ABSTRACT. The net balance of neutrophil elastase and its inhibitor, a,-antitrypsin (al-AT), is a critical determinant of connective tissue turnover during homeostasis and in disease states. In addition to liver-derived a,-AT, which translocates from blood to tissues, this elastase-a,-AT balance is maintained by expression of al-AT at the local tissue level in resident mononuclear phagocytes. Our previous studies have shown that this elastase-al-AT balance is also tightly controlled at a cellular level in that addition of exogenous neutrophil elastase (serpine-type elastase) to cultured mononuclear phagocytes is associated with an increase in expression of the al-AT gene. Subsequent studies have demonstrated that this novel regulatory loop involves interaction between exogenous neutrophil elastase and endogenous a,-AT inducing a structural rearrangement in the al-AT molecule and exposing highly conserved conformation-specific domain of a,-AT, which can then be recognized by a specific cell surface receptor, the serpinenzyme complex receptor. In the following study, we examined the effect of a bacterial metalloelastase, Pseudomonas aeruginosa elastase, on expression of a,-AT in human mononuclear phagocytes. We show that pseudomonas elastase inactivates monocyte-derived a,-AT by limited proteolysis but, in so doing, a,-AT becomes recognized by the serpin-enzyme complex receptor and mediates an increase in de novo synthesis of a,-AT in these cells. However, the concentrations of pseudomonas elastase needed to proteolytically inactivate al-AT in monocyte culture fluid are higher than those required for inactivation of purified plasma a,-AT. Results of experiments in this report show that this can be explained, at least in part, by binding of pseudomonas elastase to another endogenous protease inhibitor, a2-macroglobulin. Thus, the results of this study further define the elaborate mechanisms by which the host mononuclear phagocyte controls the elastase-a,-AT balance and, in turn, connective tissue turnover. (Pediatr Res 29: 133-140,1991) Abbreviations a,-AT, a,-antitrypsin LPS, lipopolysaccharide SEC, serpin-enzyme complex