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MORE ON WOBENZYME:::::::::::::talks more about the liver.....

Wobenzym in complex therapy of chronic liver diseases

A. M. Vasilenko, S. V. Svec

State Medical Academy in Dnepropetrovsk

II National Congress of Rheumatologists in the Ukraine, Kiev, 1997

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Current complex therapy of chronic liver diseases focuses on elimination =

of basic pathogenetic syndroms of the disease. Glucocorticoids (GC) are =

the most effective in the treatment of chronic autoimmune hepatitis =

(CAH) and active liver cirrhosis (LC) with a significant autoimmune =

process. They appear to be effective regulators of immune reaction which =

suppress antibody production. One of the undesirable side-effects of GC =

is formation of circulating middle size immune complexes (CIC) which =

intensify cytolytic syndrom ( 1, 2, 4). One of the main characteristics =

of CIC - pathogenesity - is mainly determined by the size of complexes. =

Pathogenesity is caused, among others factors, also by a quantitative =

relation between antigen and antibody. During overproduction of =

antibodies against any antigen or in the case of equivalent relation =

when antigen is fully or partially bound, large CIC are formed. Mild =

excess of antigen over appropriate antibody (ratio 3:2) leads to a =

formation of middle sized immune complexes. Insufficient antibody =

production causes a formation of low molecular weight complexes. =

Literature data (l, 2, 4) show that cytolysis is higher when middle size =

CIC prevail. Optimal conditions for middle size CIC formation arise in =

2nd - 3rd week of the treatment by big doses of GC. Wide use of GC is =

limited also by risk of possible side-effects: pathological changes in =

organs of digestive system and kidney, insufficient anti-inflammatory =

effect, impossible induction of remission of the disease. All above =

mentioned facts speak for a necessity to search for new methods to treat =

chronic liver diseases. Systemic enzyme therapy seems to be one of the =

prospective options.

In agreement with literature data (3, 5), therapeutical effect of =

polyenzymatic preparations steams from effect of enzymes on =

immunopathological mechanisms. They:

- increase cytotoxic activity of macrophages

- influence interleukins (induce cytokines and IL-1) - decrease =

activation of component

- remove immune complexes fixed in tissues

- prevent formation of new immune complexes in tissues=20

- help to decompose CIC

- lessen damage caused by complement=20

- induce fagocytosis

- influence autoimmune processes by effecting CD-4 lymphocyte system =

- lessen number of CIC bound to tissues through complement system

- increase border of T-leucocyte activation

Enzymes improve rheological properties of blood: curb an aggregation of =

erythrocytes and thrombocytes, decrease blood viscosity, and slightly =

increase fibrinolysis.

Polyenzymatic preparations decrease cholesterol and triglyceride level.

The aim of our investigation was to test the efficacy of preparation =

Wobenzym in the complex treatment of patients suffering from CAH and =

active LC with the 1st degree of hepatocellular insufficiency. Test =

group was compared to control group including patients treated according =

to traditional therapy. 56 patients with chronic liver diseases were =

observed: 34 patients with CAH and 22 patients with active LC. All =

patients showed cholestatic syndrom. Diagnosis was based on clinical and =

laboratory data, results of ultrasound examination and radioisotopic =

scanning. Viral infection was excluded serologically.

Observed patients were divided into two groups, each including 28 =

patients. First (control) group obtained basic therapy: Prednisolon in =

the middle zone (30 mg), Delagil, Ursosan, lipoic acid, vitamins A, E, K =

D2, detoxication therapy, protein preparations. Cytostatics were not =

administered. Second (test) group obtained the same preparations but the =

dose of Prednisolon consisted of 20 mg. Additionally, during 3rd-4th =

week they obtained Wobenzym (15-30 coated tablets per day). The Wobenzym =

dose was decreased to 15-20 coated tablets per day and the therapy was =

prolonged by 2 weeks. In some patients the Wobenzym therapy was =

prolonged up to 3 months.

The therapy efficacy was evaluated in each group based on subjective =

perceptions (degree of disease intensity, dispeptic, and =

astenovegetative syndrom), objective data (liver and spleen size, body =

weight, intensity of yellowish colour), dynamics of clinical and =

laboratory signs, sedimentation value, content of CIC, immunoglobulins, =

gammaglobulins, blood aminotransferases, billirubin and its fractions, =

alkaline phosphatase, albumin, coagulograms, dynamics of sonografic =

observations.

To ensure comparable results we selected uniform groups: 18 patients =

with CAH, 10 patients with active LC in the first group and 16 patients =

with CAH and 12 patients with active LC in the second group.

