Protease Inhibitors in Plasma and Faecal Extracts from Patients with Active Inflammatory Bowel Disease

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Abstract
The level and functional activity of the major protease inhibitors in plasma and faecal extracts were analysed in 26 consecutive patients admitted during their first attack of acute severe colitis. The patients were retrospectively divided into two groups: one with total colitis and another with distal colitis. The patients with total colitis had a significantly lower alpha2-macroglobulin level in plasma than normal individuals and patients with distal disease, whereas no difference in the levels of alpha1-protease inhibitor, antichymotrypsin, antithrombin III, and alpha2-antiplasmin was noted between the two groups. The protease-inhibiting capacity was saturated, and free proteolytic activity was present in the faecal extracts. In the extracts complex formation was demonstrated between leukocyte proteases and the antiproteases alpha1-protease inhibitor and alpha2-macroglobulin. It is concluded that the low plasma level of alpha2-macroglobulin in patients with severe total colitis is mainly due to a consumption caused by complex formation with proteases, as earlier demonstrated in patients with acute pancreatitis and sepsis.