Post-Acute Pancreatitis Pancreatic Exocrine Insufficiency: Rationale and Methodology of a Prospective, Observational, Multicenter Cohort Study

Alterations in exocrine pancreatic function after acute pancreatitis

Exocrine pancreatic dysfunction (EPD) is a malabsorptive complication of pancreatic disorders that can lead to a host of symptoms ranging from flatulence to diarrhea and contribute to weight loss and metabolic bone disease. It is increasingly recognized to occur after acute pancreatitis (AP), including episodes with mild severity. The risk of developing EPD after AP is influenced by a range of factors, including the degree of acinar cell destruction and inflammation during AP, and persistent structural derangements following AP. In this article, we discuss the epidemiology, pathophysiology, and clinical management of EPD after AP while highlighting key knowledge gaps.

Incident diabetes following acute pancreatitis in a multicenter prospective observational cohort

Diabetes mellitus following an episode of acute pancreatitis (AP) is an increasingly discussed complication, but there are sparse prospective data on the incidence and risk factors. We evaluated data from a prospective, multicenter observational cohort study that enrolled adults hospitalized with AP between 2017 and 2021 and followed them for one year. Ninety-eight participants who completed 12-month follow-up were included in this analysis. Diabetes status was assessed using a combination of measured glycated hemoglobin (HbA1c) at predetermined time intervals or physician diagnosis. In 68 participants without diabetes at enrollment, the cumulative incidence of new-onset diabetes was 4.4 % (n = 3) at 3 months and 10.3 % (n = 7) at 12 months. No differences were observed in demographic or pancreatitis-related characteristics between those who did versus did not develop diabetes, in part due to small sample size. In summary, new-onset diabetes was identified in approximately 10 % within one year after an episode of AP. Larger prospective studies are needed to further define the incidence, risk factors, and mechanisms of diabetes and pre-diabetes following AP. NCT03063398.

Gut microbiota interacts with inflammatory responses in acute pancreatitis

Acute pancreatitis (AP) is one of the most common acute abdominal conditions, and its incidence has been increasing for years. Approximately 15-20% of patients develop severe AP (SAP), which is complicated by critical inflammatory injury and intestinal dysfunction. AP-associated inflammation can lead to the gut barrier and function damage, causing dysbacteriosis and facilitating intestinal microbiota migration. Pancreatic exocrine deficiency and decreased levels of antimicrobial peptides in AP can also lead to abnormal growth of intestinal bacteria. Meanwhile, intestinal microbiota migration influences the pancreatic microenvironment and affects the severity of AP, which, in turn, exacerbates the systemic inflammatory response. Thus, the interaction between the gut microbiota (GM) and the inflammatory response may be a key pathogenic feature of SAP. Treating either of these factors or breaking their interaction may offer some benefits for SAP treatment. In this review, we discuss the mechanisms of interaction of the GM and inflammation in AP and factors that can deteriorate or even cure both, including some traditional Chinese medicine treatments, to provide new methods for studying AP pathogenesis and developing therapies.

Acute Pancreatitis: Current Clinical Approaches, Molecular Pathophysiology, and Potential Therapeutics

OBJECTIVE

Severe acute pancreatitis (SAP), pancreatic inflammation leading to multiorgan failure, is associated with high morbidity and mortality. There is a critical need to identify novel therapeutic strategies to improve clinical outcomes for SAP patients.

MATERIALS AND METHODS

A comprehensive literature review was performed to identify current clinical strategies, known molecular pathophysiology, and potential therapeutic targets for SAP.

RESULTS

Current clinical approaches focus on determining which patients will likely develop SAP. However, therapeutic options are limited to supportive care and fluid resuscitation. The application of a novel 5-cytokine panel accurately predicting disease outcomes in SAP suggests that molecular approaches will improve impact of future clinical trials in AP.

CONCLUSIONS

Inflammatory outcomes in acute pancreatitis are driven by several unique molecular signals, which compound to promote both local and systemic inflammation. The identification of master cytokine regulators is critical to developing therapeutics, which reduce inflammation through several mechanisms.

Effect of lncRNA H19 targeting miR-30a-5p on cell apoptosis, secretion of inflammatory factors, and autophagy in caerulein-induced acute pancreatitis

BACKGROUND

We hypothesized that H19 might promote the progression of acute pancreatitis by targeting miR-30a-5p.

AIM

To investigate the effect of lncRNA H19 targeting miR-30a-5p on cell apoptosis, secretion of inflammatory factors, and autophagy in a caerulein-induced acute pancreatitis cell model.

