[Effects of ulinastatin on endotoxin shock in dogs]

The therapeutic effect of ulinastatin, an inhibitor of the protease activity, on endotoxin shock was evaluated using 17 Beagle dogs. Single intravenous injection of ulinastatin at a dose of 5,000 or 25,000 U.kg-1 failed to suppress the endotoxin-induced circulatory disturbance but significantly inhibited increases in pulmonary arterial pressure and pulmonary vascular resistance that occur early following administration of endotoxin. Elevation of PGI2, TXA2 and LTB4 by endotoxin shock was significantly inhibited by administration of 25,000 U.kg-1 of ulinastatin. Elevation of the granulocytic elastase activity was inhibited dose-dependently by administration of ulinastatin. The above results indicate that ulinastatin may be a promising drug for the treatment of endotoxin shock.

Soybean trypsin inhibitor and cerulein accelerate recovery of cerulein-induced pancreatitis in rats

The role of exogenous and endogenous cholecystokinin has been studied in the process of pancreatic regeneration after acute pancreatitis. A mild form of pancreatitis was induced in rats by subcutaneous cerulein at 12 micrograms.kg-1, three times a day for 2 days. After 3 days of rest, the cerulein-treated rats were divided into four groups: rats with acute pancreatitis fed 20% casein, who received no treatment; rats fed 50% casein; rats fed 20% casein supplemented with 1% soybean trypsin inhibitor (SBTI); and rats fed 20% casein who received 1 microgram.kg-1 of subcutaneous cerulein, three times a day. Controls were fed 20% casein plus saline subcutaneously. Rats were killed after 5, 10, or 20 days of treatment. Pancreatitis resulted in significant decreases in pancreatic weight and contents of protein, amylase, chymotrypsin, RNA and DNA. During the regenerative process, 1 microgram.kg-1 of cerulein increased all parameters to control values within 5 days and induced pancreatic growth thereafter. SBTI restored the pancreas to normal after 10 days with cellular hypertrophy; the 50% casein diet gave a response similar to SBTI without hypertrophy. It can be concluded that cerulein and SBTI can accelerate pancreatic regeneration after an attack of acute pancreatitis.

[Effects of ulinastatin on granulocyte elastase and fibronectin in patients undergoing cardiopulmonary bypass]

We investigated the effects of ulinastatin on the increase of granulocyte elastase (GEL) and the decrease of fibronectin (FN) after cardiopulmonary bypass (CPB) in 30 patients undergoing cardiopulmonary bypass. Ulinastatin 300,000 units were given immediately after the induction of anesthesia (U1) or during CPB (U2). GEL increased by 20 times after CPB. GEL was lower in U2 than those in other groups. FN increased by 7-13% after CPB in U1 but decreased in other groups. FN decreased by 21-13% on the first postoperative day in three groups. There was a close relationship between CPB time and increase of GEL in the control group (no ulinastatin given) (y = 18.5 x -833, r = 0.751), between CPB time and increase of FN in U1 (y = 1.4 x -163.4, r = 0.683) or increases of GEL and FN in the control group (y = 0.068 x -202.6, r = 0.812). From these results, we recommend that ulinastatin should be given after the induction of anesthesia and during CPB, to keep a favorable host defense function after CPB.

[Effect of FOY-305 on post-operative reflux esophagitis in rats (II). Analysis of mechanism in the pathogenesis of reflux esophagitis after total gastrectomy in rats]

Esophagitis after total gastrectomy has been associated with biliary and pancreatic reflux into the esophagus. The purpose of this study is to clarify the effect of FOY-305 on these factors in the esophagitis. We initially produced esophagitis in rats with total gastrectomy followed by an end-to-side esophago-jejunostomy (Billroth-II). After treatment of FOY-305 on post-operative day 7 in this model, esophageal washout samples were analyzed for increases in activity of trypsin and total bile acid concentration. FOY-305 completely inhibited increases of trypsin activity in 2 and 4 hr, and it significantly (P less than 0.05) reduced bile acid concentration in 4 hr after initiating treatment. In addition, we evaluated the injurious effect of trypsin and sodium taurocholate (Tc-Na) on isolated esophagus of rats by measuring released tyrosine in the medium and used it as an index of the degree of injury. Tc-Na (3-fold of enteral bile acid concentration) inflicted only a slight injurious effect with negligible tyrosine release increases, and it did not show synergistic action when concomitantly used with trypsin. However, trypsin clearly induced increased tyrosine release from the esophageal mucosa, and this effect was significantly (P less than 0.001) inhibited by FOY-305 (50 microM). These results indicate that trypsin is one of the important factors in the pathogenesis of reflux esophagitis after total gastrectomy, and FOY-305 exerts a therapeutic effect by eliciting an inhibitory action against trypsin activity.

