Urinary levels of activated trypsin in whole-organ pancreas transplant patients with duodenocystostomies

Nanophotonic platform for the highly sensitive detection of trypsin enzyme in human urine

Trypsin is an important indicator of pancreatic disease. We introduce a nanophotonic test for the detection of trypsin. Our approach is based on the hydrolysis of β-casein by trypsin. We demonstrate 0.1 ng mL-1 of trypsin detection in human urine and across the clinically relevant range.

Simple and sensitive fluorescence detection of trypsin with Cu2+-Bovine serum albumin complex as a peroxidase mimic

Trypsin is a serine protease playing a key role in regulating pancreatic exocrine function and can be applied as a marker for the diagnosis of pancreatitis. In this work, a convenient and sensitive fluorescent assay was developed toward trypsin. Hydrogen peroxide slowly oxidized a non-fluorescent o-phenylenediamine (OPD) into a fluorescent product 2,3-diaminophenothiazine (DAP) under the catalytic from copper ions. After the introduction of bovine serum albumin (BSA), the combination of BSA with copper ions formed a peroxidase mimic and significantly accelerated the reaction rate. As an efficient protease, trypsin cleaved the lysine and arginine residues in BSA. This destroyed the binding between Cu2+ and BSA, and brought in a reduction of the catalytic effect. The accompanying decrease in fluorescence provided a response to trypsin in the range of 0.01-600 ng/mL, with a detection limit of 0.007 ng/mL. The scheme had a good selectivity and was successfully applied to the detection of real samples.

Ultrasensitive Determination of Trypsin in Human Urine Based on Amplified Fluorescence Response

The determination of trypsin activity in human urine is important for evaluating pancreatic disease. We designed an effective fluorescence sensing strategy based on a self-assembled amphiphilic pyrene/protamine complex system that provides an amplified fluorescence response for highly sensitive and selective detection of trypsin. In aqueous solution, the functionalized pyrene formed fluorescent, π-extended aggregates inside micelles, which were effectively quenched by protamine (a trypsin substrate). However, this quenched fluorescence was very sensitively recovered by the trypsin's enzymatic reaction, and this was attributed to a marked reduction in enhanced exciton migration caused by protamine in π-delocalized pyrene aggregates. The devised sensing platform was successfully utilized to selectively and sensitively detect trypsin at very low concentrations (0.03-0.5 μg mL^-1) in non-pretreated human urine and to screen for trypsin inhibitors at concentrations of 0.1-5.0 μg mL^-1.

A Label-Free Fluorescence Aptasensor Based on G-Quadruplex/Thioflavin T Complex for the Detection of Trypsin

A novel, label-free fluorescent assay has been developed for the detection of trypsin by using thioflavin T as a fluorescent probe. A specific DNA aptamer can be combined by adding cytochrome c. Trypsin hydrolyzes the cytochrome c into small peptide fragments, exposing the G-quadruplex part of DNA aptamer, which has a high affinity for thioflavin T, which then enhances the fluorescence intensity. In the absence of trypsin, the fluorescence intensity was inhibited as the combination of cytochrome c and the DNA aptamer impeded thioflavin T’s binding. Thus, the fluorescent biosensor showed a linear relationship from 0.2 to 60 μg/mL with a detection limit of 0.2 μg/mL. Furthermore, the proposed method was also successfully employed for determining trypsin in biological samples. This method is simple, rapid, cheap, and selective and possesses great potential for the detection of trypsin in bioanalytical and biological samples and medical diagnoses.

Synthesis of a β-Arylethenesulfonyl Fluoride-Functionalized AIEgen for Activity-Based Urinary Trypsin Detection

Trypsin is one of the most important enzymes of the digestive system produced by the pancreatic acinar cells. Abnormal trypsin activity will affect pancreatic function, resulting in the corresponding pathological changes in the human body. Herein, we present a strategy based on the ensemble of a novel dual warhead probe HPC-ESF and the natural trypsin substrate bovine serum albumin (BSA) for the detection of trypsin activity including in real urine samples. The β-arylethenesulfonyl bearing HPC-ESF is nonemissive when dissolved in aqueous solution but becomes highly fluorescent upon conjugation to BSA through covalent bond formation with nucleophilic amino acids to create the HPC-ESF:BSA sensing system. The HPC-ESF:BSA complex can be hydrolyzed in the presence of trypsin, which results in a distinct fluorescence decrease in correlation with trypsin concentration and thus allows the detection of trypsin. Compared to previous methods, our covalent approach is simple to prepare and highly reliable. Our work will provide a different avenue for researchers to design fluorescent sensors based on a covalent labeling strategy, enriching the small library of functional groups available for such applications.

