57
2.4.1 Pancreatic Enzyme Supplements for Malabosrption
Malabsorption is often caused by exocrine pancreatic insufficiency (EPI), referring
to the inability or insufficient production of digestive enzymes by pancreas. EPI
may occur due to various clinical conditions such as cystic fibrosis, chronic pancreatitis, pancreatic surgeries, etc. Pancreatic enzymes usually comprise amylase,
lipase and protease. Protease digests proteins in food to peptides; amylase digests
carbohydrates other than cellulose into oligo and disaccharides; while lipase hydrolyses fat into fatty acids and monoglycerides. Pancreatic amylase and protease deficiency are usually compensated by amylase from salivary enzymes, pepsin from
gastric juice, peptidases and saccharidases from mucosa of the small intestine, etc.
Fat digestion is mostly accomplished by pancreatic lipase, and its insufficiency is a
major concern in EPI. Weight loss, steatorrhea, abdominal pain, etc. are some of the
symptoms associated with EPI. Apart from this, deficiencies of fat-soluble vitamins
also occur in EPI patients. Steatorrhea occurs with pancreatic insufficiency while
the volume of pancreatic lipase has declined to less than 10% of normal secretion.
One of the best ways to overcome malabsorption due to EPI is supplemental
enzyme therapy or pancreatic enzyme replacement therapy (PERT). Pancreatic
enzymes are available from a wide variety of sources including animal, plant and
fungal sources. The first pancreatic preparations were freeze-dried hog pancreas
itself, which was later replaced by total pancreatic extracts. They usually comprise
pancreatic trypsin, amylase and lipase. Lipase is the least stable among all pancreatic enzymes and often gets destroyed by gastric acid, which is the major challenge
in PERT. Attempts were made to overcome inactivation of enzymes by coadministration of bicarbonates and antacids. Later acid resistant enteric-coated
enzymes were developed but release of lipase from coated preparation was not easy.
With the advent of newer techniques, improvement in PERT has been attained.
Currently available pancreatic enzyme preparations are from porcine source. Except
Viokaze
®
, a non-enteric-coated pancreatic enzyme of porcine origin, all of them are
enteric-coated microspheres which are acid resistant. The enteric-coated microspheres release pancreatic lipase at a pH of 5.5-6 (Baker 2008). Varieties of enzyme
preparations are available which differ in particle size and release mechanism (pH
related). PERT certainly improved the quality of the patient’s life by improving fat
absorption and reduction of steatorrhea, weight loss and other symptoms associated
with malabsorption. Lipase preparations are available from various microbial
sources with improved stability. None of the non-porcine preparations has been
licenced for use in humans, though some are in clinical trials. Some of the commercially available pancreatic enzyme preparations are CREON
®
, Pancreaze
®
, Zenpep
®
,
Ultresa
®
, Pertyze
®
and Viokase
®
.
2.4.2 β Galactosidase for Lactose Intolerance
Lactose intolerance is the inability to hydrolyse lactose, a disaccharide in mammalian milk. It is a metabolic disorder due to β galactosidase (lactase) enzyme
2 Therapeutic Enzymes
2.4.1 Pancreatic Enzyme Supplements for Malabosrption
Malabsorption is often caused by exocrine pancreatic insufficiency (EPI), referring
to the inability or insufficient production of digestive enzymes by pancreas. EPI
may occur due to various clinical conditions such as cystic fibrosis, chronic pancreatitis, pancreatic surgeries, etc. Pancreatic enzymes usually comprise amylase,
lipase and protease. Protease digests proteins in food to peptides; amylase digests
carbohydrates other than cellulose into oligo and disaccharides; while lipase hydrolyses fat into fatty acids and monoglycerides. Pancreatic amylase and protease deficiency are usually compensated by amylase from salivary enzymes, pepsin from
gastric juice, peptidases and saccharidases from mucosa of the small intestine, etc.
Fat digestion is mostly accomplished by pancreatic lipase, and its insufficiency is a
major concern in EPI. Weight loss, steatorrhea, abdominal pain, etc. are some of the
symptoms associated with EPI. Apart from this, deficiencies of fat-soluble vitamins
also occur in EPI patients. Steatorrhea occurs with pancreatic insufficiency while
the volume of pancreatic lipase has declined to less than 10% of normal secretion.
One of the best ways to overcome malabsorption due to EPI is supplemental
enzyme therapy or pancreatic enzyme replacement therapy (PERT). Pancreatic
enzymes are available from a wide variety of sources including animal, plant and
fungal sources. The first pancreatic preparations were freeze-dried hog pancreas
itself, which was later replaced by total pancreatic extracts. They usually comprise
pancreatic trypsin, amylase and lipase. Lipase is the least stable among all pancreatic enzymes and often gets destroyed by gastric acid, which is the major challenge
in PERT. Attempts were made to overcome inactivation of enzymes by coadministration of bicarbonates and antacids. Later acid resistant enteric-coated
enzymes were developed but release of lipase from coated preparation was not easy.
With the advent of newer techniques, improvement in PERT has been attained.
Currently available pancreatic enzyme preparations are from porcine source. Except
Viokaze
®
, a non-enteric-coated pancreatic enzyme of porcine origin, all of them are
enteric-coated microspheres which are acid resistant. The enteric-coated microspheres release pancreatic lipase at a pH of 5.5-6 (Baker 2008). Varieties of enzyme
preparations are available which differ in particle size and release mechanism (pH
related). PERT certainly improved the quality of the patient’s life by improving fat
absorption and reduction of steatorrhea, weight loss and other symptoms associated
with malabsorption. Lipase preparations are available from various microbial
sources with improved stability. None of the non-porcine preparations has been
licenced for use in humans, though some are in clinical trials. Some of the commercially available pancreatic enzyme preparations are CREON
®
, Pancreaze
®
, Zenpep
®
,
Ultresa
®
, Pertyze
®
and Viokase
®
.
2.4.2 β Galactosidase for Lactose Intolerance
Lactose intolerance is the inability to hydrolyse lactose, a disaccharide in mammalian milk. It is a metabolic disorder due to β galactosidase (lactase) enzyme
2 Therapeutic Enzymes