Chymoral A-P (Chymotrypsin): Uses and Clinical Applications
Chymoral A-P is primarily used as a proteolytic enzyme with anti-inflammatory properties for various clinical conditions, though it has limited FDA-approved indications in the United States.
Primary Uses
- Chymoral A-P (chymotrypsin) is a topical preparation that helps relieve local itching and discomfort associated with hemorrhoids, temporarily shrinks hemorrhoidal tissue, and aids in protecting irritated anorectal areas 1
- It functions as both a vasoconstrictor and astringent when used topically 1
- In pancreatic enzyme replacement therapy, chymotrypsin is sometimes included as one of the proteolytic enzymes, though it is not the primary component compared to lipase, amylase, and trypsin 2
Anti-inflammatory Applications
- Chymotrypsin has demonstrated anti-inflammatory effects in burn patients by modulating cytokine levels, particularly IL-6 and IL-1β, which may help regulate the severity of the inflammatory phase 3
- High-dose chymotrypsin (0.2 mg/ml) has shown effectiveness in ameliorating clinical signs of experimental autoimmune encephalomyelitis by decreasing IL-17 and increasing IL-4 and FoxP3, suggesting dose-dependent anti-inflammatory effects 4
- In adjuvant-induced arthritis models, chymotrypsin attenuates joint damage by reducing the expression of inflammatory markers (MMP-1, TNF-α, IL-1β, IL-6) through the TLR4/NF-κB signaling pathway 5
- Chymotrypsin in combination with trypsin has shown anti-oxidant properties in burn injuries by decreasing lipid peroxidation products and increasing levels of enzymatic antioxidants 6
Diagnostic Applications
- In pancreatic function testing, chymotrypsin assays were historically used but have largely been replaced by fecal elastase testing due to elastase's greater stability and improved sensitivity 2
- Stool chymotrypsin assays were previously used to diagnose pancreatic insufficiency but are now considered less reliable than newer tests 2
Limitations and Considerations
- In lumbar disc prolapse treatment, Chymoral showed only marginally better results than placebo in a double-blind study, with significant improvement only in straight-leg raising and reduced analgesic requirements 7
- When used medically, papain and bromelain in conjunction with animal proteases like trypsin and chymotrypsin offer a spectrum of therapeutic effects including anti-edematous, anti-inflammatory, anti-thrombotic, and fibrinolytic actions 2
- Chymotrypsin can be identified in acinar cell lesions through immunohistochemical labeling, which is used to demonstrate pancreatic acinar differentiation 2
Monitoring and Precautions
- When using proteolytic enzymes like chymotrypsin for anti-inflammatory purposes, monitoring of inflammatory markers may be beneficial to assess treatment efficacy 3
- The anti-inflammatory effects appear to be dose-dependent, with higher concentrations potentially offering greater benefits 4
- In Adult-onset Still's disease, differences in levels of acute phase reactants (including chymotrypsin) have been reported between adult and pediatric forms of the disease 2
While Chymoral A-P has several potential applications based on its proteolytic and anti-inflammatory properties, its clinical use should be guided by the specific approved indications and available evidence for each condition.