A thorough analysis of the mechanism of inhibition of human leukocyte elastase (HLE) by a monocyclic 8-lactam and the mechanism of@-lactam hydrolysis led to the preparation of potent and highly stable inhibitors of HLE. This work led to the identification of 4-[(4- carboxyphenyl)-oxy]-3, 3-diethyl-l-[[(phenylmethyl) aminolcarbonyl]-2-azetidinone (2) as the first orally active inhibitor of human leukocyte elastase (HLE). Analogs of 2 with different ...