雨蛙素联合脂多糖致小鼠重症急性胰腺炎模型的建立及其机理的探讨

为建立一种快速、简便、无创伤性的小鼠重症急性胰腺炎模型。本实验运用雨蛙素联合脂多糖小鼠腹腔内给药;血淀粉酶和胰腺湿重测定;胰腺和胰外器官病理学检查;腺泡细胞透射电镜观察;血清NO浓度测定;胰腺组织SOD和MDA测定。结果发现,雨蛙素联合脂多糖组血淀粉酶、NO浓度和胰腺湿重均增高,SOD活力降低,MDA含量升高,胰腺间质水肿、实质出血坏死、炎症细胞浸润,腺泡细胞受损严重,胰外多器官受到不同程度的损害;雨蛙素组胰腺无明显出血坏死,胰外器官正常;脂多糖组胰腺基本正常,胰外器官轻微炎症浸润。由本实验结果显示,雨蛙素联合脂多糖致小鼠重症急性胰腺炎模型具有人类重症急性胰腺炎的病理特征,为非创伤性,成模快速稳定,重复性好;脂多糖促使雨蛙素诱导的急性水肿型胰腺炎重症化的机理与自由基释放-清除机制和氧化-抗氧化机制紊乱有关。     

雨蛙素联合脂多糖致小鼠重症急性胰腺炎模型的建立及其机理的探讨

为建立一种快速、简便、无创伤性的小鼠重症急性胰腺炎模型。本实验运用雨蛙素联合脂多糖小鼠腹腔内给药;血淀粉酶和胰腺湿重测定;胰腺和胰外器官病理学检查;腺泡细胞透射电镜观察;血清NO浓度测定;胰腺组织SOD和MDA测定。结果发现,丙蛙素联合脂多糖组血淀粉酶、NO浓度和胰腺湿重均增高,SOD活力降低,MDA含量升高,胰腺间质水肿、实质出血坏死、炎症细胞浸润,腺泡细胞受损严重,胰外多器官受到不同程度的损害;雨蛙素组胰腺无明显出血坏死,胰外器官正常;脂多糖组胰腺基本正常,胰外器官轻微炎症浸润。由本实验结果显示,丙蛙素联合脂多糖致小鼠重症急性胰腺炎模型具有人类重症急性胰腺炎的病理特征,为非创伤性,成模快速稳定,重复性好;脂多糖促使雨蛙素诱导的急性水肿型胰腺炎重症化的机理与自由基释放—清除机制和氧化—抗氧化机制紊乱有关。     

急性胰腺炎伴脾脏密度减低的研究现状

急性胰腺炎是临床上较常见的急腹症,以急性上腹痛和血尿淀粉酶或脂肪酶升高为其主要的临床特点,急性胰腺炎除了对胰腺自身组织的产生损伤外,对胰腺外器官也会产生不同的损伤,并引起一系列的并发症。在急性胰腺炎的脾脏并发症中,脾梗死在CT图像中表现为脾脏密度不均匀性减低,除此之外脾脏实质的密度在CT图像中是相对比较固定的,但是在有些急性胰腺炎患者的CT图像中会出现脾脏密度一过性弥漫性减低的影像表现,治疗后复查CT显示脾脏密度恢复正常,该现象的形成原因尚不清楚,国内外有关该现象的文献报道及研究十分的有限,本文通过分析急性胰腺炎的病因及发病机制,回顾相关的文献病例,探讨急性胰腺炎伴脾脏密度一过性弥漫性减低产生的可能性原因。     

胰腺的病理生理学

本文主要论述胰腺的外分泌并着重于胰腺的炎症。在阐明胰腺炎发病学方面以及改善胰腺诊断方面的进步,使这一疾病症状表现的机制得以相当明了,并使治疗变得更加合理而有效。胰腺的生理学我们对胰腺生理学的知识是在研究了下列问题后获得的:胰腺外分泌及其调节机制;胆管和胰腺导管系统的解剖学和生理学;胰腺的蛋白质代谢以及胰腺导管压力改变对胰腺刺激所引起的反应。胰腺的外分泌胰液是一种主要由重碳酸     

