u . s . pat . no . 5 , 560 , 910 disclosed the combined use of substance p inhibitors and proteolytic enzymes as an anti - inflammatory composition for relief of pain or pruritus due to inflammation . the capsaicin was the naturally occurring capsaicin oleo resin ( pcca , houston , tex .). the caspaicin is dissolved in 0 . 5 ml - 0 . 75 ml of ethanol and then added to the 10 grams of soy lecitihin 10 ml of isopropyl palmitate with homogenization . the 20 g of bromelain is first triturated and then dissolved in 40 ml of distilled water which is then homogenized . 10 g of the mixture of bromelain and water is then added to the capsaicin mixture of soylecithin and isopropyl palmitate and homogenization is repeated . 16 g of the pluronic 127 ( basf . parsippany , n . j .) is dissolved in 80 ml of water and refrigerated for 24 - 36 hours with occasional stirring . 94 ml of the 16 . 5 % pluronic mixture . the pluronic lecithin organogel is obtained by adding 80 ml of the 16 . 5 pluronic mixture to the mixture of isopropyl palmitate , soylecithin , bromelain and capsaicin to make a 100 g formulation . of course , other concentrations of pluronic , deemed suitable by people with ordinary skill in the art , may used to obtain a satisfactory result under a particular circumstance . as disclosed in u . s . pat . no . 5 , 560 , 910 , bromelain is a protease composition that may be isolated from pineapple . the enzyme has been reported to have anti - inflammatory activity when administered orally or parenterally ( see taussig , s . j ., “ the mechanism of the physiological action of bromelain ”, medical hypotheses , 6 ; 99 - 104 , 1980 ). commercially available bromelain used in the manufacture of pharmaceuticals is not a chemically homogeneous substance , but its principal component is a proteolytic enzyme , which is a glycoprotein with a molecular weight of approximately 33 , 000 daltons . capsaicin is an oleoresin that may be obtained by extracting cayenne pepper with ether . the synthetic capsaicin is trans - 8 - methyl - vanillyl - 6 - nonenamide . capsaicin gels have been described in u . s . pat . no . 5 , 178 , 879 as being effective in treating topical pain . in addition , capsaicin is available commercially in over - the - counter compositions intended for pain relief including lotions such as heet , omega oil , sloan &# 39 ; s liniment and zostrix . bromelain has been reported to be an anti - inflammatory agent , an inhibitor of platelet aggregation , an agent that increases proteolytic and fibrinolytic activity in blood , and as a selective prostaglandin inhibitor . bromelain has been administered by injection and has been reported to be effective after oral administration . however , because bromelain is a macromolecule , it cannot be administered transdermally using prior art formulations . with respect to the proteolytic enzyme component of the composition , it comprises , in one embodiment , bromelain extracted from the pineapple stem ( spectrum , gardena , calif . ), a protease composition which has a proteolytic enzyme as a principle component . ( bromelain is the general name for a family of sulhydryl proteolytic enzymes .) commercially available bromelain used in the manufacture of pharmaceuticals is not a chemically homogeneous substance , but the principal component is a proteolytic enzyme that is a glycoprotein . the molecular weight of bromelain is approximately 33 , 000 daltons . the capsaicin may be provided at a concentration of between 0 . 0001 % and 2 . 5 % by weight , with a preferred concentration of between about 0 . 001 % to 0 . 0025 % by weight and with the most preferred concentration of about 0 . 0015 % by weight . ( mk 869 , hydro - cinnamoyl -( s - benzoyl - homocysteine ) benzyl ester , drugs which antagonize the substance p recepetor ( nk 1 receptor ), compound a , cp - 22721 , nkp - 608 , 679769 ns , tak - 637 , proyl endopeptidase ( pep , ec ), aa501 , neurokinina , nepaduant aqnd sr48968 or other known to those skilled in the art )& gt ; the bromelain may be provided at a concentration of between 0 . 5 % and 20 % by weight , with a preferred concentration of between approximately 3 . 5 % and 15 % by weight , and with the most preferred concentration of approximately 5 % by weight . it should be understood that other proteolytic enzymes can be used in the present invention , including , but not limited to , gelatinase and elastase and others known to those skilled in the art . it should be noted that the quantity of the composition necessary for effective therapy will depend on many different factors , including the physiological state of the patient and other medicaments administered . thus , treatment dosages should be titrated to optimize safety and efficacy . typically , dosages used in vitro may provide useful guidance in the amounts useful for in situ administration of the active ingredients in a quantity sufficient to constitute a therapeutic dose . animal testing of effective doses for treatment of particular disorders will provide further predictive indication of a human therapeutic dosage . various considerations are described , for example , in goodman and gilman &# 39 ; s the pharmacological basis of therapeutics , 7th edition ( 1985 ), macmillan publishing company , new york , and remington &# 39 ; s pharmaceutical sciences 18th edition , ( 1990 ) mack publishing co , easton , pa . furthermore , as a topically applied pharmaceutical composition , the concentration can be varied in a much wider range than with orally administered medicines and injections and can be readily adjusted according to specific situations by the practitioners . thus , the concentrations provided in the above are for example only , but not presented as limitation to the present invention . the composition of the present invention is preferably loaded into a liposome , for topical administration to a human or animal patient , such as natipide ii preformed liposomes ( american lecithin co , oxford ). similarly , the method of mezzei , et al ., u . s . pat . no . 