METHODS

Human pancreatic AR42J cells were cultured and treated with caerulein to establish a pancreatic injury cell model. The cells were divided into cerulean + si-NC group, cerulean + si-H19 group, cerulean + miR-NC group, cerulean + miR-30a-5p group, cerulean + si-H19 + anti-miR-NC group, and cerulean + si-H19 + anti-miR-30a-5p group. Real-time fluorescence quantitative PCR was used to detect the expression levels of H19 and miR-30a-5p in cells; flow cytometry was used to detect apoptosis; enzyme-linked immunosorbent assay (ELISA) was used to detect TNF-α, IL-1β, and IL-6 levels; Western blot was used to detect autophagy-related microtubule-associated protein 1 light chain 3-Ⅰ(LC3-Ⅰ) and microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) protein expression; dual luciferase assay was used to detect the target relationship between H19 and miR-30a-5p in cells.

RESULTS

Compared with normal pancreatic cells, H19 expression was increased and miR-30a-5p expression was decreased in pancreatitis cells induced by caerulein (P < 0.05). Compared with the cerulean + si-NC group, H19 expression was reduced, the cell survival rate was increased, the levels of TNF-α, IL-1β, and IL-6 were reduced, and LC3-Ⅰ protein expression was reduced and LC3-Ⅱ protein expression was increased in the cerulein+si-H19 group (P < 0.05). Compared with the caerulein + miR-NC group, miR-30a-5p expression was increased, the cell survival rate was increased, the levels of TNF-α, IL-1β, and IL-6 were decreased, and LC3-Ⅰ protein expression was reduced and LC3-Ⅱ protein expression was increased in the caerulein + miR-30a-5p group (P < 0.05). Compared with the cerulean + si-H19 + anti-miR-NC group, the expression of miR-30a-5p was significantly reduced, the cell survival rate was reduced, the levels of TNF-α, IL-1β, and IL-6 were increased, and LC3-Ⅰ protein expression was increased and LC3-Ⅱ protein expression was decreased in the cerulean + si-H19 + anti-miR-30a-5p group (P < 0.05).

CONCLUSION

Down-regulation of H19 inhibits the apoptosis, secretion of inflammatory factors, and autophagy in the acute pancreatitis cell model induced by caerulein by targeting miR-30a-5p.

Recruitment and Retention Strategies for the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: From the Type 1 Diabetes in Acute Pancreatitis Consortium

ABSTRACT

Recruitment and retention of patients with acute pancreatitis (AP) in clinical studies can be challenging. While some obstacles are similar to other clinical conditions, some are unique to AP. Identifying potential barriers early and developing targeted solutions can help optimize recruitment and retention in AP studies. Such pre-emptive and detailed planning can help prospective, longitudinal studies focus on exocrine and endocrine complications of AP in accurately measuring outcomes. This article highlights the challenges in recruitment and retention strategies in AP studies and reviews available resources to create opportunities to address them. We describe the multifaceted approach used by the Recruitment and Retention Committee of the Type 1 Diabetes in Acute Pancreatitis Consortium, which builds upon earlier experiences to develop a recruitment and retention plan for the DREAM (Diabetes RElated to Acute pancreatitis and its Mechanisms) study.

Rationale and Design for the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: A Prospective Cohort Study From the Type 1 Diabetes in Acute Pancreatitis Consortium

ABSTRACT

Acute pancreatitis (AP) is a disease characterized by an acute inflammatory phase followed by a convalescent phase. Diabetes mellitus (DM) was historically felt to be a transient phenomenon related to acute inflammation; however, it is increasingly recognized as an important late and chronic complication. There are several challenges that have prevented precisely determining the incidence rate of DM after AP and understanding the underlying mechanisms. The DREAM (Diabetes RElated to Acute Pancreatitis and its Mechanisms) Study is a prospective cohort study designed to address these and other knowledge gaps to provide the evidence needed to screen for, prevent, and treat DM after AP. In the following article, we summarize literature regarding the epidemiology of DM after AP and provide the rationale and an overview of the DREAM study.

Nutrition in acute pancreatitis

PURPOSE OF REVIEW

This review aims to discuss recent developments in different topics regarding nutrition and acute pancreatitis (AP), including oral refeeding, nutritional therapy, and implications of gut microbiota.

RECENT FINDINGS

Obesity increases the risk for severe AP and mortality. Considering the worldwide obesity rates, this finding could have major implications in the global outcomes of patients admitted with AP. Recent research confirms that early oral feeding leads to shorter length of stay, fewer complications, and lower costs. In case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24-72 h, whereas enteral nutrition (EN) has been shown superior to parenteral nutrition. EN can be administered through gastric or jejunal feeding, depending on digestive tolerance and the presence of ileus. Nevertheless, modalities of EN in patients undergoing endoscopic drainage of pancreatitis-related collections are still undetermined. Weight-loss after discharge occurs frequently and could reflect post-AP pancreatic exocrine failure. Finally, novel research regarding gut microbiota could open new therapeutic opportunities to prevent bacterial translocation and pancreatic necrosis' infection.

SUMMARY

Despite available evidence many questions regarding nutritional management in patients with AP remain open. Modulation of gut microbiota could play an important role in further therapeutic management.