Neutrophil elastase activity in acute lung injury and respiratory distress syndrome.
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.
Hashimoto
Satoru
S
Department of Anaesthesiology and Intensive Care, Kyoto Prefectural School of Medicine, Kyoto, Japan. satoru@koto.kpu-m.ac.jp
Okayama
Yoko
Y
Shime
Nobuaki
N
Kimura
Akio
A
Funakoshi
Yosuke
Y
Kawabata
Kazuhito
K
Ishizaka
Akitoshi
A
Amaya
Fumimasa
F
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*
D004791:Enzyme Inhibitors; D013449:Sulfonamides; D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; C069195:sivelestat; D019272:Leukocyte Elastase; D005998:Glycine