Ulinastatin – Cardiology MCQ – Answer
Ulinastatin is a (choose the correct answer):
- Urinary trypsin inhibitor
Higher plasma levels of neutrophil elastase and markedly activated neutrophils have been associated with poor response to intravenous immunoglobulin (IVIG) and coronary artery lesions in Kawasaki disease. Ulinastatin, a urinary trypsin inhibitor has been used as a suppressor of neutrophils.
A retrospective study by Kanai T et al  evaluated the benefits of this drug in Kawasaki disease. They could identify 369 patients who were treated with a combination of ulinastatin, intravenous immunoglobulin and aspirin. 1178 patients who were treated with IVIG and aspirin served as the control group. They found that those treated with ulinastatin had lower rates of coronary artery lesions (3% versus 7%; P=0.01).
The drug has been tried in other conditions like pancreatitis, multiorgan dysfunction syndrome, sepsis and post operative cognitive dysfunction. It is considered as an immunomodulator in some of this conditions. Its anti inflammatory effects are dependent on inhibition of neutrophil derived elastase, tumour necrosis factor alpha, pro-inflammatory cytokines and interleukins. It can also suppress activation of macrophages and platelets. The medications has been approved in Japan. Clinical trials are progressing across the globe. Use in Kawasaki disease at present can be considered as an off label use.
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- Kanai T, Ishiwata T, Kobayashi T, Sato H, Takizawa M, Kawamura Y, Tsujimoto H, Nakatani K, Ishibashi N, Nishiyama M, Hatai Y, Asano Y, Kobayashi T, Takeshita S, Nonoyama S. Ulinastatin, a urinary trypsin inhibitor, for the initial treatment of patients with Kawasaki disease: a retrospective study. Circulation. 2011 Dec 20;124(25):2822-8. More references…