Prophylactic administration of urinary trypsin inhibitor prevents postoperative hyperamylasemia after R2 gastrectomy in patients with gastric cancer. A prospective randomized trial

The purpose of this prospective randomized study was to determine whether prophylactic administration of urinary trypsin inhibitor prevents postoperative damage to the pancreas caused by R2 gastrectomy in patients with gastric cancer, by analyzing related enzyme activities. Among the 22 patients who underwent distal partial gastrectomy together with R2 lymphadenectomy, 12 were given the drug for 3 days postoperatively, and 10 no therapeutic agent. These groups were otherwise comparable. Postoperatively, the control patients had significantly higher levels of total amylase activity in the serum and P-type amylase when compared to the preoperative data. These amylase activities almost remained at the preoperative level in those given the drug. When the ratio of increase in enzyme activities (postoperative value divided by preoperative value) were compared, on the 7th postoperative day, total amylase activity in the serum and P-type amylase were significantly different between the two groups (p less than 0.05). This difference was also evident when comparing total amylase activity in the urine (p less than 0.05). These findings indicate that prophylactic administration of urinary trypsin inhibitor would aid in preventing postoperative hyperamylasemia caused by R2 gastrectomy in patients with gastric cancer.

[Effect of acute aprotinin (Gordox) therapy on hemostasis in heart surgery patients, with special reference to hyperfibrinolysis]

Authors have studied the effect of Gordox-therapy on haemostasis after open heart surgery in a prospective clinical trial. Thirty seven patients (pts) undergoing cardiac surgery due to their valve disease were randomly assigned either to control-group (20 pts) or to Gordox-group (17 pts). The patients in the Gordox group were given Gordox according the following scheme: 2 M IU within 20 min. after induction of anaesthesia followed by 0.5 M IU/hour infusion until the end of the operation. One M IU also was given into the oxygenator before starting the extracorporeal circulation. The postoperative chest tube drainage was less in Gordox-group (534 +/- 260 ml vs. 987 +/- 583 ml, p less than 0.005), and donor blood and fresh frozen plasma requirement was also lower in this group (534 +/- 633 ml vs. 935 +/- 718 ml p less than 0.05; 70 +/- 153 ml vs. 211 +/- 245 ml p less than 0.05, respectively). There was no significant difference between the two groups concerning the postoperative activated partial thromboplastin time, prothrombin time, thrombin time values. The authors could document significantly higher fibrinogen concentration and significantly lower fibrinolytic activity postoperatively in the Gordox-group (p less than 0.05). Gordox therapy has advantageous effect on haemostasis after open heart surgery which can be documented both by clinical and laboratory examination.

Prevention of experimental acute pancreatitis by intraduodenal trypsin inhibitor in rat

To confirm that trypsin activity is a most important initiating factor in closed duodenal loop pancreatitis in rats, we observed the course of acute pancreatitis when trypsinogen activation was inhibited by intraduodenal infusion of a potent synthetic trypsin inhibitor (TI, nafamostat mesilate) but the other conditions were left unchanged. Intraduodenal and intrapancreatic trypsinogen activation was inhibited for 16 hr after the intraduodenal infusion of the inhibitor, although elevation of serum amylase and immunoreactive trypsin and pancreatic trypsinogen remained similar both in the TI and control groups. The mortality decreased from 44% (control) to 4% (TI) at 48 hr after establishing the model. Active trypsin in duodenal reflux is an initiating factor for further development of acute pancreatitis in the closed loop model, and inhibition of the initial activation of trypsinogen has a favorable effect on acute pancreatitis even if other deleterious factors remain unchanged.

[Usefulness of a protease inhibitor (urinastatin) in ARDS with infectious diseases]

The usefulness of urinastatin (UST) for adult respiratory distress syndrome (ARDS) induced by gram-negative sepsis was evaluated in clinical and experimental studies. Twelve cases of clinical septic ARDS were treated with combination therapy of UST and methylprednisolone (M-PSL). Ten out of 12 responded favorably. This result was considered to some extent to be better than that of our previous experience with single administration of M-PSL for patients with septic ARDS. Pathophysiologic experiments on UST in endotoxic status were then performed. Immediately after the intravenous administration of endotoxin to rats, serum levels of beta-glucuronidase and elastase released from PMNs were increased and pulmonary edema was observed at 48-hours after the endotoxin injection. Various degrees of pulmonary edema were also observed by the intravenous administration of beta-glucuronidase and PMNs-elastase. These changes induced by the endotoxin were significantly inhibited by the intraperitoneal administration of UST, and they were inhibited more by the combination therapy of UST and M-PSL. In an in vitro study, significantly large amounts of beta-glucuronidase and elastase were released from PMNs by incubating human PMNs with endotoxin. By adding UST to this system, the release of these PMNs proteases was inhibited. These results suggested that UST neutralizes the PMNs-elastase release in the status endotoxemics, and consequently resulted in a better prognosis in cases of septic ARDS.

