Related Experiment Videos
Collagenase and elastase released during peritonitis are complexed by plasma protease inhibitors
Surgery
|June 1, 1976
Summary
Diffuse peritonitis involves high levels of collagenase and elastase enzymes from granulocytes. Postoperative peritoneal lavage aimed to remove these enzymes, mitigating protease defense failure.
Area of Science:
- Gastroenterology and Surgical Infections
- Biochemistry of Inflammation
- Protease-Antiprotease Interactions
Background:
- Diffuse peritonitis, often resulting from appendiceal perforation, presents a complex inflammatory environment.
- Peritoneal fluid analysis reveals significant enzymatic activity, particularly collagenase and elastase, originating from granulocytes.
- These enzymes form complexes with plasma protease inhibitors, indicating a dynamic interplay during infection.
Purpose of the Study:
- To investigate the role and quantity of specific proteases (collagenase, elastase) in peritoneal fluid during diffuse peritonitis.
- To assess the effectiveness of the body's natural protease defense mechanisms, including plasma protease inhibitors and complement.
- To explore the therapeutic potential of peritoneal lavage in managing protease accumulation postoperatively.
Main Methods:
- Analysis of peritoneal fluid from patients with diffuse peritonitis secondary to appendiceal perforation.
- Quantification of collagenase and elastase activity and their complexation with plasma protease inhibitors (alpha 1-antitrypsin, alpha 2-macroglobulin).
- Assessment of complement component C3 conversion as an indicator of protease defense failure.
- Implementation of postoperative peritoneal lavage using fluid devoid of plasma inhibitors but sufficient in volume to clear enzymes.
Main Results:
- Elevated levels of collagenase and elastase were detected in peritoneal fluids.
- These enzymes were significantly bound to alpha 1-antitrypsin and alpha 2-macroglobulin.
- Complete conversion of the C3 complement component indicated a failure in regional protease defense.
- Postoperative lavage effectively reduced enzyme accumulation.
Conclusions:
- Diffuse peritonitis involves substantial granulocyte-derived protease activity that overwhelms local inhibitory capacity.
- The failure of protease defense, evidenced by C3 conversion, suggests the release of toxic peptides.
- Plasma protease inhibitors are crucial in regional defense, and their depletion highlights a therapeutic target for peritoneal lavage.