The Forms and the Levels of Fecal PMN-Elastase in Patients with Colorectal Diseases

Objectives : To compare the form of polymorphonuclear leukocyte (PMN)-elastasc in feces with that in plasma and to investigate the usefulness of measuring fecal PMN-elastase levels in patients with colorectal diseases. Methods : We examined PMN-elastase complexed with αl-antitrypsin (αl-AT), chymotrypsin, and α2-macroglobulin by ELISA in feces and plasma. Fecal levels of total PMN-elastase were determined in patients with colonic polyp ( N = 19), colonic cancer ( N = 20), ulcerative colitis (UC; N = 36), colonic Crohn's disease (CD; N = 26), and in control subjects ( N = 20). Result : Most PMN-elastase was not complexed with αl-AT, chymotrypsin, or α2-macroglohu)in in feces, whereas most plasma PMN-elastase was complexed with αl-AT. Fecal concentrations and daily fecal extretion of PMN-elastase were significantly increased in patients with active UC (medians 54.8 μg/g, 15.14 nig/day) and active CD (41.5 μg/g, 10.24 mg/day) compared to those values in control subjects (0.6 μg/g, 0.11 mg/day) and in patients with colonic cancer (2.5 μg/g, 0.33 mg/day). In inactive UC and CD, these values (3.4 μg/g, 0.52 mg/day and 5.2 μg/g, 0.59 mg/day, respectively) were significantly lower than in active UC and CD, respectively. In UC, all patients whose rectal biopsies showed infiltration of PMN had high fecal PMN-elastase levels. Conclusions : Our results suggest that the measurement of fecal PMN-da.stase concentrations are useful for monitoring the disease activity of UC and CD, especially when evaluating whether intestinal inflammation has disappeared completely.