Heparin-enhanced peroxidase-like activity of iron-cobalt oxide nanosheets for sensitive colorimetric detection of trypsin

Iron-cobalt oxide nanosheets (FeCo-ONSs) were proved to have intrinsic peroxidase-like activity. Additionally, the peroxidase-like activity of FeCo-ONSs toward the oxidation of 3,3,5,5-tetramethylbenzidine (TMB) was dramatically enhanced after heparin addition due to the stronger affinity toward TMB. Protamine combines with heparin, so the promotion of peroxidase-like activity of FeCo-ONSs with heparin was suppressed. With the addition of trypsin, protamine was hydrolyzed and the enhancement effect of catalytic activity of FeCo-ONSs was recovered. Based on above process, a sensitive colorimetric platform for trypsin activity determination was constructed through measuring the absorbance of produced oxTMB at 652 nm, providing a linear detection range of 5 to 500 ng/mL and a low detection limit of 2.8 ng/mL. The method was applied to trypsin determination in real samples (human urine sample and multienzyme tablet sample) with satisfactory results, illustrating the potential application of this biosensor.

Coenzyme-Mediated Electro-RAFT Polymerization for Amplified Electrochemical Interrogation of Trypsin Activity

Trypsin is a key proteolytic enzyme in the digestive system and its abnormal levels are indicative of some pancreatic diseases. Taking advantage of the coenzyme-mediated electrografting of ferrocenyl polymers as a novel strategy for signal amplification, herein, a signal-on cleavage-based electrochemical biosensor is reported for the highly selective interrogation of trypsin activity at ultralow levels. The construction of the trypsin biosensor involves (i) the immobilization of peptide substrates (without free carboxyl groups) via the N-terminus, (ii) the tryptic cleavage of peptide substrates, (iii) the site-specific labeling of the reversible addition-fragmentation chain transfer (RAFT) agents, and (iv) the grafting of ferrocenyl polymers through the electro-RAFT (eRAFT) polymerization, which is mediated by potentiostatic reduction of nicotinamide adenine dinucleotide (NAD⁺) coenzymes. Through the NAD⁺-mediated eRAFT (NAD⁺-eRAFT) polymerization of ferrocenylmethyl methacrylate (FcMMA), the presence of a few tryptic cleavage events can eventually result in the recruitment of a considerable amount of ferrocene redox tags. Obviously, the NAD⁺-eRAFT polymerization is low-cost and easy to operate as a highly efficient strategy for signal amplification. As expected, the as-constructed biosensor is highly selective and sensitive toward the signal-on interrogation of trypsin activity. Under optimal conditions, the detection limit can be as low as 18.2 μU/mL (∼72.8 pg/mL). The results also demonstrate that the as-constructed electrochemical trypsin biosensor is applicable to inhibitor screening and the interrogation of enzyme activity in the presence of complex sample matrices. Moreover, it is low-cost, less susceptible to false-positive results, and relatively easy to fabricate, thus holding great potential in diagnostic and therapeutic applications.

Label-free SERS detection of Raman-Inactive protein biomarkers by Raman reporter indicator: Toward ultrasensitivity and universality

It is still challenging to sensitively detect protein biomarkers via surface-enhanced Raman scattering (SERS) technique owing to their low Raman activity. SERS tag-based immunoassay is usually applied; however, it is laborious and needs specific antibodies. Herein, an ultrasensitive and universal "Raman indicator" sensing strategy is proposed for protein biomarkers, with the aid of a glass capillary-based molecularly imprinted SERS sensor. The sensor consists of an inner SERS substrate layer for signal enhancement and an outer mussel-inspired polydopamine imprinted layer as a recognition element. Imprinted cavities have two missions: first, selectively capturing the target protein, and second, the only passageway of Raman indicator to access SERS substrate. Specific protein recognition means filling imprinted cavities and blocking Raman indicator flow. Thus, the quantity of captured protein can be reflected by the signal decrease of ultra-Raman active indicator molecule. The capillary sensor exhibited specific and reproducible detection at the level down to 4.1 × 10^-3 μg L^-1, for trypsin enzyme in as-received biological samples without sample preparation. The generality of the mechanism is confirmed by using three different protein models. This platform provides a facile, fast and general route for sensitive SERS detection of Raman inactive biomacromolecules, which offers great promising utility for in situ and fast point-of-care practical bioassay.

