title: AANA journal course. Update for nurse anesthetists--part 4--life in the balance: the role of serpins in disease genesis and prevention.
abstract: Complex biological systems are often shaped and maintained by opposing forces. A relevant biological example is the delicate balance between proteases and their inhibitors. Serine proteases contain a serine residue in the active site of the molecule that is essential to the activity of the enzyme. Protease inhibitors limit the activity of proteases in the body. As examples, aprotinin (Trasylol), a serine protease inhibitor, and aminocaproic acid (Amicar), a lysine protease inhibitor, are used to decrease the rate of fibrinolysis and have recently been the subject of considerable controversy in the literature regarding safety and efficacy. This AANA journal course reviews 2 common examples of protease inhibitor disorders, angioedema and a form of emphysema, that are of particular anesthetic relevance.
authors.affiliation: Children's Mercy Hospitals & Clinic, Kansas City, MO, USA. sprints4@mchsi.com
authors.forename: John
authors.initials: J
authors.lastname: Aker
authors.forename: Chuck
authors.initials: C
authors.lastname: Biddle
mesh_terms: D000799:Angioedema / Q000209:etiology / Q000628:therapy; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D008264:Macrophages / Q000502:physiology; D009504:Neutrophils / Q000502:physiology; D009719:Nurse Anesthetists / Q000193:education; D017510:Protein Folding; D011656:Pulmonary Emphysema / Q000209:etiology / Q000628:therapy; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects / Q000502:physiology*; D015843:Serpins / Q000009:adverse effects / Q000502:physiology*; D016709:Yin-Yang; D000515:alpha 1-Antitrypsin / Q000600:supply & distribution / Q000627:therapeutic use; D019896:alpha 1-Antitrypsin Deficiency / Q000209:etiology / Q000628:therapy
chemical_list: D015842:Serine Proteinase Inhibitors; D015843:Serpins; D000515:alpha 1-Antitrypsin