Inhibition of neutrophil elastase by alpha-1-proteinase inhibitor oxidized by activated neutrophils

The present study was aimed at testing whether neutrophil-oxidized alpha 1-proteinase inhibitor (alpha 1PI) is a slow-binding inhibitor of neutrophil elastase like N-chlorosuccinimide-oxidized alpha 1PI or whether it does not inhibit this enzyme at all as currently thought. alpha 1PI was reacted with phorbol-myristate-acetate-activated neutrophils and isolated from the oxidation medium by fast protein liquid chromatography on an anion exchange column. When sufficient time was allowed for oxidized alpha 1PI to react with neutrophil elastase (2 h), enzyme-inhibitor complex formation could be demonstrated by three means: (1) inhibition of elastase activity, (2) detection of the complex using an enzyme-linked immunosorbent assay specific for the native alpha 1PI-elastase complex, and (3) SDS-polyacrylamide gel electrophoresis, which evidenced a complex with a molecular weight of 80,000. Porcine pancreatic elastase was not inhibited. Neutrophil-oxidized alpha 1PI behaved as an irreversible inhibitor of neutrophil elastase, as revealed by the kinetic analysis of the inhibition reaction. The rate constant for the inhibition of neutrophil elastase by neutrophil-oxidized alpha 1PI (0.76 +/- 0.22 x 10(4) M-1 s-1) was close to that for the inhibition of the enzyme by N-chlorosuccinimide-oxidized alpha 1PI (0.96 +/- 0.24 x 10(4) M-1 s-1), but it was more than three orders of magnitude lower than that for the reaction of native alpha 1PI with neutrophil elastase. Both native and oxidized alpha 1PI were temporary elastase inhibitors: the enzyme slowly and spontaneously escaped the complex with formation of an inactive alpha 1PI derivative with a molecular weight of 49,000.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alpha1-antitrypsin and neutrophil elastase imbalance and lung cancer risk

OBJECTIVE: Imbalance between alpha(1)-antitrypsin and neutrophil elastase is an underlying cause of lung tissue damage that may create a favorable host environment for carcinogenesis. We conducted a case-control study to investigate whether genetic variations indicative of alpha(1)-antitrypsin deficiency (A1ATD) or an excess of neutrophil elastase modify lung cancer risk DESIGN: The case patients were 305 consecutively identified primary lung cancer patients, and the control subjects were 338 community residents. Protease inhibitor-1 (PI1), encoding alpha(1)-antitrypsin, was typed by an isoelectric focusing assay. Neutrophil elastase-2 (ELA2), encoding neutrophil elastase, was typed by two single-nucleotide polymorphism sites. Multivariable logistic regression models tested the independent and interactive effects of PI1, ELA2, tobacco smoke exposure, COPD, and family history of lung cancer RESULTS: Sex and ethnicity were comparable between case patients and control subjects, but case patients were more likely to be smokers, and to have a history of COPD, environmental tobacco smoke exposure, and a positive family history of lung cancer. Haplotype analysis indicated an overall strong association between the two ELA2 markers and lung cancer risk. Our best-fitting model showed significant and independent effects of the PI1-deficient allele (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 3.0) and the ELA2 T-G haplotype (OR, 4.1; 95% CI, 1.9 to 8.9) on lung cancer risk, and an increased risk (OR, 2.6; 95% CI, 2.4 to 2.8) for individuals carrying both a PI1-deficient allele and a G-G haplotype CONCLUSIONS: Genotypes indicative of A1ATD and/or an excess of neutrophil elastase are significantly associated with lung cancer risk. Our findings may provide opportunities to better understand the mechanisms of lung cancer development and risk reduction.     

中性粒细胞弹性蛋白酶及其抑制剂与肺癌关系的研究进展

肿瘤转移作为一系列复杂事件的结果,这一过程需要很多酶的参与.中性粒细胞弹性蛋白酶在肺癌侵袭和转移中发挥重要作用,在生理条件下,中性粒细胞弹性蛋白酶有很多特殊的作用底物,过量的中性粒细胞弹性蛋白酶可导致弹力蛋白的降解,还可导致细胞外基质的降解.肺癌组织中的中性粒细胞弹性蛋白酶的量不仅可作为肺癌预后的独立指标,而且在重度联合免疫缺陷小鼠的肺癌种植模型中,一种特殊的中性粒细胞弹性蛋白酶抑制剂ONO-5046完全抑制了肺癌细胞的生长.中性粒细胞弹性蛋白酶免疫抑制剂的应用有望成为阻止肺癌侵袭和转移的有效方法.     

