Pancreatic enzymes in the gut contributing to lung injury after trauma/hemorrhagic shock

Objective: To examine whether pancreatic proteolytic enzymes involve in lung injury induced by trauma/hemorrhagic shock (T/HS). Methods: Male Sprague Dawley rats received intraluminal or intravenous pancreatic serine protease inhibitor, 6 amidino 2 naphthyl p guanidinobenzoate dimethanesulfate (ANGD) during laparotomy (trauma), and were subjected to 90 minutes of T/HS or trauma sham shock (T/SS). Degree of lung injury was assessed 3 hours after resuscitation with Ringer’s lactate solution. Results: Lung permeability, pulmonary myeloperoxidase levels and the ratio of bronchoalveolar lavage fluid protein to plasma protein increased after T/HS, and significantly decreased in intraluminal ANGD treated but not in intravenous ANGD treated rats. Histological analysis demonstrated fewer injured villi in the intraluminal ANGD treated rats compared with those in the control rats. Linear regression analysis revealed that the percentage of injured ileal mucosal villi directly related to pulmonary polymorphic neutrophil sequestration and lung permeability to Evans blue dye. Conclusions: Pancreatic proteolytic enzymes in the ischemic gut may be important toxic factors contributing to lung injury after T/HS.