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Acute pancreatitis (AP) is a major, globally increasing gastrointestinal disease and a biliary origin is the most common cause. However, the effects of bile acids (BAs), given systemically, on the pancreas and on disease severity remains elusive. In this study, we have investigated the roles of different circulating BAs in animal models for AP to elucidate their impact on disease severity and the underlying pathomechanisms. BAs were incubated on isolated acini and AP was induced through repetitive injections of caerulein or L-arginine; pancreatic duct ligation (PDL); or combined biliopancreatic duct ligation (BPDL). Disease severity was assessed using biochemical and histological parameters. Serum cholecystokinin (CCK) concentrations were determined via enzyme immunoassay. The binding of the CCK1 receptor was measured using fluorescence-labeled CCK. In isolated acini, hydrophobic BAs mitigated the damaging effects of CCK. The same BAs further enhanced pancreatitis in L-arginine- and PDL-based pancreatitis, whereas they ameliorated pancreatic damage in the caerulein and BPDL models. Mechanistically, the binding affinity of the CCK1 receptor was significantly reduced by hydrophobic BAs. The hydrophobicity of BAs and the involvement of CCK seem to be relevant in the course of AP. Systemic BAs may affect the severity of AP by interfering with the CCK1 receptor.
Chronic pancreatitis (CP) is characterized by chronic inflammation and the progressive fibrotic replacement of exocrine and endocrine pancreatic tissue. We identify Treg cells as central regulators of the fibroinflammatory reaction by a selective depletion of FOXP3-positive cells in a transgenic mouse model (DEREG-mice) of experimental CP. In Treg-depleted DEREG-mice, the induction of CP results in a significantly increased stroma deposition, the development of exocrine insufficiency and significant weight loss starting from day 14 after disease onset. In CP, FOXP3+CD25+ Treg cells suppress the type-2 immune response by a repression of GATA3+ T helper cells (Th2), GATA3+ innate lymphoid cells type 2 (ILC2) and CD206+ M2-macrophages. A suspected pathomechanism behind the fibrotic tissue replacement may involve an observed dysbalance of Activin A expression in macrophages and of its counter regulator follistatin. Our study identified Treg cells as key regulators of the type-2 immune response and of organ remodeling during CP. The Treg/Th2 axis could be a therapeutic target to prevent fibrosis and preserve functional pancreatic tissue.
Background
In acute pancreatitis, secondary infection of pancreatic necrosis is a complication that mostly necessitates interventional therapy. A reliable prediction of infected necrotizing pancreatitis would enable an early identification of patients at risk, which however, is not possible yet.
Methods
This study aims to identify parameters that are useful for the prediction of infected necrosis and to develop a prediction model for early detection. We conducted a retrospective analysis from the hospital information and reimbursement data system and screened 705 patients hospitalized with diagnosis of acute pancreatitis who underwent contrast-enhanced computed tomography and additional diagnostic puncture or drainage of necrotic collections. Both clinical and laboratory parameters were analyzed for an association with a microbiologically confirmed infected pancreatic necrosis. A prediction model was developed using a logistic regression analysis with stepwise inclusion of significant variables. The model quality was tested by receiver operating characteristics analysis and compared to single parameters and APACHE II score.
Results
We identified a total of 89 patients with necrotizing pancreatitis, diagnosed by computed tomography, who additionally received biopsy or drainage. Out of these, 59 individuals had an infected necrosis. Eleven parameters showed a significant association with an infection including C-reactive protein, albumin, creatinine, and alcoholic etiology, which were independent variables in a predictive model. This model showed an area under the curve of 0.819, a sensitivity of 0.692 (95%-CI [0.547–0.809]), and a specificity of 0.840 (95%-CI [0.631–0.947]), outperforming single laboratory markers and APACHE II score. Even in cases of missing values predictability was reliable.
Conclusion
A model consisting of a few single blood parameters and etiology of pancreatitis might help for differentiation between infected and non-infected pancreatic necrosis and assist medical therapy in acute necrotizing pancreatitis.
