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Jeropoulos RM, Joshi D, Aldeiri B, Davenport M. Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience. CHILDREN (BASEL, SWITZERLAND) 2024; 11:74. [PMID: 38255387 PMCID: PMC10813922 DOI: 10.3390/children11010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.
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Affiliation(s)
- Renos M. Jeropoulos
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Deepak Joshi
- Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK;
| | - Bashar Aldeiri
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, London SE5 9RS, UK
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Baş H, Dişibeyaz S, Öztaş E, Aydemir Y, Temel T, Çilingir O, Durak Aras B, Artan S. Genetic Investigations in Turkish Idiopathic Pancreatitis Patients Show Unique Characteristics. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1240-1248. [PMID: 37823318 PMCID: PMC10765213 DOI: 10.5152/tjg.2023.22773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND/AIMS Pancreatitis is one of the leading causes of digestive system-related hospital admissions, and it has a genetic background in a considerable portion of the patients. In this study, we aimed to investigate the genetic risk factors of idiopathic pancreatitis in Turkish patients and the contribution of copy number variations to the pathogenesis. MATERIALS AND METHODS Idiopathic pancreatitis is defined as failure to detect risk factors despite comprehensive clinical assessments. Next-generation sequencing and multiple ligand-dependent probe amplification of PRSS1, SPINK1, CTRC, and CFTR were performed. For further genotype-phenotype correlations, patients were also questioned for the age of onset, family history, and pancreatic divisum. RESULTS A total of 68 idiopathic pancreatitis cases were enrolled. Variants with potential clinical significance of PRSS1 were identified in 13.4%, SPINK1 in 6.3%, CTRC in 4.7%, and CFTR in 26.5% of the patients. No copy number variants were seen in any of these genes. At least 7.4% of the participants had complex genetic etiology involving 2 genes. CONCLUSIONS At least 42.6% of the participants had a potential genetic risk factor. Five novel genetic variants were identified, and distinctive genetic risk factors of Turkish population were shown. The results showed that genetic etiology was frequent in pancreatitis and it was even more prominent in patients with early-onset disease. Considering that genetic risk factors may be informative for decisionmaking in the treatment options in addition to providing extensive prognostic value and familial genetic consultation; clinicians need to be more eager to offer genetic tests to pancreatitis patients.
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Affiliation(s)
- Hasan Baş
- Department of Medical Genetics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
- Department of Medical Genetics, SBÜ Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Selçuk Dişibeyaz
- Department of Internal Medicine, Division of Gastroenterology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Erkin Öztaş
- Department of Internal Medicine, Division of Gastroenterology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Yusuf Aydemir
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Tuncer Temel
- Department of Internal Medicine, Division of Gastroenterology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Oğuz Çilingir
- Department of Medical Genetics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Beyhan Durak Aras
- Department of Medical Genetics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Sevilhan Artan
- Department of Medical Genetics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Uc A, Cress GA, Wang F, Abu-El-Haija M, Ellery KM, Fishman DS, Gariepy CE, Gonska T, Lin TK, Liu QY, Mehta M, Maqbool A, McFerron BA, Morinville VD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Serrano J, Shah U, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe ME. Analysis of INSPPIRE-2 Cohort: Risk Factors and Disease Burden in Children With Acute Recurrent or Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2022; 75:643-649. [PMID: 35976273 PMCID: PMC9617760 DOI: 10.1097/mpg.0000000000003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). METHODS Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. RESULTS Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. CONCLUSIONS Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.
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Affiliation(s)
- Aliye Uc
- University of Iowa, Stead Family Children’s Hospital, Iowa City, IA
| | | | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Maisam Abu-El-Haija
- Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Douglas S. Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | | | | | - Tom K. Lin
- Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Quin Y. Liu
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Megha Mehta
- University of Texas Southwestern Medical School, Dallas, TX
| | - Asim Maqbool
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian A. McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | - Chee Y. Ooi
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales and Sydney Children’s Hospital Randwick Sydney, Sydney, Australia
| | | | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
| | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | | | | | - Yuhua Zheng
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark E. Lowe
- Washington University School of Medicine, St. Louis, MO
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Mun KS, Nathan JD, Jegga AG, Wikenheiser-Brokamp KA, Abu-El-Haija M, Naren AP. Personalized medicine approaches in cystic fibrosis related pancreatitis. Am J Transl Res 2022; 14:7612-7620. [PMID: 36398272 PMCID: PMC9641468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
We report a rare case of a patient with cystic fibrosis suffering from debilitating abdominal pain due to chronic pancreatitis. This 13-year-old patient was evaluated for surgical intervention to relieve pain from chronic pancreatitis and to improve quality of life. The patient carried two mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene; the most common ΔF508 variant and a second variant, p.Glu1044Gly, which has not been previously described. The patient's condition did not improve despite medical management and multiple endoscopic interventions, and therefore total pancreatectomy with islet autotransplantation and a near-total duodenectomy was offered for definitive management. Patient-derived duodenal crypts were isolated and cultured from the resected duodenum, and duodenal organoids were generated to test CFTR function. Our studies demonstrate that this novel mutation (ΔF508/p.Glu1044Gly) caused severely impaired CFTR function in vitro. The Food and Drug Administration (FDA)-approved drug ivacaftor, a CFTR potentiator, was identified to robustly improve CFTR function in the context of this novel mutation. Herein, we describe a personalized medicine approach consisting of performing drug testing on individual patient derived organoids that has potential to guide management of patients with novel CFTR genetic mutations. Identified effective medical therapeutics using this approach may avoid irreversible surgical treatments such as total pancreatectomy with islet autotransplantation in the future.