Optical Fingerprints of Proteases and Their Inhibited Complexes Provided by Differential Cross-Reactivity of Fluorophore-Labeled Single-Stranded DNA

The detection of proteases and their complexes with inhibitor proteins is of great importance for diagnosis and medical-treatment applications. In this study, we report a fingerprint-based sensor using an array of single-stranded DNAs (ssDNAs) labeled with environment-responsive 3'-carboxytetramethylrhodamine (TAMRA) for the identification of proteases. Four TAMRA-modified ssDNAs with different sequences solubilized in two different buffer solutions were incorporated in an array that was capable of generating fluorescent fingerprints unique to the proteases through diverse cross-reactive interactions, allowing the discrimination of (i) 8 proteases and (ii) 12 different mixtures of trypsin and its inhibitor protein (α₁-antitrypsin) by multivariate analysis. Constructing an array with TAMRA-modified DNA aptamers that bind to different sites of human thrombin provides fluorescence fingerprints that reflect a reduction of the exposed surface area of thrombin upon complexation with antithrombin III, even in the presence of human serum. We finally demonstrate the potential of hybridization with complementary DNAs as an effective means to easily double the fingerprint information for proteases. Our approach based on the cross-reactive capability of ssDNAs enables high-throughput fingerprint-based sensing that can be flexibly designed and easily constructed, not only for the identification of a variety of proteins including proteases but also for the evaluation of their complexation ability.

Peptide-induced aggregation of glutathione-capped gold nanoclusters: A new strategy for designing aggregation-induced enhanced emission probes

A series of polymers and metal ions have been observed to be useful in triggering aggregation-induced emission (AIE) and AIE enhancement (AIEE) of thiolated gold nanoclusters (AuNCs). However, peptide-induced AIEE of thiolated AuNCs and their applications in biosensors have rarely been investigated. In this study, we showed that positively charged peptides induced efficient AIEE of negatively charged glutathione-capped AuNCs (GSH-AuNCs) through electrostatic attraction. In contrast to GSH-AuNCs, polyarginine (polyArg), a cationic peptide, stimulated the AIEE of the GSH-AuNCs, resulting in a 3.5-fold luminescence enhancement, 10-fold enhancement in quantum yield, 8-nm blueshift in the luminescence maximum, and a 2.1-fold increase in the mean luminescence lifetime. Four different AIEE-based biosensors with excellent selectivity and acceptable sensitivity were fabricated using cationic peptides as an AIEE-active trigger and as a biorecognition element. A heparin biosensor with a limit of detection (LOD) of 3 nM was constructed by combining AG73 peptide-mediated AIEE of the GSH-AuNCs and the specific interaction of AG73 peptides with heparin macromolecules. The concentration of human trypsin was selectively detected at a concentration as low as 1 nM using an arginine-glycine repeat peptide as an enzymatic substrate and as an AIEE-active trigger. Alkaline phosphatase (ALP)-catalyzed dephosphorylation of phosphopeptides paired with the corresponding product-mediated AIEE of the GSH-AuNCs was used for ALP sensing with an LOD of 0.3 U L^-1. A peptide consisting of a cyclic RGD unit and an AIEE-active unit was designed to synthesize RGD-modified GSH-AuNC aggregates that can target αvβ3 integrin receptors. These AIEE-based sensors were practically applied for the quantitative determination of heparin in human plasma, trypsin in human urine, and ALP in human plasma as well as for luminescent imaging of αvβ3 integrin-overexpressing HeLa cells.

Morphology-Dependent Luminescence in Complex Liquid Colloids

Complex liquid colloids hold great promise as transducers in sensing applications as a result of their tunable morphology and intrinsic optical properties. Herein, we introduce meta-amino substituted green fluorescence protein chromophore (GFPc) surfactants that localize at the organic-water interface of complex multiphase liquid colloids. The meta-amino GFPc exhibits hydrogen-bonding (HB) mediated fluorescence quenching, and are nearly nonemissive in the presence of protic solvents. We demonstrate morphology-dependent fluorescence of complex liquid colloids and investigate the interplay between GFPc surfactants and other simple surfactants. This environmentally responsive surfactant allows us to observe morphological changes of complex emulsions in randomized orientations. We demonstrate utility with an enzyme activity based fluorescence "turn-ON" scheme. The latter employs an oligopeptide-linked GFPc that functions as both a surfactant and trypsin target. The cleavage of hydrophilic peptide results in a morphology change and ultimately a fluorescence turn-on. Fluorescent complex colloids represent a new approach for biosensing in liquid environments.