急性胰腺炎营养支持的现状及意义

急性胰腺炎是常见外科急腹癌,其治疗方法包括胃肠减压,禁食,抗炎,抑酸,补液营养支持治疗.营养支持治疗使胰腺充分休息,在急性胰腺炎治疗中具有重要作用,营养支持治疗分为肠内营养和肠外营养.经过多年临床实践与研究,肠内营养和肠外营养的应用已相当广泛,其效果各有利弊.本文将对急性胰腺炎的肠内营养和肠外营养加以论述.     

急性胰腺炎的研究进展

急性胰腺炎是临床常见的急腹症之一,其病因及发病机制复杂,死亡率居高不下。目前,急性胰腺炎被定义为一种以急性炎症和胰腺实质坏死为特征的炎症性疾病,按照其严重程度分为轻度急性胰腺炎、中度重症急性胰腺炎、重症急性胰腺炎。急性胰腺炎的发生机制尚未完全阐明,目前主要存在几种学说,包括胰酶的自身消化、腺泡细胞凋亡、过度炎症反应、微循环改变、钙超载及肠道细菌易位学说等。本文主要对急性胰腺炎的定义、病因、分型、发生机制和治疗策略的研究进展进行了综述。     

miR-124a在胰腺发育及疾病中的作用

microRNA(miRNA)是一类长度为18~25个核苷酸非编码小分子RNA,广泛存在于真核生物中并高度保守,主要参与基因转录后调控。miR-124a在中枢神经系统和胰腺中含量最为丰富,在其他器官中的表达量约低100倍。近年研究显示,miR-124a参与胰腺发育、生理及病理多种过程的调节,包括:(1)通过阻断TGFβ途径诱导人胎盘间充质干细胞向胰腺祖细胞方向分化(2)靶向调控Foxa2、iGluR等与胰岛激素分泌相关的重要转录因子,介导胰岛激素的释放(3)通过与下游靶基因Rac1的相互作用在胰腺癌细胞生长,侵袭和转移中起关键作用(4)通过调控CHSY1及其下游靶点CASP1的表达水平参与慢性胰腺炎CP的发生等。研究miR-124a对于深入了解胰腺发生及疾病机理及其治疗具有重要意义。     

胃激素ghrelin和nesfatin-1与骨骼肌糖代谢

胃肠系统既是物质消化吸收和能量代谢调节的重要器官,其分泌的胃肠激素又可以整合中枢和外周对摄食及体重的调控,并且通过中枢间接地或者直接作用于外周胰岛素敏感器官,从而调节糖代谢。骨骼肌作为葡萄糖摄取的主要位点和胰岛素的主要靶器官之一,其糖代谢对2型糖尿病有着至关重要的作用。胃激素,尤其是ghrelin作为已知的唯一一种血液中促进摄食的激素,对糖代谢的影响已经成为目前的研究热点。探索胃激素与骨骼肌糖代谢之间的关系将会为胰岛素抵抗和2型糖尿病的治疗带来新的希望。     

胰腺微环境外泌体miRNA参与胰腺炎症和纤维化的发病机制研究进展

慢性胰腺炎(chronic pancreatitis, CP)发病率逐年上升，目前尚无明确根治性治疗方法且后期有进展为胰腺癌的风险。CP的典型病理学特征是胰腺慢性炎症和纤维化，CP进展与胰腺微环境中三种主要细胞(腺泡细胞、巨噬细胞以及胰腺星状细胞)间的相互作用密切相关，然而它们具体是如何进行细胞间联系的目前尚不清楚。新近研究表明外泌体作为细胞间重要的通讯介质，其携带的miRNA可通过调控主要细胞内基因表达和信号通路等影响CP的发生发展。本文围绕胰腺微环境中外泌体来源miRNA与三种主要细胞相互作用的机制，对其最新研究进展进行归纳和总结分析，以期为CP发病机制的深入认识提供参考。     

