BACKGROUND: Alpha-1-antitiypsin (∝-1-AT) is responsible for ∼90% of the anti-protease activity in serum. High endogenous levels of ∝-1-AT seem to confer a degree of protection against post-ERCP pancreatitis (Gastrointest Endosc 1996;43:406). Cayol et al. demonstrated that ∝-1-AT levels rise after diphtheria-tetanus-polio-typhoid vaccination (Clin Sci 1995;89:389). This on-going study examines the effect of Tetanus toxoid adsorbed vaccination [Td] (Connaught Labs) on pre-ERCP ∝-1-AT levels. METHODS: Patients seen 24, 48 or 72h prior to their ERCP were recruited. Exclusion criteria included active infection, immunosuppression or Td within 1 year of study entry. Baseline ∝-1-AT and C-reactive protein [CRP] (control) levels were drawn prior to intramuscular Td and again immediately prior to ERCP. RESULTS: 15 pts have been vaccinated to date. None of the nine 24h-pts have had a significant rise in either ∝-1-AT or CRP. One of 4 pts who received Td 48h prior to ERCP had 145% and 9% elevations in CRP and ∝-1-AT, respectively; another had a 34% elevation in CRP level but no change in ∝-1-AT. Two 72h-pts have had no alteration in either CRP or ∝-1-AT levels. Significant adverse effects from Td have not been reported by any patient. ACUTE PHASE PROTEIN LEVELS AFTER TETANUS TOXOID mean serum ∝-1-AT * mean serum CRP * pre post pre post 24h (n = 9) 170 ± 17 161 ± 18 0.7 ± 0.2 0.7 ± 0.2 48h (n = 4) 177 ± 18 178 ± 21 1.3 ± 1.3 2.0 ± 1.9 72h (n = 2) 167 ± 4 169 ± 4 0.6 ± 0.1 0.6 ± 0.1 ± 1 standard deviation; * mg/dl SUMMARY: Preliminary analysis suggests that pre-procedure vaccination with Tetanus toxoid adsorbed is not an adequate stimulus to cause an elevation of acute phase proteins. This study is on-going. CONCLUSION: Further study is needed to determine the optimal stimulus and timing of intervention necessary to elevate endogenous ∝-1-AT levels, and hopefully decrease the incidence of post-ERCP pancreatitis.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging