multiple correlations were based on micro-dosages of three selected enzymes (trypsin-alpha 1 antitrypsin and alpha 2 macroglobulin, the fourth cathepsin B having not been found, even in perilymph pools) in each of the selected samples, and on their relationship with the cochlear deterioration expressed in dBs of B.C. decrease and in audiometric stages corrected with reference to the patients' age. This study leads to an enzymatic mechanism, based on the previously reported trypsin-alpha 1 antitrypsin balance, but in which alpha 2 macroglobulin appears to play as essential a role as that of alpha 1 A. This enzymatic mechanism explains NaF efficiency, due in fact to a double action, not only to direct trypsin inhibition, but also to an overall reduction in enzymatic levels in the perilymph of otosclerotic patients. The authors conclude by suggesting the possibility of future NaF replacement by proteinase inhibitors, either of microbial origin currently under study by Japanese researchers, or even of synthetic origin.