Serum Prolidase Activity Research Articles

Serum prolidase activity in patients with pulmonary tuberculosis

Aim. To investigate serum prolidase activity (SPA) in patients with pulmonary tuberculosis (PTB). Material and methods. Twenty-nine PTB patients and 32 controls were included in the study. PTB patients (cavitary and non-cavitary) and controls were compared in terms of mean SPA. Correlations were evaluated between SPA and acute phase reactants. Results. Mean SPA was significantly higher in PTB patients than in the control group. Mean SPA was significantly higher in patients with cavitary TB than non-cavitary TB. Mean SPA in patients with mild PTB was lower than patients with moderate and severe disease. We found significant correlations between SPA and CRP, ESR, albumin, platelet counts, HDL-cholesterol and LDH activity. Conclusion. This study has shown that PTB patients have higher SPA than controls. The increase in SPA might be related to tissue destruction, increased immunoglobulin, complement levels and increased fibroblastic activity; all of which are involved in the natural history of PTB.

Serum prolidase activity and oxidative–antioxidative status in Legg–Calve–Perthes disease

We aimed to find out that whether collagen turnover is altered in the context of Legg-Calve-Perthes disease (LCPD) by evaluating serum prolidase activity. We also investigated the correlation between collagen turnover and oxidative-antioxidative status in LCPD. Plasma prolidase activity, total oxidant status (TOS), total antioxidant capacity, and oxidative stress index (OSI) were determined for 39 patients with LCPD and 40 healthy controls. Serum prolidase activity, TOS, and OSI were higher, but TAC was lower in patients with LCPD compared with controls. Prolidase activity was positively correlated with TOS and OSI levels. Serum prolidase activity is significantly associated with LCPD.

Oxidative Stress Increased in Healthcare Workers Working 24-Hour On-Call Shifts

IntroductionLong work hours, night shifts, stressful situations and insufficient social support increase levels of anxiety and depression and decrease motivation to perform among healthcare professionals. In this study, we evaluated oxidative stress levels in medical residents working 24-hour on-call shifts, and in nurses, relative to non-healthcare hospital staff in sedentary positions. We also measured serum prolidase activity, a measure of collagen turnover, as an objective proxy for level of physical activity. MethodsFifty-five male and 15 female medical residents on 24-hour, in-house, on-call duty, and 45 nurses and 30 (15male/15 female) non-healthcare staff working 8-hour shifts were recruited. All were healthy nonsmokers. Parameters of oxidative stress and serum prolidase activity were measured twice for each subject, upon arising at 8 am after an overnight fast; and then again near the end of the work shift, or after 16hours of consecutive work (at 12 pm) for residents. ResultsAfter hours of continuous work, serum total oxidative status and the oxidative stress index increased significantly, whereas total antioxidant status decreased (all P < 0.0001) in healthcare staff (nurses, male and female residents). All these variables remained virtually unchanged in non-healthcare staff. Similarly, serum prolidase activity increased in healthcare staff (P < 0.0001), but failed to increase statistically in non-healthcare staff. ConclusionsHealthcare workers suffer increased oxidative stress after prolonged work hours, especially while still on duty. Possible mechanisms for this include increased workload and, perhaps, psychological stress as well. However, long-term studies are needed to clarify the effects of sustained exposure to oxidative stress.

Prolidase activity and its diagnostic performance in bipolar disorder

Objective Proline has an important role in the brain. Prolidase, a proline splitting enzyme, which is also involved in oxidative stress is not investigated in bipolar disorder (BD). Methods 66 BD type I patients and 66 healthy controls were enrolled. Serum prolidase activity was measured in both groups via venous sampling. We have compared patients and controls as well as 3 subgroups of patients (24 euthymic, 22 manic, and 20 depressive patients). Results Prolidase activity was significantly higher in patients (p < 0.001, t = 14.517). There wasn't any significant difference among euthymic, manic and depressives (p = 0.305, f = 1.211). Positive predictive value was 98.5% and negative predictive value was 92.4% above the cutoff point 502.9375 U/L of prolidase activity. Conclusion Prolidase activity is impaired in BD, which may be associated with oxidative stress. Prolidase activity may be a trait marker for diagnosing bipolar disorder.

The Association of Serum Prolidase Activity and Erectile Dysfunction

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with carboxy-terminal proline or hydroxyproline and plays a major role in collagen turnover. Collagen is the essential content in atherosclerotic plaque, playing a key role in the stability/instability and progression of endothelial dysfunction in the pathogenesis of erectile dysfunction (ED). Consequently, in this study we sought to determine serum prolidase activity and markers of oxidative stress, such as lipid hydroperoxide and total free sulfhydryl, in vasculogenic ED. We evaluated 92 patients with vasculogenic ED and 50 control subjects by clinical and laboratory investigations. We measured serum prolidase activity and serum total free sulfhydryl levels spectrophotometrically. Serum lipid hydroperoxide levels were determined with ferrous ion oxidation-xylenol orange method. We assessed the association of serum prolidase activity with the presence and severity of vasculogenic ED and clinical characteristics, as well as laboratory parameters. We also assessed the association of serum prolidase activity with the variables according to the vascular status of patients with vasculogenic ED. The comparison included 92 vasculogenic ED patients grouped into 3 categories according to the vascular status of patients with ED-arterial insufficiency (n = 26), veno-occlusive dysfunction (n = 37), and mixed-type impotence (n = 29)-and 50 controls. Receiver-operator characteristics (ROCs) were analyzed to find a cutoff value with the best sensitivity and lowest false-positive rate. Serum prolidase activity (53.5 +/- 5.5 U/L vs 45.7 +/- 4.9 U/L, respectively; P < .001) and serum lipid hydroperoxide levels were significantly increased in patients with vasculogenic ED compared with controls, whereas serum total free sulfhydryl levels were significantly decreased in patients with vasculogenic ED compared with controls (P < .001). The lowest and highest mean serum prolidase activities were detected in control participants and in patients with arterial insufficiency, respectively (analysis of variance P < .001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 0.78. Findings of this study have shown that serum prolidase activity is significantly associated with the presence and severity of vasculogenic ED, and elevated serum prolidase activity might be an independent predictor of ED.

Dilatation of the Ascending Aorta Is Associated with Low Serum Prolidase Activity

The pathogenesis of ascending aortic aneurysm (AAA) involves many factors; elastin degradation could lead to initial dilation, and changes in the collagen structure predispose the aneurysm to rupture. Prolidase is an enzyme that catalyzes the final step of collagen breakdown by liberating free proline for collagen recycling. The enzyme activity may be a step-limiting factor in the regulation of collagen biosynthesis. Consequently, in this study we sought to determine serum prolidase activity in AAAs. Eighty consecutive patients with the diagnosis of hypertension or chest pain, referred for echocardiographic examination in the outpatient cardiology clinic, were included in the study. The subjects were grouped into three categories according to the aortic diameter; control group without aortic dilatation (<or= 3.7 cm, n = 20), medium (3.8-4.3 cm, n = 36), and large (>or= 4.4 cm, n = 24) group. We assessed the association of serum prolidase activity with the presence and severity of AAAs, clinical characteristics and laboratory parameters. Serum prolidase activity was significantly higher in the patients without aortic dilatation (1386.3 +/- 320.5 U/L) compared to medium group (1212.0 +/- 282.5 U/L) and large group (1072.2 +/- 192.3 U/L): control group vs. medium group (P = 0.023) and control group vs. large group (P < 0.001). Ascending aortic diameter was inversely correlated with serum prolidase activity and in multivariate analysis, serum prolidase activity was the only independent predictor of aortic dilatation (beta = -0.44, P = 0.006). In conclusion, the presence of AAAs is associated with low serum prolidase activity.

