title: The capacity of alpha2-macroglobulin to inhibit an exogenous protease is significantly increased in critically ill and septic patients.
abstract: The image of alpha2-macroglobulin is based on a paradigm evolved in the 1970s. During this decade alpha2-macroglobulin was shown to irreversibly entrap and thereby inhibit a maximum of two proteases. Additional binding of nonproteolytic proteins, i.e., inflammatory mediators and growth factors, is dependent on the conformational status of alpha2-macroglobulin. It was our aim to clarify whether the interaction of nonproteolytic proteins with alpha2-macroglobulin during inflammatory conditions might also modulate the capacity of alpha2-macroglobulin to inhibit proteases. To explore this possibility, bromelain, an exogenous protease, was titrated against plasma of critically ill or septic patients, whose pathophysiological conditions are defined by a massive release of inflammatory mediators. The stoichiometry of bromelain inhibition by alpha2-macroglobulin was quantified by caseolytic activity assays. The maximal alpha2-macroglobulin/bromelain inhibition ratios were significantly increased (1:6 and 1:8 in the two patient groups, P < 0.01) as compared with control groups (1:2 with purified alpha2-macroglobulin and 1:4 in healthy volunteers). The increase of alpha2-macroglobulin inhibition capacity in patients was paralleled by the appearance of a large signal on Western blots, suggesting the formation of additional complexes. Our results demonstrate alpha2-macroglobulin to have more flexibility than had been thought, and it may thereby contribute to a shift in a 30-year-old paradigm.
authors.affiliation: Department of Surgery, University of Cologne, Cologne, Germany. u.schaefer@uni-koeln.de
authors.forename: Ute
authors.initials: U
authors.lastname: Schaefer
authors.forename: Beate
authors.initials: B
authors.lastname: Brücker
authors.forename: Andrea
authors.initials: A
authors.lastname: Elbers
authors.forename: Edmund
authors.initials: E
authors.lastname: Neugebauer
mesh_terms: D000328:Adult; D000368:Aged; D001963:Bromelains / Q000494:pharmacology; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors; D012016:Reference Values; D018805:Sepsis / Q000503:physiopathology*; D000511:alpha-Macroglobulins / Q000378:metabolism*
chemical_list: D011480:Protease Inhibitors; D000511:alpha-Macroglobulins; D001963:Bromelains