[Effect of ulinastatin (UL) on renal function and lactic acidosis during open-heart surgery: comparison with aprotinin (Ap)]

Comparison was made on the renal function and lactic acidosis during cardiopulmonary bypass (CPB) between the group Ul (n = 15) and group Ap (n = 27). A 300,000 u, of ulinastatin was administered intravenously before CPB and 300,000 u, in the prime solution. A 300,000 u, of aprotinin was administered in the prime solution. Urine output during CPB was not significantly different, but the total dose of furosemide administered was less in group Ul and a significant difference (p less than 0.05) was observed in the free water clearance at CPB 1 hr. and 3 hr. postoperatively, -0.83 +/- 0.16 and -1.74 +/- 0.14 in group Ul and -0.43 +/- 0.10, -0.99 +/- 0.14 in group Ap, respectively. Arterial lactate increased as the perfusion time increased but the level at the end of CPB was significantly lower (p less than 0.05) in group Ul and the added 7% NaHCO3 to correct metabolic acidosis during CPB of 29.3 +/- 9.5 ml in group Ul was less than in group Ap of 82.2 +/- 15.2 ml (p less than 0.01). The result suggests the favourable effects of ulinastatin on the renal function and lactic acidosis during CPB.

[Effects of ulinastatin on plasma polymorphonuclear leukocyte elastase activity and respiratory function in patients undergoing cardiopulmonary bypass]

Plasma polymorphonuclear leukocyte elastase (PMNE) activity is known to increase during cardiopulmonary bypass (CPB), and is considered to mediate pulmonary tissue damage causing postoperative respiratory failure. We made a clinical study in order to clarify the effects of ulinastatin (Miraclid), a proteolytic enzyme inhibitor, on plasma PMNE activity and respiratory function. Twenty adult patients undergoing coronary artery bypass grafting were divided into 2 groups; 10 to group U and 10 to group C. The patients in group U received 500 U/kg body weight of ulinastatin intravenously before and after CPB, and the patients in group C not receiving the dose served as controls. Arterial blood samples were obtained before the operation, 1 hour after CPB, 3 hours, 1 day and 4 days after the operation. The leukocyte count was significantly lower in group U 1 hour after CPB and 3 hours after the operation compared to group C (p less than 0.01). The plasma PMNE activity rose rapidly after starting CPB and the peak level appeared 1 hour after CPB; 1165 +/- 560 micrograms/l in group U and 1981 +/- 562 micrograms/l in group C (p less than 0.02). There was a significant correlation between the leukocyte reduction and the rate of increase of beta-glucuronidase activity were diminished in group U compared to preoperative values (p less than 0.05). The recovery of the oxygenation index (PaO2/F1O2), which was used for evaluation of the respiratory function, was worse in group C (p less than 0.01). These results suggest that the administration of ulinastatin in patients undergoing CPB is useful for the prevention of the deleterious effects of PMNE on the lung.

Analogues of 1,5-bis(4-amidinophenoxy)pentane (pentamidine) in the treatment of experimental Pneumocystis carinii pneumonia

A series of 33 analogues of the anti-Pneumocystis carinii drug 1,5-bis(4-amidinophenoxy)pentane (pentamidine) was synthesized for screening against a rat model of P. carinii pneumonia (PCP). Twenty-five of the compounds showed efficacy against PCP when compared to a saline-treated control group. Two compounds, 1,4-bis(4-amidinophenoxy)butane (butamidine, 6) and 1,3-bis(4-amidino-2-methoxyphenoxy)propane (DAMP, 16), were statistically more effective than the parent drug in treating PCP in the rat model of infection. In addition to their activity against PCP, the compounds were also evaluated for antitrypsin activity, ability to inhibit thymidylate synthetase, affinity for DNA, and toxicity. No correlation was observed between the tested molecular interactions of the diamidines and their effectiveness against PCP.

[Reduction in leukocyte elastase levels in patients with sepsis by administration of urinastatin]

Leukocyte elastase (LE) plays a role in the development of shock. Therefore, we examined the effects of urinastatin, a protease inhibitor, on LE in 7 patients with sepsis. LE levels before the administration of urinastatin were high in all patients, especially those in shock. Administration of urinastatin markedly decreased LE levels, with the decrease being more remarkable in patients showing high LE levels before treatment. These results suggest that urinastatin not only reduces LE levels but also suppresses factors that are involved in the development of septic shock.

