March 4, 1983

Chymopapain: tropical tree to surgical suite Chymopapain

JAMA. 1983;249(9):1115-1120. doi:10.1001/jama.1983.03330330005002

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A bit of medical history is being made in connection with the Food and Drug Administration's recent approval of chymopapain to treat so-called slipped disks.

First, take the Nov 10, 1982, decision itself— considered historic because it marks the successful conclusion of a long and sometimes highly controversial struggle to gain official approval for chymopapain.

It's been more than 40 years since the papain enzyme was first isolated (1941). In 1956, author and medical commentator Lewis Thomas, MD, then a pathologist at New York University-Bellevue Medical Center, showed it could break down cartilaginous protein polysaccharide when injected into the tall, rigid ears of rabbits, causing the ears to collapse.

About seven years later, Illinois orthopedic surgeon Lyman Smith, MD, developed chemonucleolysis, a technique in which chymopapain is injected into herniated lumbar intervertebral disks that have not responded to conservative therapy to hasten chondromucoprotein degradation (JAMA 1964;187:137-140). Clinical trials began soon