Serum prolidase activity in patients with degenerative and rheumatic heart valve diseases

It is known that renin-angiotensin system, inflammation, signaling pathways, and genetic predisposition play a major role in the pathogenesis of heart valve disease. Scarring and collagen deposition in the valves and destruction of myocytes may result from the combined effects of rheumatic and degenerative process in heart valve diseases. Prolidase plays an important role in collagen metabolism, matrix remodeling and cell growth. The aim of the study was to comparatively assess the serum prolidase activity in rheumatic and degenerative heart valve diseases. Materials and methods: The study included 26 patients who had undergone valve replacement due to rheumatic etiology (Group I), 24 patients who had undergone valve replacement due to degenerative etiology (Group II) and 20 healthy volunteers (Group III). Prolidase activity was determined in all subjects. High sensitive C-reactive protein and white blood cell count were studied in only valve patients. Results: Prolidase activity was significantly greater in control group than in patients group (51.23.± 5.9 U/L vs. 39.40 ± 4.6 U/L, respectively; P < 0.001). There was no statistically significant difference between Group I and Group II (P = 0.721). No correlation was detected between serum prolidase activity and severity of valve disease (P > 0.05). Conclusion: These results suggested that rheumatic and degenerative heart valve diseases seem to be associated with decreased serum prolidase activity.

Prolidase activity and oxidative status in patients with thalassemia major

Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation. The study aimed to evaluate the relationship between prolidase activity and oxidative status in patients with thalassemia major. Comparison was made between 87 patients diagnosed with thalassemia major and 33 healthy children of similar age and gender. Mean age of the subjects was 7.5+/-4.3 years in the group of patients with thalassemia major and 8.9+/-3.1 years in the control group. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurement. Prolidase activity was significantly increased in patients with thalassemia major (53.7+/-8.7 U/l) compared to the control group (49.2+/-7.2 U/l, P<0.001). TOS was significantly increased in the patient group (5.31+/-3.14 mmol H2O2 equiv./l) compared to the control group (3.49+/-2.98 mumol H2O2 equiv./l) and the OSI was also significantly increased in the patient group (3.86+/-3.28 arbitrary unit) compared to the control group (2.53+/-2.70 arbitrary unit) (P<0.0001 and P<0.001, respectively), while there were no significant differences between the patient (1.61+/-0.30 mumol Trolox equiv./l) and control (1.64+/-0.33 mumol Trolox equiv./l) groups with respect to TAC. Significant increases in prolidase activity in patients with thalassemia major may constitute a key parameter in demonstrating a disorder of the collagen metabolism.

Serum prolidase enzyme activity and its relation to histopathological findings in patients with non‐alcoholic steatohepatitis

The aim of this study was to investigate serum prolidase enzyme activity and to find out its association with liver biopsy specimens' histopathological findings in patients with nonalcoholic steatohepatitis (NASH), which may progress to liver fibrosis and cirrhosis. Thirty-six patients with biopsy-proven NASH and 29 healthy controls were enrolled. Serum prolidase enzyme activity was measured spectrophotometrically. Serum prolidase enzyme activity was significantly higher in patients with NASH than controls (P=0.016). A significant correlation was observed between serum prolidase enzyme activity and fibrosis score in patients with NASH (r=0.661, P<0.001). Serum prolidase activity seems to be correlated with the level of fibrosis. Monitoring serum prolidase activity may be a useful adjunctive tool in predicting liver fibrosis, especially in the absence of advanced fibrosis and other conditions, which may affect the interpretation of prolidase activity.

Serum prolidase activity in idiopathic and ischemic cardiomyopathy patients

Idiopathic and ischemic dilated cardiomyopathies (DCM) are the most common types of DCM, and both exhibit the same histopathological feature of fibrosis. Prolidase is an enzyme that serves a rate-limiting function in collagen turnover. Several studies have shown increased prolidase activity in fibrosis, though controversy persists. In this study, we measured prolidase enzyme activity in patients with idiopathic or ischemic DCM and in healthy controls, making this, to our knowledge, the first study to do so. What we found is that serumprolidase activity was significantly lower in both DCM groups relative to healthy volunteers and lower in ischemic DCM than idiopathic. These intriguing results could be attributed either to decreased collagen turnover in the heart tissues in which DCM develops, a result of diminished functional heart tissue, or to decreased physical activity levels among DCM patients stemming from their heart failure. Either way, further studies are needed to verify and clarify our results.