[The effect of open heart surgery and an operation on thoracic aneurysm on organs and the prevention of an organ system failure: comparison between the group using ulinastatin and not using group]

We studied the effect of the open heart surgery and the thoracic aortic aneurysm surgery on renal, liver and respiratory function and the coagulofibrinolytic system. We also investigated as to whether ulinastatin was effective or not with regard to preventing an organ system failure. The renal function, liver function and the coagulofibrinolytic system were preserved, although there was a greater number of severe cases in the group which used ulinastatin (US group) than in the group that did not use ulinastatin (non-US group). In the US group, PaO2 did not decrease postoperatively. However, in the non-US group, PaO2 decreased significantly after the operation. The variables in relation to using ulinastatin, examined by a stepwise method, included kind of disease, emergency operation, PaO2, BUN and serum plasminogen. The multiple coefficient for these five variables was 0.623 (p less than 0.01) and the contribution was 38.8%. It was suggested that ulinastatin could prevent an organ system failure, especially respiratory failure, after open heart surgery and the thoracic aortic aneurysm surgery.

[A cured case of adult respiratory distress syndrome caused by septicemia of Staphylococcus aureus]

A 33-year-old woman was admitted as an emergency case because of shock condition after delivery. Physical examination revealed fever, cyanosis and coarse crackles throughout the entire chest. Laboratory data showed leukocytosis and increase of CRP value. Adult respiratory distress syndrome (ARDS) was diagnosed based on progressive severe hypoxemia and bilateral diffuse alveolar shadows on chest X-ray film. The cause of ARDS was considered to be septicemia as staphylococcus aureus was cultured from lochia. The patient was intubated, then artificially ventilated employing PEEP. Chemotherapy using three different kinds of antibiotics was started, combined with the administration of corticosteroid and a protease inhibitor, Urinastatin. The patient finally recovered completely.

Modulation of lung tumor development in mice with the soybean-derived Bowman-Birk protease inhibitor

Male strain A mice were treated with a single i.p. injection of 3-methylcholanthrene (MCA). Four months later, the number of lung tumors was counted. In mice treated three times a week, for 8 weeks, with crude soybean extract containing the Bowman-Birk protease inhibitor (BBI), the number of lung tumors was significantly lower than in control animals receiving carcinogen treatment only (40-70% of controls). On the other hand, treatment initiated 8 weeks after MCA only had no effect on tumor development. A reduction in the number of lung tumors was also found in animals treated i.p. or orally with purified BBI three times a week for 8 weeks following MCA administration. It is concluded that BBI is capable of partially blocking the development of lung tumors in mice.

[Effect of urinastatin on immunity during anesthesia and surgery for malignant disease]

The effect of urinastatin (Miraclid) on the changes of peripheral lymphocyte subpopulations during the operation for malignancy was investigated. Ten urinastatin-treated patients and twelve non-treated patients undergoing surgery for gastric cancer under general anesthesia were studied. Peripheral lymphocyte subpopulations were measured before and during operation employing two color analysis utilizing two kinds of monoclonal antibody, such as Leu3a and Leu8, Leu2a and Leu15, or Leu4 and HLA-DR. With this analysis, it was possible to classify peripheral lymphocytes into helper T cells, inducer T cells, cytotoxic T cells. suppressor T cells and B cells. Decrease in inducer T cells, increase in suppressor T cells and decrease in B cells were observed in the non-urinastatin-treated group during the operation. Furthermore, decrease in OKT4/OKT8 (Leu3a/Leu2a) ratio was demonstrated. But these changes were inhibited in the urinastatin-treated group. This result suggests that the administration of urinastatin improves immunosuppressive state during operation.

Urinastatin (Kunitz-type proteinase inhibitor) reducing cisplatin nephrotoxicity

The authors investigated the reductive effects of a Kunitz-type proteinase inhibitor, urinastatin, on the nephrotoxicity seen in lung cancer patients treated with cisplatin by measuring N-acetyl-beta-D-glucosaminidase (NAG) activity and beta 2-microglobulin (BMG) content in 24 hour urine, creatinine clearance, blood urea nitrogen (BUN), serum creatinine, uric acid, and BMG as factors of nephrotoxicity. In control patients treated with anticancer drugs containing cisplatin but no supplemental urinastatin, the 24 hour urine NAG and BMG levels increased more than three-fold over the pretreatment levels, 3 days after anticancer therapy, respectively. Creatinine clearance significantly decreased and levels of BUN, serum uric acid, and BMG in control patients significantly increased over the corresponding pretreatment levels, 3 days after anticancer therapy. However, supplemental urinastatin reduced abnormalities in levels of all these factors 3 days after therapy. These results suggest that supplemental urinastatin protects from cisplatin-induced nephrotoxicity, especially proximal tubular damage.