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Affiliation(s)
- Kyu Shik Mun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center127 South San Vicente Boulevard, Los Angeles 90048, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center127 South San Vicente Boulevard, Los Angeles 90048, CA, USA
| | - Jaimie D Nathan
- Department of Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children’s Hospital700 Children’s Drive, Columbus 43205, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center395 West 12th Avenue, Columbus 43210, OH, USA
| | - Anil G Jegga
- Department of Pediatrics, College of Medicine, University of Cincinnati3230 Eden Avenue, Cincinnati 45267, OH, USA
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Kathryn A Wikenheiser-Brokamp
- Division of Pathology and Laboratory Medicine, The Perinatal Institute, and Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center3333 Burnet Avenue, Cincinnati 45229, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine3333 Burnet Avenue, Cincinnati 45267, OH, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati3230 Eden Avenue, Cincinnati 45267, OH, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Anjaparavanda P Naren
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center127 South San Vicente Boulevard, Los Angeles 90048, CA, USA
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center3333 Burnet Avenue, Cincinnati 45229, OH, USA
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Girodon E, Rebours V, Chen JM, Pagin A, Levy P, Ferec C, Bienvenu T. WITHDRAWN: Clinical interpretation of PRSS1 gene variants in patients with pancreatitis. Clin Res Hepatol Gastroenterol 2022; 46:101531. [PMID: 36057185 DOI: 10.1016/j.clinre.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Clinics and Research in Hepatology and Gastroenterology, Volume 45, Issue 1, 2021, 101497. https://doi.org/10.1016/j.clinre.2020.07.004. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Emmanuelle Girodon
- Laboratoire de G..n..tique et Biologie Mol..culaires, H..pital Cochin, APHP.Centre-Universit.. de Paris, France
| | - Vinciane Rebours
- Service de Pancr..atologie-Gastroent..rologie, P..le des Maladies de l'Appareil Digestif, Universit.. Denis Diderot, H..pital Beaujon, APHP, DHU UNITY, Clichy, and Centre de R..f..rence des Maladies Rares du Pancr..as...PAncreaticRaresDISeases (PaRaDis), France
| | - Jian Min Chen
- INSERM UMR1078 "G..n..tique, G..nomique Fonctionnelle et Biotechnologies", EFS - Bretagne, Universit.. de Brest, CHRU Brest, Brest, France
| | - Adrien Pagin
- CHU Lille, Service de Toxicologie et G..nopathies, Lille, France
| | - Philippe Levy
- Service de Pancr..atologie-Gastroent..rologie, P..le des Maladies de l'Appareil Digestif, Universit.. Denis Diderot, H..pital Beaujon, APHP, DHU UNITY, Clichy, and Centre de R..f..rence des Maladies Rares du Pancr..as...PAncreaticRaresDISeases (PaRaDis), France
| | - Claude Ferec
- INSERM UMR1078 "G..n..tique, G..nomique Fonctionnelle et Biotechnologies", EFS - Bretagne, Universit.. de Brest, CHRU Brest, Brest, France
| | - Thierry Bienvenu
- Laboratoire de G..n..tique et Biologie Mol..culaires, H..pital Cochin, APHP.Centre-Universit.. de Paris, France.
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6
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deVries JM, Sidhu S, Kimsey KM, Barnett GS, Wilsey M. No Stone Left Unturned: Pediatric Pancreatic Stones Presenting With Obstructive Jaundice. JPGN REPORTS 2022; 3:e217. [PMID: 37168618 PMCID: PMC10158305 DOI: 10.1097/pg9.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/27/2022] [Indexed: 05/13/2023]
Abstract
Pancreatic lithiasis, the formation of calcifications in the pancreatic duct, occurs uncommonly in pediatric patients but can occur more frequently with chronic pancreatitis (CP). Cystic fibrosis (CF) is one of the major causes of pancreatic lithiasis in pediatric patients, with mutations in the CF transmembrane conductance regulator (CFTR) gene reported in up to 23% of pediatric CP patients. Mutations in the CFTR gene can lead to mild cases of CF, which may delay diagnosis and treatment. In such cases, pancreatitis can be the presenting symptom in children with CF. We report a unique case of a 10-year-old female with previously undiagnosed and untreated CF presenting with abdominal pain, vomiting, and obstructive jaundice. Her pancreatic lithiasis and biliary obstruction were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Jonathan M. deVries
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Sarah Sidhu
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Kathryn M. Kimsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Grafton S. Barnett
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Michael Wilsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
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7
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Zou WB, Cooper DN, Masson E, Pu N, Liao Z, Férec C, Chen JM. Trypsinogen (PRSS1 and PRSS2) gene dosage correlates with pancreatitis risk across genetic and transgenic studies: a systematic review and re-analysis. Hum Genet 2022; 141:1327-1338. [PMID: 35089416 DOI: 10.1007/s00439-022-02436-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/15/2022] [Indexed: 12/22/2022]
Abstract
Trypsinogen (PRSS1, PRSS2) copy number gains and regulatory variants have both been proposed to elevate pancreatitis risk through a gene dosage effect (i.e., by increasing the expression of wild-type protein). However, to date, their impact on pancreatitis risk has not been thoroughly evaluated whilst the underlying pathogenic mechanisms remain to be explicitly investigated in mouse models. Genetic studies of the rare trypsinogen duplication and triplication copy number variants (CNVs), and the common rs10273639C variant, were collated from PubMed and/or ClinVar. Mouse studies that analyzed the influence of a transgenically expressed wild-type human PRSS1 or PRSS2 gene on the development of pancreatitis were identified from PubMed. The genetic effects of the different risk genotypes, in terms of odds ratios, were calculated wherever appropriate. The genetic effects of the rare trypsinogen duplication and triplication CNVs were also evaluated by reference to their associated disease subtypes. We demonstrate a positive correlation between increased trypsinogen gene dosage and pancreatitis risk in the context of the rare duplication and triplication CNVs, and between the level of trypsinogen expression and disease risk in the context of the heterozygous and homozygous rs10273639C-tagged genotypes. We retrospectively identify three mouse transgenic studies that are informative in relation to the pathogenic mechanism underlying the trypsinogen gene dosage effect in pancreatitis. Trypsinogen gene dosage correlates with pancreatitis risk across genetic and transgenic studies, highlighting the fundamental role of dysregulated expression of wild-type trypsinogen in the etiology of pancreatitis. Specifically downregulating trypsinogen expression in the pancreas may serve as a potential therapeutic and/or prevention strategy for pancreatitis.
