title: Neutrophil elastase activity in acute lung injury and respiratory distress syndrome.
abstract: OBJECTIVE
  Neutrophil elastase (NE) may play a key role in the development of acute lung injury (ALI) or ARDS. NE activity (NEA) was measured in patients with ALI treated with a selective NE inhibitor.
  
  
  METHODS
  NEA and NE-alpha1-antitrypsin (NE-AT) complex were measured in plasma before, during and after the administration of the selective NE inhibitor, sivelestat, in 32 patients with a diagnosis of ALI or ARDS. NEA index (NEAI) was calculated as NEA/NE-AT. The sequential organ failure assessment (SOFA) score and the ratio PaO(2)/fraction of inspired oxygen (FiO(2)) were measured.
  
  
  RESULTS
  NEA and NE-AT was raised in all patients. Sivelestat reduced NEAI and NEA (P < 0.01 for both) but not NE-AT and NEA, and NEAI returned to pretreatment levels. NEA correlated closely with NE-AT before, but not after treatment. No relationship was observed between these indices and SOFA score or PaO(2)/FiO(2) ratio.
  
  
  CONCLUSIONS
  Sivelestat reduced NEA and NEAI in patients with ALI or ARDS suggesting NE inhibition. A larger study is needed to determine the relationship of NEA, NE-AT and NEAI with the outcome of ALI/ARDS.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural School of Medicine, Kyoto, Japan. satoru@koto.kpu-m.ac.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okayama
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shime
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Funakoshi
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Kawabata
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Ishizaka
authors.forename: Fumimasa
authors.initials: F
authors.lastname: Amaya
mesh_terms: D000368:Aged; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D019272:Leukocyte Elastase / Q000037:antagonists & inhibitors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000201:enzymology*; D013449:Sulfonamides / Q000627:therapeutic use; D000515:alpha 1-Antitrypsin / Q000097:blood*
chemical_list: D004791:Enzyme Inhibitors; D013449:Sulfonamides; D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; C069195:sivelestat; D019272:Leukocyte Elastase; D005998:Glycine