Background and study aims: Gastric cancer (GC) is one of the leading causes of malignancy-related death in Vietnam, with increasing incidence of non-cardia early gastric cancer (N-EGC). Data on accurate diagnosis of EGC and treatment by endoscopic submucosal dissection (ESD) in Vietnam are very sparse. The aim of this study was to describe the characteristics of N-EGC and evaluate the effectiveness and the safety of ESD in Central Vietnam.
Patients and methods: We prospectively enrolled patients with N-EGC detected by magnified chromoendoscopy from December 2013 to August, 2018 in Central Vietnam. Selected cases of N-EGC received standardized ESD technique and have been following up carefully as in protocol.
Results: Among 606 GC patients, 46 had N-GEC and underwent ESD. The depth of invasion was pT1a in 33 (71.7 %), pT1b1 in 10 (21.7 %), and pT1b2 in three cases (6.6 %). Mild chronic atrophic gastritis, most being C2 (63 %), and gastritis-like EGC that did not appear malignant was the predominant type. ESD achieved a 97.8 % en bloc resection rate; the mean procedure time was 76 ± 22 minutes (range 24–155), and mean endoscopic tumor size was 23 ± 5 mm (range 13–52) and ESD sample size was 28 ± 7 mm (range 16.5–60). Complications consisted of two patients with bleeding and one with a minor perforation, all of which were successfully managed by endoscopy. The longest and the mean follow-up times were 84 and 64 months, respectively, with no recurrence.
Conclusions: A significant proportion patients with N-EGC have a background mucosa of mild chronic atrophic gastritis. Our results 7 years after starting ESD demonstrate early promising outcomes with the procedure.
Background: Pancreatic cancer is the fourth leading cause of cancer-related mortality in both genders. More than 80% of patients suffer from significant weight loss at diagnosis and over time develop severe cachexia. Early nutritional support is therefore essential. Summary: This review evaluates the different nutritional therapies, such as enteral nutrition, parenteral nutrition and special nutritional supplements, on nutritional status, quality of life and survival. Key Message: Due to the high prevalence of malnutrition and the rapid development of anorexia-cachexia-syndrome, early nutritional intervention is crucial and supported by clinical data. Practical Implications: Enteral nutrition should be preferred over parenteral nutrition. Omega-3 fatty acids and <smlcap>L</smlcap>-carnitine are promising substances for the prevention of severe cachexia, but further randomized controlled trials are needed to establish generally accepted guidelines on nutrition in pancreatic cancer.
Background/Aims: Acute pancreatitis (AP) is characterized by premature zymogen activation, systemic inflammatory response resulting in inflammatory infiltrates, sustained intracellular calcium, neurogenic inflammation and pain. The inhibitory neurotransmitter and cytoprotective amino acid glycine exerts a direct inhibitory effect on inflammatory cells, inhibits calcium influx and neuronal activation and therefore represents a putative therapeutic agent in AP. Methods: To explore the impact of glycine, mild AP was induced in rats by supramaximal cerulein stimulation (10 µg/kg BW/h) and severe AP by retrograde injection of sodium taurocholate solution (3%) into the common biliopancreatic duct. 100/300 mmol glycine was administered intravenously before induction of AP. To elucidate the effect of glycine on AP, we determined pathomorphology, pancreatic cytokines as well as proteases, serum lipase and amylase, pancreatic and lung MPO activity and pain sensation. Results: Glycine administration resulted in a noticeable improvement of pathomorphological alterations in AP, such as a reduction of necrosis, inflammatory infiltrates and cytoplasmic vacuoles in cerulein pancreatitis. In taurocholate pancreatitis, glycine additionally diminished pancreatic cytokines and MPO activity, as well as serum lipase and amylase levels. Conclusions: Glycine reduced the severity of mild and much more of severe AP by attenuating the intrapancreatic and systemic inflammatory response. Therefore, glycine seems to be a promising tool for prophylactic treatment of AP.
