Enteropancreatic circulation of digestive enzyme as a conservation mechanism

The activity of trypsin in the pancreatic juice and blood of poultry increases simultaneously in the postprandial period

Modern literature data indicate that the role of trypsin goes far beyond its digestive function. Once in the blood, trypsin is involved as part of the kallikrein-kinin system in the regulation of blood pressure, regulates pancreatic function by activating PAR receptors, and influences inflammation and immunity in the cell. The interaction of trypsin in the intestine and serum in the living healthy organism has been insufficiently studied. On the basis of our own studies and literature data, we concluded that after overnight fasting the increase of trypsin activity in pancreatic juice and blood serum in the postprandial period occurs in parallel, which determines not only digestion of food protein but also the level of metabolism. Consequently, determining the optimal amount of crude protein in the diet during the morning meal is a paramount task for physiologists.

Potato tuber proteins efficiently inhibit human faecal proteolytic activity: implications for treatment of peri-anal dermatitis

BACKGROUND

Frequent diarrhoea after intestinal resections and faecal incontinence in healthy infants may lead to perianal injury. A causative agent may be a high concentration of pancreatic proteases in faeces. The aim of the present study was to assess whether protease inhibitors are applicable for treating and preventing peri-anal dermatitis by inhibiting the initial cause of the inflammation, the faecal proteases.

DESIGN

Proteolytic activity was estimated in faeces of subjects frequently suffering from peri-anal dermatitis: patients with intestinal resections and healthy infants. The development of perianal dermatitis was studied after the construction of a reservoir with ileoanal anastomosis. The inhibitory effect of crude and partly purified potato juice on proteolytic activity of faecal output from patients with intestinal resections and healthy infants was investigated in vitro and in vivo (skin tests).

RESULTS

Faecal protease activity in faeces from patients with intestinal resections and healthy infants was found to be significantly higher than in healthy adults. After the construction of an ileum reservoir, 46 of 48 patients developed a protease-related peri-anal dermatitis. The partly purified protein fraction from potatoes inhibited the larger part of faecal proteases in vitro and completely prevented skin irritation by pancreatic proteases dissolved in sterilized faecal fluid, in a 24-h skin test, on the back of healthy human volunteers.

CONCLUSIONS

Potato proteins contain protease inhibitors, which suppress almost the complete proteolytic activity in faeces. Topical application of potato protease inhibitors might be a novel approach in preventing protease-induced peri-anal dermatitis, and therapeutic studies are needed to confirm our results.

Cancer: a single disease with a multitude of manifestions?

The relationships of critical nutrients such as plant phenolics, vitamins, minerals and lipids are considered with respect to the incidence of a variety of cancers, and analyzed in terms of how these nutrient deficiencies alter immune function, DNA integrity and cell proliferation. With a significant correlation found between cancer and these nutrient deficiencies, the hypothesis is presented here that nutrition could provide a unifying perception of cancer and recast it as a single disease. This further suggests that a coordinated administration of specific, critical nutrients to cancer patients could lead to the reversal of the disease. It is also proposed that the concurrent presence of a variety of nutritional deficiencies in cancer patients requires a multilevel, systemic approach to this disease as opposed to the single active therapeutic agent approach that is the cornerstone of contemporary research and pharmacology.

Conservation of digestive enzymes

The traditional understanding is that an entirely new complement of digestive enzymes is secreted by the pancreas into the small intestines with each meal. This is thought to be necessary because, like food itself, these enzymes are degraded during digestion. In this review we discuss experiments that bring this point of view into question. They suggest that digestive enzymes can be absorbed into blood, reaccumulated by the pancreas, and reutilized, instead of being reduced to their constituent amino acids in the intestines. This is called an enteropancreatic circulation of digestive enzymes.

