Therapeutic potential and clinical efficacy of acid-resistant fungal lipase in the treatment of pancreatic steatorrhoea due to cystic fibrosis.
We investigated the therapeutic potential of an acid-resistant fungal lipase prepared from Aspergillus niger. We first demonstrated in vitro that it had a wide pH optimum of 2.5-5.5 and was resistant to pepsin and trypsin. We gave the enzyme or matching placebo in random order by mouth with a fatty meal to 10 adult patients with pancreatic steatorrhoea due to cystic fibrosis (CF) and sampled gastric contents for the following 2 h. Mean acid-resistant lipase activity was 330 nmol/ml/min free fatty acid released on placebo, compared with 896 nmol/ml/min on fungal lipase (p = 0.006 for area under the curve). We compared this lipase's clinical efficacy with that of two conventional pancreatin microsphere formulations in an open randomised crossover fat-balance study in 10 similar patients. Each preparation was given for 2 weeks, and a fat-balance study, using a faecal recovery marker, was performed on the final 3 days; a period without treatment was also included. The fungal lipase had no effect on faecal wet weight or on the coefficient of fat absorption (59.0% vs. 52.3%; NS) in comparison with placebo. The established enteric-coated microsphere preparation (Creon) produced a significant reduction in faecal wet weight and improvement in coefficient of fat absorption (81.4% vs. 52.3%; p less than 0.01) in comparison with placebo. The newer microsphere preparation (Pancrex M) was also effective, but perhaps less so than Creon; there were no significant differences between the two preparations.(ABSTRACT TRUNCATED AT 250 WORDS)
Zentler-Munro
P L
PL
Department of Medicine, Raigmore Hospital, Inverness, Scotland, U.K.
Assoufi
B A
BA
Balasubramanian
K
K
Cornell
S
S
Benoliel
D
D
Northfield
T C
TC
Hodson
M E
ME
D000143:Acids; D000328:Adult; D001234:Aspergillus niger / Q000201:enzymology*; D002446:Celiac Disease / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D003550:Cystic Fibrosis / Q000150:complications*; D004041:Dietary Fats / Q000378:metabolism; D005656:Fungal Proteins / Q000627:therapeutic use*; D006801:Humans; D008049:Lipase / Q000627:therapeutic use*; D010182:Pancreatic Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism
D000143:Acids; D004041:Dietary Fats; D005656:Fungal Proteins; D008049:Lipase