Activation of cellular immune response in acute pancreatitis.

BACKGROUND: Inflammatory mediators have recently been implicated as potential markers of severity in acute pancreatitis. AIMS: To determine the value of neopterin and polymorphonuclear (PMN) elastase as markers of activation of cellular immunity and as early predictors of disease severity. PATIENTS: Fifty two non-consecutive patients classified according to their clinical outcome into mild (n = 26) and severe pancreatitis (n = 26). METHODS: Neopterin in serum and the PMN elastase/A1PI complex in plasma were measured during the first three days of hospital stay. RESULTS: Within three days after the onset of acute pancreatitis, PMN elastase was significantly higher in the severe pancreatitis group. Patients with severe disease also showed significantly higher values of neopterin on days 1 and 2 but not on day 3 compared with patients with mild disease. There was a significant correlation between PMN elastase and neopterin values on days 1 and 2. PMN elastase on day 1 predicted disease severity with a sensitivity of 76.7% and a specificity of 91.6%. Neopterin did not surpass PMN elastase in the probability of predicting disease severity. CONCLUSIONS: These data show that activation of cellular immunity is implicated in the pathogenesis of acute pancreatitis and may be a main contributory factor to disease severity. Neopterin was not superior to PMN elastase in the prediction of severity.

An impaired phagocytic function is associated with leucocyte activation in the early stages of severe acute pancreatitis.

BACKGROUND: An excessive leucocyte activation takes place early in severe acute pancreatitis. Furthermore, some indirect evidences suggest a disturbance of the mononuclear phagocytic system in the severe cases. AIMS: To compare the early functionalism of leucocytes obtained from patients with mild disease and severe disease, under the hypothesis that an impaired phagocytic function could be associated with the leucocyte activation. PATIENTS AND METHODS: Flow cytometric parameters of leucocyte function, such as phagocytosis, and fluorescence of leucocytes with acridine orange (FLAO) were prospectively measured together with granulocyte elastase plasma concentrations in 21 patients with severe (n = 7) and mild (n = 14) acute pancreatitis. Samples were drawn at 24 hours from admission, 48 hours, 72 hours, and on day 5. RESULTS: There was a greater leucocyte activation together with a deficient phagocytosis before 72 hours in severe patients. The results (mean (SEM)) severe v mild were: 440 (115) microgram/l v 77 (14) micrograms/l for granulocyte elastase, 2.218 (377) v 1.308 (155) for FLAO, 64 (7) v 90 (2), and 55 (9) v 81 (3) for percentages of phagocytising neutrophils and monocytes, respectively. Phagocytic capacity returned to normal later on day 5. CONCLUSIONS: The excessive leucocyte activation together with the impaired phagocytosis could be related to the onset of complications in severe acute pancreatitis.

Clinical value of an automated granulocyte elastase assay in predicting severity of acute pancreatitis.

OBJECTIVE: Quantification of circulating levels of granulocyte elastase has been shown to be a reliable method to predict severity of acute pancreatitis. The ELISA method until now available is, however, not easily applicable to the clinical routine. MATERIAL AND METHODS: In the present study we analyzed, retrospectively the clinical usefulness of an automated granulocyte elastase assay, the immunoactivation (IMAC) procedure, in predicting the course of acute pancreatitis, and we compared it with the ELISA method. PATIENTS: Plasma samples from 39 patients with acute pancreatitis, 18 with mild episodes and 21 with severe disease, were analyzed for granulocyte elastase concentration by both automated and manual ELISA procedures, on admission and on days 1, 2, 3, 5, 7 and 10. RESULTS: Automated elastase values did not differ statistically (Mann-Whitney test) from manual granuloma elastase values obtained by ELISA. Higher plasma elastase concentration was invariably found in severe pancreatitis when compared to mild cases. The optimal discriminating (severe vs mild illness) cutoff values were 200 micrograms/L on admission and 250 micrograms/L at 24 hours. Both assays showed similar prognostic reliability upper 90 per cent. CONCLUSIONS: Automated procedures enable faster and simpler granulocyte elastase determinations and exploit the benefits of this early and efficient prognostic marker.

Activities of creatine kinase and its isoenzymes in serum in various skeletal muscle disorders.

We studied possible correlations between anatomopathological and clinical features and the values for total creatine kinase (CK; EC 2.7.3.2) and its isoenzymes, including the proportion of CK-MB, in a population displaying several neuromuscular pathologies. Although we observed no specific isoenzyme pattern associated with the different myopathies, we found isoenzyme analysis useful in studying the histopathological evolution of illness. We also considered whether the pathology was regenerative or nonregenerative, and what type of fiber (I or II) was involved. High CK-MB percentages (greater than 6%) were associated with regenerative and type I fiber myopathies, with regenerative type tissues being the principal factor associated with an increasing proportion of CK-MB. Studying the changes in CK-MB percentage in serum appears to be useful in discriminating neuromuscular from myocardial pathologies.

Total creatine kinase (CK) and CK-B activity in maternal blood and cord-blood samples after vaginal and cesarean births.

We studied variations in the activity of total creatine kinase (CK; EC 2.7.3.2) and of CK-B in maternal and cord-blood samples, comparing data obtained for vaginal and cesarean births. CK-B activity was determined with an immunoinhibition assay. In all cases, there was a significant postpartum increase in total CK and in CK-B activity in maternal sera, whereas cord-blood samples showed no significant differences between activities in arterial and venous blood for either vaginal or cesarean births. Statistically significant differences were found in CK-B activity, but not in total CK, between cord-blood samples from vaginal births and those from cesareans.