Serum Trypsin Research Articles

Low serum trypsin levels predict deep pancreatic cannulation failure during ERCP in patients with symptomatic obstructive chronic pancreatitis

Advances in cell and molecular biology studies have revolutionized the diagnosis and treatment of many different diseases. Cell and molecular diagnostics (CMD) have become an essential part of investigations required in providing optimal care and has become an important tool for the health care providers for better treatment. CMD gives insights into the pathogenesis and prognosis of various diseases. Rapid technological advances have helped to increase the speed and performance of various molecular assays thereby reducing turnaround time, in turn translating to providing better clinical services. With the increase in CMD applications to clinical services, entire world has seen a sudden spurt of cellular and molecular labs. However, this has highlighted an acute shortage of trained laboratory personnel who can carry out cellular or molecular assays in a diagnostic mode. Understanding the mechanisms of disease at the molecular and genetic levels can now be translated into diagnostic, prognostic, and therapeutic applications in modern medicine. Molecules at abnormal levels (quantitative or qualitative) provide not only a signature for the presence of a disease, but also the indication for a drug targeting the specific abnormal function. Concurrently, the role of CMD has expanded from mere study observations to constantly translating new discoveries and novel technologies into useful clinical tests that provide a molecular fingerprint of diseases and that are predictive of the response. In the introductory chapter we will cover the importance of biological sample collection from different methods; cell-based diagnostic methods, cellular pathway diagnostic targets, and molecular-based methods.

The Relationship between Trypsin/Calcitonin Gene Related Peptide (CGRP) in Serum and Acute Pancreatitis (AP).

Activation of trypsin from proteolytic cleavage of trypsinogen in the pancreas can lead to acute pancreatitis. Calcitonin gene related peptide (CGRP) from both peripheral and central neurons is involved in a variety of physiological/pathophysiological processes, especially sensory (nociceptive) and efferent (effector) functions. To better understand the change of trypsin/CGRP in acute pancreatitis, the study investigated the serum level of trypsin/CGRP in patients with acute pancreatitis. The study investigated 140 patients with acute pancreatitis, including 72 cases of biliary acute pancreatitis, 60 cases of hyperlipidemic acute pancreatitis, and 8 cases of idiopathic acute pancreatitis. Sixty volunteers acted as the normal control group. The levels of trypsin and CGRP in serum were analyzed. The serum levels of trypsin and CGRP in males with acute pancreatitis were higher than in females, but there was no statistical difference (p > 0.05). However, the serum levels of trypsin and CGRP in different types of acute pancreatitis were significantly higher than controls (p < 0.001), and the level of trypsin and CGRP in serum of patients with inflammation effusion was significantly higher than patients without inflammation effusion (p < 0.001). In addition, the serum levels of trypsin and CGRP in patients with I-II, III, IVA and IVB acute pancreatitis were higher than controls (p < 0.001). According to the results, we concluded that the trypsin and CGRP in serum can act as a new detection index of acute pancreatitis occurring. The serum levels of trypsin and CGRP in patients with acute pancreatitis is able to determine whether inflammation effusion happens.

Does dietary insect meal affect the fish immune system? The case of mealworm, Tenebrio molitor on European sea bass, Dicentrarchus labrax

Feeding small European sea bass, Dicentrarchus labrax, for 6 weeks with Tenebrio molitor larval meal showed significant anti-inflammatory responses (ceruloplasmin, myeloperoxidase and nitric oxide). Serum bacteriolytic activity against a Gram negative bacterium was not significantly affected by dietary Tenebrio, while both lysozyme antibacterial activity and serum trypsin inhibition usually linked to the anti-parasite activity of the fish, were significantly enhanced. The latter may be due to the similarities in the composition of the exoskeleton of parasites and insects that may therefore act as an immunostimulant potentially increasing the anti-parasitic activity. The addition of exogenous proteases significantly decreased both trypsin-inhibition and serum bacteriolytic activity probably through direct inhibition of the proteins responsible for these immune functions. Further investigation involving bacterial or parasitic challenges will be necessary to assess if the effects of dietary mealworm meal on the immune system observed in the present study are translated into an improved resistance to diseases.

Clarithromycin suppresses induction of monocyte chemoattractant protein-1 and matrix metalloproteinase-9 and improves pathological changes in the lungs and heart of mice infected with influenza A virus.