Alpha 2-macroglobulin-mediated degradation of amyloid beta 1--42: a mechanism to enhance amyloid beta catabolism

Peptides derived from proteolytic degradation of the amyloid precursor protein, e.g., amyloid beta (A beta), are considered to be central to the pathology of Alzheimer's disease (AD). Soluble A beta is present in measurable concentrations in cerebrospinal fluid and blood. There are indications that soluble A beta present in circulation can cross the blood-brain barrier via transcytosis mediated by brain capillary endothelial cells. It implies that A beta originating from circulation may contribute to vascular and parenchymal A beta deposition in AD. Enhancing of A beta catabolism mediated by proteolytic degradation or receptor-mediated endocytosis could be a key mechanism to maintain low concentrations of soluble A beta. To launch A beta clearance we have exploited the A beta-degrading activity of diverse alpha 2-macroglobulin (alpha 2-M)-proteinase complexes. Complexes with trypsin, alpha-chymotrypsin, and bromelain strongly degrade (125)I-A beta 1--42 whereas complexes with endogenous proteinases, e.g., plasmin and prostate-specific antigen, were not effective. A beta degradation by the complexes was not inhibited by alpha 1-antichymotrypsin and soybean trypsin inhibitor which normally would inactivate the free serine proteinases. A prerequisite for A beta degradation is its binding to specific binding sites in alpha 2-M that may direct A beta to the active site of the caged proteinase. Ex vivo, enhanced degradation of (125)I-A beta 1--42 in blood could be achieved upon oral administration of high doses of proteinases to volunteers. These results suggest that up-regulation of A beta catabolism could probably reduce the risk of developing AD by preventing A beta accumulation in brain and vasculature.

Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support

Historically, large doses of proteolytic enzymes, along with diet, nutritional supplements, and "detoxification" procedures, have been used in alternative therapies to treat all forms of cancer, without formal clinical studies to support their use. A 2-year, unblinded, 1-treatment arm, 10-patient, pilot prospective case study was used to assess survival in patients suffering inoperable stage II-IV pancreatic adenocarcinoma treated with large doses of orally ingested pancreatic enzymes, nutritional supplements, "detoxification" procedures, and an organic diet. From January 1993 to April 1996 in the authors' private practice, 10 patients with inoperable, biopsy-proven pancreatic adenocarcinoma were entered into the trial. After one patient dropped out, an 11th patient was added to the study (however, all 11 are considered in the data tabulation). Patients followed the treatment at home, under the supervision of the authors. As of 12 January 1999, of 11 patients entered into the study, 9 (81%) survived one year, 5 (45%) survived two years, and at this time, 4 have survived three years. Two patients are alive and doing well: one at three years and the other at four years. These results are far above the 25% survival at one year and 10% survival at two years for all stages of pancreatic adenocarcinoma reported in the National Cancer Data Base from 1995. This pilot study suggests that an aggressive nutritional therapy with large doses of pancreatic enzymes led to significantly increased survival over what would normally be expected for patients with inoperable pancreatic adenocarcinoma.

Prevention of murine EAE by oral hydrolytic enzyme treatment

Clinical trials that test the efficacy of Phlogenzym (consisting of the hydrolytic enzymes bromelain and trypsin and the anti-oxidant rutosid) as a treatment for T cell-mediated autoimmune diseases including multiple sclerosis (MS), type 1 diabetes and rheumatoid arthritis are presently ongoing. We tested the effects of Phlogenzym treatment in the murine model for MS, experimental allergic encephalomyelitis (EAE), a disease induced in SJL mice by immunization with proteolipid protein (PLP) peptide 139-151. Oral administration of Phlogenzym resulted in complete protection from EAE. In Phlogenzym-treated mice, the dose response curve of the PLP:139-151-specific T cell response was shifted to the right, that is, the primed T cells required higher peptide concentrations to become activated. Additionally, the T cell response to this peptide was shifted towards the T helper 2 cytokine profile. Both effects are consistent with an increased T cell activation threshold. In support of this interpretation, we found that the accessory molecules CD4, CD44, and B7-1 (all of which are involved in T cell co-stimulation) were cleaved by Phlogenzym, while CD3 and MHC class II molecules (which are involved in the recognition of antigens by T cells) and LFA-1 were unaffected. These data show the efficacy of oral Phlogenzym treatment in an animal model of T cell-mediated autoimmune disease and suggest that the protective effect might be the result of an increase in the activation threshold of the autoreactive T lymphocytes brought about by the cleavage of accessory molecules involved in the interaction of T cells and antigen presenting cells.

Transport of proteolytic enzymes across Caco-2 cell monolayers

PURPOSE

To investigate the mechanisms by which proteolytic enzymes, such as trypsin, chymotrypsin, papain, and bromelain, are able to cross the intestinal mucosal barrier after oral administration to man.

