Influence of a human protease inhibitor on surgical stress induced immunosuppression.
OBJECTIVE
Postoperative tissue injury and immunosuppression can occur after major surgery. In this study, we explore the potential benefits of administering a protease inhibitor to treat immunosuppression caused by surgical stress.


METHODS
Sixteen patients with esophageal cancer were preoperatively allocated at random into two equal groups. A urinary trypsin inhibitor, ulinastatin (UTI), was intravenously administered to the treatment (UTI) group at a dose of 150,000 U every 12 h from the start of surgery until postoperative day 5, whereas the control group received a placebo. One unit of UTI was defined as the amount of UTI necessary to inhibit the activity of 2 microg of bovine pancreatic trypsin by 50%. We measured the plasma levels of polymorphonuclear neutrophil elastase, interleukin 8, circulating T lymphocyte subsets, and mitogenic activity and in vitro production of tumor necrosis factor alpha in lipopolysaccharide-stimulated whole blood.


RESULTS
The postoperative serum value of polymorphonuclear neutrophil elastase was significantly lower in the UTI group, but the interleukin 8 concentrations did not significantly vary between the two groups. On the other hand, the severity of the postoperative immunosuppression was reduced in the UTI group, and immune functions, such as the numbers of T lymphocytes, the mitogenic activity of lymphocytes, and the level of tumor necrosis factor alpha production in whole blood, recovered significantly earlier in the UTI group.


CONCLUSIONS
These data suggest that a protease-modulating therapy may be a new strategy for the treatment of surgical stress induced immune dysfunction.
Department of Surgery I, Iwate Medical University School of Medicine, Morioka, Japan. satonobu@iwate-med.ac.jp
Nobuhiro
N
Sato
Shigeatsu
S
Endo
Yusuke
Y
Kimura
Kenichirou
K
Ikeda
Kiichi
K
Aoki
Takeshi
T
Iwaya
Yuji
Y
Akiyama
Yoshinori
Y
Noda
Kazuyoshi
K
Saito
D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006023:Glycoproteins / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects*; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011184:Postoperative Period; D013270:Stomach / Q000601:surgery; D013312:Stress, Physiological / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000378:metabolism; D014361:Trypsin Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D006023:Glycoproteins; D016209:Interleukin-8; D014361:Trypsin Inhibitors; D014409:Tumor Necrosis Factor-alpha; C028665:urinastatin