Faecal neutrophil elastase-antiprotease balance reflects colitis severity

Rachael Barry, David Ruano-Gallego, Shiva T Radhakrishnan, Scott Lovell, Lu Yu, Olga Kotik, Izabela Glegola-Madejska, Edward W Tate, Jyoti S Choudhary, Horace R T Williams, Gad Frankel

Research output: Contribution to journalArticlepeer-review

30 Citations (SciVal)


Given the global burden of diarrheal diseases on healthcare it is surprising how little is known about the drivers of disease severity. Colitis caused by infection and inflammatory bowel disease (IBD) is characterised by neutrophil infiltration into the intestinal mucosa and yet our understanding of neutrophil responses during colitis is incomplete. Using infectious (Citrobacter rodentium) and chemical (dextran sulphate sodium; DSS) murine colitis models, as well as human IBD samples, we find that faecal neutrophil elastase (NE) activity reflects disease severity. During C. rodentium infection intestinal epithelial cells secrete the serine protease inhibitor SerpinA3N to inhibit and mitigate tissue damage caused by extracellular NE. Mice suffering from severe infection produce insufficient SerpinA3N to control excessive NE activity. This activity contributes to colitis severity as infection of these mice with a recombinant C. rodentium strain producing and secreting SerpinA3N reduces tissue damage. Thus, uncontrolled luminal NE activity is involved in severe colitis. Taken together, our findings suggest that NE activity could be a useful faecal biomarker for assessing disease severity as well as therapeutic target for both infectious and chronic inflammatory colitis.

Original languageEnglish
Pages (from-to)322-333
Number of pages12
JournalMucosal Immunology
Issue number2
Early online date26 Nov 2019
Publication statusPublished - 31 Mar 2020


  • Acute-Phase Proteins/metabolism
  • Animals
  • Biomarkers/metabolism
  • Citrobacter rodentium/physiology
  • Colitis/metabolism
  • Dextran Sulfate
  • Disease Models, Animal
  • Disease Progression
  • Enterobacteriaceae Infections/metabolism
  • Feces/chemistry
  • Humans
  • Inflammatory Bowel Diseases/metabolism
  • Leukocyte Elastase/metabolism
  • Mice
  • Neutrophils/immunology
  • Protease Inhibitors/metabolism
  • Serpins/metabolism
  • Severity of Illness Index


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