Das Pankreaskarzinom zeichnet sich durch ein aggressives Tumorwachstum verbunden mit einer sehr geringen 5-Jahres-Überlebensrate und einem schlechten Ansprechen auf eine zytostatische Therpie aus. Eines der Merkmale von Tumorzellen ist ihre Resistenz gegenüber Apoptose. Heat Shock Proteine (HSPs) bilden eine große homologe Proteingruppe, die nicht nur zytoprotektive Funktionen haben, sondern auch in malignen Tumorzellen überexprimiert werden und die apoptotische Kaskade an mehreren Stellen hemmen können. In dieser Arbeit untersuchten wir, ob Heat Shock Proteine auch im Pankreaskarzinom überexprimiert sind und welchen Einfluss HSP70 auf die Apoptose in Pankreaskarzinomzellen hat. Die humanen duktalen Adenokarzinomzelllinien Panc-1, MIA PaCa-2, BxPC-3 und Capan-2 sowie nicht-transformierte duktale Pankreaszellen wurden hierfür verwendet. Mittels Western Blot und Immunzytochemie wurde die Expression von HSP70 detektiert, die Bestimmung der Zellproliferation erfolgte durch eine kolorimetrische Messung. Zur Inhibition von HSP70 wurden sowohl Quercetin, ein pflanzliches Polyphenol, als auch HSP70 spezifische siRNA verwendet. Die Apoptose wurde durch Messung der Caspasen-3 und -9, der Bestimmung des Anteils Annexin-V positiver Zellen in der Durchflusszytometrie und in situ durch TUNEL-Färbungen untersucht. Wir konnten nachweisen, dass HSP70 trotz identischer Kultivierungsbedingungen in Tumorzellen stärker exprimiert wird als in den duktalen Zellen. Thermischer Stress konnte die HSP70 Expression weiter steigern. Durch Quercetin gelang eine Inhibition der HSP70 Expression, die zu einer verrringerten Zellproliferation von Tumorzellen führte, nicht jedoch von normalen duktalen Zellen, die nur wenig HSP70 exprimierten. Dihydroquercetin, ein ineffektives Analogon von Quercetin ohne HSP70 reduzierende Eigenschaften, hatte weder in Tumorzellen noch in normalen pankreatischen duktalen Zellen eine Wirkung. In den Karzinomzelllinien Panc-1 und MIA PaCa-2 führte der Verlust von HSP70 durch Quercetin zu einer gesteigerten Apoptose, wie durch Caspase-3 und -9 Messung, Annexin-V Markierung und im TUNEL-Assay gezeigt wurde, während Dihydroquercetin in keiner der untersuchten Zelllinie Apoptose auslöste. Diese Ergebnisse konnten unter Verwendung von HSP70 spezifischer siRNA bestätigt werden. Nach 48 bzw. 72 Stunden wurde HSP70 in Panc-1 und MIA PaCa-2 fast vollständig inhibiert und eine gesteigerte Apoptoserate gemessen. Kontrollexperimente mit nicht-spezifischer „scrambled“ siRNA konnten keine Induktion der Apoptose nachweisen. Unsere Ergebnisse legen nahe, dass die Anwesenheit von Heat Shock Protein 70 die erhöhte Apoptoseresistenz von Pankreaskarzinomzellen miterklärt. Depletion von HSP70 leitet die Apoptose in pankreatischen Tumorzellen ein. Um mögliche andere pro-apoptotische Effekte von Bioflavonoiden zu umgehen, verwendeten wir RNA Interferenz, die ein gezieltes Ausschalten eines einzelnen Gens gewährleistet. Damit konnten wir unsere vorher mit Quercetin erzielten Ergebnisse bestätigen. Wir konnten zeigen, dass HSP70 anti-apoptotische Eigenschaften im Pankreaskarzinom hat, HSP70 inhibierende Substanzen könnten daher ein therapeutisches Potential in der Behandlung des Pankreaskarzinoms haben.