Michael ES, Kuliopulos A, Covic L, Steer ML, Perides G. Pharmacological inhibition of PAR2 with the pepducin P2pal-18S protects mice against acute experimental biliary pancreatitis. Am J Physiol Gastrointest Liver Physiol 304: G516 -G526, 2013. First published December 28, 2012 doi:10.1152/ajpgi.00296.2012.-Pancreatic acinar cells express proteinase-activated receptor-2 (PAR2) that is activated by trypsin-like serine proteases and has been shown to exert model-specific effects on the severity of experimental pancreatitis, i.e., PAR2 Ϫ/Ϫ mice are protected from experimental acute biliary pancreatitis but develop more severe secretagogue-induced pancreatitis. P2pal-18S is a novel pepducin lipopeptide that targets and inhibits PAR2. In studies monitoring PAR2-stimulated intracellular Ca 2ϩ concentration changes, we show that P2pal-18S is a full PAR2 inhibitor in acinar cells. Our in vivo studies show that P2pal-18S significantly reduces the severity of experimental biliary pancreatitis induced by retrograde intraductal bile acid infusion, which mimics injury induced by endoscopic retrograde cholangiopancreatography (ERCP). This reduction in pancreatitis severity is observed when the pepducin is given before or 2 h after bile acid infusion but not when it is given 5 h after bile acid infusion. Conversely, P2pal-18S increases the severity of secretagogue-induced pancreatitis. In vitro studies indicate that P2pal-18S protects acinar cells against bile acid-induced injury/death, but it does not alter bile acid-induced intracellular zymogen activation. These studies are the first to report the effects of an effective PAR2 pharmacological inhibitor on pancreatic acinar cells and on the severity of experimental pancreatitis. They raise the possibility that a pepducin such as P2pal-18S might prove useful in the clinical management of patients at risk for developing severe biliary pancreatitis such as occurs following ERCP.proteinase-activated receptors; calcium; bile acid receptors; Gpbar1; proteinase-activated receptor-2 ACUTE PANCREATITIS IS AN INFLAMMATORY process most commonly associated with either biliary tract stone disease, abuse of ethanol, or performance of the endoscopic retrograde cholangiopancreatography (ERCP) procedure. The morbidity and mortality rates of acute pancreatitis are directly related to its severity, but, to date, no specific therapy for clinical acute pancreatitis has been identified. In general, the diagnosis of acute pancreatitis is only made after the disease is well established, and, as a result, clinical studies exploring the early cellular events and mechanisms that regulate the severity of an acute pancreatitis attack have not been possible. As an alternative, most investigators probing these processes have, by necessity, utilized experimental models of pancreatitis in laboratory animals for their studies.The most frequently used of those models involves either administration of a supramaximally stimulating dose of a secretagogue (i.e., the cholecystokinin analog caerulein) or retrograde ...