The influenza A virus (IAV)-cytokine-trypsin/matrix metalloproteinase-9 (MMP-9) cycle is one of the important mechanisms of multiple organ failure in severe influenza. Clarithromycin, a macrolide antibiotic, has immune modulatory and anti-inflammatory effects. We analyzed the effects of clarithromycin on the induction of chemokines, cytokines, MMP-9, trypsin, vascular hyper-permeability and inflammatory aggravation in mice with IAV infection. IAV/Puerto Rico/8/34(H1N1) infection increased the levels of monocyte chemoattractant protein-1 (MCP-1) and cytokines in serum, and MMP-9 and trypsin in serum and/or the lungs and heart. Clarithromycin significantly suppressed the induction of serum MCP-1 and MMP-9 and vascular hyperpermeability in these organs in the early phase of infection, but did not suppress the induction of trypsin, IL-6 or IFN-γ. Histopathological examination showed that clarithromycin tended to reduce inflammatory cell accumulation in the lungs and heart. These results suggest that clarithromycin suppresses infection-related inflammation and reduces vascular hyperpermeability by suppressing the induction of MCP-1 and MMP-9.

Sa1038 Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure During ERCP in Patients With Chronic Pancreatitis

Sa1038 Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure During ERCP in Patients With Chronic Pancreatitis

Diagnosing Chronic Pancreatitis.

Diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes in CP. The workup of suspected CP should follow a progressively noninvasive to more invasive STEP-wise approach in a patient with a suspicious clinical presentation and risk factors that raise their pretest probability of disease. After a thorough history and physical examination, basic laboratories should be obtained such as lipase, amylase, metabolic panel, and indirect PFTs (fecal elastase-1, serum trypsin). Computed tomography remains the best initial imaging modality to obtain as it has good sensitivity for severe CP and may obviate the need for other diagnostic tests. When equivocal, an MRCP should be obtained for a more detailed evaluation of the both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, EUS should be performed with or without pancreas function testing. ERCP remains a last-line diagnostic test and seldom should be used outside of therapeutic purposes. Future advances should target optimizing current diagnostic tools to more accurately diagnose early CP, as it is in this population where the benefits of delaying progression of CP may have the most profound effect. Likely the best way at establishing a diagnosis in these patients is via pancreatic function testing in the setting of indeterminate EUS results. Biomarker studies of pancreas fluid may supplement diagnosis.

Nano-encapsulant of ascorbic acid-loaded apoferritin-assisted photoelectrochemical sensor for protease detection

A signal-on photoelectrochemical (PEC) biosensor based on nano-encapsulant of ascorbic acid-loaded apoferritin-assisted for protease detection is described. The loaded ascorbic acid could be released from the central cavity of apoferritin into the buffer solution as sacrificial electron donor to capture the photo-generated holes of CdTe quantum dots when light is turned on. In this system, the biosensor relied on monitoring the photocurrent intensity as a result of enzymatic substrate proteolysis in the homogeneous aqueous solution. A low detection limit of 2.7ngmL−1 for trypsin in the linear range from 30 to 450ngmL−1 is achieved. We believe that such a sensing system not only holds the potential ability as a probe for trypsin activity assay, but also could be used for the corresponding inhibitor-screening. It might provide a potentially feasible alternative tool for determining trypsin in human serum in a clinical laboratory. The established method could open a different perspective for PEC enzyme detection and provide a new platform for future development of PEC analysis with other clinically important proteins.

On the Activities of Pancreatic Proteases and Alpha-1 Proteinase Inhibitor in Meat-Type Chicken

The study was aimed at the evaluation of the effects of breed, age, different digestion stimulators, and dietary crude protein (CP) level on the activities of proteolytic enzymes in pancreatic tissue and duodenal chymus (in vivo), serum trypsin and α1-proteinase inhibitor (A1PI) concentrations in meat-type chicks. The study of age dynamics of trypsin and A1PI concentrations was performed on the chicks of hybrid cross “Smena-8”and two parental lines (Plymouth Rock and Cornish) fed standard commercial corn-wheat-SBM diets. Twenty birds per breed were euthanized at 1, 7, 14, 21, 28 and 35 days of age to obtain blood samples and pancreatic homogenate. Experiments on the effects of different digestion promotors (probiotic, acidifier, phytobiotic, enzymatic preparation) and different CP levels (finisher diet, CP 20%, vs. ground corn, CP 8.5%) were performed on 12 hybrid chicks with fistulated duodenum from 14 to 50 days of age. The following conclusions were made: 1) At 1 day of age high proteolytic activity in pancreatic tissue and maximal serum concentrations of trypsin and A1PI were found in both hybrid and parental lines. Since 7 to 35 days of age A1PI concentration was nearly constant, serum trypsin concentration decreased while proteolytic activity in pancreatic tissue exhibited undulate increase; 2) Proteolytic activity in pancreatic tissue was higher in hybrids compared to the parental lines from 7 to 35 days of age (p 0.05); 3) Supplementation of diet with exogenous enzymes stimulated the digestion due to the increase in protease activity in duodenal chymus by 9.1% compared to unsupplemented control (p 0.05); 4) Proteolytic activity in duodenal chymus significantly responded to the substitution of ground corn for the complete diet by 2-fold decrease while serum trypsin concentration responded by 2.5-fold increase (p 0.001). This fact can indicate that physiological functions of digestive proteases are not confined to the digestive processes.