[Therapeutic effects and influence on the urinary enzyme activity of human urinary trypsin inhibitor (urinastatin) in cases with acute renal failure--changes in the urinary activities of NAG and AAP]

We studied the therapeutic effects of human urinary trypsin inhibitor (UTI) in 5 cases with acute renal failure, resulting from traumatic shock in 1 case, post-operative shock in 2 cases, septic shock in 1 case, and dehydration in 1 case. We administered 300,000 u/day of UTI intravenously at the initial phase of acute renal failure for 7 days. We measured the activities of urinary N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP) and the activities of serum beta-glucuronidase, PMN-elastase serially. As a control, we also studied same markers in 5 cases with acute renal failure without the administration of UTI. We could obtain the following results. 1) Urinary activities of NAG and AAP were already elevated markedly at the onset phase of acute renal failure. 2) The administration of UTI caused a significant decrease of the activities of NAG and AAP in the urine as compared with those in the controls. 3) The administration of UTI caused also the significant suppression of the activities of beta-glucuronidase and PMN-elastase in the serum. These results suggested that UTI has the protective effects on the tubular epithelial cell injuries in cases of acute renal failure.

[The effect of protease inhibitors in shock]

Protease inhibitors, such as ulinastatin and gabexate mesilate, are widely used for the patients in shock state. The purpose of this study was to evaluate the effects of these protease inhibitors on renal protection and coagulofibrinolytic disorders. The obtained results were as follows: 1. Ulinastatin studies. 1) Beta 2-microglobulin (BMG) excretion and N-acetyl-beta-D-glucosaminidase (NAG) activity in urine were increased in cases of emergency operation (10 patients) compared with elective operation (38 patients). 2) In canine experimental model of renal ischemia, ulinastatin significantly improved urine volume and urine NAG levels. 3) Administration of ulinastatin suppressed urine NAG level in 12 patients, but BMG level did not significantly change. 2. Gabexate mesilate (FOY) studies. 1) All patients in shock state showed coagulofibrinolytic disorders. Especially remarkable hypercoagulability was observed in 21 patients. 2) FOY suppressed platelet aggregation and the release of beta-thromboglobulin and platelet factor 4. 3) In 24 patients, administration of FOY markedly increased the antithrombin III levels in early postoperative period. 4) Fibrinolytic system was not affected any significant changes with administration of FOY.

CONCLUSION

Our results suggested that protease inhibitors are useful for management of the patients in shock state.

Local administration of human pancreatic secretory trypsin inhibitor prevents the development of experimental acute pancreatitis in rats and dogs

The objective of this investigation was to test the capacity of recombinant human pancreatic secretory trypsin inhibitor (rhPSTI) to provide prophylaxis against experimental pancreatitis. Acute hemorrhagic pancreatitis was induced by intraductal injection of sodium taurocholate in rats and by intraductal injection of bile in dogs. In one treatment group of rats the injection of taurocholate was preceded by injection of rhPSTI. In a second group of rats the rhPSTI was given intraperitoneally starting 15 min after the induction of acute pancreatitis. The survival rate in a control group of rats was 13%. In contrast, the survival rate in groups receiving rhPSTI intraductally or intraperitoneally was 80% and 63%, respectively. The survival rate in a control group of dogs was 40% at 24 h and 0% at 48 h. In contrast, all the dogs receiving a single intraductal dose of rhPSTI, either immediately before the bile injection or mixed with the bile, survived for up to 6 weeks. Detailed biochemical and immunohistologic studies in the dog indicate that, whereas rhPSTI cannot prevent the initial bile-induced injury, it does prevent the subsequent development of that injury to the point where there is massive damage to the pancreas and the surrounding tissues, and changes in blood chemistry. The development of the initial injury is, therefore, presumed to involve activation of trypsinogen. Since rhPSTI prevents the serious consequences of experimental pancreatic injury by blocking the action of trypsin, and since the pathobiochemistry of human acute pancreatitis also implies an important role for trypsin, it is possible that rhPSTI could protect humans from the pancreatitis that complicates endoscopic retrograde cholangiopancreatography and endoscopic papillotomy.

[Study of proteolytic enzymes and their inhibitors in maxillary sinus exudates in patients with chronic suppurative maxillary sinusitis]

Specific proteolytic and antitryptic activities were measured in the sinus exudate of 27 patients with chronic suppurative maxillary sinusitis. Most patients showed a shift in the proteinase-inhibitor system with proteolytic activity being predominant. In the course of treatment antitryptic activity in the exudate increased. It was found that biochemical data were correlated with clinical manifestations. It is concluded that patients with the above pathology should be prescribed proteolytic enzymes on an individual basis and that natural proteinase inhibitors should be included into the combined therapy.

[Effects of ulinastatin on operative stress in major surgery]

Effects of ulinastatin on operative stress in upper abdominal surgery were investigated. The operation caused damages to the body functions such as enhancement of protein catabolism, hepatic dysfunction and pancreatic dysfunction, followed by elevation of GOT, GPT, LDH and serum amylase. The operative stress also decreased the total lymphocyte and T cell counts in the peripheral blood, and attenuated the lymphocyte transformation induced by phytohaemagglutinin (PHA) and concanavalin A (Con A). Ulinastatin 7500 u.kg-1 failed to decrease the elevation of plasma enzyme levels and the depression of immune function. But ulinastatin had no immunosuppressive effect like glucocorticoid and attenuated the decrease in plasma levels of protein and albumin. The results suggest that ulinastatin has an effect in modulating the enhancement of protein catabolism by operative stress.