METHODS

Filter-grown Caco-2 cell monolayers were incubated with proteolytic enzymes and then the transepithelial electrical resistance (TEER) and the transport of the paracellular marker fluorescein were monitored. The effects of the enzymes on the cells were investigated by light microscopy and by biochemical assays. Transport of intact proteases across the cells was verified by monitoring the proteolytic activity and MALDI-TOF mass spectroscopic identification of undegraded trypsin.

RESULTS

Depending on time, concentration, and side of exposure to Caco-2 cell monolayers, all proteases decreased the TEER and increased the transport of fluorescein. Some morphological and metabolic changes were observed. The effects were reversible, but until 24 hours after removal of the proteases. Under the conditions of this in-vitro model, approximately 10% of the apically applied dose reached the basolateral compartment as biologically active, non-degraded molecules.

CONCLUSIONS

Proteolytic enzymes were found to exert considerable effects on the barrier function of Caco-2 monolayers, facilitating the transport of normally non-absorbable compounds. This suggests the also reported, but so far unexplained, systemic absorption of proteolytic enzymes after oral administration in vivo may occur by self-enhanced paracellular transport.

Pentagastrin increases pepsin secretion without increasing its fractional synthetic rate

We studied the effects of increasing doses of pentagastrin on gastric secretion of pepsin and on incorporation of L-[1-13C]leucine into gastric aspirate protein as an index of pepsin synthesis. Pentagastrin (0.25-4.0 micrograms.kg-1.h-1) significantly increased pepsin output from basal 76 mg/h to < or = 181 mg/h but did not significantly alter incorporation of L-[1-13C]leucine from the basal fractional synthetic rate of 3.63 +/- 0.05%/h. In four subjects in whom infusion of tracer leucine was continued for > 1 day, aspiration of pepsin between 24 and 27 h demonstrated that plateau 13C labeling of leucine in pepsin had been attained, but at a value that was only 48% of the 13C labeling of plasma alpha-ketoisocaproic acid (alpha-KIC) [0.730 +/- 0.02 (SE) vs. 1.520 +/- 0.14 atoms %excess]. This suggests that actual rates of pepsin synthesis were approximately double those calculated on the basis of alpha-KIC labeling. The results are consistent with an interpretation that increasing doses of pentagastrin cause increased secretion of pepsinogen by recruitment of gastric chief cells, each synthesizing pepsinogen at an unaltered rate. Plateau 13C enrichment of alpha-KIC may not be a valid surrogate for plateau 13C leucine enrichment when fractional synthetic rates of some secreted proteins are calculated.

Biologically active peptides in the gastrointestinal lumen

The release of a variety of biologically active peptides into the gastrointestinal lumen via gastric, duodenal and intestinal secretions, as well as in the saliva, pancreatic juice and bile, has been explored. The key features of luminal secretion of peptides such as secretion at high concentrations, neurohormonal regulation, luminal orientation of stimulated secretion, stability of peptides in the gastrointestinal lumen, altered secretion under pathophysiological conditions, and biological activity of luminally administered peptides are discussed. This review develops a detailed picture of the current understanding of luminal secretion of peptides and their possible biological functions under normal and pathophysiological conditions.

A difference in stimulatory effects on pancreatic exocrine secretion between ursodeoxycholate and trypsin inhibitor in the rat

We previously reported that intraduodenally infused ursodeoxycholate produced hypersecretion of pancreas in bicarbonate and fluid secretion in the rabbit (Digestive Diseases and Sciences, 28:942, 1983). Since trypsin inhibitor stimulates pancreatic secretion in the rat whose pancreatic exocrine secretion is regulated by a luminal feedback mechanism, in the present study we examined the stimulatory effect of ursodeoxycholate in comparison to Trasylol in unanesthetized rats with both the presence and the absence of returning bile-pancreatic juice. Under the condition in which bile-pancreatic juice were continuously returned to the intestine, the intraduodenally infused ursodeoxycholate produced significant increases in juice flow and bicarbonate and protein outputs, while Trasylol significantly increased protein output only. After an 8- to 10-hr period of bile-pancreatic juice diversion, Trasylol no longer affected pancreatic secretion, whereas ursodeoxycholate still stimulated the bicarbonate output significantly. Trypsin activities in the proximal half of the small intestine were not decreased by the infusion of UDCA. The mechanism of stimulatory effect of ursodeoxycholate on pancreatic secretion is independent of luminal feedback regulation and appears to differ from that of trypsin inhibitor.