Label-Free Fluorescent Detection of Trypsin Activity Based on DNA-Stabilized Silver Nanocluster-Peptide Conjugates.

Trypsin is important during the regulation of pancreatic exocrine function. The detection of trypsin activity is currently limited because of the need for the substrate to be labeled with a fluorescent tag. A label-free fluorescent method has been developed to monitor trypsin activity. The designed peptide probe consists of six arginine molecules and a cysteine terminus and can be conjugated to DNA-stabilized silver nanoclusters (DNA-AgNCs) by Ag-S bonding to enhance fluorescence. The peptide probe can also be adsorbed to the surface of graphene oxide (GO), thus resulting in the fluorescence quenching of DNA-AgNCs-peptide conjugate because of Förster resonance energy transfer. Once trypsin had degraded the peptide probe into amino acid residues, the DNA-AgNCs were released from the surface of GO, and the enhanced fluorescence of DNA-AgNCs was restored. Trypsin can be determined with a linear range of 0.0–50.0 ng/mL with a concentration as low as 1 ng/mL. This label-free method is simple and sensitive and has been successfully used for the determination of trypsin in serum. The method can also be modified to detect other proteases.

BLOOD SERUM TRYPSIN LEVELS IN CHILDREN WITH ACUTE VIRAL HEPATITIS AND THEIR ASSOCIATIONS WITH THE CLINICAL AND LABORATORY MANIFESTATIONS OF THE DISEASE

The objective of the study was to determine blood serum trypsin levels in children with mild viral hepatitis B and their correlations with the clinical and laboratory manifestations of the disease. Studied were 48 children aged 3 to 15 years. The first group comprised 33 patients with mild hepatitis B. The second (control) group comprised 15 healthy children. All hepatitis patients had significantly increased blood trypsin levels suggesting that their disease was combined hepatopancreatitis. Blood trypsin levels were found to correlate with the clinical and laboratory manifestations of the disease and its enzymatic exaggerations associated with delayed recovery. Blood serum trypsin levels were found to correlate linearly with the specific markers of hepatitis: HBs antigen level at patient’s admission and the duration of increases in HBs and HBe levels. This suggests that serum trypsin may be the earliest prognostic marker of lingering and chronic disease. It is recommended to treat the icteric forms of hepatitis B in children as combined conditions (hepatopancreatitis) and to follow-up and cure such patients in collaboration of infectiologists with gastroenterologists in order to reduce the incidence of complication and adverse outcomes and to timely recognize lingering and chronic pancreatitis in children.

PRSS1 mutations and the proteinase/antiproteinase imbalance in the pathogenesis of pancreatic cancer.

This study aimed to investigate the mutations in the serine protease 1 gene (PRSS1) and the imbalance between trypsin and α1-antitrypsin in patients with pancreatic cancer. Polymerase chain reaction (PCR) was performed to amplify the sequences of PRSS1 from 65 patients with pancreatic cancer and 260 healthy controls, direct sequencing was performed, and the clinical features were analyzed. In addition, enzyme-linked immunosorbent assay (ELISA) was employed to detect serum trypsin and α1-antitrypsin in pancreatic cancer patients and healthy controls in the same period. Mutations were found at the promoter and exon 3 of the PRSS1 in patients with pancreatic cancer. That is, five patients had c.410 C > T mutation causing p.Thr 137 Met, and three patients had c. -338T > G mutation at the promoter of the PRSS1. In patients with PRSS1 mutations, serum trypsin was 34.5 ± 18.3ng/mL, which was significantly higher than that in normal controls (10.65 ± 6.03ng/mL) and other pancreatic cancer (28.61 ± 8.96ng/mL). What is more, in pancreatic cancer patients, serum α1-antitrypsin was 1.69 ± 0.86g/L, which was comparable to that in normal controls (1.55 ± 0.53g/L), while the ratio of serum trypsin to α1-antitrypsin was 1.46-fold to normal controls. The results presented here have provided a greater insight into the PRSS1 mutations and proteinase-inhibitor interactions occurring in pancreatic cancer.

