PMN-ELASTASE IN ASSESSMENT OF PATIENTS WITH INFLAMMATORY BOWEL-DISEASE

PMN-elastase is a proteinase released by activated neutrophils. PMN-elastase was determined in two independent populations with inflammatory bowel disease In an unselected population of 70 consecutive patients with Crohn's disease and 24 patients with ulcerative colitis with different degrees of disease activity plasma PMN-elastase levels were statistically significantly higher in patients with active than in patients with inactive disease [Crohn's disease: 80.5 +/- 33.2 ng/ml vs 60.1 +/- 24.6 ng/ml (means +/- sD), P = 0.0017; ulcerative colitis: 98.2 +/- 54.9 ng/ml vs 59.2 +/- 16 8 ng/ml, P = 0.026]. PMN-elastase levels in feces were also higher in patients with active Crohn's disease (23.6 +/- 15.3 ng/g vs 13.6 +/- 12.5 ng/g, P = 0.0021) and active ulcerative colitis (46.5 +/- 60.5 ng/g vs 20.2 +/- 25.0 ng/g, P = 0.46), but the difference reached significance only in Crohn's disease. Correlation of disease activity and PMN-elastase in individual patients showed a statistically significant correlation between plasma and fecal elastase concentrations and disease activity in ulcerative colitis (plasma: r = 0.72, P < 0.001; feces: r = 0.57, P = 0.002). In patients with Crohn's disease only plasma levels of PMN-elastase (r = 0.423, P < 0.001) but not fecal elastase concentrations (r = 0.0083, P = 0.485) correlated significantly with disease activity. Plasma PMN-elastase correlated weakly with fecal PMN-elastase levels in Crohn's disease (r = 0.431, P < 0.01) and in ulcerative colitis (r = 0.515, P = 0.05). In 28 patients with highly active Crohn's disease [median severity activity index (SAI) 203] and 11 patients with highly active ulcerative colitis [median Rachmilewitz index (RI) 14] studied before and four weeks after steroid therapy, treatment lowered the median SAI to 140 and the median RI to 4.5. Mean plasma elastase concentrations decreased concomitantly from 83 +/- 44.9 ng/ml to 61.8 +/- 25.8 (P = 0.0035) in patients with Crohn's disease and from 110 +/- 49.5 to 71.6 +/- 28.8 ng/ml (P = 0.0069) in patients with ulcerative colitis. In conclusion, there is a release of PMN-elastase in active IBD, which can be detected in plasma as well as in feces. Plasma elastase levels reflect disease activity in patients with IBD. The variation of the data and the large overlap between different groups, however, strongly reduce the clinical value