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction

OBJECTIVES:To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity.METHODS:Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate.RESULTS:Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1±0.0 vs. 1.6±0.0 µmol H2O2 Eq/L, 10.3±1.1 vs. 6.9±1.2 µmol H2O2 Eq/L, and 236.4±19.5 vs. 228.2±19.2 U/L, respectively (p<0.0001 for all).CONCLUSIONS:Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.

Assessment of preoperative serum prolidase activity in epithelial ovarian cancer

Assessment of preoperative serum prolidase activity in epithelial ovarian cancer

Decreased Serum Prolidase Activity and Increased Oxidative Stress in Early Pregnancy Loss

Aims: To compare the levels of serum prolidase activity and oxidative stress markers including total oxidative status (TOS), total antioxidant capacity (TAC), lipid hydroperoxide (LOOH) and total free sulfhydryl (–SH) in healthy pregnant women without early pregnancy loss (EPL) and women with EPL. Methods: Serum samples were obtained from 45 healthy first-trimester pregnancies and 45 pregnancies complicated with EPL. We have measured serum prolidase activity, TAC, TOS, –SH and LOOH levels spectrophotometrically. Results: Serum prolidase, TAC and –SH levels were significantly lower in the women with EPL than in the women without EPL (p <0.001, p = 0.001, p < 0.001, respectively), whereas TOS and LOOH levels were significantly higher (p < 0.001, p = 0.004, respectively). Prolidase activity was negatively correlated with TOS and LOOH levels (r = –0.299, p = 0.004; r = –0.323, p = 0.002, respectively), while positively correlated with TAC and –SH levels (r = 0.232, p = 0.028, and r = 0.418, p <0.001, respectively) Conclusion: Findings of this study have shown that serum prolidase activity and oxidative stress are significantly associated with the presence of EPL, and the correlation between serum prolidase activity and the markers of oxidative stress was reflected in increased serum TOS and LOOH levels and decreased serum TAC and –SH levels.

Serum prolidase activity and oxidative stress markers in pregnancies with intrauterine growth restricted infants

To compare the levels of serum prolidase activity and oxidative stress markers, including total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and total free sulfhydryl (-SH) in healthy pregnant women and pregnant women with intrauterine growth restricted infants. Serum samples were obtained from 18 healthy third trimester pregnancies and 14 pregnancies complicated by fetal growth restriction (FGR). The criteria for FGR were clinical evidence of suboptimal growth, ultrasonographic demonstration of deviation from normal percentiles of growth, and birthweight under the 10th percentile. We spectrophotometrically measured serum prolidase activity, TAC, TOS, and -SH levels. Oxidative stress was determined from total antioxidant capacity and total oxidant status measurement and calculation of the oxidative stress index. Serum TAC and -SH levels were significantly lower in the FGR group than in the healthy control group (P = 0.001, P < 0.001, respectively), whereas TOS level, OSI value, and prolidase activity were significantly higher (P = 0.003, P < 0.001, P < 0.001, respectively). Prolidase activity was positively correlated with TOS and OSI values (rho = 0.552, P = 0.041 and rho = 0.635, P = 0.015, respectively) and negatively correlated with TAC and -SH levels (rho = -0.578, P = 0.030 and rho = -0.622, P = 0.018, respectively). The present study shows that serum prolidase activity and oxidative stress are significantly associated with the presence of FGR and that the correlation between serum prolidase activity and markers of oxidative stress are represented as increased serum TOS level and decreased serum TAC and -SH levels, suggesting an association of collagen turnover and oxidative stress in vascular dysfunction.