Polyethylene glycol (PEG) gel arrays for differentiating oligopeptide fragments and on-chip protease assays

Polyethylene glycol (PEG) hydrogel is permeable to biomolecules, but its permeability depends on the molecular weight of monomers and the concentration of monomer solutions. In this study, we show that PEG hydrogel made from 20% to 30% of PEG700 monomer is permeable to amino acids yet impermeable to oligopeptides. Because of its unique permeability, the gel can be used to detect protease by separating amino acids from oligopeptides when proteases cleave the oligopeptides and release amino acids. Based on this principle, an UV crosslinked gel array is fabricated on a chip for simultaneous detection of protease in up to 40 samples with only 1µl of volume required for each sample. As a proof of concept, the on-chip protease assays are used to detect trypsin in buffer and serum. The detection limits are 1.2nM in buffer and 17.7nM in serum, which are comparable to conventional protease assays. Moreover, because only 1µl of liquid is required, as little as 1.2fmol of trypsin can be detected by using the on-chip assay. The protease assay also shows good specificity for trypsin and chymotrypsin. The gel array chip could be a useful miniaturized platform for high-throughput detection of different proteases and screening of their inhibitors.

Synthesis of coumarin-appended cyclophanes and evaluation of their complexation with myoglobin

Coumarin-appended cyclophanes bearing positively or negatively charged side chains were synthesized as a water-soluble host (1a or 1b, respectively). Host 1a and 1b showed fluorescence bands with fluorescence maxima at 404 nm originated from coumarin moiety. As a host for guest molecules by using macrocyclic cavity, cationic host 1a binds anionic guests such as 6-p-toluidinonaphthalene-2-sulfonate (TNS), 6-anilinonaphthalene-2-sulfonate (2,6-ANS), and 8-anilinonaphthalene-1-sulfonate (1,8-ANS) more strongly than anionic host 1b, reflecting intermolecular electrostatic interactions. In addition, both host 1a and 1b showed protein surface recognition and fluorescence response toward myoglobin, a small and globular protein. The fluorescence intensity originating from the hosts decreased upon the addition of myoglobin, reflecting the formation of 1a- and 1b-myoglobin complexes. On the other hand, such fluorescence response of 1a and 1b was almost negligible for other proteins such as egg white albumin, bovine serum albumin, human albumin, concanavaline A, fibrinogen, γ-globlin, peanut agglutinin, trypsin, and lysozyme.

Sensitive electrochemical immunoassay based on polythionine-Au nanocomposites as enhanced sensing signal for selective detection of biomarker with high isoelectric point

Herein, polythionine-Au nanocomposites (PTh-Au) were prepared through one-pot reaction using HAuCl4 as co-oxidant in thionine solution. The prepared PTh-Au exhibited intrinsic electrochemical activity based on the dual participation of protons and electrons during electrochemical doping/dedoping process. Thus, a label-free electrochemical immunoassay to detect a high isoelectric point (pI) biomarker (using trypsin as a model) was developed based on co-participation of proton and electron in the PTh-Au's response. In a detecting buffer with pH values lower than trypsin's pI (=10.8), positively charged trypsin prevented proton and electron transfer simultaneously to reduce the current response of PTh-Au. The decreasing amplitude of the current can be used to quantify the concentration of trypsin, which can be utilized to determine the health condition of pancreas. The proposed immunoassay exhibited wide linear range, low limit of detection and high specificity in a detecting buffer (pH 5.5). The obtained immunosensor was successfully applied to detect trypsin in human serum accurately. Additionally, this sensing strategy may be used to detect other important biomarkers with relatively high pIs (>7).

Application of an Electrochemical Immunosensor with a MWCNT/PDAA Modified Electrode for Detection of Serum Trypsin

Objective: To establish an electrochemical immunosensor for the determination of serum trypsin levels using a multiwall carbon nanotubes (MWCNTs)-composite-modified electrode. Method: A MWCNT composite coated on the surface of bare gold electrodes was used for fixation of an anti-trypsin antibody. The assembly process and the performance indicators, including sensitivity, linear range of detection, anti-jamming performance, and stability, of the electrochemical immunosensor were examined by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Results: With optimized experimental conditions, the difference of the current value measured by differential pulse voltammetry (DPV) showed a linear relationship with the concentration of serum trypsin within 0.10–100 ng/mL. The detection limit for trypsin using this sensor was 0.002 ng/mL. Conclusions: The electrochemical immunosensor built using the MWCNT-composite-modified electrode is simple to operate and has a fast response time, along with a wide linear range, high sensitivity, and accuracy, making it suitable for serum trypsin detection.