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Affiliation(s)
- Wen-Bin Zou
- Department of Gastroenterology, Changhai Hospital, The Secondary Military Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
- Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Na Pu
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
- Department of Critical Care Medicine, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Secondary Military Medical University, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
- Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France.
- INSERM UMR1078, EFS, UBO, 22 avenue Camille Desmoulins, Brest, France.
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Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases. Genes (Basel) 2021; 12:genes12091372. [PMID: 34573354 PMCID: PMC8465218 DOI: 10.3390/genes12091372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) are chronic relapsing inflammatory conditions of the gastrointestinal tract, encompassing Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U). They are currently considered as systemic disorders determined by a set of genetic predispositions, individual susceptibility and environmental triggers, potentially able to involve other organs and systems than the gastrointestinal tract. A large number of patients experiences one or more extraintestinal manifestations (EIMs), whose sites affected are mostly represented by the joints, skin, bones, liver, eyes, and pancreas. Pancreatic abnormalities are not uncommon and are often underestimated, encompassing acute and chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency and asymptomatic elevation of pancreatic enzymes. In most cases they are the result of environmental triggers. However, several genetic polymorphisms may play a role as precipitating factors or contributing to a more severe course. The aim of this paper is to provide an updated overview on the available evidence concerning the etiology, pathogenesis and clinical presentation of pancreatic diseases in IBD pediatric patients.
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Disordered Gut Microbiota in Children Who Have Chronic Pancreatitis and Different Functional Gene Mutations. Clin Transl Gastroenterol 2021; 11:e00150. [PMID: 32352720 PMCID: PMC7145041 DOI: 10.14309/ctg.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pancreatitis (CP) is a serious condition whose pathogenic mechanism is unclear. Interactions of host genetic factors with gut microbiota have a role, but little is known, especially in children with CP (CCP), in which the external factors are less important. Our objective was to identify the main gut microbiota genera in CCP and to characterize the functional mutations of these patients.
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Clinical Outcomes Following Therapeutic Endoscopic Retrograde Cholangiopancreatography in Children With Pancreas Divisum. J Pediatr Gastroenterol Nutr 2021; 72:300-305. [PMID: 33230075 DOI: 10.1097/mpg.0000000000002996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Pancreas divisum (PD) is a risk factor in children for the development of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (mPES) may be of clinical benefit, however, the clinical outcomes from endotherapy remain unclear. We sought to review the outcomes and safety of therapeutic ERCP in children with PD. METHODS We performed a retrospective chart of children with PD who underwent an ERCP between February 2012 and December 2018. Pertinent patient, clinical and procedure information was collected including procedure-related adverse events. A follow-up questionnaire of the parent was conducted to determine the clinical impact from endotherapy. RESULTS Fifty-eight ERCPs were performed in 27 patients (14 boys; mean age: 9.7 years, range 2-19) with PD. All patients underwent a successful mPES. A genetic variant was identified in 19/26 (73%) tested patients. Post-ERCP pancreatitis (PEP) was the only observed adverse event; 21% (12/58). Median follow-up interval from first ERCP intervention to questionnaire completion was 31.5 months (range: 4--72 months). Of the 20 questionnaire responders, 13 reported clinical improvement from endotherapy. CONCLUSIONS The majority of children from our PD cohort possessed at least 1 genetic variant. Most questionnaire responders had a favorable response to endotherapy. PEP rate was comparable with that of prior reports in adult patients.
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Clinical interpretation of PRSS1 variants in patients with pancreatitis. Clin Res Hepatol Gastroenterol 2021; 45:101497. [PMID: 33257277 DOI: 10.1016/j.clinre.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/01/2020] [Indexed: 02/04/2023]
Abstract
Since the description of the PRSS1 gene encoding the cationic trypsinogen as being involved in dominant hereditary pancreatitis, more than 50 PRSS1 variants have been reported. Among the PRSS1 variants that have been classified as pathogenic, some have a high penetrance and others have a low penetrance. Assessing the clinical relevance of PRSS1 variants is often complicated in the absence of functional evidence and interpretation of rare variants is not very easy in clinical practice. The aim of this study was to review the different variants identified in the PRSS1 gene and to classify them according to their degree of deleterious effect. This classification was based on the results of several in vitro experiments and on population data, in comparing the allelic frequency of each variant in patients with pancreatitis and in unaffected individuals. This review should help geneticists and clinicians in charge of patient's care and genetic counseling to interpret molecular results.
