Urinary trypsin inhibitor: miraculous medicine in many surgical situations?

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC Recently, we encounter several articles regarding urinary trypsin inhibitor (UTI) published nationally [1,2]. When we take a glance at these articles, it feels like UTI acts as a miraculous medicine on patients under general anesthesia because of its protection effect against surgical stress. Yet, even after the first report on antitryptic action of urine by Bauer and Reich III in 1909 [3]; the start of use of the term UTI by Astrup and Sterndorff in 1955 [4]; and numerous animal experiments and clinical research done about UTI (803 articles about UTI and 982 articles about ulinastatin in SCOPUS), UTI is not yet to be used commonly. Therefore, it is important to understand the reason behind this situation. According to the webpage of Nextbio, it records that " currently, the drug is being used for research purpose only. " UTI is a glycoprotein stable in both heat and acids derived from human urine, and is a serine protease inhibitor found in human urine or blood. UTI is secreted when inter-α-trypsin inhibitors are degraded by neutrophilic elastase [5]. UTI is found to have many physiologic effects, including the inhibition of neutrophilic elastase, trypsin, α-chymotrypsin, plasmin, and cathepsin G. It has been known for a long time [3] and called ulinastatin, mingin, human inhibitor 30, serpin, miraclid, urinastatin (in japanese literature) and bikunin [6]. It has been reported that, in human, the plasma half-life of UTI is 33 min [7]. Currenlty, there are three pharmaceutical companies in Korea that produce UTI: Ulistin Trypsin inhibitors act to suppress the proteolytic action of trypsin on a variety of tissues and exert a localized anti-inflammatory effect [8]. Therefore UTI is indicated for acute inflammatory disorders, including acute pancreatitis, systemic inflammatory reaction syndrome, circulatory insufficiency, Stevens-Johnson syndrome, Toxic epidermal necrolysis (TEN), disseminated intravascular coagulation (DIC) and multiple organ failure [9]. Previous studies of UTI have focused mainly on modulating inflammatory reaction. UTI attenuates the elevation of neutrophil elastase release, thereby blunting the rise of pro-inflammatory cytokine level; however, the actual mechanism in vivo is not clear [10]. In twenty years, lately, there has been an increase in the number of reports that UTI inhibits secretion of cytokines (IL-6 and IL-8) …