Serum Prolidase Activity and Oxidative Status in Patients With Stage I Endometrial Cancer

We aimed to investigate the serum prolidase activity, total oxidant status (TOS), total antioxidant capacity (TAC), and total free sulfhydryl (-SH) groups in patients with stage I endometrial cancer. Serum prolidase activity, TOS, TAC, and -SH levels were measured in patients with endometrial cancer (n = 23) and controls (n = 25). Serum prolidase activity and TOS were significantly higher in patients with endometrial cancer than in controls (P = 0.02 and P = 0.02, respectively), whereas TAC and -SH group levels were significantly lower (P = 0.004 and P = 0.001, respectively). There were no differences between surgical stages IA and IB or between stages IB and IC (P = 0.189 and P = 0.161, respectively) with respect to prolidase levels, whereas there was a significant difference between stages IA and IC (P < 0.001). Increased serum prolidase activity and oxidative stress may be associated with endometrial cancer, and increased serum prolidase activity may be related to local invasion of endometrial cancer.

Assessment of preoperative serum prolidase activity in epithelial ovarian cancer

Objective Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with C-terminal proline and hydroxyproline and plays a major role in collagen turnover. The aim of this study was to evaluate preoperative serum prolidase activity, total oxidant status (TOS), and total antioxidant capacity (TAC) in patients with newly diagnosed epithelial ovarian cancer (EOC). Study design Serum prolidase activity, TOS, and TAC were measured spectrophotometrically in both EOC cases ( n = 28) and controls ( n = 28). Results Preoperative serum prolidase activity and TOS were significantly higher in patients with EOC compared to controls ( p = 0.009 and 0.008, respectively), whereas TAC was significantly lower in cases ( p < 0.001). A significant positive correlation was found between the stage, grade, and CA-125 level of EOC and serum prolidase activity ( rho = 0.466, p = 0.012; rho = 0.501, p = 0.007; and rho = 0.447, p = 0.017, respectively) and TOS ( rho = 0.588, p = 0.001; rho = 0.412, p = 0.029; and rho = 0.568, p = 0.002, respectively). In contrast, there was a negative correlation between TAC and the stage, grade, and CA-125 level of EOC ( rho = −0.555, p = 0.002; rho = −0.566, p = 0.002; and rho = −0.581, p = 0.001, respectively). Conclusion Findings of the present study demonstrate that serum prolidase activity is significantly associated with the stage, tumor grade, and preoperative CA-125 level of EOC.

Serum prolidase activity and oxidative status in patients with bronchial asthma.

Asthma is a disease where there is an accumulation of collagen in the reticular basal membrane of the airway leading to chronic inflammation. The enzyme prolidase plays an important role in the breakdown of collagen and the breakdown of intracellular protein especially in the final stage when peptides and dipeptides contain a high level of proline. To evaluate the relationship between prolidase activity and oxidative status in asthma patients. Comparison was made between 42 patients diagnosed with bronchial asthma and 32 healthy children of similar age and gender. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement. The prolidase activity of the asthma patient group was statistically significant compared with the control group (P< or =0.001). TAC and TOS levels in the asthma patient group were higher than the control group (P< or =0.001, P< or =0.002, respectively). No correlation was found between the prolidase and oxidative levels of the two groups. A positive correlation was determined between the prolidase activity and TAC in the asthma patient group (P< or =0.001, r=0.501). The prolidase enzyme activity, which plays a role in the collagen turnover, was low in the asthma patients; therefore, their collagen metabolism had undergone a change and this indicates that there may be an effect on the accumulation of collagen in the reticular basal membrane. Moreover, the high level of TOS indicates that these patients were exposed to severe oxidative stress with an increased TAC response.

The association of serum prolidase activity with the presence and severity of coronary artery disease

