Enzymes may leak outside intestines and cause deadly condition
By Nathan Seppa
Digestive enzymes that escape from the intestines into adjacent tissues and the bloodstream may be a key player in triggering shock, the dangerous condition that sometimes occurs after major medical trauma. A new study finds that giving enzyme inhibitors to rats in the throes of shock can alleviate the potentially lethal condition.
The findings could shed some much needed light on shock, which typically shows up as the end result of some other medical problem such as hemorrhage, sepsis, a heart attack or a systemic allergic reaction called anaphylaxis. In all cases, blood pressure plummets, sabotaging circulation and threatening tissue viability.
The new study, in the Jan. 23 Science Translational Medicine, suggests that digestive enzymes play a role in this crisis. The enzymes normally help break down food, but they need to be confined to the ducts in the pancreas, where they are made, or the small intestine, where they digest food. If not, the enzymes can digest a person’s own tissue.
A mucosal lining in the intestines keeps the enzymes from escaping the gastrointestinal tract and from damaging the intestines themselves. But hemorrhage, sepsis and other conditions disrupt blood flow to the intestinal wall and hinder maintenance of this barrier, says Geert Schmid-Schönbein, a bioengineer at the University of California, San Diego in La Jolla. If digestive enzymes stray into the rest of the body, he hypothesizes, they could damage vital organs and trigger massive inflammation.
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