自噬在胰腺炎中的研究及进展

自噬是广泛存在于真核细胞内的一种溶酶体依赖性降解途径,作为细胞生存的一种机制,在很多生理过程如清除损伤、衰老细胞器以及冗余蛋白上发挥重要作用。自噬在人类胰腺炎的研究最早由Helin等人早在1980年提出,随着不断深入研究,发现自噬在胰腺炎发生发展过程中起主导作用。急性胰腺炎是一种发病率和死亡率极高的疾病,目前表明这种疾病始于胰腺腺泡细胞,主要诊断指标为高淀粉酶血症,胰腺腺泡细胞内消化酶的激活、液泡的大量堆积和炎症因子的聚集,最终胰腺炎症细胞侵润及引起的全身炎症反应导致腺泡细胞的凋亡和坏死,在其发病机制和治疗方面仍需进一步研究探讨。本文综述近年最新研究成果,深入探讨自噬在胰腺炎中的研究及进展。     

Autoimmune pancreatitis: current concepts

Autoimmune pancreatitis(AIP) is a distinct type of chronic pancreatitis with unique clinical,pathological,serological,and imaging features.AIP usually presents with obstructive jaundice.Imaging studies often reveal enlargement of the pancreas with a pancreatic mass and strictures of the main pancreatic duct.Two subtypes of AIP have recently been identified.Type I AIP is more prevalent in elderly Asian males and is characterized by lymphoplasmacytic sclerosing pancreatitis,obliterative phlebitis,and infiltration of large numbers of IgG4-positive plasma cells.Type II AIP is more prevalent in Caucasians and is characterized by granulocyte epithelial lesions.Most patients with type I AIP have a significantly elevated serum IgG4 concentration,which is an important feature for diagnosis and for differentiating between AIP and other conditions such as pancreatic cancer.Extrapancreatic complications are common,such as sclerosing cholangitis,sclerosing sialadenitis,retroperitoneal fibrosis in type I AIP,and ulcerative colitis in type II AIP.A rapid response to glucocorticoids treatment is suggestive of AIP,but the relapse rate is high,warranting the use of immunosuppressant treatment.B-cell depletion with rituximab may be a promising therapy.The prognosis of AIP is generally benign if treated promptly,and spontaneous remission occurs in a proportion of patients.     

Lymphoplasmacytic sclerosing pancreato-cholangitis: a case report and review of the literature

Autoimmune pancreatitis is a rare but important cause of pancreatitis that is becoming increasingly recognized in the West. Lymphoplasmacytic sclerosing pancreatitis (LPSP) is a benign form of chronic pancreatitis characterized clinically by infrequent attacks of abdominal pain, jaundice, and weight loss, and pathologically by focal or diffuse chronic or lymphoplasmacytic inflammatory infiltrates centered around pancreatic ducts and ductules, accompanied by obliterative phlebitis, acinar atrophy, and interstitial fibrosis. It has been described alone or as a part of the spectrum of autoimmune gallbladder and biliary tract disease, with clinical, radiological, and pathological overlap reported with primary sclerosing cholangitis. It has been described as "primary sclerosing pancreatitis," "sclerosing cholangitis," "non-alcoholic duct destructive chronic pancreatitis," and "autoimmune pancreatitis." We report a case of LPSP that mimicked pancreatic adenocarcinoma and was subsequently treated with a pylorus-preserving Whipple procedure. This may point towards a primary biliary autoimmune process involving the pancreatic duct, causing a benign form of chronic pancreatitis that may be difficult to characterize pre-operatively to avoid surgery. This case typifies the growing awareness of this relatively recently characterized clinical entity, its similar presentation to pancreatic carcinoma, and the importance for LPSP to be included in the differential diagnosis of pancreaticobiliary disease. Finally, we review the literature.     