[Protective effects of ulinastatin on hepatic oxygen metabolism during halothane anesthesia in the presence of graded hypoxic hypoxemia]

Hepatic oxygen metabolism and the hepatic energy charge were assessed in mongrel dogs receiving 40,000 U.kg-1 of ulinastatin intra-portally during 2 MAC halothane anesthesia combined with graded hypoxic hypoxemia (21-6% oxygen) for the purpose of evaluating the role of ulinastatin in protecting the liver against the deprivation of the hepatic energy charge resulting in halothane-induced hepatotoxicity. Hepatic blood flow was measured using electromagnetic flowmetry; hepatic oxygen delivery and consumption were calculated from measured hepatic blood flow and oxygen content in hepatic arterial, portal venous and hepatic venous blood. In the animals who received ulinastatin during halothane anesthesia (the UST group), nine out of ten survived even at 8% oxygen, whereas six out of eight died in the halothane-alone group. There was no significant difference in total hepatic blood flow between the two groups. PaO2 was higher in the UST group than the halothane-alone group at 15 and 12% oxygen. Therefore hepatic oxygen delivery was significantly higher in the UST group at 15 and 12% oxygen. Hepatic oxygen consumption and the delivery/consumption ratio were also higher in the UST group at the various inspired oxygen levels. The arterial ketone body ratio, which indicates the mitochondrial energy charge level, significantly decreased with the progress of hypoxia in both groups, but it was significantly higher in the UST group at 8% oxygen.(ABSTRACT TRUNCATED AT 250 WORDS)

Amelioration of immune complex-mediated glomerulonephritis by synthetic protease inhibitors

Proteases are involved in the pathogenesis of inflammatory diseases by participating in the activation of mediator systems and by producing proteolytic tissue injury. Homeostatic control of inflammation is accomplished in part by physiologic protease inhibitors. The authors investigated the effectiveness of a number of synthetic protease inhibitors in ameliorating the glomerular injury induced by immune complex-mediated glomerulonephritis in mice. Two amidine-type protease inhibitors, bis (5-amidino-2-benzimidazolyl)methane and 1,2-bis (5-amidino-2-benzimidazolyl)ethane, had the greatest effects. They caused a marked reduction in glomerular necrosis (P less than 0.001) but did not affect the amount or site of immune complex localization or leukocyte influx. The inhibition constants of the protease inhibitors against nine purified physiologic proteases were determined. These results were discussed in relation to the effectiveness of the protease inhibitors in reducing glomerular injury. This investigation indicates that the administration of synthetic protease inhibitors can have a beneficial effect on immune-mediated inflammatory injury.

[Effect of urinastatin on disseminated intravascular coagulation]

Effect of urinary enzyme inhibitor urinastatin (MTI) on disseminated intravascular coagulation (DIC) was investigated. The prolongation of PTT and increase in FDP in endotoxin-induced DIC in rats were restored by the intravenous infusion of MTI. The reduction in platelet counts, decrease in fibrinogen level and prolongation of PT were partially suppressed by the drug. Furthermore, in vitro addition of MTI prevented the decrease in r and k values and increase in ma and m epsilon values in the thromboelastogram of whole blood in endotoxin-induced DIC in rabbits. It is suggested that MTI might prevent DIC in vivo and in vitro through the inhibition of Factor XII activity and through the prevention of thromboplastin release caused by endotoxin.

Inhibition of oral carcinogenesis by a protease inhibitor

The effect of the Bowman-Birk inhibitor (BBI) and soybean trypsin inhibitor (SBTI) on experimental 7,12-dimethylbenz[a]anthracene [(DMBA) CAS: 57-97-6]-induced oral carcinogenesis in Syrian male hamsters was examined. All treatments were applied topically on both cheek pouches for 20 weeks, and the animals were then sacrificed. Gross and microscopic evaluations revealed a statistically significant reduction in the number of invasive carcinomas, the total number of tumors, and the tumor mass for the DMBA + BBI treatment group compared to animals treated with DMBA alone, DMBA and autoclaved BBI (a preparation in which protease inhibitor activity is destroyed), or DMBA + SBTI. A protease activity (with the use of Boc-Val-Pro-Arg-MCA as substrate) was measured and found to be elevated about tenfold in tumorous and nontumorous tissue from DMBA-treated cheek pouches. This protease activity was found to be decreased in the DMBA and BBI treatment group but not in the DMBA + SBTI or DMBA and autoclaved BBI treatment groups, as compared to the protease activity in the DMBA treatment group. Partial characterization of the Boc-Val-Pro-Arg-MCA hydrolyzing activity with diisopropyl fluorophosphate suggests that the proteolytic activity is a serine protease. Iodoacetamide and diethyl pyrocarbonate also inhibit enzyme activity, suggesting that other residues may be necessary for catalysis, possibly including cysteine and histidine. Our results suggest that this protease activity may play a role in DMBA-induced cheek pouch carcinogenesis.