Evaluation of tamoxifen as a therapy to augment alpha-1-antitrypsin concentrations in Z homozygous alpha-1-antitrypsin-deficient subjects

Tamoxifen, an agent that binds to intracytoplasmic estrogen receptors, was evaluated as a possible means of increasing alpha-1-antitrypsin (alpha 1AT) synthesis and/or secretion and thus alpha 1AT serum levels in subjects with the homozygous form of alpha 1AT deficiency. Administration of tamoxifen (10 mg twice daily) to 30 Z homozygotes for a 30-day period was not associated with adverse reactions. However, although serum alpha 1AT levels increased significantly (p less than 0.03), the increase was minor (average pretreatment levels, 32 +/- 1 mg/dl; levels at 30 days of therapy, 35 +/- 1 mg/dl) and far below the "threshold" level of 80 mg/dl considered "protective" against an increased risk for emphysema. Thus, while the concept that increasing alpha 1AT synthesis and/or secretion is a rational goal for treating the Z homozygous form of alpha 1AT deficiency, tamoxifen will not be useful in this regard.     

Hypoxia and cyanosis in alpha-1-antitrypsin deficiency. Cirrhosis as an unusual etiologic factor

A patient with type PiZZ alpha-1-antitrypsin deficiency was found to have severe hypoxia despite normal pulmonary function testing and a normal chest radiograph. A nuclear medicine ventilation-perfusion study revealed a right-to-left shunt. Computed tomography showed minimal bleb formation, no diffuse changes, and hepatic changes of cirrhosis with portal hypertension. No nodular pulmonary masses or enlarged peripheral pulmonary vessels were found. The diagnosis of diffuse intrapulmonic arteriovenous shunts ("pulmonary spiders of cirrhosis") was suggested and then confirmed with a dynamic radionuclide flow study.     

Exocrin pancreatic deficiency revealing an alpha-1-antitrypsin deficiency

There are genetic mutations taking part in the physiopathology of pancreatitis. The role of alpha-1-antitrypsin (AAT) deficiency in this pathology is debated. We report the case of a 60-year-old man with a pancreatic exocrine insufficiency. He was diagnosed with AAT deficiency. The phenotype was Pi SZ, with genotyping confirmation. The place of AAT deficiency in the midst of pancreatic diseases should be further studied.     

Secretory leukocyte proteinase inhibitor,alpha-1-antitrypsin deficiency and emphysema: Preliminary study,speculation and an hypothesis

OBJECTIVES: This study investigated (i) whether adequate concentrations of secretory leukocyte proteinase inhibitor (SLPI) in the lungs of alpha-1-antitrypsin (A1AT) deficient patients can explain the variability in the development of emphysema in these individuals, and (ii) whether cigarette smoking jeopardises the protective screen provided by functional SLPI. METHODOLOGY: Four subjects [two normal proteinase inhibitor M (PiM), two abnormal PiZ] were selected from patients presenting for diagnostic bronchoscopy and lung function testing (spirometry, DLco). Each subject underwent BAL and had blood taken for A1AT and SLPI estimation. RESULTS: As expected serum and BAL A1AT concentrations were within the normal range in the normal PiM subjects. In normal subjects, SLPI concentrations in serum and BAL were within the normal range. A1AT-deficient subjects had reduced serum and BAL levels of A1AT reflecting their genetic disorder but showed increased concentrations of SLPI in BAL and serum. Percentage neutrophil elastase (NE) inhibitory capacity of BAL fluid was low in both A1AT-deficient subjects and a cigarette-smoking normal subject. In contrast, the NE inhibitory capacity for the normal subject who had never smoked was normal. CONCLUSIONS: These findings suggest that in A1AT deficiency there may be a compensatory increase in SLPI. This may protect the lung against the development of emphysema in A1AT-deficient individuals. Cigarette smokers may have a lower SLPI concentration than non-smokers. This provides an explanation for at least some of the observed variation in the development of emphysema in A1AT deficient subjects.     

