ELANE and chronic obstructive pulmonary disease: When the hydrolytic capacity of protease exceeds the protective capacity of anti-protease, this balance is disrupted and lung parenchyma damage occurs, ultimately leading to the development of COPD [38].The main proteases and anti-proteases involved in the pathogenesis of COPD include neutrophil elastase (NE), matrix metalloproteinase (MMP), andα1-antitrypsin [39].