Soybean trypsin inhibitor attenuates ischemic injury to the feline small intestine

Recent evidence suggests that oxygen free radicals are largely responsible for the increased vascular permeability and early mucosal lesions associated with partial intestinal ischemia. It is postulated that oxygen radicals are produced by the reaction of the enzyme xanthine oxidase with hypoxanthine and molecular oxygen. In normal healthy cells, xanthine oxidase exists as a nicotinamide adenine dinucleotide-reducing dehydrogenase and not the oxygen radical-producing oxidase. In the intestine, dehydrogenase-to-oxidase conversion is nearly complete with less than 1 min of ischemia. Biochemical evidence from the intestine and liver indicate that ischemia-induced conversion of xanthine dehydrogenase to xanthine oxidase can be prevented by administration of protease inhibitors such as soybean trypsin inhibitor. In order to assess the role of proteases in oxygen radical-mediated ischemic injury to the small bowel, quantitative analyses of mucosal lesion development and vascular permeability were performed in autoperfused segments of cat ileum subjected to 1 or 3 h of ischemia and pretreated with 15 mg/kg (i.v.) soybean trypsin inhibitor. One hour of ischemia produced a significant increase in intestinal vascular permeability. The ischemia-induced increase in vascular permeability was significantly attenuated by soybean trypsin inhibitor pretreatment. Three hours of ischemia led to the development of mucosal lesions in untreated animals. Pretreatment with soybean trypsin inhibitor largely prevented the development of the mucosal lesions. The findings of our study are consistent with biochemical evidence that, during ischemia, proteases trigger the conversion of xanthine dehydrogenase to xanthine oxidase and thereby lead to oxygen radical production and subsequent tissue injury.

A rational approach to the specific chemotherapy of pancreatitis

Oedematous pancreatitis is pancreatic acinar cell damage with leakage into the peritoneal cavity and circulation of the inactive zymogens of digestive enzymes and active amylase and lipase. Pancreatic oedema and intra-abdominal fat necrosis occur. Necrotising pancreatitis is pancreatic acinar cell damage accompanied by the specific conversion of trypsinogens to trypsins, at a rate, and on a scale, sufficient to overwhelm local defences. Rapid release of the whole spectrum of activated pancreatic enzymes leads to necrosis of parts of the pancreas and blood vessels, and the disseminated enzyme-mediated damage which characterises the molecular pathology of the established severe disease. Chronic pancreatitis, although less well understood, is also associated with trypsinogen activation within the gland. Two mechanisms have emerged as initiators of trypsinogen activation, lysosomal cathepsins and bile-borne enterokinase. Chemotherapeutic strategies against disease initiation include preparation of synthetic enterokinase and Cathepsin B inhibitors. Chemotherapeutic strategies against second-stage mediation of multi-organ damage in the disease, include oligopeptide or organic functionalities with novel catalytic site-directed moieties (such as fluoromethyl ketones) suitable for in vivo use and the specific inhibition of the relevant range of enzymes in complex with alpha 2-macroglobulin. Interference with pancreatic enzyme biosynthesis using proteolysis-resistant constructs mimicking receptor-binding domains of inhibitor peptide hormones as well as inhibitors of pancreatic signal peptidase are promising additional chemotherapeutic approaches worthy of active investigation.

Acute and chronic pancreatitis. An update on management

Therapeutic measures for acute pancreatitis depend on the severity of the disease and its complications. Since complications of acute pancreatitis may develop at any time, patients should be admitted to an intensive care unit for assessment (and frequent reassessment) of the severity of the disease and the development of complications. Basic therapy should include relief of pain, total fasting, nasogastric suction, parenteral replacement of fluids, electrolytes, albumin and blood, and antibiotics. Hyperglycaemia should be corrected and heparin should be given in cases of disseminated intravascular coagulation. In renal insufficiency, peritoneal dialysis is important, and in respiratory complications, humidified oxygen or artificial ventilation including positive and expiratory pressure therapy should be applied. Although the effect of peritoneal dialysis has been proven only in animal experiments and in retrospective studies in man, it is recommended in severe cases for shock therapy and for correction of electrolyte imbalance when ascites is present, even before anuria occurs. Conservative treatment measures in chronic pancreatitis are limited to the management of pain and of exocrine and endocrine pancreatic insufficiency.

