Comparative effects of secretin (SEC) and cholecystokinin-octapeptide (CCK-8) on pancreatic microcirculation

Pancreatic Blood Flow with Special Emphasis on Blood Perfusion of the Islets of Langerhans

The pancreatic islets are more richly vascularized than the exocrine pancreas, and possess a 5- to 10-fold higher basal and stimulated blood flow, which is separately regulated. This is reflected in the vascular anatomy of the pancreas where islets have separate arterioles. There is also an insulo-acinar portal system, where numerous venules connect each islet to the acinar capillaries. Both islets and acini possess strong metabolic regulation of their blood perfusion. Of particular importance, especially in the islets, is adenosine and ATP/ADP. Basal and stimulated blood flow is modified by local endothelial mediators, the nervous system as well as gastrointestinal hormones. Normally the responses to the nervous system, especially the parasympathetic and sympathetic nerves, are fairly similar in endocrine and exocrine parts. The islets seem to be more sensitive to the effects of endothelial mediators, especially nitric oxide, which is a permissive factor to maintain the high basal islet blood flow. The gastrointestinal hormones with pancreatic effects mainly influence the exocrine pancreatic blood flow, whereas islets are less affected. A notable exception is incretin hormones and adipokines, which preferentially affect islet vasculature. Islet hormones can influence both exocrine and endocrine blood vessels, and these complex effects are discussed. Secondary changes in pancreatic and islet blood flow occur during several conditions. To what extent changes in blood perfusion may affect the pathogenesis of pancreatic diseases is discussed. Both type 2 diabetes mellitus and acute pancreatitis are conditions where we think there is evidence that blood flow may contribute to disease manifestations. © 2019 American Physiological Society. Compr Physiol 9:799-837, 2019.

Disturbances of the microcirculation in acute pancreatitis

BACKGROUND

Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemic inflammation. Pancreatitis affects both the systemic and pancreatic vasculature. This review focuses on the underlying processes involved in the changes of microvascular anatomy following acute pancreatitis.

METHODS

A Medline/PubMed search (January 1966 to December 2005) with manual cross-referencing was conducted. All relevant articles investigating the pancreatic microcirculatory anatomy and the effect of pancreatitis on the microcirculation were included.

RESULTS

The pancreas is susceptible to ischaemic insult, which can exacerbate acute pancreatitis. There is also increasing evidence of pancreatic and systemic microvascular disturbances in the pathogenesis of pancreatitis, including vasoconstriction, shunting, inadequate perfusion, and increased blood viscosity and coagulation. These processes may be caused or exacerbated by ischaemia-reperfusion injury and the development of oxygen-derived free radicals.

CONCLUSION

Acute pancreatitis impairs the pancreatic and systemic microcirculation, which is a key pathological process in the development of severe necrotizing disease.

Effect of exogenous cholecystokinin on islet blood flow in anesthetized rats

Although a number of studies have investigated the effect of cholecystokinin (CCK) on pancreatic blood flow and exocrine function, few have addressed the effect of CCK on islet blood flow. Here, we studied the effect of exogenous CCK on islet blood flow in anesthetized rats. Islet blood flow was measured by the color microsphere method. Bolus intravenous administration of CCK (10 microg/kg) significantly increased pancreatic and islet blood flow in control Long-Evans Tokushima Otsuka (LETO) rats, but not in Otsuka Long-Evans Tokushima Fatty (OLETF) rats lacking CCK-A receptors. Since fractional islet blood flow expressed as a percentage of whole pancreatic blood flow was decreased after CCK administration in LETO rats, the vasodilating effect of CCK appeared to be stronger in exocrine than endocrine tissue. Although vagotomy failed to alter the CCK-induced increase in pancreatic and islet blood flow, pretreatment with nitric oxide synthase inhibitor N(G)-monomethyl-L-arginine completely prevented the increase in pancreatic and islet blood flow. Our results demonstrated that exogenous CCK is a potent vasodilator of exocrine as well as islet vasculature via CCK-A receptors, and that such action is mediated by a NO-dependent mechanism rather than by vagal mechanisms.

Caerulein-induced pancreatitis and islet blood flow in anesthetized rats

BACKGROUND

Microcirculatory mechanisms have been suggested to be involved in the development of acute pancreatitis. Islet blood flow has not previously been studied in this disease. The present study aimed to investigate the effects of caerulein-induced pancreatitis on pancreatic blood perfusion, especially islet blood flow.

MATERIALS AND METHODS

Continuous 4 h caerulein-infusion was used to induce mild, edemateous pancreatitis in anesthetized Sprague-Dawley rats. Some animals were then given an additional 2 h infusion of saline. Thus, at 4 or 6 h after initiating caerulein infusion the blood flow to the pancreas, pancreatic islets, and intestines was measured with a microsphere technique.

RESULTS

All infused animals demonstrated an edemateous pancreatitis, without hemorrhages. Both total pancreatic and islet blood flow was increased after the 4-h infusion. However, the increase was less pronounced in the islets. After an additional 2 h with only saline infused, the blood flow values in rats initially infused with caerulein were lower than at 4 h, but total pancreatic blood was still higher than in control rats. No effects on intestinal blood flow values were seen.

CONCLUSIONS

Pancreatic islet blood flow in rats with mild edematous pancreatitis is increased, but not to the same extent as that in the whole pancreas.

Comparison of Celsior and UW solution in experimental pancreas preservation

BACKGROUND

The University of Wisconsin solution (UW) is the gold standard for pancreas preservation. Celsior (CEL) was formulated specifically for heart preservation. Recently, experimental and clinical experience has been reported on the application of CEL to abdominal organs. In this animal study, pancreas preservation with CEL was compared with that in UW solution.