Spontaneous development of a pancreatic exocrine disease in CD28-deficient NOD mice

Autoimmune pancreatitis (AIP) is a heterogeneous autoimmune disease in humans characterized by a progressive lymphocytic and plasmacytic infiltrate in the exocrine pancreas. In this study, we report that regulatory T cell-deficient NOD.CD28KO mice spontaneously develop AIP that closely resembles the human disease. NOD mouse AIP was associated with severe periductal and parenchymal inflammation of the exocrine pancreas by CD4(+) T cells, CD8(+) T cells, and B cells. Spleen CD4(+) T cells were found to be both necessary and sufficient for the development of AIP. Autoantibodies and autoreactive T cells from affected mice recognized a approximately 50-kDa protein identified as pancreatic amylase. Importantly, administration of tolerogenic amylase-coupled fixed spleen cells significantly ameliorated disease severity, suggesting that this protein functions as a key autoantigen. The establishment and characterization of this spontaneous pancreatic amylase-specific AIP in regulatory T cell-deficient NOD.CD28KO mice provides an excellent model for the study of disease pathogenesis and development of new therapies for human autoimmune pancreatitis.     

Early rise in inflammation and microcirculatory disorder determine the development of autoimmune pancreatitis in the MRL/Mp-mouse

Autoimmune pancreatitis (AIP) is a rare cause of chronic pancreatitis and mimics pancreatic cancer. Although there is strong interest in research, etiology and pathophysiology of AIP are still unknown. Therefore, we analyzed a total of 92 MRL/Mp-mice of either sex, which are prone to develop AIP, in four different age groups (8-12, 16-20, 24-28, and 32-40 wk). Using intravital fluorescence microscopy, histology, laboratory analysis, and Western blot, onset, severity, and pathophysiological mechanisms of AIP were evaluated. Female animals showed in vivo an age-dependent increase of intrapancreatic leukocyte accumulation, as well as a loss in functional capillary perfusion. In contrast, intrapancreatic inflammation in male mice was less pronounced and not age dependent. Furthermore, pancreatic tissue specimen of female animals exhibited major organ destruction with significantly higher values of mean pathological scores (1.5 +/- 0.3 vs. < or =0.2; P < 0.05), as well as significantly increased CD4-, CD8-, CD11b-, and CD138-positive cells compared with male animals of the same age. Interestingly, there was a significant positive correlation between intravascular leukocyte adherence and the histopathological score of the pancreas, indicating a determining role of the innate immune system for the late onset of AIP. The present study shows that the onset of AIP is characterized by an inflammatory response and microcirculatory failure, most probably constituting initiators and propagators of this autoimmune disease.     

A concept on the role of Helicobacter pylori infection in autoimmune pancreatitis

Autoimmune pancreatitis, an inflammatory process of the pancreas due to an autoimmune mechanism establishing etiology of chronic pancreatitis, is characterized by the presence of autoantibodies, hypergammaglobulinemia, pancreatic enlargement, pancreatic duct strictures, and pathologic features of fibrotic changes with intense, mainly lymphocytic infiltrations, which may contribute to tissue destruction probably by apoptosis. In almost 60% of the cases, this type of pancreatitis coexists with other autoimmune diseases such as Sjogren's syndrome, sclerosing extrahepatic cholangitis, primary biliary cirrhosis, autoimmune hepatitis, or other extrapancreatic disorders, and recently with gastric peptic ulceration. The diversity of extrapancreatic lesions with similar histopathologic findings suggests general involvement of the digestive system in this disease, although the presence of such involvement has not been fully elucidated. Similarly, Helicobacter pylori (H. pylori) infection, a well known cause of gastric ulcer, has been associated, via molecular mimicry of host structures by its constituents with the same autoimmune conditions, also characterized by fibrotic changes and/or lymphoplasmacytic inflammations, accompanied by aberrations of T cell apoptosis that contribute to hepatobiliary- or extrahepatic-tissue destruction. Considering that H. pylori is involved in the pathogenesis and pathophysiology of these autoimmune disorders, we propose that this organism might trigger autoimmune pancreatitis through induction of autoimmunity and apoptosis.     