Simple and label-free liquid crystal-based sensor for detecting trypsin coupled to the interaction between cationic surfactant and BSA

Trypsin plays a central role in catalyzing the hydrolysis of peptide bonds, so a technique with simple operation is needed to monitor the activity of trypsin. Here a simple and label-free senor based on liquid crystals (LCs) was developed by employing bovine serum albumin (BSA) as the enzyme substrate and dodecyl trimethyl ammonium bromide (DTAB) as the controller for the alignment of LC. It was found that DTAB could form a self-assembled monolayer at the aqueous/LC interface to produce the dark optical images of LCs. And the addition of BSA could disturb the monolayer, so that the optical signal of LCs turned bright from dark. But the hydrolysis of BSA by trypsin resulted in the dark appearance. The sensing platform allows detection as low as 1 U/mL under the polarized light microscope based on at least three measurements. Moreover, this method was successfully applied in the detection of trypsin in human urines, suggesting its potential applications in clinic diagnosis.

A gold nanocluster-based fluorescent probe for simultaneous pH and temperature sensing and its application to cellular imaging and logic gates

Metal nanocluster-based nanomaterials for the simultaneous determination of temperature and pH variations in micro-environments are still a challenge. In this study, we develop a dual-emission fluorescent probe consisting of bovine serum albumin-stabilized gold nanoclusters (BSA-AuNCs) and fluorescein-5-isothiocyanate (FITC) as temperature- and pH-responsive fluorescence signals. Under single wavelength excitation the FITC/BSA-AuNCs exhibited well-separated dual emission bands at 525 and 670 nm. When FITC was used as a reference fluorophore, FITC/BSA-AuNCs showed a good linear response over the temperature range 1-71 °C and offered temperature-independent spectral shifts, temperature accuracy, activation energy, and reusability. The possible mechanism for high temperature-induced fluorescence quenching of FITC/BSA-AuNCs could be attributed to a weakening of the Au-S bond, thereby lowering the charge transfer from BSA to AuNCs. Additionally, the pH- and temperature-responsive properties of FITC/BSA-AuNCs allow simultaneous temperature sensing from 21 to 41 °C (at intervals of 5 °C) and pH from 6.0 to 8.0 (at intervals of 0.5 pH unit), facilitating the construction of two-input AND logic gates. Three-input AND logic gates were also designed using temperature, pH, and trypsin as inputs. The practicality of using FITC/BSA-AuNCs to determine the temperature and pH changes in HeLa cells is also validated.

Label-free nanopore single-molecule measurement of trypsin activity

Trypsin is the most important digestive enzyme produced in the pancreas, and is a useful biomarker for pancreatitis. In this work, a rapid and sensitive method for the quantitative determination of trypsin activity is developed by using a biological alpha-hemolysin protein nanopore. Due to its much larger molecular diameter than the narrow pore constriction, trypsin itself cannot transport through the alpha-hemolysin channel. Hence, an indirect trypsin detection method is developed by monitoring its proteolytic cleavage of a lysine-containing peptide substrate. Based on the current modulations produced by the translocation of the substrate degradation products in the nanopore, the activity levels of trypsin could be determined. The method is rapid and highly sensitive, with picomolar concentrations of trypsin detected in minutes. In addition, the effects of cation and temperature on the sensor sensitivity, trypsin inhibition, and serum sample analysis are also investigated.