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12
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Affiliation(s)
| | - Karla Au Yeung
- Department of Pediatric Gastroenterology and Nutrition, and
| | - Brian Pugmire
- Department of Radiology, Valley Children's Hospital, Madera, CA
| | - Roberto Gugig
- Department of Pediatric Gastroenterology and Nutrition, and
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13
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Girodon E, Rebours V, Chen JM, Pagin A, Levy P, Ferec C, Bienvenu T. Clinical interpretation of SPINK1 and CTRC variants in pancreatitis. Pancreatology 2020; 20:1354-1367. [PMID: 32948427 DOI: 10.1016/j.pan.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
Since the description of the SPINK1 gene encoding the serine protease inhibitor Kazal type 1 and the CTRC gene encoding the Chymotrypsin C as being involved in chronic pancreatitis, more than 56 SPINK1 and 87 CTRC variants have been reported. Assessing the clinical relevance of SPINK1 and CTRC variants is often complicated in the absence of functional evidence and interpretation of rare variants is not very easy in clinical practice. The aim of this study was to review the different variants identified in these two genes and to classify them according to their degree of damaging effect. This classification was based on the results of in vitro experiments, in silico analysis using different prediction tools, and on population data, in comparing the allelic frequency of each variant in patients with pancreatitis and in unaffected control individuals. This review should help geneticists and clinicians in charge of patient's care and genetic counseling to interpret the results of genetic studies.
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Affiliation(s)
- Emmanuelle Girodon
- Laboratoire de Génétique et Biologie Moléculaires, Hôpital Cochin, APHP. Centre-Université de Paris, France
| | - Vinciane Rebours
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Université Denis Diderot, Hôpital Beaujon, APHP, DHU UNITY, Clichy, France; Centre de Référence des Maladies Rares du Pancréas, PAncreaticRaresDISeases (PaRaDis), France
| | - Jian Min Chen
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", INSERM, EFS - Bretagne, Université de Brest, CHRU Brest, Brest, France
| | - Adrien Pagin
- CHU Lille, Service de Toxicologie et Génopathies, Lille, France
| | - Philippe Levy
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Université Denis Diderot, Hôpital Beaujon, APHP, DHU UNITY, Clichy, France
| | - Claude Ferec
- Centre de Référence des Maladies Rares du Pancréas, PAncreaticRaresDISeases (PaRaDis), France
| | - Thierry Bienvenu
- Laboratoire de Génétique et Biologie Moléculaires, Hôpital Cochin, APHP. Centre-Université de Paris, France.
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14
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Jiang M, Li Z, Fu S, Xu Y, Tan Y, Jia W, Jiang Z, Mo N, Wei X, Zhang R, Zhang Z, Jiang G, Yang X. IVS8-5T Allele of CFTR is the Risk Factor in Chronic Pancreatitis, Especially in Idiopathic Chronic Pancreatitis. Am J Med Sci 2020; 360:55-63. [PMID: 32439152 DOI: 10.1016/j.amjms.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/04/2020] [Accepted: 04/17/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator IVS8-5T gene variation appears to be associated with a higher risk of chronic pancreatitis (CP); however, there is inconsistency between previous reported studies. Here, we performed a meta-analysis to investigate this relationship. MATERIALS AND METHODS PubMed and WANFANG databases were searched for the case-control studies that contained Patients with CP with IVS8-5T variation. Odd ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the relevance of IVS8-5T gene variation and CP. RESULTS Analysis showed that the frequency of the 5T allele was significantly higher in CP subjects than that in control subjects (OR = 1.43, 95% CI: 1.13-1.81, I2 = 1.2%). Based on the subgroup analysis stratified by etiology, the 5T allele was associated with a higher risk of idiopathic chronic pancreatitis (ICP) (OR = 1.80, 95% CI: 1.18-2.76, I2 = 0.0%) and not alcoholic CP (OR = 2.14, 95% CI: 0.98-4.66, I2 = 0.0%). Further study indicated that the 5T allele was related to higher ICP prevalence in the European population (OR = 1.79, 95% CI: 1.06-3.03, I2 = 0.0%). In contrast, there was no significant difference between ICP subjects and healthy controls within the Asian population (OR = 1.84, 95% CI: 0.91-3.72, I2 = 38.0%). CONCLUSIONS Cystic fibrosis transmembrane conductance regulator IVS8-5T is a risk factor in patients with CP. IVS8-5T variation may play a significant role in the occurrence of ICP, especially in the European population.
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Affiliation(s)
- Min Jiang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhouquan Li
- Scientific Research Center, Guilin Medical University, Nanning, Guilin, China
| | - Shien Fu
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanzhen Xu
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanjun Tan
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Wenxian Jia
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhiwen Jiang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Nanfang Mo
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Xinyan Wei
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Ruoheng Zhang
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Zaiping Zhang
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Guangjian Jiang
- Diabetes Research Center, Beijing University of Chinese Medicine, Beijing, China..
| | - Xiaoli Yang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Scientific Research Center, Guilin Medical University, Nanning, Guilin, China.