[Pharmacological studies of FUT-175, nafamstat mesilate. II. Effects on experimental acute pancreatitis]

Effects of FUT-175, a novel synthetic protease-inhibiting agent, on various models of experimental acute pancreatitis were examined. FUT-175 infused i.v. at a dose range of 5-50 micrograms/kg/min inhibited the increase in plasma trypsin activity and reduced the mortality of rabbits in trypsin-induced acute pancreatitis in a dose-dependent manner. Increase in serum amylase activity and pancreatic tissue lesion were attenuated in rabbits. In addition, FUT-175 infused i.v. at a dose range of 1-50 micrograms/kg/min reduced the mortality of rats in experimental acute pancreatitis produced by trypsin and endotoxin. FUT-175 infused i.v. at a dose range of 1-100 micrograms/kg/min protected the dogs from the increase in plasma trypsin activity and hypotension and shock induced by trypsin, well-known characteristics of acute pancreatitis. These results suggest that FUT-175 is beneficial as a therapeutic agent of acute pancreatitis.

[Pharmacological studies of FUT-175, nafamstat mesilate. III. Anti-inflammatory activities of FUT-175]

Anti-inflammatory effects of FUT-175 (nafamstat mesilate), a new synthetic serine protease inhibitor, on various types of experimental inflammation were investigated in vivo and in vitro, in comparison with non-steroidal anti-inflammatory drugs (NSAID). The in vivo studies showed that FUT-175 has the abilities to inhibit almost all types of inflammatory reactions employed in the present study. In particular, being evaluated on the basis of the effect of indomethacin, FUT-175 exhibited relatively higher potencies against some reactions such as zymosan-induced increase of vascular permeability, scald paw edema, zymosan-induced granuloma-pouch, the Arthus reaction and acetic acid-induced writhing in which the complement system or the kallikrein-kinin system are considered to play an important role. The in vitro studies showed that FUT-175 is quite different from NSAID, that is, FUT-175 had no effects on heat-induced erythrocyte-lysis and heat-induced denaturation of bovine serum albumin. FUT-175 also had no effect on chemotaxis of polymorphonuclear leucocytes, but inhibited the production of chemotactic factor by antigen-antibody reaction. These above results suggested that FUT-175 has a different mode of action from NSAID and that serine protease inhibiting activities of this compound might play an important role in its anti-inflammatory effect.

[Antiviral and therapeutic action of protease inhibitors in viral infections: experimental and clinical observations]

The effect of protease inhibitors (gordox, contrycal, epsilon-aminocapronic acid) on the development of influenza virus-induced infectious process was studied. Administration of the above-mentioned drugs exerted a marked antiviral and therapeutic effect both in animal experiments and in treatment of children suffering from influenza. Electron microscopic examinations of lungs from influenza virus-infected animals treated with protease inhibitors revealed definite decrease in the number of virus particles and significant diminution of pathological lesions; the changes were noted which indicated activation of the body immune response. The use of a protease inhibitor, epsilon-aminocapronic acid, in children with influenza shortened the duration of influenza virus antigens persistence in the nasopharyngeal epithelium and reduced the duration of the disease symptoms by 1 1/2-2-fold. Administration of epsilon-aminocapronic acid in inhalations exerted most effective antiviral and therapeutic effect. The results obtained demonstrate the possibility of influenza treatment with inhibitors of proteolytic enzymes.

[Effect of gordox on the pancreas in experimental pancreonecrosis]

Early treatment with gordox of white rats with experimental pancreonecrosis reduces amylasemia and prevents dissemination of steatonecroses. The drug appreciably improves pancreatic microcirculation. Similarly to the control, the injured part of the gland undergoes necrosis. However, the severity of hemorrhagic component is minimal. The treatment with gordox enhances leukocytic infiltration aimed at elimination of necrotic tissues.

[Therapeutic effects of human urinary trypsin inhibitor on acute experimental pancreatitis]

Therapeutic effects of human urinary trypsin inhibitor (MTI) on acute pancreatitis were examined. MTI potently inhibited not only proteases such as trypsin or alpha-chymotrypsin, but also inhibited lipase or creatine phosphokinase which are considered to be related to pancreatitis. Although gabexate mesilate (gabexate) and aprotinin also strongly inhibited trypsin, their inhibition spectra against pancreatic enzymes were narrower and aprotinin also strongly inhibited trypsin, their inhibition against pancreatic enzymes were narrower than MTI. MTI inhibited proteases released from pancreatic slice by trypsin more potently than gabexate or aprotinin. The therapeutic effects of MTI on experimental acute trypsin-induced pancreatitis in dogs or rats were stronger than those of gabexate or aprotinin. These results suggest that MTI may suppress pathogenesis and development of pancreatitis in several ways, for example, by directly inhibiting trypsin and by inhibiting tissue-damaging enzymes released from the pancreas by stimulation with trypsin.