A sensitive and label-free trypsin colorimetric sensor with cytochrome c as a substrate

The development of simple and sensitive methods for protease sensing plays important roles in clinical diagnostics and drug development. Here a simple, rapid, label-free, and sensitive trypsin colorimetric sensor was developed by employing cytochrome c (cyt c) as an enzyme substrate and 3,3´,5,5´-tetramethylbenzidine (TMB) as a chromogenic reagent. It was found that cyt c hardly catalyzes H2O2-mediated TMB oxidation to produce a blue solution. But the hydrolysate of cyt c by trypsin displays an intense catalytic effect on the aforementioned reaction, resulting in the formation of a blue solution immediately. The detection process allows visually perceiving as low as 50 ng/mL trypsin with the naked eyes. With the aid of a spectrophotometer, the absorbance at 652 nm was proportional to the concentration of trypsin in the range from 5.0 ng/mL to 2.0 μg/mL with a detection limit of 4.5 ng/mL. The sensor showed better precision with relative standard deviation of 2.5% and 1.7% for eleven repetitive measurements of 50.0 ng/mL and 1.0 μg/mL trypsin solution, respectively. The procedure has been successfully applied to the determination of trypsin in human urines and for inhibitor screening, demonstrating its potential application in clinic diagnosis and drug development.

Gold nanoclusters-based chemiluminescence resonance energy transfer method for sensitive and label-free detection of trypsin

A chemiluminescence resonance energy transfer (CRET) platform was developed for sensitive and label-free detection of protease by using trypsin as a model analyte. In this CRET platform, bis(2,4,6-trichlorophenyl)oxalate-hydrogen peroxide chemiluminescence (CL) reaction was utilized as an energy donor and bovine serum albumin (BSA)-stabilized gold nanoclusters (Au NCs) as an energy acceptor. The BSA-stabilized Au NCs triggered the CRET phenomenon by accepting the energy from TCPO-H2O2 CL reaction, thus producing intense CL. In the presence of trypsin, the protein template of BSA-stabilized Au NCs was digested, which frustrated the energy transfer efficiency between the CL donor and the BSA-stabilized Au NCs, leading to a significant decrease in the CL signal. The decreased CL signal was proportional to the logarithm of trypsin concentration in the range of 0.01-50.0µg mL(-1). The detection limit for trypsin was 9ng mL(-)(1) and the relative standard deviations were lesser than 3% (n=11). This Au NCs-based CRET platform was successfully applied to the determination of trypsin in human urine samples, demonstrating its potential application in clinical diagnosis.

Current status of pancreas transplantation

Pancreas transplantation has emerged as the treatment of choice for patients with end-stage diabetes mellitus. Over the last four decades, many improvements have been made in the surgical techniques and immunosuppressive regimens, which contributed to increased number of indications and improved allograft survival. Pancreas transplantation can be justified on the basis that patients replace daily injections of insulin with an improved quality of life but at the expense of a major surgical procedure with a relatively higher complication rate, and lifelong immunosuppression. Therefore, efforts to develop more minimally invasive techniques for endocrine replacement therapy such as islet transplantation have been in progress. This article summarizes the current understanding of pancreas transplantation-associated indications, donor selection, surgical techniques, immunosuppression, and rejection.

Pancreas transplantation

Since the introduction of pancreas transplantation more than 40 years ago, efforts to develop more minimally invasive techniques for endocrine replacement therapy have been in progress, yet this surgical procedure still remains the treatment of choice for diabetic patients with end-stage renal failure. Many improvements have been made in the surgical techniques and immunosuppressive regimens, both of which have contributed to an increasing number of indications for pancreas transplantation. This operation can be justified on the basis that patients replace daily injections of insulin with an improved quality of life but at the expense of a major surgical procedure and lifelong immunosuppression. The various indications, categories, and outcomes of patients having a pancreas transplant are discussed, particularly with reference to the effect on long-term diabetic complications.

Possible origins of undetectable EPO in urine samples

BACKGROUND

In order to determine the possible origins of undetectable EPO profiles in athletes' urine, we analyzed the data obtained from a large number of official anti-doping urine tests aimed at detecting recombinant erythropoietin. The following variables were considered as potential causes for lack of EPO detection: athlete's gender, competition effect, urine specific gravity as well as possible usage of proteasic adulterants to evade doping detection.

RESULTS

Statistical analyses indicated that undetectable EPO profiles were clearly related to urine properties such as low EPO concentrations or extreme specific gravities. The addition of very small quantities of protease was shown to remove all traces of EPOs in urine. This finding led to the development of a simple, specific and sensitive test that reveals proteasic activity based on albumin digestion.

CONCLUSIONS

Urine characteristics clearly affect the detectability of an EPO profile. At the same time, addition of anti-proteases prevents the adulteration of urine. These two findings have clear practical implications with regards to the timing of urine collection as well as the entire anti-doping control procedure.