4 , 937 , 078 , incorporated herein by reference in its entirety , may be utilized . other formulations known to one skilled in the art - may also be used . the method of the present invention involves topical administration of a pharmaceutically acceptable composition containing the substance p inhibitor and / or the proteolytic enzyme , loaded into a liposome , at the location of the pain or discomfort experienced by the patient . application may be for any desired period for which benefit is provided , whether in the form of pain / discomfort relief or cartilage re - growth . the method of the present invention involves topical administration of a pharmaceutically acceptable composition containing a substance p inhibitor and a proteolytic enzyme , preferably loaded into liposomes , at the location of the cartilage damage . application may be for any desired period for which benefit is provided . this composition is suitable for relatively long term use , for example , it may be used indefinitely unless irritation occurred . while topical delivery by liposomes has been described as a preferred a method , it is to be appreciated that other methods of topical administration may also be used within the confines of the invention . for example , as shown in examples 1 and 2 below , the active ingredients may be delivered by other known methods . in another embodiment , the composition is created as follows : 5 . 0 g of 1200 or 2400 g . d . u . bromelain ( spec ; trum la , gardena , calif .) is triturated and added to 15 - 25 g of distilled water is added with magnetic stirring , followed by homogenization . 0 . 15 g of capsaicin is dissolved in 0 . 5 - 0 . 75 ml of 90 % ethyl alcohol with magnetic stirring . the bromelain is then added to this beaker and homogenization is repeated for an adequate amount of time to evenly disperse the substance p inhibitor . a preservative such as sorbic acid , which is optional , is added to the composition . optional stablilizers , antioxidants , preservatives , humectants , regreasing agents , solvents or auxiliaries is added to complete the 100 g total weight and improve the stability and / or adhesiveness of the formulations . this formulation is then loaded into naptide ii liposomes ( american lecithin co ., oxford , conn .). this composition is applied topically in a uniform manner to the injured joint once cutaneous healing has occurred . preoperative x - rays are used to assess the amount of osteoarthritis and assess the amount of joint cartilage present in chronic injuries . physical exam of an injured knee can determine the stability of the cruciate ligaments and if there are torn menisci . athroscopic exam or mri will be definitive for cartilage damage or the necessity of surgically repairing a partially torn cruciate ligament . an individual had arthroscopic surgery for a bilateral meniscus tear . while the pain diminished , ibuprofen was still occasionally necessary . the pain developed further in the left leg and reexamination demonstrated that chondro malacia of the left patella existed . a retinacular release was performed to reposition the patella and avoid contact with the area of chondro malacia . there was short - term improvement , but the pain returned in the left and right legs after six months . ibuprofen was used at the maximum dosage . a 5 % by weight bromelain and 0 . 0015 % capsaicin composition was applied topically in a pluronic lecithin organogel ( plo ) b . i . d . the composition was used for a three month treatment period , during which time pain in the patella could not be evoked while climbing stairs or elicited by medial & amp ; lateral displacement . chondromalacia patellae means “ softening of the articular cartilage of the knee - cap .” the articular cartilage is the cartilage lining under the knee - cap that articulates with the knee joint . under normal circumstances , it is smooth and shiny , so that it glides smoothly along the articular groove of the femur as the knee bends . when it “ softens ”, it may break down , causing irregularities along the undersurface of the patella . the etiology is variable and the problem is common even in the young . the shiny white cartilage surface of the patella is at the back of the patella , where it makes contact with the cartilage of the femur as the knee is bent and straightened . damage to the patellar cartilage is often mirrored by damage to the femoral cartilage as well , and then this is referred to as ‘ patello - femoral ’ damage . cartilage ( joint surface ) damage is serious as cartilage heals poorly , and damage may be the beginning of a process leading to arthritis . a three year old labrador retriever was examined for chronic lameness and an “ anterior drawer sign ” was discovered indicating a torn anterior cruciate ligament ( acl ). x - rays did not reveal osteoarthritis . surgery was done and a partial tear in the anterior horn of the lateral meniscus was resected . the color of the torn meniscus was “ yellowish ” from the normal pearly white . the acl was debrided and 60 lb . monofilament was used to recreate the acl . the patella was examined and found normal . there was limited area of cartilage loss on the distal femoral condyles . the animal went home with a 5 % by weight bromelain and 0 . 0015 % capsaicin composition to be used b . i . d . for three months . suture removal was done at seven days and the dog was beginning weight bearing at that time . exercise was limited to walking on the leash for one month and the dog was then reexamined . the dog was seen the next year or rountine vaccinations and lab work . the owner reported that the dog tolerated exercise very well . shortly thereafter , the , dog was killed in a car accident and permission to do an autopsy was obtained . the previously injured knee was inspected upon autopsy . there was normal appearing cartilage on the distal femur and the meniscus was a pearly white . the patella was also normal in appearance . for pain relief applications , the composition may be applied for a period of hours , with treatments repeated for a period of weeks or months , depending on the results produced . treatment may be administered in advance of certain pain - causing activities , such as piano playing , typing , exercise , etc . while there have been described and pointed out fundamental novel features of the invention as applied to a preferred embodiment thereof , it will be understood that various omissions and substitutions and changes in the form and details of the embodiment illustrated , and in their operation , may be made by those skilled in the art without departing from the spirit of the invention . for example , it is expressly intended that all combinations of those elements and / or method steps which perform substantially the same function in substantially the same way to achieve the same results are within the scope of the invention .
a method of treating cartilage damage by topically administering an effective amount of a pharmaceutical composition comprising a substance p inhibitor and a proteolytic enzyme with an suitable pharmaceutical carrier . the pharmaceutical composition is capable of promoting cartilage regeneration in animal and human subjects .