PATIENTS AND MATERIALS

Heterotopic, allogeneic pancreaticoduodenal transplantation was performed in female Göttingen Minipigs (n = 12 donors, n = 12 recipients). The grafts were flushed and stored for 6 h at 4 degrees C in UW or CEL. The recipients were randomized into two groups receiving either UW (n = 6)- or CEL (n = 6)-preserved grafts with a follow-up of 5 days. Blood flow (laser Doppler), partial oxygen tension, histological changes, endothelin-1 (plasma, immunohistochemistry), lipase, amylase, trypsinogen activation peptide, and C-reactive protein (CRP) were measured.

RESULTS

Partial oxygen tension was lower in the CEL group (P < 0.05). However, blood flow did not differ between UW- and CEL-preserved organs. The histomorphologic analysis of the pancreatic grafts revealed significantly less edema in the UW-preserved organs. Serum levels of amylase, lipase, CRP, and TAP taken from the central venous blood were comparable in the two groups, except for higher amylase values 36 h after reperfusion in the CEL group compared to the UW group (P < 0.05). Likewise, TAP taken from the portal venous effluent of the graft was found to be higher in the CEL group than in UW (P < 0.05). Endothelin-1 serum levels rose significantly during reperfusion without differences between the two groups. ET-1 immunohistochemistry revealed increased local ET-1 during reperfusion in all grafts. However, the ET-1 immunostaining in the CEL group was more pronounced than that in the UW group (P < 0.05).

CONCLUSIONS

Our results suggest that CEL solution is not as effective in preventing pancreatic ischemia/reperfusion damage as the standard UW solution in experimental pancreas transplantation. Increased ET-1 immunostaining and reduced p(ti)O(2) in the CEL group indicate increased microcirculatory damage in the CEL group.

Secretin and pancreatic islet blood flow in anesthetized rats: increased insulin secretion with no augmentation of blood perfusion

Secretin is a stimulator of both endocrine and exocrine secretions of the pancreas, and we aimed to evaluate its effects on splanchnic blood flow in rats with a microsphere technique. Anesthetized rats were infused with secretin (0.5 or 2.0 micrograms/kg body weight/hr) for 10 minutes. Some animals were normoglycemic, whereas other received a glucose injection 3 minutes before blood flow measurements. Secretin did not affect serum insulin concentrations in normoglycemic animals but consistently led to higher insulin concentrations in the hyperglycemic rats. Total pancreatic blood flow was increased by the highest secretin dose in normoglycemic animals, whereas no effects were seen in the hyperglycemic rats. Administration of glucose caused a pronounced increase in islet and fractional islet blood flow in saline-infused animals. Secretin affected neither islet nor fractional blood flow in normoglycemic or hyperglycemic rats. Glucose administration increased duodenal blood flow in animals infused with saline and both duodenal and colonic blood flow in rats given the lowest dose of secretin. No effects on either colonic or duodenal blood perfusion were seen in animals infused with the highest dose of secretin. Secretin mainly affects blood flow to the whole pancreas and not that of the islets. Furthermore, glucose-induced insulin release can be achieved without a simultaneous increase in islet blood flow; that is these two events may be dissociated from one another.

Cellular distribution of secretin receptor expression in rat pancreas

Secretin is an important regulator of pancreatic function, but the molecular basis of its actions is not well understood. We have, therefore, used in situ autoradiography, photoaffinity labeling, and RNase protection assays with healthy rat pancreas, dispersed acinar cells, and pancreas depleted of acinar cells to explore the cellular distribution and molecular identity of high-affinity secretin receptors in this complex organ. The autoradiographic examination of 125I-labeled [Tyr10]rat secretin-27 binding to normal pancreas demonstrated saturable and specific high-affinity binding sites on both acinar and duct cells, with a uniform lobular distribution, but with no binding above background over islets or vascular structures. Photoaffinity labeling demonstrated that the ductular binding site in acinar cell-depleted copper-deficient rat pancreas represented the same glycoprotein with a molecular weight of 50,000-62,000 that was present on acinar cells. RNase protection assays confirmed the molecular identity of the secretin receptors expressed on these distinct cells. The apparent absence or extreme low density of similar secretin receptors on islets and pancreatic vascular structures suggests that the pharmacological effects of secretin on those cells may either be indirect or mediated by another secretin family receptor that recognizes this hormone with lower affinity.

Effects of somatostatin (SMS) on pancreatic microcirculation

The effect of bolus infusion of increasing somatostatin (SMS) concentrations (1, 10, 100, 200 micrograms/100 g body wt) on pancreatic microcirculation and pancreatic tissue PO2 were investigated by using in vivo epifluorescence microscopy and a polarographic PO2 measurement technique. Additionally, the microperfusion of the pancreas, liver, spleen, stomach, and duodenum was measured by a laser Doppler device. Bolus infusion of SMS caused a significant, transient, and dose-dependent decrease in pancreatic capillary RBC velocities (to 50% of baseline) and acinar capillary overall perfusion (to 20% of baseline), which was not caused by a macrocirculatory depression. This pronounced decrease in microperfusion was not paralleled by a decline in tissue PO2. Laser Doppler measurements revealed that pancreatic and gastric microperfusion were reduced only at maximal SMS concentrations, considering that microperfusion of the liver, spleen, and duodenum was not altered. Therefore, we found further evidence that circulatory adjustment might occur during SMS inhibited secretory activity of the exocrine pancreas.