High serum trypsin levels and the -409 T/T genotype of PRSS1 gene are susceptible to neonatal sepsis.

Neonatal sepsis remains an important and common cause of morbidity and mortality among newborn infants, especially in developing countries. The aim of the present study was to determine whether serum trypsin levels and genotypes of cationic trypsinogen (PRSS1) gene could be served as markers for predicting neonatal sepsis. The serum trypsin levels and genotypes of PRSS1 were examined in both 50 infants with infection during neonatal period and 56 healthy neonates as controls. The infected infants were further subdivided into infants with sepsis group (n=18) and infected infants without sepsis (n=32). The genotype of PRSS1 was analyzed by direct sequencing, and the serum trypsin level was measured by immunoassay. It showed that the median value of serum trypsin was significantly higher in infected infants (31.90 ng/mL) than in controls (12.85 ng/mL; P=0.030). More importantly, sepsis subgroup (50.95 ng/mL) had significantly higher median serum trypsin than infected infants without sepsis subgroup (19.10 ng/mL) and controls (12.85 ng/mL) (P=0.015 and P=0.002, respectively). Additionally, the median serum trypsin levels were found significantly higher in infants who had T/T (37.90 ng/mL) genotype of PRSS1 compared with those who had C/T genotype (12.80 ng/mL; P=0.005). This study suggested that serum trypsin and rs10273639 C/T of PRSS1 were revealed to be novel markers for predicting neonatal sepsis.

Serum trypsin and TCR as novel markers for predicting disease activity in IgG4-related disease.

BackgroundIgG4-related disease (IgG4-RD) is a novel disease named in recent years. Because of its varied clinical manifestations, like tumor but not tumor, it brings a great challenge to clinical diagnosis. Trypsin and T-cell receptor (TCR) are thought to mediate the regulation of B cell maturation, survival and antibody production. In this study, we investigated the clinical features and important novel markers of IgG4-RD.Material and methodsA prospective cohort study of 22 patients with IgG4-RD was carried out from May 2009 to December 2012, and 65 cases with acute pancreatitis, 60 cases with pancreatic cancer and 120 healthy individuals were studied as controls. Serum TCR, trypsin and IgG4 levels were measured during pre- and post-treatment in the patients with IgG4-RD and their correlations with IgG4 were also assessed.ResultsSerum IgG4 and IgE levels in all patients were significantly increased, and tumor markers (carbohydrate antigen 19-9 and/or carbohydrate antigen 125) were also increased (12/22). Serum trypsin in patients with IgG4-RD was lower than in the ones with acute pancreatitis, pancreatic cancer, and healthy individuals. But serum TCR of IgG4-RD was significantly higher than in the pancreatic cancer group and normal controls and it was inversely correlated with the levels of IgG4 (r = –3.160, p = 0.042).ConclusionsThe results indicate that serum TCR and trypsin might be useful markers for predicting disease activity in IgG4-RD.

Serine proteases affect in situ vasa recta capillary diameter: mechanism for kidney failure associated with pancreatitis?

Serine proteases are proteolytic enzymes involved in the regulation of renal function and hemodynamics. Serum trypsin (the archetypal serine protease) levels are elevated in a number of pathophysiological conditions, notably pancreatitis, which is associated with acute renal failure.Here we use the kidney slice model to investigate the effect of trypsin on vasa recta diameter in situ. Kidney slices (200 μm thick) were obtained from adult male rats as previously described [1]. Kidney slices were superfused with trypsin and DIC video imaging techniques were used to record real‐time changes in vasa recta diameter.Application of trypsin (2 U/ml) caused a significant constriction of vasa recta capillaries, specifically at smooth muscle‐like pericyte cell sites (15.5±1.4% p&lt;0.05).Here we demonstrate that acute application of trypsin (at levels similar to those detected in patients with severe acute pancreatitis) significantly decreases vasa recta diameter and thus renal medullary blood flow, specifically via its action at pericytes. Data presented here identifies a novel potential role for pericytes in the acute renal failure observed in patients with acute pancreatitis.Research supported by BBSRC, Wellcome Trust and the MRC