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15
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Abu-El-Haija M, Valencia CA, Hornung L, Youssef N, Thompson T, Barasa NW, Wang X, Denson LA. Genetic variants in acute, acute recurrent and chronic pancreatitis affect the progression of disease in children. Pancreatology 2019; 19:535-540. [PMID: 31088717 PMCID: PMC6589390 DOI: 10.1016/j.pan.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Acute pancreatitis (AP) is emerging in pediatrics. A subset of children with AP progresses to acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). The role of extensive gene testing in the progression has not been investigated previously. We have followed children enrolled in the registry and at our center for progression to ARP and CP after the first attack. METHODS This study utilizes an extensive gene sequencing panel as a platform to evaluate the role of genetics in first attack AP, and the progression over time, from first attack to ARP and CP in children. RESULTS Genes, with corresponding variants were involved in the 3 groups studied: AP, ARP and CP. We have shown that the presence of gene variants from the eight tested genes is enriched in the CP group compared to the AP and ARP groups. The presence of more than one gene was associated with CP (p = 0.01). SPINK1 mutation(s) was significantly associated with faster progression to ARP, (p = 0.04). Having a variant from CFTR, SPINK1 or PRSS1, was associated with the faster progression from AP to CP over time (p < 0.05). CONCLUSIONS This study shows that genetics have a significant role in progression to ARP and CP from the first attack of pancreatitis.
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Affiliation(s)
- Maisam Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, Gastroenterology, Hepatology & Nutrition, 3333 Burnet Ave, Cincinnati, OH, 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | - Lindsey Hornung
- Cincinnati Children's Hospital Medical Center, Biostatistics and Epidemiology, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Nour Youssef
- Cincinnati Children's Hospital, Clinical Rotation, LAU, School of Medicine, Lebanon.
| | - Tyler Thompson
- Cincinnati Children's Hospital Medical Center, Gastroenterology, Hepatology & Nutrition, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Nathaniel W Barasa
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Laboratory Genetics and Genomics, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Xinjian Wang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Laboratory Genetics and Genomics, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Lee A Denson
- Cincinnati Children's Hospital Medical Center, Gastroenterology, Hepatology & Nutrition, 3333 Burnet Ave, Cincinnati, OH, 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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16
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Zou WB, Ru N, Wu H, Hu LH, Ren X, Jin G, Wang Z, Du YQ, Cao YN, Zhang L, Chang XY, Zhang RC, Li XB, Shen Y, Li P, Li ZS, Liao Z. Guidelines for the diagnosis and treatment of chronic pancreatitis in China (2018 edition). Hepatobiliary Pancreat Dis Int 2019; 18:103-109. [PMID: 30922816 DOI: 10.1016/j.hbpd.2019.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/02/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai 200433, China
| | - Nan Ru
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Hao Wu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai 200433, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Xu Ren
- Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin 150030, China
| | - Gang Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yi-Qi Du
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Ya-Nan Cao
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Lei Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai 200080, China
| | - Xiao-Yan Chang
- Department of Pathology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Rong-Chun Zhang
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xiao-Bin Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Yan Shen
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Peng Li
- Department of Digestive Endoscopy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai 200433, China.
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai 200433, China.
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17
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Lin YC, Kor CT, Su WW, Hsu YC. Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study. World J Gastroenterol 2018; 24:5034-5045. [PMID: 30510378 PMCID: PMC6262246 DOI: 10.3748/wjg.v24.i44.5034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP.
METHODS Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.
RESULTS Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system (risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve (AUC) [95% confidence interval (CI)] in predicting the 5-year CP incidence in risk score 1 (without the number of AP episodes) was 0.83 (0.79, 0.87), whereas the AUC (95%CI) in risk score 2 (including the number of AP episodes) was 0.84 (0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.
CONCLUSION In the study,we identified the risk factors of CP and developed a prediction score model for CP.
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Affiliation(s)
- Yen-Chih Lin
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Wei-Wen Su
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Yu-Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
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18
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Pediatric chronic pancreatitis: Updates in the 21st century. Pancreatology 2018; 18:354-359. [PMID: 29724605 DOI: 10.1016/j.pan.2018.04.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/11/2022]
Abstract
Pediatric Pancreatitis has gained a lot of attention in the last decade. Updates in medical management include new testing technologies in genetics, function testing and imaging modalities. Updates in surgical management have taken place as well, with total pancreatectomy islet auto transplantation reserved for a specific patient population that meets the clinical criteria. Multidisciplinary team management is needed for patients with chronic pancreatitis to ensure optimal outcomes.
