Acute pancreatitis induced by anticancer chemotherapy

Drug-Induced Acute Pancreatitis: An Evidence-Based Classification (Revised)

INTRODUCTION

Drug induced acute pancreatitis is a difficult diagnosis for clinicians. We previously published an "Evidence-Based Classification System" on Drug-Induced Acute Pancreatitis widely used by clinicians to assist in the identification of drugs. Unfortunately, this prior analysis based only on published case reports has been misunderstood. The prior review did not include studies with higher evidentiary value, such as randomized trials, case-control studies, and/or pharmacoepidemiologic studies. The use of the prior classification system has led to many patients being inappropriately labeled as having drug-induced acute pancreatitis. We now propose a "Revised" Evidence- Based Classification System for the purpose of determining which drugs cause acute pancreatitis based on the Grading of Recommendations, Development, and Evaluation criteria.

METHODS

A search of the English Language literature was performed to identify all case reports with medication and/or drug induced acute pancreatitis. We divided the drugs implicated as causing acute pancreatitis into four groups based on the quality of evidence as defined by GRADE quality parameters.

RESULTS

Although 141 drugs were identified in the literature as causing acute pancreatitis, only 106 drugs published in the literature as causing acute pancreatitis were high quality case reports. Only 3 drugs had evidence as causing acute pancreatitis from randomized controlled clinical trials, including 6-mercaptopurine and azathioprine.

DISCUSSION

The vast majority of drugs implicated as causing acute pancreatitis in the literature have low or very low quality of evidence supporting those claims.

Isoliquiritigenin ameliorates doxorubicin-induced acute pancreatitis by inhibiting ROS production via modulation of Nrf2/HO-1 oxidative stress pathway

BACKGROUND

Several case studies have reported that doxorubicin (DOX) could induce acute pancreatitis, but no animal experiments have confirmed such side effect of DOX, and there is no specific treatment. Isoliquiritigenin (ISL) has a variety of pharmacological functions, including anti-inflammatory and antioxidant activities; however, the role and mechanism of ISL on DOX-induced acute pancreatitis (DAP) remain unclear.

AIM

To confirm whether doxorubicin (DOX) results in pancreatic tissue injury, and to determine the role and mechanism of isoliquiritigenin (ISL) in protecting against DOX-induced pancreatitis.

METHODS

Male ICR mice (25-30 g) were randomly divided into a control group (intraperitoneal injection of normal saline), DOX-DAP model group (intraperitoneal injection of DOX 10 mg/kg every other day), and ISL treatment group (DOX + ISL group; intraperitoneal injection of DOX 10 mg/kg every other day and intragastric administration of ISL 100 mg/kg per day), with 8 mice in each group. Pancreatic histopathology and scoring were performed 5 d after modeling. The expression of alpha amylase in pancreatic tissue was detected by immunohistochemistry. Immunofluorescence assay was used to detect ROS production in pancreatic tissue. Protein expression of Nrf2 and HO-1 in pancreatic tissue was detected by Western blot.

RESULTS

Compared with the control group, the mice in the DOX-DAP model group showed characteristic pathological damage, such as pancreatic tissue edema and inflammatory cells infiltration, with significantly increased histopathological scores (P < 0.001) and decreased expression of alpha amylase in the pancreas (P < 0.01). Compared with the DOX-DAP model group, the DOX + ISL group had significantly decreased histopathological scores (P < 0.05) and increased expression of alpha amylase in the pancreas (P < 0.05). ROS fluorescence staining and Western blot analysis showed that compared with the control group, ROS generation in pancreatic tissue in the DOX-DAP model group was significantly increased (P < 0.001), and the expression levels of Nrf2 and HO-1 proteins were slightly increased (P < 0.001). Compared with the DOX-DAP group, the DOX + ISL group had significantly decreased ROS levels in pancreatic tissuesed (P < 0.001), and significantly increased expression of Nrf2 and HO-1 proteins (P < 0.001).

CONCLUSION

DOX can cause pancreatic pathological damage in mice, which is mainly characterized by pancreatic tissue edema and inflammatory cells infiltration. ISL administration has a protective effect on DOX-induced pancreatitis by enhancing the antioxidant stress level in pancreatic tissue, which is expected to provide a new method for the prevention and treatment of drug-induced pancreatitis.

Drug-induced pancreatitis: An update

Drug-induced pancreatitis is a disease that is receiving increasing attention. This article reviews the advances in the incidence, risk factors, pathogenesis, diagnosis, treatment and prevention of drug-induced pancreatitis by reviewing the literature on drug-induced pancreatitis, especially in the literature of the latest 10 years. The incidence of drug-induced pancreatitis is relatively low, however, there is an increasing trend with the widespread use of drugs, and the incidence seems to be related to regional distribution. There is currently lack of data on the epidemiology of drug-induced pancreatitis in China. In recent years, research on the pathogenesis of drug-induced pancreatitis has made some progress, but further research is needed. Drug-induced pancreatitis is a diagnosis of exclusion. With further understanding and research, a new diagnostic approach has been proposed. Pharmacogenomics is expected to help prevent and perform an individual treatment of drug-induced pancreatitis.