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Nikkola A, Mäkelä KA, Herzig KH, Mutt SJ, Prasannan A, Seppänen H, Lehtimäki T, Kähönen M, Raitakari O, Seppälä I, Pakkanen P, Nordback I, Sand J, Laukkarinen J. Pancreatic Secretory Trypsin Inhibitor (SPINK1) Gene Mutation in Patients with Acute Alcohol Pancreatitis (AAP) Compared to Healthy Controls and Heavy Alcohol Users without Pancreatitis. Int J Mol Sci 2022; 23:ijms232415726. [PMID: 36555366 PMCID: PMC9778821 DOI: 10.3390/ijms232415726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Only 3-5% of heavy alcohol users develop acute alcohol pancreatitis (AAP). This suggests that additional triggers are required to initiate the inflammatory process. Genetic susceptibility contributes to the development of AAP, and SPINK1 mutation is a documented risk factor. We investigated the prevalence of the SPINK1(N34S) mutation in patients with AAP compared to heavy alcohol users who had never suffered an episode of pancreatitis. Blood samples for the mutational analysis from patients with first episode (n = 60) and recurrent AAP (n = 43) and from heavy alcohol users without a history of AAP (n = 98) as well as from a control population (n = 1914) were obtained. SPINK1 mutation was found in 8.7% of the patients with AAP. The prevalence was significantly lower in healthy controls (3.4%, OR 2.72; 1.32-5.64) and very low in alcoholics without pancreatitis (1.0%, OR 9.29; 1.15-74.74). In a comparison adjusted for potential cofounders between AAP patients and alcoholics, SPINK1 was found to be an independent marker for AAP. The prevalence of the SPINK1 mutation is overrepresented in AAP patients and very low in alcoholics without pancreatitis. This finding may play a role in understanding the variable susceptibility to AAP found in heavy alcohol users.
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Affiliation(s)
- Anssi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
| | - Kari Antero Mäkelä
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
- Medical Research Center Oulu, Oulu University, Oulu University Hospital, 90220 Oulu, Finland
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Shivaprakash Jagalur Mutt
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Aishwarya Prasannan
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Hanna Seppänen
- Department of Surgery, Helsinki University Hospital, 00260 Helsinki, Finland;
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Fimlab Laboratories, Department of Clinical Chemistry, 33520 Tampere, Finland;
- Finnish Cardiovascular Research Center, 33520 Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Finnish Cardiovascular Research Center, 33520 Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, 33520 Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20521 Turku, Finland;
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20014 Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20521 Turku, Finland
| | - Ilkka Seppälä
- Fimlab Laboratories, Department of Clinical Chemistry, 33520 Tampere, Finland;
| | - Pihla Pakkanen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Isto Nordback
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Correspondence: ; Tel.:+358-3-311-64314
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Abstract
PURPOSE OF REVIEW The aim was to review evidence about diabetes secondary to hereditary pancreatitis, seeking novel diagnostic and treatment features. RECENT FINDINGS Hereditary pancreatitis (HP) is an autosomal dominant condition, characterized by recurrent episodes of acute pancreatitis, progression to fibrosis, and chronic pancreatitis. Clinical presentation includes diabetes of the exocrine pancreas (DEP). HP prevalence ranges from 0.3 to 0.57 per 100,000 people, with up to 80% of these develop DEP. This condition often requires specific interventions: with regard to metabolic control, metformin is the first choice for those with mild DEP, and for those in advanced disease, insulin is considered the first-line therapy. Insulin analogues and insulin pump therapy are preferred due to the brittle glycemic pattern and risk of hypoglycemia. In case of exocrine insufficiency, pancreatic enzyme replacement therapy is recommended. Pancreatic polypeptide administration is a promising novel treatment feature. DEP due to HP appears to be a misdiagnosed condition. The requirement of specific management demonstrates the importance of this matter; therefore, appropriate recognition and classification are important.
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Affiliation(s)
- Gabriel Xavier Ramalho
- School of Medicine, Faculty of Education and Health Sciences, University Center of Brasilia (UniCEUB), Brasilia, Brazil
| | - Marcio Garrison Dytz
- School of Medicine, Faculty of Education and Health Sciences, University Center of Brasilia (UniCEUB), Brasilia, Brazil.
- Endocrinology Division, Department of Intern Medicine, Sobradinho Regional Hospital, Brasilia, Brazil.
- Endocrinology and Metabolism Medical Residency, Superior School of Health Sciences (ESCS), Brasilia, Brazil.
- Institute of Diabetes and Endocrinology of Brasilia, SHS Qd. 6 Cj. A Bl. E Sl 1119, Brasilia, DF, 70316-902, Brazil.
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Abstract
Introduction The acute pancreatitis is a rare disease, but it has started to be diagnosed more often in children. Aim The aim of the study was single-centre, retrospective analysis of the incidence, aetiology, and clinical course of acute pancreatitis in children. Material and methods We analysed the medical records of patients with acute pancreatitis hospitalised in the Gastroenterology Unit of the Paediatrics Department, Medical University of Silesia from Jan 2004 to Dec 2013. Results There were 76 cases of acute pancreatitis among 51 children (average age: 12.07 years) hospitalised in the Gastroenterology Unit between January 2004 and December 2013. The diagnosis of acute pancreatitis was performed on the basis of INSPIRE criteria and modified Atlanta classification. Patients were divided into groups: I - 1-12 years old, which included 20 (39.21%) children and II - 13-18 years old, with 31 (60.78%) children. The idiopathic aetiology was the most common cause of acute pancreatitis, occurring in 22 (43.1%) children, and in 15 cases the aetiology of the disease was biliary (29.4%). Genetically determined causes were diagnosed in 8 (15.7%) patients, the PRSS1 mutation in four patients, mutation in SPINK1 in 1 child, and CFTR gene mutation in 1 child. Two children simultaneously had two genes mutations (CFTR, SPINK1), and during the considered period had more than one episode of acute pancreatitis. Conclusions Acute pancreatitis of idiopathic aetiology was most common among the examined children, and this should encourage the continued search for the causes of disease, especially genetic, and with particular emphasis on younger age group.
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