Redistribution of amylase activity accompanying its secretion by the pancreas

Amylase activity in several tissue and body fluid compartments in the rat changed markedly when the secretion of digestive enzyme was augmented over a 3-hr period with a cholinergic agonist. As a result of stimulation, the pancreas was depleted of about one-third of its amylase activity and accounted for only 75% of the amount recovered from the animal, compared to 92% in the fasted state. Despite the continuous augmented secretion of the enzyme into the small intestine, no increase in amylase activity was detected there at the end of 3 hr. On the other hand, amylase activity in plasma and extracellular fluid increased by about an order of magnitude and accounted for 13% of the total pool, compared to approximately 1% in the fasted state. Amylase activity in several solid tissues also increased, including a 50- to 100-fold increase in parotid gland and an almost 10-fold increase in submandibular gland and kidney. The potential sources of the increased amylase activity in blood, the endocrine secretion of the enzyme by the pancreas, and its absorption from the intestine are considered. Changes in the amylase content of various tissues appear to reflect increased uptake due to increased plasma levels.

Transport of proteases across neonatal intestine and development of liver disease in infants with alpha-1 antitrypsin deficiency

The transport of macromolecules from the intestinal lumen into the systemic circulation is considerably greater in neonatal than in adult animals. Transport of both immunoglobin and non-immunoglobulin proteins is enhanced. It is postulated that luminal enzymes are also transported into the systemic circulation of the neonate and reach the liver. In the absence of protease inhibitors, such as occurs in alpha 1-antitrypsin (alpha 1-AT) deficiency, these intestinal enzymes may cause inflammation and, eventually, fibrosis of the liver. If this hypothesis is valid, treatment with trypsin inhibitors and elemental diets until the excessive macromolecular transport across the intestine ceases may help to prevent the liver disease associated with (alpha 1-AT) deficiency.

Origin of circulating serum immunoreactive trypsin in man

Serum trypsin concentrations within the portal venous system have been measured in man during transhepatic portal venography in an attempt to determine its source. In eight experiments, mean serum trypsin concentration at the splenic hilum was 180 +/- 25 ng/ml (mean +/- SEM). Trypsin concentration in the rest of the splenic vein was not significantly different. The mean concentrations in the portal vein (210 +/- 32 ng/ml) and within the superior mesenteric vein (233 +/-- 29 ng/ml) were, however, significantly higher than at the hilum (P less than 0.05). Following cholecystokinin-pancreozymin (CCK-PZ) and secretin stimulation, marked increases in serum trypsin concentration were seen within the portal vein (two patients) and deep within the superior mesenteric (two out of three patients). We conclude that circulating serum trypsin is derived, at least in part, from intestinal reabsorption.

Protein digestion and proteolytic activity in the digestive tract of an omnivorous cyprinid

1. In adult and juvenile roach (Rutilus rutilus) feeding on meal worms or grass and acclimated to temperatures between 6 and 20 degrees C the following variables were determined: pH, protein and proteolytic activity of gut fluid and faeces, food consumption, duration of gut passage and efficiency of protein assimilation. 2. Proteolytic enzymes of fish are very stable against autolysis but they disappear in posterior portions of the intestine, suggesting the existence of a pinocytotic process. 3. In herbivorous roach as well as in adult carnivorous roach feeding at 20 degrees C this results in very low proteolytic activities in the faeces, whereas in juvenile fish and in adults feeding on meal worms at lower temperatures, the process of reabsorption seems to be less efficient. 4. Daily production of proteases as well as "daily proteolytic duration" are higher in herbivorous than in carnivorous roach. 5. For the same amount of protein consumed, fish feeding on grass require 10 times higher proteolytic activities than fish feeding on meal worms.

Antihypertensive effect of orally administered glandular kallikrein in essential hypertension. Results of double blind study

The antihypertensive effect of oral administration of pig pancreatic kallikrein was investigated in a double blind study of 20 patients with essential hypertension. Kallikrein treatment lowered the blood pressure (BP) significantly from 159.5/104.5 to 146.3/92.8 mm Hg in the supine and from 153/106.1 to 136.1/95.6 mm Hg in the standing position. Blood pressure remained unchanged in the placebo group. Urinary kallikrein, sodium excretion, and GFR increased with treatment, but these changes did not reach statistical significance, In the kallikrein-treated patients but not in the placebo group, urinary kallikrein was correlated both to GFR (r = 0.7, p less than 0.001) and sodium excretion (r = 0.5, p less than 0.01). The antihypertensive mechanism of kallikrein treatment remains unknown. It could be speculated that kallikrein may induce changes in local blood flow, mediated by kinin and prostaglandin release.

