The role of alpha-macroglobulin in experimental intestinal ischemia

Intestinal ischemia can lead to mucosal damage and presumably increased intestinal permeability. alpha-Macroglobulin (alpha-MG) is a plasma protein responsible for the inhibition and clearance of systemic proteases, including those derived from the intestinal lumen. In this study, we sought to determine the relationship between intestinal ischemia and alpha-MG in dogs using a nonsurgical model of ischemia. In addition, we sought to detect plasma alpha-MG complexes after ischemic injury. We found that alpha-MG levels were significantly reduced 24 h after induction of occlusion compared with those values obtained immediately after vascular occlusion. The onset of the decline in alpha-MG coincided with the onset of full-thickness intestinal damage, alpha-MG levels in the control animals were unchanged. However, alpha-MG complexes were not elevated in the experimental dogs after ischemia. We suggest that the decline in alpha-MG levels reflects a response to excessive protease uptake across a damaged intestine, leading to increase formation of alpha-MG-protease complexes, which are then rapidly cleared. The absence of detectable systemic complexes suggests that in ischemia, clearance is effective in removing the complexes from the bloodstream, alpha-MG appears to play an important role in protecting against proteolytic damage in prolonged intestinal ischemia.