Pancreatic stone protein. What is it and what does it do?

Obstructing Pancreatic Ductal Calculus: A Case Report and Literature Review

Pancreatic calculi are typically a sequela of chronic pancreatitis. Here, we present a patient who was found to have an obstructing one-centimeter pancreatic calculus secondary to recurrent gallstone pancreatitis. Recent retrospective studies have focused on the optimal treatment of large pancreatic calculi that were defined as greater than five millimeters. But most studies fail to comment on much larger stone as in this case report. Further guidelines and investigation need to be done aiming toward the optimal treatment of relatively large pancreatic stones. 

Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Osteopontin expression in chronic pancreatitis

INTRODUCTION

Chronic pancreatitis (CP) is frequently associated with stone formation within the pancreatic duct system. The mechanism of pancreatic stone formation, however, is still unclear.

AIMS

Osteopontin expression is related to urinary stone formation and several diseases associated with calcification such as atherosclerosis, breast cancer, and meningioma. We therefore hypothesized and studied whether that osteopontin may contribute to the formation of calculi in CP.

METHODOLOGY

Twenty patients with CP who underwent elective surgery were included in the study. As controls, normal pancreas specimens were collected from five additional patients. We used reverse transcription polymerase chain reaction and reverse transcription in situ polymerase chain reaction to evaluate osteopontin mRNA expression and immunohistochemical staining to evaluate osteopontin-producing cells.

RESULTS

No expression of osteopontin was seen in normal pancreas cells. Osteopontin expression was detected in acinar or ductal cells in all 11 cases of chronic calcifying pancreatitis, whereas in 5 of 9 CP cases without pancreatic stones there was no expression of osteopontin in acinar or ductal cells. The data revealed a high incidence of osteopontin expression in chronic calcifying pancreatitis in comparison with its expression in CP without stones (p = 0.0081). Osteopontin mRNA expression was observed in chronic calcifying pancreatitis samples but not in normal pancreas tissues. Signals corresponding to osteopontin mRNA were observed in the cytoplasm of ductal cells and macrophages.

CONCLUSION

These results provide the first evidence that osteopontin may play an important role in stone formation in CP. Better understanding of the pancreatic stone formation process may lead to an effective therapeutic approach to the inhibition of pancreatic calcification associated with CP.

Idiopathic chronic calcifying pancreatitis with diabetes mellitus. Analysis of pancreatic stone protein gene

We present a case of a 27-year-old female suffering from chronic calcifying pancreatitis with diabetes mellitus. Radiographic examinations and exocrine pancreatic function tests revealed considerable dilatation of pancreatic ducts with large intraductal calculi and exocrine pancreatic insufficiency, respectively. Recent literature indicates that a decrease in the activity of pancreatic stone protein (PSP), which inhibits CaCO3 crystal formation in pancreatic juice, is closely related to the development of chronic calcifying pancreatitis. The patient had no apparent cause or family history of pancreatitis. We therefore investigated the possibility that alterations in the PSP gene might explain the chronic pancreatitis seen in this patient. Six exons of the PSP gene amplified by polymerase chain reaction were directly sequenced, but there was no apparent base mutation observed. Furthermore, Southern blot analysis revealed neither rearrangement nor deletion of the PSP gene in the genomic DNA of this case. However, this genetic approach will be useful for future study of the etiology of hereditary pancreatitis.