Exogenous secretory proteins do not inhibit carbamylcholine-stimulated release of pulse-labelled secretory proteins from rat pancreatic tissue slices

Experiments were conducted to test the concept that the results of secretion studies employing pancreatic tissue slices are significantly biased by the distribution of exocrine secretory proteins between the tissue and the incubation medium. The findings demonstrate (1) that the kinetics of release of pulse-labelled secretory proteins from cholinergically-stimulated tissue slices are independent of the concentration of exogenous exocrine secretory proteins and (2) that if there are bidirectional fluxes of secretory proteins across the cell membrane of pancreatic exocrine cells, these fluxes do not account for the fractional release of pulse-labelled secretory proteins.

Pancreatic hypofunction in extrahepatic portal venous obstruction

Pancreatic function was studied in 29 patients with extrahepatic portal venous obstruction, and 30 age-matched controls. The aetiology of the portal venous obstruction was known in 20 out of 29 patients. No patient had a history of pancreatitis. Serum trypsin, both fasting and for 120 minutes after a Lundh meal, was significantly lower in the patients than in controls (P less than 0.005). 5/28 (18%) patients had reduced fasting serum trypsin levels and in 5/14 trypsin was abnormal after a Lundh meal. Mean fasting serum glucose (3.8 +/- ).49 mmol/l was significantly higher than in control subjects (mean 3.4 +/- 0.42 mmol/l) (P less than 0.05). After 100 g glucose orally, mean serum glucose at 180 minutes (5.26 +/- 1.58 mmol/l) was higher than the control value (3.96 +/- 1.45 mmol/l) (P less than 0.05), and 30 and 60 minutes serum C-peptide values were significantly lower (P less than 0.005). Pancreatic hypofunction found in these patients probably results from an abnormal portal circulation in association with mild pancreatic damage secondary to chronic venous congestion.

Decreased urinary kallikrein activity and elevated blood pressure normalized by orally applied kallikrein in essential hypertension

Urinary kallikrein excretion was significantly lower in patients with essential hypertension (0.48 +/- 0.05 EU/24 h) than in normotensive controls (1.26 +/- 0.14 EU/24 h). Oral administration of hog pancreatic kallikrein normalized decreased urinary kallikrein and reduced arterial pressure. The treatment-induced rise in urinary kallikrein was due to an enhanced release of endogenous enzyme, as was determined by radioimmunoassay. It is proposed that in the hypertensive patients the low urinary kallikrein excretion reflects a defect in renal kallikrein formation which is normalized by oral kallikrein. The hypotensive action of oral kallikrein as well as its stimulating effects on renal kallikrein release suggest that the kallikrein-kinin system is involved in blood pressure regulation and that impaired renal kallikrein activity may be a factor in the maintenance of essential hypertension.

Transpancreatic transport of digestive enzyme

When porcine alpha-amylase or bovine chymotrypsinogen A was added to the medium bathing the rabbit pancreas in short-term organ culture, the secretion of these enzymes collected via the duct system increased greatly. To determine if it was indeed the amylase added to the bath that was recovered in secretion, endogenous enzyme stores were prelabeled during a 4 h incubation with [3H]-leucine and the specific radioactivity of amylase in secretion followed. The addition of unlabeled exogenous amylase to the bathing medium reduced the specific radioactivity of secreted amylase by about 90% suggesting that the response was due to the transpancreatic transport of the added enzyme. This inhibition was maintained over time, and was a result, not only of the increased secretion of unlabeled enzyme, but also of a 72% steady-state inhibition in the secretion of endogenous (labeled) amylase. This latter observation indicates that the exogenous enzyme crosses the acinar cell and mixes with endogenous cellular stores. A cellular route is also suggested by the observation that the addition of amylase to the bath increased the amylase concentration in ductal fluid relative to that in the bath by about 20 times; it did not reduce it as would be expected if paracellular shunts were involved. In addition, a cellular pathway is suggested by the observation that a 2 h prior incubation in bovine chymotrypsinogen resulted in a greatly augmented chymotrypsinogen response to a maximal cholinergic stimulus. In all, the data support the prediction of the equilibrium theory of digestive enzyme secretion that enzyme secretion should be responsive to mass action, and the prediction of the enteropancreatic circulation hypothesis that a capacity exists for a substantial transpancreatic flux of digestive enzyme.

