The Effect of Proteolytic Enzyme Serratiopeptidase in the Treatment of Experimental Implant-Related Infection

Mecikoglu, Mete; Saygı, Baransel; Yıldırım, Yakup; Karadağ-Saygı, Evrim; Ramadan, Saleem Z.; Esemenli, Tanıl

doi:10.2106/00004623-200606000-00006

Cited by 17 publications

(13 citation statements)

References 21 publications

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“…Previous in vitro studies performed by our research group showed that serratiopeptidase, a bacterial protease commercially available as an oral anti-inflammatory drug, and favoring the penetration of antibiotics at infected sites, is able to significantly enhance the actrvity of several antibiotics against bacterial biofilms (18). Different in vivo trials also showed the ability of this enzyme to enhance therapeutic outcomes of antibiotic therapy in the treatment of different prosthetic infections (19)(20).…”

mentioning

confidence: 74%

“…In this complex context, basing on previous data obtained by our research group and showing that serratiopeptidase, a bacterial protease commercially available as an anti-inflammatory oral drug, is able to significantly enhance the activity of several antibiotics against bacterial biofilms (18) and to enhance therapeutic outcomes of antibiotic therapy in the treatment ofdifferent prosthetic infections (19,20), we decided to evaluate the effect of introducing serratiopeptidase in a combined protocol to treat PI (based on surgical debridement and administration of systemic antibiotics). The rationale of this combined treatment protocol relies in the additional capacity of serratiopeptidase to make residual bacterial biofilm that survived mechanical debridement of the implant surface, more susceptible to the action of the antibiotic (18) and in parallel to enhance the penetration of systemically administered antibiotics at the infected site (31).…”

Section: Discussionmentioning

confidence: 99%

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Clinical, Microbiological and Inflammatory Evidence of the Efficacy of Combination Therapy Including Serratiopeptidase in the Treatment of Periimplantitis

et al. 2012

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The first two authors contributed equally to this workThe present study was aimed to evaluate the effect of introducing administration of the proteolytic enzyme serratiopeptidase in the combined mechanical-antibiotic treatment of periimplantitis (PI). Two randomized groups of 64 adults with a diagnosis of PI were studied over a 6-month period. All patients were treated with a combined mechanical and antibiotic protocol for 15 days. The experimental group (EG) was administered antibiotic and serratiopeptidase, while the control group was administered antibiotic alone. To evaluate the effects of the two treatment protocols, clinical and radiographic indices, the concentration of IL-l p, IL-6 and TNF-a in the gingival crevicular fluid, the amount of total bacterial DNA and the presence of specific bacteria were assessed at baseline and at 6 months from treatment. Success rates of combined treatments at 6 months were 96.9% and 78.1% for the EG and CG respectively (P :::;0.01). Implants of the EG showed greater enhancement of clinical, microbiological and inflammatory parameters as compared to those of the CG. Microbiological analyses showed that resistance to combined therapy was constantly associated with the isolation of bacterial species that are not common periodontal pathogens (mainly S.aureus and P.aeruginosa). The data demonstrate that the addition of serratiopeptidase to combined mechanical-antibiotic treatment protocols of periimplantitis significantly improves outcomes and suggest that serratiopeptidase acts at different levels during the healing process.

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confidence: 74%

Section: Discussionmentioning

confidence: 99%

Clinical, Microbiological and Inflammatory Evidence of the Efficacy of Combination Therapy Including Serratiopeptidase in the Treatment of Periimplantitis

et al. 2012

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“…The validity of this model of periprosthetic infection lies in bone changes found to be similar to those observed clinically in patients and has been reported in earlier studies from our group 16 and others. 23,24 Thus, there was marked periosteal elevation and reactive bone formation as well as cortical disruption. Remarkably, when the SGV was present in the femoral canal, few, if any, of these radiographic changes were evident.…”

Section: Discussionmentioning

confidence: 99%

Controlled release of vancomycin from thin sol‐gel films on implant surfaces successfully controls osteomyelitis

Adams

Antoci

Harrison

et al. 2009

Journal Orthopaedic Research

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Peri-prosthetic infection remains a serious complication of joint replacement surgery. Herein, we demonstrate that a vancomycin-containing sol-gel film on Ti alloy rods can successfully treat bacterial infections in an animal model. The vancomycin-containing sol-gel films exhibited predictable release kinetics, while significantly inhibiting S. aureus adhesion. When evaluated in a rat osteomyelitis model, microbiological analysis indicated that the vancomycin-containing sol-gel film caused a profound decrease in S. aureus number. Radiologically, while the control side showed extensive bone degradation, including abscesses and an extensive periosteal reaction, rods coated with the vancomycin-containing sol-gel film resulted in minimal signs of infection. mCT analysis confirmed the radiological results, while demonstrating that the vancomycin-containing sol-gel film significantly protected dense bone from resorption and minimized remodeling. These results clearly demonstrate that this novel thin sol-gel technology can be used for the targeted delivery of antibiotics for the treatment of periprosthetic as well as other bone infections. Keywords: peri-prosthetic infection; osteomyelitis; vancomycin; sol-gel; controlled release Despite the current level of operative success, bone infection remains a major complication of joint replacement surgery, especially after revision surgery. 1 This is borne out by the numbers as the infection rate after revision surgery more than triples. The most serious complication usually involves the development of a periprosthetic infection, requiring removal of the prosthesis, resection of infected soft tissue and bone, placement of an antibiotic cement spacer, prolonged period of systemic antibiotic administration with difficult recovery, and finally, reimplantation. 2,3 A major factor contributing to the development of periprosthetic infection is adherence of bacteria to the implant surface. 4,5 Upon attachment, microorganisms reorganize into specialized communities termed biofilms and produce a protective glycocalyx 6,7 that provides protection against systemic antibiotics. 8 One strategy utilized to overcome the refractivity to treatment engendered by the biofilm is to administer high doses of antibiotics at the bone-implant interface. 2 However, due to the uncontrolled and rapid release of the antibiotic at the target site many of the delivery systems have proved to be of limited value. Moreover, the carrier itself can serve as a nidus for further microbial colonization. [9][10][11] Release from a room temperature processed sol-gel film provides a novel mechanism for the controlled local delivery of drugs or antibiotics. Silica sol-gel based glass has been shown to be an effective carrier for transforming growth factor b1, 12 trypsin inhibitor, 13 vancomycin, 14 and other molecules. 15 Furthermore, because porosity as well as pore size can be varied, predictable and controlled elution kinetics can be generated. We have chosen to test the efficacy of an antibiotic-containi...

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“…Several studies investigating the systemic use of serrapeptase have demonstrated no adverse effects 3,5,10,12,13,15,16,18,19,21,23 . In this study the drug was very well tolerated by all patients, and none of them reported any untoward reaction.…”

Section: Discussionmentioning

confidence: 99%

Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars

Al-Khateeb¹,

Nusair²

2008

International Journal of Oral and Maxillofacial Surgery

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The Effect of Proteolytic Enzyme Serratiopeptidase in the Treatment of Experimental Implant-Related Infection

Cited by 17 publications

References 21 publications

Clinical, Microbiological and Inflammatory Evidence of the Efficacy of Combination Therapy Including Serratiopeptidase in the Treatment of Periimplantitis

Clinical, Microbiological and Inflammatory Evidence of the Efficacy of Combination Therapy Including Serratiopeptidase in the Treatment of Periimplantitis

Controlled release of vancomycin from thin sol‐gel films on implant surfaces successfully controls osteomyelitis

Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars

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