Evaluation of danazol therapy for patients with PiZZ alpha-1-antitrypsin deficiency

An inherited deficiency of alpha 1-antitrypsin with blood concentrations less than 80 mg/dl is associated with the accelerated development of emphysema. Current concepts of the pathogenesis of emphysema suggest that an imbalance between neutrophil elastase and alpha 1-antitrypsin in the lung allows neutrophil elastase to work unimpeded to destroy the alveolar structures. Because the common form of the inherited deficiency (homozygous Z) results from impaired hepatic release of alpha 1-antitrypsin, one therapeutic approach to increase plasma and hence lung alpha 1-antitrypsin concentrations is to enhance hepatic release or production of alpha 1-antitrypsin. In a preliminary trial with 6 alpha 1-antitrypsin-deficient subjects, we have previously shown that in 1 month, the impeded androgen danazol can augment serum alpha 1-antitrypsin concentrations by 37%. To evaluate the use of impeded androgens in alpha 1-antitrypsin deficiency on a broader scale, we have treated: 43 homozygous Z patients with danazol 200 mg given orally 3 times a day for 30 days; 6 homozygous Z patients with a similar danazol dose but given for 6 to 18 months; and 7 homozygous Z patients with stanazolol, another synthetic androgen, 2 mg given orally 3 times a day for 30 days. Of the 43 patients treated with danazol for 1 month, 23 (53%) responded with a serum alpha 1-antitrypsin concentration greater than or equal to 20% higher than baseline, an average increase of 52% over the pretreatment concentration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Z alpha1-antitrypsin polymerizes in the lung and acts as a neutrophil chemoattractant

BACKGROUND: Alpha1-antitrypsin (A1AT) is an abundant protein that is synthesized in the liver and is secreted into the plasma. From the plasma, A1AT diffuses into various body compartments, including the lung where it provides much of the antiprotease protection. The current understanding of the pathogenesis of emphysema in A1AT-deficient individuals focuses on the polymerization of mutant protein within the liver, which results in a deficiency of circulating A1AT and a protease-antiprotease imbalance in the lungs. METHODS AND RESULTS: In this study, we evaluated BAL fluid samples from five healthy volunteers, five individuals with ZA1AT deficiency, and an individual with the PiZZ phenotype who had received a liver transplant. We show that the lung itself is a source of A1AT. In addition, the Z protein formed in the lung polymerizes, and these polymers are detectable in lung epithelial lining fluid by enzyme-linked immunosorbent assay and Western blot analysis. Finally, we show that polymeric ZA1AT is a potent neutrophil chemoattractant that is similar to polymerized MA1AT. CONCLUSIONS: Our findings suggest that the polymerization of locally produced ZA1AT is a contributory factor to the lung inflammation experienced by those with A1AT deficiency and that standard antiprotease therapies may not address this problem.     

中性粒细胞弹性蛋白酶抑制剂研究现状

中性粒细胞弹性蛋白酶(NE)与许多疾病,尤其是急性肺损伤(ALI)的发生、发展有关。人体内存在四种内源性中性粒细胞弹性蛋白酶抑制剂(NEI)α1Pi、SLPI、elafin、α2-MG,但它们分子量较大,对氧自由基敏感,因而难以渗透到炎症区域发挥作用。人工合成NEI(西维来西钠)分子量小,对氧自由基不敏感,在治疗不同急性肺损伤实验动物模型及大规模临床研究的结果表明,西维来西钠均表现出明显的保护作用,其肺泡灌洗液中性粒细胞数、蛋白浓度、NE活性明显下降,肺血管通透指数下降,肺水肿减轻,氧合指数(PaO2/FiO2)改善。NEI新药的开发及用于治疗ALI是目前研究的热点。     

Hereditary alpha-1-antitrypsin deficiency in duodenal ulcer

An alpha-1-antitrypsin study was carried out on 184 patients with endoscopically proven duodenal ulcer, 66 first degree relatives of the patients and in 150 healthy controls, to establish the role of genetic factors in the etiology of duodenal ulcer. Alpha-1-antitrypsin served as a genetic marker in this study; it was estimated in terms of serum trypsin inhibitor capacity by the method of Jaccobson. Deficiency of alpha-1-antitrypsin level was recorded in patients as well as their family members when compared with controls.