Abstract
PMN-elastase is a proteinase released by activated neutrophils. PMN-elastase was determined in two independent populations with inflammatory bowel disease. In an unselected population of 70 consecutive patients with Crohn's disease and 24 patients with ulcerative colitis with different degrees of disease activity plasma PMN-elastase levels were statistically significantly higher in patients with active than in patients with inactive disease [Crohn's disease: 80.5±33.2 ng/ml vs 60.1±24.6 ng/ml (means±sd),P=0.0017; ulcerative colitis: 98.2±54.9 ng/ml vs 59.2±16.8 ng/ml,P=0.026]. PMN-elastase levels in feces were also higher in patients with active Crohn's disease (23.6±15.3 ng/g vs 13.6±12.5 ng/g,P=0.0021) and active ulcerative colitis (46.5±60.5 ng/g vs 20.2±25.0 ng/g,P=0.46), but the difference reached significance only in Crohn's disease. Correlation of disease activity and PMN-elastase in individual patients showed a statistically significant correlation between plasma and fecal elastase concentrations and disease activity in ulcerative colitis (plasma:r=0.72,P<0.001; feces:r=0.423,P<0.001) but not fecal elastase concentrations (r=0.0083,P=0.485) correlated significantly with disease activity. Plasma PMN-elastase correlated weakly with fecal PMN-elastase levels in Crohn's disease (r=0.431,P<0.01) and in ulcerative colitis (r=0.515,P=0.05). In 28 patients with highly active Crohn's disease [median severity activity index (SAI) 203] and 11 patients with highly active ulcerative colitis [median Rachmilewitz index (RI) 14] studied before and four weeks after steroid therapy, treatment lowered the median SAI to 140 and the median RI to 4.5. Mean plasma elastase concentrations decreased concomitantly from 83±44.9 ng/ml to 61.8±25.8 (P=0.0035) in patients with Crohn's disease and from 110±49.5 to 71.6±28.8 ng/ml (P=0.0069) in patients with ulcerative colitis. In conclusion, there is a release of PMN-elastase in active IBD, which can be detected in plasma as well as in feces. Plasma elastase levels reflect disease activity in patients with IBD. The variation of the data and the large overlap between different groups, however, strongly reduce the clinical value.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Borregaard N: The human neutrophil. Function and dysfunction. Eur J Haematol 41:401–413, 1988
Smedley LA, Tennessen MG, Sandhouse RA, Haslett C, Guthrie LA, Johnston RB Jr, Henson PM Worthen GS: Neutrophil mediated injury of endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase. J Clin Invest 77:1233–1243, 1986
Ohlsson K, Ohlsson J: The neutral proteases of human granulocytes III. Interactions between human granulocyte elastase and plasma protease inhibitors. Scand J Clin Lab Invest 34:349–355, 1974
Beatty K, Bieth J, Travis J: Kinetic of association of serine proteinases with native and oxidized alpha-1-proteinase inhibitor and alpha-1-antichymotrypsin. J Biol Chem 255:3931–3934, 1980
Duswald KH, Jochum M, Schramm W, Fritz H: Released granulocyte elastase: An indicator of pathobiochemical alterations in septicemia after abdominal surgery. Surgery 98:892–899, 1985
Speer CP, Rethwilm H, Gahr M: Elastase-alpha-1-proteinase inhibitor: An early indicator of septicemia and bacterial meningitis in children. J Pediatr 11:667–671, 1987
Struelens M, Dilville J, Luypaert P, Wybran J: Granulocyte elastase compared to C-reactive protein for early diagnosis of septicemia in critically ill patients. Eur J Clin Microbiol Infect Dis 7:193–195, 1988
Gross V, Schölmerich J, Leser H-G, Salm R, Lausen M, Rückauer K, Schöffel U, Lay L, Heinisch A, Farthmann EH, Gerok W: Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute phase proteins C-reactive protein, α1-antitrypsin, and protease inhibitor α2-macroglobulin. Dig Dis Sci 35:97–105, 1990
Adeyemi EO, Neumann S, Chadwick VS, Hodgson HJF, Pepys MB: Circulating human leucocyte elastase in patients with inflammatory bowel disease. Gut 26:1306–1311, 1985
Fischbach W, Becker W, Mössner J, Ohlemueller H, Koch W, Börner W: Leucocyte elastase in chronic inflammatory bowel diseases: A marker of inflammatory activity? Digestion 37:88–95, 1987
Saverymuttu SH, Camilleri M, Rees H, Lavender JP, Hodgson HJF, Chadwick VS: Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease. Gastroenterology 90:1121–1128, 1986
Schölmerich J, Schmidt E, Schümichen C, Billmann P, Schmidt H, Gerok W: Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamthyl propylene amine oxine as leukocyte label. Gastroenterology 95:1287–1293, 1988
Goebell H: Different activity indices in Crohn's disease and their possible role.In Inflammatory Bowel Disease—Basic Research and Clinical Implications. H Goebell, BM Peskar, H Malchow (eds). Lancaster, MTP Press, 1988, pp 253–258
Rachmilewitz D: Coated mesalazine (5-amino-salicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: A randomized trial. Br Med J 198:82–86, 1989
Author information
Authors and Affiliations
Additional information
This research was supported by the SFB 154 of the Deutsche Forschungsgemeinschaft. V. Gross is supported by a “Heisenberg-Stipendium” of the Deutsche Forschungsgemeinschaft.
Rights and permissions
About this article
Cite this article
Andus, T., Gross, V., Caesar, I. et al. PMN-elastase in assessment of patients with inflammatory bowel disease. Digest Dis Sci 38, 1638–1644 (1993). https://doi.org/10.1007/BF01303172
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01303172