Difficulties in evaluating urinalysis following combined pancreas-kidney transplantation

Combined pancreas-kidney transplantation has been introduced in the treatment of patients with type 1 diabetes and renal failure 20 years ago. By 1985 374 combined pancreas-kidney transplantations had been reported to the International Pancreas Transplant Registries. Surgical drainage of the transplanted exocrine pancreas into the urinary bladder solves most of the postoperative problems encountered with the exocrine secretions. Furthermore, monitoring of pancreatic enzyme (amylase) activity in urine has been shown to be useful in diagnosis of rejection of the pancreatic graft. However, little attention has been paid to the biochemical consequences of high activities of proteolytic pancreatic enzymes on the determination of urinary proteins. The present case illustrates the difficulties in interpreting proteinuria in patients with combined pancreas-renal transplant with pancreaticocystostomia. In the propositus, interpretation of the urinary protein electrophoresis is hampered by the presence of pancreatic juice proteins and peptides originating from digestion of proteins by activated pancreatic enzymes. Results of immunochemically determined marker proteins ([micro]albumin, transferrin, beta 2-microglobulin) are unreliable due to digestion by pancreatic enzymes.

Urological complications of pancreatic transplantation

PURPOSE

Pancreas transplantation is increasingly being used in the treatment of type I insulin-dependent diabetes mellitus. Because bladder drainage of the exocrine pancreatic secretion is the procedure of choice, urological complications are frequent. As the number of these procedures increases the urologist will have an extended role in the management of the postoperative complications, the majority of which are urological.

MATERIALS AND METHODS

The literature from 1985 on the complications related to pancreas transplants was reviewed.

RESULTS

Approximately 50 to 60% of bladder drained pancreas transplant recipients will have a urological complication postoperatively.

CONCLUSIONS

The increasing application of bladder drained pancreas transplantation in the treatment of type I insulin-dependent diabetes mellitus necessitates that the clinical urologist is familiar with the management of complications related to this procedure.

Native and graft pancreatitis following combined pancreas-renal transplantation

Ten patients who had undergone whole-organ pancreas transplantation and pancreatoduodenocystostomy from a total of 60 simultaneous cadaveric kidney-pancreas transplants met the criteria for graft pancreatitis. This condition is clearly different from acute rejection on the basis of marked hyperamylasaemia and significant local findings over the allograft. Graft rejection was the cause of graft loss in one of the patients; eight are alive, seven with a functioning graft 61, 30, 27, 25, 21, 18 and 14 months after transplantation. Two patients died: one from severe graft pancreatitis and the other from cytomegalovirus infection. Bladder drainage with or without antibiotics has been the most common therapy, based on the theory that damage is caused by duodenal content and infected urine reflux. To prevent graft loss, antiviral treatment should be given when pancreatitis due to cytomegalovirus is suspected or diagnosed. Two patients with native pancreatitis are also described; the disease was severe and surgery was required in both cases. The pancreas grafts have now been functioning for 2 years 7 months and 2 years 10 months respectively.

Urinary trypsin levels observed in pancreas transplant patients with duodenocystostomies promote in vitro fibrinolysis and in vivo bacterial adherence to urothelial surfaces

This study evaluated the role of activated urinary trypsin in mediating the increased incidence of infectious and hemorrhagic lower urinary tract complications in pancreas transplant patients with pancreatico-duodenocystostomies (PDC). The effect of trypsin concentrations corresponding to those observed in the urine of PDC patients were studied using an in vitro assay of clot lysis and an in vivo assay of bacterial-urinary tract adherence. Results were compared with those of parallel assays performed using urine from a pancreas transplant patient with a duodenocystostomy and control human urine. All trypsin concentrations studied demonstrated fibrinolytic activity. Fibrinolysis increased as a direct function of both trypsin concentration and duration of substrate exposure (P < 0.0001). Fibrin lysis resulting from the urine of the transplant patient was 4.6 times greater than that predicted based upon assays of total trypsin content in the sample. Fibrinolytic activity in control urine specimens was 0.16% of that observed in transplant urine specimens. Exposure of the rat urinary bladder to 200 micrograms/ml trypsin concentrations, or transplant urine, resulted in a significant increase in bacterial adherence over that seen in control urine from treated animals (P < 0.05). These findings demonstrate a significant effect of urinary trypsin on physiologic processes involved in hemostasis and the prevention of urinary tract infection. Active urinary trypsin may play an etiologic role in hemorrhagic and infectious lower urinary tract complications observed in patients with a PDC.