Determination of human pancreatic cationic trypsinogen in serum by radioimmunoassay

A specific radioimmunoassay has been developed for human pancreatic cationic trypsin. The assay has been employed for the determination of immunoreactive forms of pancreatic cationic trypsin in blood. The trypsin employed as radioiodinated tracer in the assay was inactivated with tosyl-L-lysine chloromethyl ketone (TLCK) to prevent binding of the tracer to the serum inhibitors while maintaining its immunoreactivity. The average normal serum level determined was 26 ng/ml, with a range of 12--41 ng/ml. Eight of nine patients with acute pancreatic inflammation had at least a 15-fold elevation of total serum immunoreactive cationic trypsin. Cationic trypsinogen and cationic trypsin bound to alpha1-antitrypsin cross-react strongly in the radioimmunoassay. Thus it is possible to measure these potential molecular forms of cationic trypsin in serum. When normal human serum was fractionated on Sephadex G-200, all of the immunoreactive material eluted as a single peak of approximately 23,000 mol wt. No cationic trypsin could be detected in association with alpha1-antitrypsin or alpha2-macroglobulin. The 23,000-mol-wt peak was definitively shown to contain trypsinogen by affinity chromatography and by activation with human enteropeptidase. The identification of cationic trypsinogen in blood implies that the zymogen is secreted into the circulation by the pancreas rather than entering the bloodstream via absorption from the intestine.

Amylase transport across ileal epithelium in vitro

Amylase transport was measured across the rabbit ileum in vitro employing a modified Ussing chamber. Amylase was moved preferentially in the mucosal to serosal direction. Its rate of transfer was 2--3 orders of magnitude greater than that for inulin. Mucosal to serosal transport of exogenous amylase was completely inhibited in the absence of oxygen. There was also a constant release of endogenous amylase from intestinal tissue into both mucosal and serosal compartments in the absence of an exogenous source. An estimate of the rate of amylase absorption indicates that it may be of sufficient magnitude to account for the enteropancreatic circulation of amylase secreted by the pancreas during augmented secretion.

Immunocytochemical study of the interaction of soybean trypsin inhibitor with rat intestinal mucosa

To investigate further the cause of the pancreatic enlargment induced by orally ingested soybean trypsin inhibitor (STI), antibodies raised against STI and purified by affinity chromatography were used to localise dietary STI in the rat gut by fluorescent immunocytochemical methods. This technique permitted the clear intracellular demonstration of STI in the ileal mucosa of suckling rats. However, in adult rats no entry of STI into mucosal cells of the small intestine could be demonstrated, it being confined to the luminal surface of the mucosa. Although the passage of STI into and across the adult intestinal mucosa could not be excluded through the use of this technique, the results are consistent with an intraluminal mode of action of STI as suggested by Green and Lyman (1972)--namely, that the pancreatic enlargement caused in sensitive species results from the inhibition of trypsin (which acts as the physiological inhibitor of the mucosal secretion of pancreotrophic hormones), thus resulting in the uninhibited secretion of these hormones.

Absorption of pancreatic lipase from the duodenum into lymphatics

A significantly higher lipase activity was measured in the duodenal lymph samples of 15 dogs than in each of corresponding arterial blood plasma samples collected prior to, during and after maximal hormonal stimulation of pancreatic secretion. The result may be evaluated as a sign of pancreatic lipase absorption by the duodenum into lymphatics.

Production of pancreatitis in rabbits by intestinal re-instillation of stimulated pancreatic secretion

Pathological changes reminiscent of acute pancreatitis in man were observed in rabbits as a result of the intestinal instillation of pancreatic secretion produced by continuous cholinergic stimulation. Both the cause and nature of the pathological changes suggest a bloodborne disease produced by the absorption of digestive enzyme. It is proposed that acute pancreatitis can be the consequence of the absorption of active digestive enzyme in quantities and at rates sufficient to overwhelm natural defence mechanisms.