PANCREATIC DISEASE

Serum levels of procarboxypeptidase B and its activation peptide in patients with acute pancreatitis and non-pancreatic diseases

C A Müller¹, S Appelros², W Uhl¹, M W Büchler¹, A Borgström²

¹ Department of Visceral and Transplantation Surgery, Bern, Switzerland
² Department of Surgery, University Hospital, Malmö, Sweden

Correspondence to:
Correspondence to:
Dr A Borgström, Department of Surgery, Malmö University Hospital, University of Lund, S 205 02 Malmö, Sweden;
anders.borgstrom{at}exp.mas.lu.se

Background: Carboxypeptidase B from the pancreatic gland may exist in three different molecular and immunoreactive forms: the proenzyme, the active enzyme, and the activation peptide.

Aims: To investigate levels of procarboxypeptidase B (proCAPB) and its activation peptide in serum in acute pancreatitis to test the accuracy of these two variables as markers for the diagnosis of acute pancreatitis and for prediction of pancreatic necrosis. To elucidate whether leakage of proenzymes and activation of proenzymes reflect two different pathophysiological events in acute pancreatitis.

Methods: Sera from patients with acute pancreatitis (n=85) and acute abdominal pain of non-pancreatic origin (n=53) were analysed for proCAPB and its activation peptide. Patients with pancreatitis were divided into necrotising (n=33) and oedematous attacks (n=52) using contrast enhanced computed tomography. Accuracy was determined using receiver operating characteristic curve analysis.

Results: Immunoreactive carboxypeptidase B activation peptide (ir-CAPAP) concentration in serum on admission was 0.7 nmol/l (0–18.1) in patients with oedematous pancreatitis compared with 5.8 nmol/l (1.9–34) in patients with later development of pancreatic necrosis. Elevated levels of the activation peptide on admission correlated with an accuracy of 92% to later development of pancreatic necrosis. Ir-proCAPB concentration in serum on admission was 16.0 nmol/l (1.4–50.5) in all patients with acute pancreatitis versus 0.3 nmol/l (0–3.6) in patients with non-pancreatic acute abdominal disorders. Cases with oedematous pancreatitis had ir-proCAPB levels of 15.4 nmol/l (1.4–50.5) versus 19.1 nmol/l (2.7–36.1) in cases with later development of pancreatic necrosis. Measurement of the proenzyme can thus be useful for the diagnosis of acute pancreatitis (accuracy 99%) but levels did not correlate with later development of pancreatic necrosis (accuracy 56%).

Conclusion: Leakage of proenzymes occurs in acute pancreatitis, irrespective of severity, while development of pancreatic necrosis occurs only when there is activation of the proenzymes.

Keywords: acute pancreatitis; carboxypeptidase B; amylase; activation peptide

Abbreviations: AAD, acute abdominal disorders of non-pancreatic origin; AP, acute pancreatitis; ALP, alkaline phosphatase; CAPAP, carboxypeptidase B activation peptide; CAPB, carboxypeptidase B; CRP, C reactive protein; CT, computed tomography; ir, immunoreactive; PASP, pancreas specific protein; proCAPB, procarboxypeptidase B; ROC, receiver operating characteristic; TAP, trypsinogen activation peptide

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