Chemical pancreatectomy: an unconventional approach to preventing autodigestion in pancreatitis

Abstract

Chronic pancreatitisPicture yourself in a hospital room where your son has been admitted with pancreatitis. This is his third attack, and he is only 11 years old. You should know what to expect since his father and uncle suffer bouts of excruciating abdominal pain and diabetes from an inherited form of chronic pancreatitis. A doctor enters and says, "We are going to inject acetic acid into his pancreatic duct." Instinctively, you reply, "You are going to do what?" Chronic pancreatitis is a debilitating disease characterized pathologically by inflammation, atrophy, and fibrosis of the pancreas and clinically by recurrent abdominal pain, pancreatic enzyme insufficiency, and often, diabetes mellitus (1). Chronic pancreatitis is most commonly associated with excessive alcohol use, although genetic causes, such as muta

Alterations in exocrine pancreatic function after acute pancreatitis

“…Apoptosis leads to the release of pro-inflammatory cytokines and chemokines which results in the recruitment of immune cells to the acinar cells [ 24 – 26 ]. Recruitment and activation of immune cells at the level of the acinus further contributes to autodigestion of the pancreas, resulting in a permanent loss of exocrine cell mass and predisposing to the development of EPD [ 27 , 28 ]. During the initial phase of AP, when acinar cell stress is most severe, the prevalence of EPD may exceed 80% in patients with severe AP or pancreatic necrosis [ 29 ].…”

“…While the exocrine pancreas has the capacity to regenerate in murine models, there has been no direct evidence of regeneration in humans. Thus, while many individuals fully recover from AP, even a single episode can have potentially permanent effects [ 27 , 28 ].…”

Precision Medicine in Pancreatitis: The Future of Acute Pancreatitis Care

“…Early acinar cell damage 30 and premature trypsinogen activation 31 : autodigestion, 32 autophagy, 33 cathepsin B release, 34 excessive calcium signaling, 35 mitochondrial damage, 36 and ATP depletion. 37 …”

Chemical therapy for chronic pancreatitis: An assumption or an alternative?

“…Pancreatic ductal infusion of AcA is a potential alternative of chemical pancreatectomy to surgical pancreatectomy. Liddle [ 25 ] imagined a picture that one day in the future, patients with CP would recover by “injecting AcA into the pancreatic duct”. While we further hope that both pancreatic duct stones and chronic inflammation of the pancreatic parenchyma could be cured by chemical therapies, many more studies on chemical therapy for CP are warranted to realize this vision.…”