Persistent elastase/proteinase inhibitor imbalance during prolonged ventilation of infants with bronchopulmonary dysplasia: evidence for the role of nosocomial infections.
Acute imbalance between elastase and alpha-1-proteinase inhibitor (alpha 1Pi) may contribute to the development of bronchopulmonary dysplasia (BPD). The question of whether such an imbalance persists in BPD infants still requiring mechanical ventilation after 4 wk of life has not been previously addressed. We studied 14 infants still on mechanical ventilation at 4 wk of age: nine had BPD and five did not. Weekly (4 to 9 wk) serum and bronchoalveolar lavage (BAL) specimens were taken. alpha 1Pi and alpha-2-macroglobulin were measured in serum and BAL by immunoturbidimetric assay. BAL elastase activity was measured by cleavage of a synthetic substrate and expressed as ng of porcine pancreatic elastase equivalent. Infants with BPD had higher levels of serum alpha 1Pi and alpha-2-macroglobulin than those without BPD. In contrast, the corresponding BAL levels were either similar or even decreased (alpha 1Pi). Moreover, there was a 3-fold increase in elastase-1Pi imbalance expressed as the BAL ng of porcine pancreatic elastase equivalent/2 alpha 1Pi ratio. The role of nosocomial infections was evident in a subgroup of 11 infected BAL aspirates in BPD infants. In such cases we found a 3-fold increase in the BAL ng of porcine pancreatic elastase equivalent/alpha 1Pi ratio as compared to 35 noninfected BAL in BPD infants. These data suggest a persistent alveolitis with imbalance between elastase and proteinase inhibitors in prolonged severe BPD. Such an imbalance is, in part, explained by a local destruction and/or inactivation of alpha 1Pi. Our results also emphasize the increase in proteolysis with nosocomial pneumonia.
Walti
H
H
Neonatal Intensive Care Unit, Port-Royal Maternity, Paris, France.
Tordet
C
C
Gerbaut
L
L
Saugier
P
P
Moriette
G
G
Relier
J P
JP
D001992:Bronchoalveolar Lavage Fluid / Q000378:metabolism; D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D003428:Cross Infection / Q000150:complications / Q000378:metabolism*; D006801:Humans; D007230:Infant, Low Birth Weight / Q000378:metabolism*; D007231:Infant, Newborn; D010196:Pancreatic Elastase / Q000378:metabolism*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012709:Serum Albumin / Q000378:metabolism; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
D012709:Serum Albumin; D000515:alpha 1-Antitrypsin; D010196:Pancreatic Elastase