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19
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Masson E, Chen JM, Cooper DN, Férec C. PRSS1 copy number variants and promoter polymorphisms in pancreatitis: common pathogenetic mechanism, different genetic effects. Gut 2018; 67:592-593. [PMID: 28601843 DOI: 10.1136/gutjnl-2017-314443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Emmanuelle Masson
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078 Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Universitaire (CHU) Brest, Hôpital Morvan, Brest, France
| | - Jian-Min Chen
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078 Brest, France.,Etablissement Français du Sang (EFS) - Bretagne, Brest, France
| | - David N Cooper
- Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - Claude Férec
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078 Brest, France.,Laboratoire de Génétique Moléculaire et d'Histocompatibilité, Centre Hospitalier Universitaire (CHU) Brest, Hôpital Morvan, Brest, France.,Etablissement Français du Sang (EFS) - Bretagne, Brest, France.,Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
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20
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Vitale DS, Abu-El-Haija M. Genetic Testing in Children with Recurrent and Chronic Pancreatitis. J Pediatr 2017; 191:10-11. [PMID: 29173293 DOI: 10.1016/j.jpeds.2017.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022]
Affiliation(s)
- David S Vitale
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
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21
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Xiao Y, Yuan W, Yu B, Guo Y, Xu X, Wang X, Yu Y, Yu Y, Gong B, Xu C. Targeted Gene Next-Generation Sequencing in Chinese Children with Chronic Pancreatitis and Acute Recurrent Pancreatitis. J Pediatr 2017; 191:158-163.e3. [PMID: 29173301 DOI: 10.1016/j.jpeds.2017.08.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/24/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify causal mutations in certain genes in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). STUDY DESIGN After patients were enrolled (CP, 55; ARP, 14) and their clinical characteristics were investigated, we performed next-generation sequencing to detect nucleotide variations among the following 10 genes: cationic trypsinogen protease serine 1 (PRSS1), serine protease inhibitor, Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator gene (CFTR), chymotrypsin C (CTRC), calcium-sensing receptor (CASR), cathepsin B (CTSB), keratin 8 (KRT8), CLAUDIN 2 (CLDN2), carboxypeptidase A1 (CPA1), and ATPase type 8B member 1 (ATP8B1). Mutations were searched against online databases to obtain information on the cause of the diseases. Certain novel mutations were analyzed using the SIFT2 and Polyphen-2 to predict the effect on protein function. RESULTS There were 45 patients with CP and 10 patients with ARP who harbored 1 or more mutations in these genes; 45 patients had at least 1 mutation related to pancreatitis. Mutations were observed in the PRSS1, SPINK1, and CFTR genes in 17 patients, the CASR gene in 5 patients, and the CTSB, CTRC, and KRT8 genes in 1 patient. Mutations were not found in the CLDN, CPA1, or ATP8B1 genes. We found that mutations in SPINK1 may increase the risk of pancreatic duct stones (OR, 11.07; P = .003). The patients with CFTR mutations had a higher level of serum amylase (316.0 U/L vs 92.5 U/L; P = .026). CONCLUSION Mutations, especially those in PRSS1, SPINK1, and CFTR, accounted for the major etiologies in Chinese children with CP or ARP. Children presenting mutations in the SPINK1 gene may have a higher risk of developing pancreatic duct stones.
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Affiliation(s)
- Yuan Xiao
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wentao Yuan
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center and Shanghai Industrial Technology Institute (SITI), Shanghai, China
| | - Bo Yu
- School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yan Guo
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xu Xu
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xinqiong Wang
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yi Yu
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yi Yu
- Pediatric Department, Ruijin Hospital North, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Biao Gong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chundi Xu
- Pediatric Department, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Pediatric Department, Ruijin Hospital North, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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22
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Poddar U, Yachha SK, Borkar V, Srivastava A, Saraswat VA. Clinical profile and treatment outcome of chronic pancreatitis in children: a long-term follow-up study of 156 cases. Scand J Gastroenterol 2017; 52:773-778. [PMID: 28276824 DOI: 10.1080/00365521.2017.1295465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM There is a paucity of literature in pediatric chronic pancreatitis (CP) and most information is derived from adult literature. We, therefore, analyzed our experience of CP to look for clinical profile and long-term outcome. METHODS From January 2003 to December 2015, 156 consecutive children (≤18 years) diagnosed as CP were included. Their clinical profile, management, and follow-up data were retrieved. Genetic markers (PRSS1, SPINK1, and CFTR) were studied in 40 idiopathic cases. RESULTS The median age of the patients was 13 [inter-quartile range (IQR): 10-14] years (93 males) and 134 (86%) were idiopathic. Genetic mutations were found in 22/40 (55%) idiopathic cases. All but two presented with pain abdomen (episodic pain in 93.6%) and symptom duration was 12 (IQR: 6-24) months. There were two subsets; calcific (CCP) 68 (43.5%) and non-calcific (NCCP) 88 (56.5%). In CCP group, significantly more children had Cambridge grade 5 magnetic resonance cholangiopancreatography changes, low weight Z-score, and had continuous pain more compared to NCCP group. Over a median follow-up of 23 (IQR: 8-45.5) months, more children in CCP group had complications. Endoscopic therapy (done for persistent pain in 40) relieved pain in 52.5% of cases while medical therapy did so in 36% of cases. CONCLUSION Pediatric CP in Asia presents with episodic pain and genetic predisposition seems to be a major cause. There are two subsets; CCP and NCCP with former showing marked imaging changes, more often associated with malnutrition and complications. Endoscopic therapy for pain relief gives modest benefit but medical therapy is not encouraging.
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Affiliation(s)
- Ujjal Poddar
- a Department of Pediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Surender Kumar Yachha
- a Department of Pediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Vibhor Borkar
- a Department of Pediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Anshu Srivastava
- a Department of Pediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Vivek A Saraswat
- b Department of Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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23
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Zhao D, Xu Y, Li J, Fu S, Xiao F, Song X, Xie Z, Jiang M, He Y, Liu C, Wen Q, Yang X. Association between F508 deletion in CFTR and chronic pancreatitis risk. Dig Liver Dis 2017; 49:967-972. [PMID: 28780053 DOI: 10.1016/j.dld.2017.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The cystic fibrosis transmembrane conductance regulator (CFTR) has been reported to influence individual susceptibility to chronic pancreatitis (CP), but the results of previous studies are controversial. AIMS We performed a study to demonstrate the relationship between CFTR and CP. METHODS We searched PubMed, Scopus, and Embase for studies of patients with CP. Seven studies from 1995 to 2016 were identified, and included 64,832 patients. Pooled prevalence and 95% confidence intervals (CIs) were calculated. RESULTS F508 deletion in CFTR was significantly positively associated with CP risk in the overall analysis (odds ratio [OR]=3.20, 95% CI: 2.30-4.44, I2=31.7%). In subgroup analysis stratified by ethnicity, F508 deletion was significantly associated with CP risk in Indian populations, using a fixed effects model (ORs=5.45, 95% CI: 2.52-11.79, I2=0.0%), and in non-Indian populations, using a random effects model (ORs=3.59, 95% CI: 1.73-7.48, I2=60.9%). At the same time, we found that Indians with F508 deletion had much higher CP prevalence than non-Indians. Interestingly, F508 deletion was also associated with CP and idiopathic CP risk in subgroup analysis stratified by aeitiology, using the fixed effects model. CONCLUSIONS Based on current evidence, F508 deletion is a risk factor for CP, and Indians with F508 deletion have much higher CP morbidity.
