Neutrophil elastase α1-proteinase inhibitor complexes in pleural effusions

Abstract

Polymorphonuclear (PMN) granulocyte derived neutrophil elastase (NE) is rapidly antagonized by alpha 1-proteinase inhibitor (alpha 1 PI) in vivo. To determine the clinical value of elastase alpha 1-proteinase inhibitor complexes (E-alpha 1 PI) in pleural effusions, fluid samples of 99 patients were examined. Fifty-six had malignant effusions, 30 had non-malignant exudates (pleural protein above 3 g/dl) mainly of inflammatory origin, and 13 patients had low protein transudates (below 3 g/dl) due to congestive heart failure. Nonmalignant exudates showed significantly higher (P less than 0.001) concentrations of E-alpha 1 PI compared with malignant effusions or low protein transudates (P less than 0.001). Malignant exudates secondary to lung cancer were characterized by higher (P less than 0.001) median pleural E-alpha 1 PI concentrations compared to malignant exudates due to primarily extrathoracic malignancies. Total pleural leukocyte counts and pleural neutrophil counts were performed in 68 effusions. By this means no clear-cut differentiation between malignant and nonmalignant exudates seems possible except for marked empyema. In conclusion, E-alpha 1 PI complexes in pleural fluid may better reflect the stage of inflammation of pleural effusions rather than mere pleural leukocyte counts. Low levels of E-alpha 1 PI complexes (less than 75 ng/ml) in pleural exudates with protein values above 3 g/dl are characteristic of malignant exudates. Determination of E-alpha 1 PI in pleural exudates may serve as a sensitive marker of inflammation and useful adjunct to pleural cytology in aspects of differential diagnosis of pleural effusions.

Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions

“…Ebert et al [18]described higher PMN-E values in patients with empyema, and Klech et al [19]proved that PMN-E is a marker of pleural inflammation, observing higher values in empyema patients. But it was Castaño and Amores [11]who evaluated the role of elastase in diagnosing PE of infectious origin and reported a diagnostic efficacy, sensitivity and specificity slightly higher than what we obtained.…”

Epigallocatechin gallate modulates ferroptosis through downregulation of tsRNA-13502 in non-small cell lung cancer

“…tRNA-derived small RNAs (tsRNAs), a recently identified subset of noncoding small RNAs, are partitioned into stress-induced tRNA-derived RNAs (tiRNAs) and tRNA-derived fragments (tRFs). These tsRNAs are implicated in a variety of biological processes, demonstrating their pivotal roles [ 19 , 20 ]. They exert regulatory influence over gene silencing, RNA stability, reverse transcription, and translation, processes intimately linked with cellular proliferation, migration, cell cycle progression, and apoptosis [ 19 ].…”