Analysis of clinical data during the treatment process offered following =

results. Patients treated by Wobenzym showed faster lowering of itching, =

intensity of yellowish colour, dispeptic signs, lessening of liver and =

spleen size, in a short time an edema-ascitic syndrom disappeared. =

Ultrasound examination proved a lessening of liver and spleen size, =

disappearance of ascites, fastening of blood flow in the vena porte =

(according to doppler examination data), lessening of a liver ultrasonic =

density

In all forms of chronic hepatitis and liver cirrhosis in the active =

phase a CIC concentration was significantly higher compared to normal =

condition (Figure 1 ).

Increased concentration of CIC in patients from this group was caused =

by, firstly - permanent formation of antigens during hepatocyte =

decomposition (assumed from intensity of cytolytic syndrom), secondly - =

high concentrations of immunoglobulins taking place in CIC formation. To =

determine a degree of pathogenic effect of CIC on liver tissue, CIC =

level was compared to signs of cytolytic syndrom. Sufficiently high =

correlation between CIC level and activity of transaminases was =

discovered. In the case of CAH, a correlation coefficient between CIC =

and ALT was 0.51 (p<0.05). In LC patients a correlation coefficient was =

0.39, p<0.05.

During 2nd-3rd week of treatment of patients suffering from CAH and LC =

(n=3D28) a strengthening of cytolytic syndrom was observed. We explain =

this by increase during 2nd-3rd week in middle size CIC which is able to =

fix component, pass through vessel wall into tissue, having damaging =

effect on cell. In patients treated by Wobenzym strengthening of =

cytolytic syndrom during 2nd-3rd week was not seen.

Laboratory data evaluation showed following differences: in patients =

suffering from CAH and LC which obtained Wobenzym as a part of complex =

therapy a faster dynamics of CIC, aminotransferases, immunoglobulins M =

and G, and gammaglobulins was observed (Figure 2 - 7).

This evidently speaks for a theory that enzymes prevent CIC formation, =

suppress production of autoantibodies, activate fagocytary activity, and =

more productive elimination of CIC from organism. Such immunomodulating =

effect of Wobenzym leads to the lowering of immunological inflammatory =

activity.

Patients treated with Wobenzym showed faster regression of intrahepatic =

cholestasis. Dynamics of lowering of billirubin and cholesterol level =

plays a significant role in duration of therapy course (Figure 9-10).

Signs of blood coagulation system and fibrinolysis in two groups of =

patients did not show significant differences. Before treatment PTI =

decreased 1.2 times, fibrinolytic activity increased 1.1 times, =

fibrinogen B was present. After Wobenzym treatment in the complex basic =

therapy an increased fibrinolytic activity in comparison to control =

group was not seen. In 35% of patients a normalization of fibrinolysis =

was observed. It can be explained by improved function of liver cells =

and better liver microcirculation.

Therapy including Wobenzym lead to a lowering of Prednisolon dosage to =

10 mg.

Patients treated with Wobenzym did not complain of any side-effects =

except very few cases of mild dispeptic dysfunctions.

Conclusions:=20

1 . Obtained experimental results suggest that Wobenzym appears to =

be an effective preparation in the treatment of patients suffering from =

CAH and active LC.

2. Wobenzym statistically significantly increased efficacy of basic =

treatment in correction of basic biochemical syndroms of CAH and LC - =

immunoinflammatory, cytolytic, cholestatic.

3. Wobenzym intensified neither hepatocellular insufficiency nor =

hepatodepresive syndrom in patients suffering from CAH and active LC in =

the first stage.

Figure 2 Figure 3=20

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Figure 4 Figure 5=20

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Figure 6 Figure 7=20

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Figure 8 Figure 9=20

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Figure 10 Figure 11=20

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Figure 12 =20

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Literature=20

1. Iachontova, O.I., Duranova, O.P.: Role of Immune Complexes in =

Chronic Liver Diseases and Their Dynamics in the Treatment Process. =

Therapeut. arch. - l992, t.64.N2 - pp 10-15.=20

2. Podymova, S.B.: Liver Diseases. - M.:Medicine, 1993 - pp 244.

3. Nouza, K.: Mechanisms of Systemic Enzyme Therapy / Systemic =

Enzyme Therapy: Examinations and Clinical Practice / Ed. Nouza, K., =

Masinovski, Z., Nouza, R. - Munich, Prague, 1994. pp 42-47.

4. Perederii, V.G., Zemskov, A.M. Immune Statute, Principals of Its =

Evaluation and Correction of Immunological Dysfunctions. - Kiev - 1995. =

- pp 221.

5. Systemic Enzyme Therapy / Ed. by Mazurova A.M., Lilia U.I. =

Sternina. - sb. Mobi Dik. 1995. - pp 160.

[Guest guest]

they sound great. I guess I will mention Wobenzyme then to Dr

Marinkovich if I see him. I'll add that to my list since he says not

to take them, except for pancreatin.

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