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Affiliation(s)
- Dong Zhao
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanzhen Xu
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Department of Pathophysiology, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiatong Li
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Department of Pathophysiology, Guangxi Medical University, Nanning, Guangxi, China
| | - Shien Fu
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Feifan Xiao
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaowei Song
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Department of Gastrointestinal and Gland Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhibin Xie
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Department of Urology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Min Jiang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan He
- Department of Geriatric Cardiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chengwu Liu
- Department of Pathophysiology, Guangxi Medical University, Nanning, Guangxi, China
| | - Qiongxian Wen
- School of Nursing, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Xiaoli Yang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China.
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24
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Zhu J, Yang P, Liu X, Yan L, Rampersad S, Li F, Li H, Sheng C, Cheng X, Zhang M, Qu S. The clinical characteristics of patients with mitochondrial tRNA Leu(UUR)m.3243A > G mutation: Compared with type 1 diabetes and early onset type 2 diabetes. J Diabetes Complications 2017; 31:1354-1359. [PMID: 28599824 DOI: 10.1016/j.jdiacomp.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study presents nine patients with mitochondrial tRNA Leu (UUR) m.3243A>G mutation and compares the clinical characteristics and diabetes complications with type 1 diabetes (T1DM) or early onset type 2 diabetes (T2DM). METHODS The study covers 9 patients with MIDD, 33 patients with T1DM and 86 patients (age of onset ≤35years) with early onset T2DM, matched for sex, age at onset of diabetes, duration of diabetes. All patients with MIDD were confirmed as carrying the m.3243A>G mitochondrial DNA mutation. Serum HbA1c, beta-cell function, retinal and renal complications of diabetes, bone metabolic markers, lumbar spine and femoral neck BMD bone mineral density were compared to characterize the clinical features of all patients. RESULTS Nine patients were from five unrelated families, and the mean (SD) onset age of those patients was 31.2±7.2year. Two patients required insulin at presentation, and six patients progressed to insulin requirement after a mean of 7.2years. β-Cell function in the MIDD group was intermediate between T1DM and early-onset T2DM. In MIDD, four patients were diagnosed as diabetic retinopathy (4/9) and five patients (5/9) had macroalbuminuria. The number of patients with diabetic retinopathy and macroalbuminuria in the MIDD group was comparable to T1DM or early-onset T2DM. The rate of osteoporosis (BMD T-score<-2.5 SD) in the patient with MIDD was higher than the T1DM or early-onset T2DM group. CONCLUSION Our study indicates that of the nine subjects with MIDD, three patients (1-II-1, 1-II-3, 1-II-4) who came from the same family had a history of acute pancreatitis. Compared with T1DM or early-onset T2DM matched for sex, age, duration of diabetes, MIDD patients had the highest rate of osteoporosis.
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MESH Headings
- Adult
- Age of Onset
- Biomarkers/blood
- Biomarkers/urine
- Bone Density
- China/epidemiology
- Deafness/complications
- Deafness/genetics
- Deafness/metabolism
- Deafness/physiopathology
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 1/urine
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/urine
- Diabetic Nephropathies/epidemiology
- Diabetic Retinopathy/epidemiology
- Female
- Glycated Hemoglobin/analysis
- Humans
- Male
- Mitochondrial Diseases/complications
- Mitochondrial Diseases/genetics
- Mitochondrial Diseases/metabolism
- Mitochondrial Diseases/physiopathology
- Osteoporosis/complications
- Osteoporosis/epidemiology
- Pancreatitis/complications
- Pancreatitis/epidemiology
- Point Mutation
- Prevalence
- RNA, Transfer, Leu
- Young Adult
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Affiliation(s)
- Jie Zhu
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Peng Yang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Xiang Liu
- Department of Urology, Putuo District People's Hospital, Shanghai 200060, China
| | - Li Yan
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Sharvan Rampersad
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Feng Li
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Hong Li
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Chunjun Sheng
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Xiaoyun Cheng
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Manna Zhang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China.
| | - Shen Qu
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
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Qian YY, Zou WB, Chen JM, Li ZS, Liao Z. Identification of a novel SPINK1 deletion in a teenager with idiopathic chronic pancreatitis. Dig Liver Dis 2017; 49:941-943. [PMID: 28546060 DOI: 10.1016/j.dld.2017.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Jian-Min Chen
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France; Etablissement Français du Sang (EFS)-Bretagne, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale (UBO), Brest, France
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Shanghai Institute of Pancreatic Diseases, Shanghai, China.
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Shanghai Institute of Pancreatic Diseases, Shanghai, China.
