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Chymopapain, chemonucleolysis, and nucleus pulposus regeneration
The Journal of Bone and Joint Surgery. American Volume
|December 1, 1983
Summary
Chymopapain injection causes temporary intervertebral disc damage but the nucleus pulposus can regenerate proteoglycans. Full disc height and normal histology are restored within six months, showing a reversible effect.
Area of Science:
- Biochemistry
- Histology
- Regenerative Medicine
Background:
- Intervertebral disc degeneration is a significant health concern.
- Chymopapain is an enzyme used in chemonucleolysis for disc herniation.
Purpose of the Study:
- To investigate the effects of chymopapain on intervertebral disc structure and proteoglycan content.
- To determine the reversibility of chymopapain-induced changes in the intervertebral disc.
Main Methods:
- In vivo injection of chymopapain into the intervertebral disc of adult mongrel dogs.
- Assessment of disc-space narrowing and proteoglycan loss using safranin-O staining.
- Evaluation of proteoglycan synthesis and degradation via [35S]sulphate-labeling.
- Histological and biochemical analysis at two weeks, three months, and six months post-injection.
Main Results:
- Chymopapain induced rapid disc-space narrowing and complete proteoglycan loss.
- The nucleus pulposus retained the ability to synthesize proteoglycans, but degradation occurred.
- Disc height and proteoglycan content were restored by three months.
- Normal histology and proteoglycan composition were observed by six months.
Conclusions:
- Chymopapain causes profound but reversible damage to the intervertebral disc.
- Radiographic disc narrowing correlates with proteoglycan loss.
- Intervertebral disc regeneration with normal proteoglycans explains the restoration of disc height.
- Chemonucleolysis with chymopapain is less likely to cause permanent biochemical alterations than surgical excision.