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with carboxy-terminal proline or hydroxyproline and plays major role in collagen turnover. Collagen is the essential content in atherosclerotic plaque playing a key role in the stability/instability of and progression of coronary artery disease (CAD). Consequently, in this study we sought to determine serum prolidase activity and markers of oxidative stress such as lipid hydroperoxide and total free sulfhydryl in CAD. We have evaluated 199 patients with CAD and 122 control cases with clinical, electrocardiographic, and laboratory investigation. We have measured serum prolidase activity and serum total free sulfhydryl levels spectrophotometrically. Serum lipid hydroperoxide levels were determined with ferrous ion oxidation-xylenol orange method. We assessed the association of serum prolidase activity with the presence and severity of CAD and clinical characteristics, and laboratory parameters. Serum prolidase activity (52.5+/-5.6 vs. 46.7+/-5.1 U/l, respectively, P<0.001) and serum lipid hydroperoxide levels were significantly increased in patients with CAD compared with control cases whereas, serum total free sulfhydryl levels were significantly decreased in patients with CAD compared with control cases. Serum prolidase activity and total free sulfhydryl levels were independent predictors of the presence of CAD [(chi=75.532, ss=0.212, P=0.003) and (chi=25.969, ss=-30.486, P=0.019), respectively] and Gensini score [(beta=0.276, P<0.001) and (beta=-0.274, P<0.001), respectively]. Independent predictors of serum prolidase activity were serum high-density lipoprotein cholesterol (beta=-0.138, P=0.023) and urea levels (beta=0.146, P=0.036), and Gensini score (beta=0.317, P<0.001). Findings of this study have shown that serum prolidase activity is significantly associated with the presence and severity of CAD, and elevated serum prolidase activity might be an independent predictor of coronary atherosclerosis.

Prolidase activity in serum and pleural fluids in patients with tuberculous pleural effussion

Objectives Pleural tuberculosis, which is present in around 4% of all tuberculosis cases may resolve spontaneously or associated with progressive disease and a high recurrence rate. Recently upon exposed to cytokines and bacterial products, mesothelium has been shown to produce collagen that may be involved in pleural inflammatory responses. Prolidase is involved in the final stage of degradation in collagen catabolism. In this study we aimed to evaluate pleural fluid and serum prolidase activities in patients with tuberculous (TB) pleurisy and compared with those in non-tuberculous (non-TB) pleural effusions. Design and methods 21 patients with tuberculous (TB) pleurisy (11 F/10 M), ages 35–52 (median 44) and 22 patients (10 F/12 M), ages 41–63 (median 52) with non-tuberculous pleurisy included as non-tuberculous (non-TB) pleurisy group consecutively referred to our pulmonary clinic for evaluation. Serum and pleural prolidase activities in 21 TB and 22 non-TB pleurisy patients were analyzed by photometric method. Results Prolidase enzyme activities in serum and pleural fluids of TB group (1072 ± 171 and 1392 ± 215 U/L, respectively) were significantly higher than those values in non-TB group (787 ± 144 and 943 ± 174 U/L, respectively). Prolidase activities in pleural fluid were significantly higher than those in serum in both groups. There was a significant positive correlation between pleural and serum prolidase activities in TB group ( r = 0.579 and p = 0.006) and in non-TB group ( r = 0.858 and p < 0.001). In Receiver Operating Characteristic (ROC) analysis, sensitivity and specificity values were 86% and 82% for a cut-off value of 1130 U/L for pleural prolidase activity and were 81% and 82% for a cut-off value of 952 U/L for serum prolidase activity, respectively. Conclusion In conclusion, there is an elevated pleural fluid and serum prolidase enzyme activity in patients with TB pleurisy compared with non-TB pleurisy group. The higher enzyme activities in TB group might reflect increased collagen turnover in those patients.

Is joint hypermobility important in prepubertal children?

The purpose of this study was to investigate serum prolidase activity and its relationship with collagen metabolism and joint hypermobility, and to determine the prevalence and characteristics of joint hypermobility in prepubertal children. Serum prolidase activity was measured spectrophotometrically. Joint hypermobility was defined using Beighton criteria. The children underwent complete history and physical examination. Serum levels of prolidase were lower in the hypermobile group compared with controls and no statistical difference (1,598.61 +/- 54.99, 1,741.89 +/- 57.54; P > 0.05). However, there was significant negative correlation between prolidase level and Beighton score (r = -0.295, P = 0.002). The prevalence of hypermobility was distributed as follows: >or=4, 39.3%; >or=5, 22.7%; >or=6, 13.3%. There was correlation between joint hypermobility and pes planus (P = 0.006), arthralgia (P = 0.042), and musculoskeletal disorders in mother and/or father (P < 0.001). The decrease in prolidase activity may be related with collagen metabolism in joint hypermobility Therefore, joint hypermobility appeared to warrant further investigation due to concomitant signs and symptoms.