Serum Protein Signatures Differentiating Autoimmune Pancreatitis versus Pancreatic Cancer

Autoimmune pancreatitis (AIP) is defined by characteristic lymphoplasmacytic infiltrate, ductal strictures and a pancreatic enlargement or mass that can mimic pancreatic cancer (PaCa). The distinction between this benign disease and pancreatic cancer can be challenging. However, an accurate diagnosis may pre-empt the misdiagnosis of cancer, allowing the appropriate medical treatment of AIP and, consequently, decreasing the number of unnecessary pancreatic resections.Mass spectrometry (MS) and two-dimensional differential gel electrophoresis (2D-DIGE) have been applied to analyse serum protein alterations associated with AIP and PaCa, and to identify protein signatures indicative of the diseases. Patients'' sera were immunodepleted from the 20 most prominent serum proteins prior to further 2D-DIGE and image analysis. The identity of the most-discriminatory proteins detected, was performed by MS and ELISAs were applied to confirm their expression. Serum profiling data analysis with 2D-DIGE revealed 39 protein peaks able to discriminate between AIP and PaCa. Proteins were purified and further analysed by MALDI-TOF-MS. Peptide mass fingerprinting led to identification of eleven proteins. Among them apolipoprotein A-I, apolipoprotein A-II, transthyretin, and tetranectin were identified and found as 3.0-, 3.5-, 2-, and 1.6-fold decreased in PaCa sera, respectively, whereas haptoglobin and apolipoprotein E were found to be 3.8- and 1.6-fold elevated in PaCa sera. With the exception of haptoglobin the ELISA results of the identified proteins confirmed the 2D-DIGE image analysis characteristics. Integration of the identified serum proteins as AIP markers may have considerable potential to provide additional information for the diagnosis of AIP to choose the appropriate treatment.     

The role of lymphotoxin signaling in the development of autoimmune pancreatitis and associated secondary extra-pancreatic pathologies

The pathogenic mechanisms of autoimmune pancreatitis (AIP), an increasingly recognized, immune-mediated form of chronic pancreatitis, have so far remained elusive. Treatment options for AIP are currently limited and disease relapse is frequent. Still, AIP can be characterized by specific clinical and histologic features. It has turned out that as described in other autoimmune diseases the generation of tertiary lymphoid organs is also a hallmark of patients with AIP. We have recently demonstrated that pancreata derived from human AIP patients display overexpression of lymphotoxin (LT) α and β and LTβR-target genes expressed by immune cells but also by irradiation resistant cells of the pancreas (e.g. acinar cells). Expression of LT α and β on acinar cells in murine pancreata Tg(Ela1-Lta,b) mice led to chronic pancreatitis and sufficed to reproduce key features of human AIP including the development of autoimmunity and AIP associated secondary extra pancreatic pathologies. Here, we review how aberrant and ectopic expression of LT α and β can induce inflammation and autoimmune diseases in general and how this knowledge might specifically lead to an alternative treatment for patients suffering from autoimmune pancreatitis.     