Effect of poly(ether–ether–sulfone) concentration on the morphology, performance, thermal stability, mechanical strength, and antifouling of asymmetric cellulose acetate ultrafiltration membranes

The aim of the present work is to investigate the morphology, performance, thermal stability, mechanical strength, and antifouling of the poly(ether–ether–sulfone) (PEES)-incorporated asymmetric cellulose acetate (CA)-blended ultrafiltration membranes. High-performance CA/PEES blend ultrafiltration membranes were prepared by the phase inversion technique. The effects of PEES concentration (0–30 wt%) on pure water permeability (PWP), water content, porosity, molecular weight cutoff, mean pore size, morphology, hydrophilicity, and thermal and mechanical properties of the CA/PEES blend membranes were investigated. Morphological studies were carried out using scanning electron microscopy. scanning electron microscopic studies revealed that the incorporation of PEES resulted in the formation of a thin top layer, a porous sub-layer, and the open pores in the bottom layer. The thermal properties of these polymeric membranes were evaluated by thermogravimetric and differential thermogravimetric analyses measurements, whereas the glass transition temperature of the membranes was calculated by differential scanning calorimetry. With the increase in the concentration of PEES on the CA membranes, the PWP, hydrophilicity, water content, porosity, the thermal stability, glass transition temperature, tensile strength, tensile modulus, and elongation at break significantly improved in the blend membranes. The efficiency of these membranes in the separation of commercially important proteins such as bovine serum albumin (BSA), egg albumin, pepsin, and trypsin was studied and found to be enhanced as compared to CA membranes. In fouling experiments, BSA was used as the model protein, and flux recovery ratio (FRR) of the membranes was calculated. Attempts have been made to correlate the changes in membrane morphology with pure water flux, water content, porosity, thermal and mechanical stability, separation efficiency, and antifouling property of the CA/PEES membranes. It has been demonstrated that the fouling-resistant ability of CA/PEES membranes is enhanced due to the high FRR with the addition of PEES in the casting solution. Based on the findings, it can be concluded that the membranes prepared with 80/20 composition of CA/PEES blend membranes are promising candidates for industrial applications.

Macrolipasemia due to Crohnʼs Disease

Purpose: In a patient presenting with epigastric pain, emesis, and elevation of lipase, a diagnosis of pancreatitis may seem inevitable. But in spite of its specificity, the elevation of lipase in the context of a normal amylase value merits further investigation into other potential etiologies. A 56-year-old female with a history of longstanding severe Crohn's disease requiring multiple small bowel resections was initially seen in 2010; remission was maintained with certolizumab pegol. However, a few months later she started to experience epigastric and periumbilical pain, so cerrtolizumab pegol was boosted and split, deferring dual therapy with a thiopuine due to prior infections. Despite initial improvement, she was admitted two months later for emesis and severe periumbilical pain; lipase was elevated at 7000 U/L with a normal amylase. She did not consume alcohol, have a history of gallbladder disease, or take any known pancreatotoxins. Ultrasound and MRI demonstrated a normal pancreas; CT suggested a slightly plump pancreas, but IgG4 was negative. Serum trypsin, urinary lipase, fecal elastase, and serum amylase were all negative or normal. Colonoscopy revealed inflammation at the ileocolonic anastomosis causing significant narrowing. Based on this investigation, it was determined that the patient had macrolipasemia due to Crohn's disease. Isolated macrolipasemia is a rare finding that has been observed in celiac disease, cryptogenic liver cirrhosis, non-Hodgkin's lymphoma, and Crohn's disease. Although significantly more uncommon than hyperamylasemia, a solitary increase in lipase values in patients without pancreatitis has been reported in the literature; there has been only one such documented case of macrolipasemia and Crohn's disease. Laboratory measurements of lipase account for all forms of the enzyme regardless of composition. Macroenzyemes are formed by either self polymerization or the creation of a complex consisting of the physiologic enzyme and immunoglobulin; there have been reports of such complexes in association with autoimmune phenomena. The increased molecular mass of these macroenzymes does not allow for physiologic filtration and removal of the enzyme via the kidney, thereby accounting for the accumulation of the enzyme in serum levels and lack of presence in the urine. Currently, no evidence has been found to suggest that macroenzymes play a compelling role in the cause of disease, nor do they require treatment. Therefore, in a patient with repeated episodes of abdominal pain and isolated elevation of lipase, consider alternatives to the diagnosis of pancreatitis, particularly when another known abdominal disease exists.