Protease activation, pancreatic leakage, and inflammation in acute pancreatitis: differences between mild and severe cases and changes over the first three days.
OBJECTIVE
The pathophysiology of acute pancreatitis (AP) may be studied using markers of protease activation (active carboxypeptidase B (aCAP), the activation peptide of carboxypeptidase B (CAPAP)), leakage of pancreatic enzymes (trypsinogen-2, procarboxypeptidase B (proCAP), amylase), and inflammation (monocyte chemoattractant protein-1 (MCP-1), CRP).


METHODS
This prospective study included 140 cases of AP. Mild (n = 124) and severe (n = 16) cases were compared with respect to serum levels of trypsinogen-2, proCAP, amylase, aCAP, CAPAP (serum/urine), MCP-1 (serum/urine) and CRP on days 1, 2 and 3 from onset of symptoms. All patients with information on all 3 days were included in a time-course analysis (n = 44-55, except amylase: n = 27).


RESULTS
High levels in severe versus mild cases were seen for trypsinogen-2, CAPAP in serum and urine, and MCP-1 in serum on days 1-3. No differences were seen for proCAP, amylase and aCAP. MCP-1 in urine was significantly elevated on day 1-2, and CRP on day 2-3. CAPAP and MCP-1 levels peaked early and stayed elevated for 48 h in serum.


CONCLUSIONS
Protease activation and inflammation are early events in AP, with high levels of these markers within 24 h. Protease activation declines after 48 h, whereas inflammation is present for a longer time.
Regnér
S
S
Department of Surgery, Malmö University Hospital, Lund University, Lund, Sweden. sara.regner@med.lu.se
Manjer
J
J
Appelros
S
S
Hjalmarsson
C
C
Sadic
J
J
Borgström
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D043424:Carboxypeptidase B / Q000097:blood; D018932:Chemokine CCL2 / Q000097:blood / Q000652:urine; D004789:Enzyme Activation; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification* / Q000201:enzymology* / Q000503:physiopathology; D010447:Peptide Hydrolases / Q000097:blood*; D014357:Trypsin / Q000097:blood; D014362:Trypsinogen / Q000097:blood
C111835:CCL2 protein, human; D018932:Chemokine CCL2; C064831:PRSS2 protein, human; D014362:Trypsinogen; D002097:C-Reactive Protein; D000681:Amylases; D010447:Peptide Hydrolases; D043424:Carboxypeptidase B; D014357:Trypsin