Investigation of Susceptibility Genes Triggering Lachrymal/Salivary Gland Lesion Complications in Japanese Patients with Type 1 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis characterized by high serum IgG4 concentration and a variety of complicating extra-pancreatic lesions. In particular, lachrymal/salivary gland lesions tend to manifest in a highly active AIP disease state, and several genes are speculated to be associated with the onset of this complication. We therefore searched for candidate susceptibility genes related to lachrymal/salivary gland lesions in a genome-wide association study (GWAS) with the GeneChip Human Mapping 500k Array Set (Affymetrix, CA) that was followed by fine mapping of additional single nucleotide polymorphisms (SNPs) in strongly significant genes with TaqMan assays. Venous blood samples were obtained from 50 type 1 AIP patients with lachrymal/salivary gland lesions (A group) and 53 type 1 AIP patients without (B group). The mean values of IgG and IG4 were both significantly different (P<0.05) between the groups. SNPs that showed a significant association with the A group at the genome-wide level (P<0.0001) were identified and subsequently used in fine SNP mapping of candidate genes. In total, five SNPs had a positive association with complicated AIP (most notably rs2284932 [P=0.0000021]) and five SNPs possessed a negative association (particularly rs9371942 [P=0.00000039]). Among them, KLF7, FRMD4B, LOC101928923, and MPPED2 were further examined for complication susceptibility using additional SNPs that were not included in the GWAS. Individual genotyping of KLF7 rs2284932 revealed that the frequency of the minor C allele was significantly increased (P=0.00062, Pc=0.0018, OR=2.98, 95%CI=1.58-5.65) in group A. The minor T allele of rs4473559 in FRMD4 demonstrated a significant association in the A group (P=0.00015, OR=3.38, 95%CI=1.77-7.65). In the LOC101928923 gene, the frequency of the minor C allele of rs4379306 was significantly decreased in group A in both TaqMan and GWAS analyses. Lastly, the minor C allele of MPPED2 rs514644 carried a significantly increased risk of complications. These four genes may be linked with the onset of lachrymal/salivary gland lesions in type 1 AIP patients and require further study.     

The mtDNA nt7778 G/T Polymorphism Augments Formation of Lymphocytic Foci but Does Not Aggravate Cerulein-Induced Acute Pancreatitis in Mice

A polymorphism in the ATP synthase 8 (ATP8) gene of the murine mitochondrial genome, G-to-T transversion at position 7778, has been suggested to increase susceptibility to multiple autoimmune diseases, including autoimmune pancreatitis (AIP). The polymorphism also induces mitochondrial reactive oxygen species generation, secretory dysfunction and β-cell mass adaptation. Here, we have used two conplastic mouse strains, C57BL/6N-mtAKR/J (B6-mtAKR; nt7778 G; control) and C57BL/6N-mtFVB/N (B6-mtFVB; nt7778 T), to address the question if the polymorphism also affects the course of cerulein-induced acute pancreatitis in mice. Therefore, two age groups of mice (3 and 12-month-old, respectively) were subjected to up to 7 injections of the secretagogue cerulein (50 µg/kg body weight) at hourly intervals. Disease severity was assessed at time points from 3 hours to 7 days based on pancreatic histopathology, serum levels of α-amylase and activities of myeloperoxidase (MPO) in lung tissue. A comparison of cerulein-induced pancreatic tissue damage and increases of α-amylase and MPO activities showed no differences between the age-matched groups of both strains. Interestingly, histological evaluation of pancreatic tissue of both untreated and cerulein-treated B6-mtAKR and B6-mtFVB mice also revealed the presence of infiltrates of immune cells surrounding ducts and vessels; a finding that is compatible with an early stage of AIP. After recovery from cerulein-induced pancreatitis (day 7 after the injections), 12-month-old B6-mtFVB mice but not B6-mtAKR mice displayed aggravated lymphocytic lesions. A comparison of 12-month-old mice with other age groups of both strains revealed that lymphocytic foci were largely absent in 3-month-old mice, while 24-month-old mice were more affected. Together, our data suggest that the mtDNA nt7778 G/T polymorphism does not aggravate cerulein-induced acute pancreatitis. Autoimmune-like lesions, however, may progress faster if additional tissue damage occurs.     

The Relation of Pancreatic Disease to Weber-Christian Disease

A case of acute Weber-Christian disease is reported, in which pancreatitis was accompanied by evidence of dissemination of pancreatic enzymes causing necrosis of fat and vessels. There is clinical and experimental evidence in the literature to suggest that widespread vascular dissemination of lipase occurs in cases of pancreatitis or pancreatic carcinoma. Review of the autopsy literature of cases of Weber-Christian disease shows that a majority had pancreatitis and systemic involvement of fat. A minority showed lesions confined to the panniculus, which tended to ulcerate; these lesions were in other ways not typical of Weber-Christian disease. In this group none had autopsy evidence of pancreatitis.The opinion is expressed that Weber-Christian disease results from disruption of pancreatic tissue and subsequent vascular dissemination of pancreatic enzymes.