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26
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27
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Cho SM, Shin S, Lee KA. PRSS1, SPINK1, CFTR, and CTRC Pathogenic Variants in Korean Patients With Idiopathic Pancreatitis. Ann Lab Med 2017; 36:555-60. [PMID: 27578509 PMCID: PMC5011109 DOI: 10.3343/alm.2016.36.6.555] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/15/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study aimed to identify pathogenic variants of PRSS1, SPINK1, CFTR, and CTRC genes in Korean patients with idiopathic pancreatitis. METHODS The study population consisted of 116 Korean subjects (65 males, 51 females; mean age, 30.4 yr, range, 1-88 yr) diagnosed with idiopathic chronic pancreatitis (ICP), idiopathic recurrent acute pancreatitis (IRAP), or idiopathic acute pancreatitis (IAP). We analyzed sequences of targeted regions in the PRSS1, SPINK1, CFTR, and CTRC genes, copy numbers of PRSS1 and SPINK1, and clinical data from medical records. RESULTS We identified three types of pathogenic PRSS1 variants in 11 patients, including p.N29I (n=1), p.R122H (n=1), and p.G208A (n=9). Sixteen patients exhibited heterozygous pathogenic variants of SPINK1, including c.194+2T>C (n=12), p.N34S (n=3), and a novel pathogenic splicing variation c.194+1G>A. A heterozygous CFTR p.Q1352H pathogenic variant was detected in eight patients. One patient carried a heterozygous CTRC p.P249L pathogenic variant, which is a known high-risk variant for pancreatitis. All patients had normal PRSS1 and SPINK1 gene copy numbers. Weight loss occurred more frequently in patients carrying the p.G208A pathogenic variant, while pancreatic duct stones occurred more frequently in patients with the c.194+2T>C pathogenic variant. CONCLUSIONS Pathogenic variants of PRSS1, SPINK1, and CFTR were associated with idiopathic pancreatitis, while pathogenic variants of CTRC were not. Copy number variations of PRSS1 and SPINK1 were not detected.
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Affiliation(s)
- Sun Mi Cho
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Saeam Shin
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyung A Lee
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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28
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Hegyi E, Sahin-Tóth M. Genetic Risk in Chronic Pancreatitis: The Trypsin-Dependent Pathway. Dig Dis Sci 2017; 62:1692-1701. [PMID: 28536777 PMCID: PMC5487703 DOI: 10.1007/s10620-017-4601-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
Abstract
Genetic investigations have provided unique insight into the mechanism of chronic pancreatitis in humans and firmly established that uncontrolled trypsin activity is a central pathogenic factor. Mutations in the PRSS1, SPINK1, and CTRC genes promote increased activation of trypsinogen to trypsin by stimulation of autoactivation or by impairing protective trypsinogen degradation and/or trypsin inhibition. Here we review key genetic and biochemical features of the trypsin-dependent pathological pathway in chronic pancreatitis.
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Affiliation(s)
- Eszter Hegyi
- 0000 0004 1936 7558grid.189504.1Center for Exocrine Disorders, Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, 72 East Concord Street, Evans-433, Boston, MA 02118 USA
| | - Miklós Sahin-Tóth
- 0000 0004 1936 7558grid.189504.1Center for Exocrine Disorders, Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, 72 East Concord Street, Evans-433, Boston, MA 02118 USA
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29
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The Etiology and Clinical Course of Chronic Pancreatitis in Children With Early Onset of the Disease. J Pediatr Gastroenterol Nutr 2016; 63:665-670. [PMID: 27673710 DOI: 10.1097/mpg.0000000000001414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The etiological factors of chronic pancreatitis (CP) in children differ from those in adults. To date, no study has assessed the clinical course of CP in young children. The aim of our study was to evaluate the etiology and the clinical presentation of the disease in children with disease onset before 5 years of age in comparison to later-onset of CP. METHODS A total of 276 children with CP, hospitalized from 1988 to 2015, were enrolled in the study. Data on presentation, diagnostic findings, and treatment were reviewed. Two hundred sixty patients were screened for the most frequent mutations in major pancreatitis-associated genes, such as cationic trypsinogen/serine protease gene (PRSS1), serine protease inhibitor, Kazal type 1 gene (SPINK1), and cystic fibrosis transmembrane conductance regulator gene (CFTR). RESULTS The disease onset before the age of 5 years occurred in 51 patients (group 1), the later onset in 225 patients (group 2). We found no significant discrepancies in distribution of the etiological factors between groups. The youngest patients (group 1) had more pancreatitis episodes (median 5.0 vs 3.00; P < 0.05) and underwent surgeries more frequently (25.5% vs 8.9%; P < 0.05). It could be associated with significantly longer follow-up in early onset group (median 6 vs 4 years; P < 0.05). There were no differences in nutritional status or exocrine and endocrine pancreatic function. CONCLUSIONS Early- and later-onset pancreatitis have similar etiological factors with predominance of gene mutations. The most frequent mutation found was p.Asn34Ser (N34S) in SPINK1 gene. The clinical presentation differed in number of pancreatitis episodes and frequency of surgeries.
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30
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Sofia VM, Da Sacco L, Surace C, Tomaiuolo AC, Genovese S, Grotta S, Gnazzo M, Ciocca L, Petrocchi S, Alghisi F, Montemitro E, Martemucci L, Elce A, Lucidi V, Castaldo G, Angioni A. Extensive molecular analysis suggested the strong genetic heterogeneity of idiopathic chronic pancreatitis. Mol Med 2016; 22:300-309. [PMID: 27264265 DOI: 10.2119/molmed.2016.00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Rationale: Genetic features of Chronic Pancreatitis (CP) have been extensively investigated mainly testing genes associated to the trypsinogen activation pathway. However, different molecular pathways involving other genes may be implicated in CP pathogenesis. Objectives: 80 patients with Idiopathic CP were investigated using Next Generation Sequencing approach with a panel of 70 genes related to six different pancreatic pathways: premature activation of trypsinogen; modifier genes of Cystic Fibrosis phenotype; pancreatic secretion and ion homeostasis; Calcium signalling and zymogen granules exocytosis; autophagy; autoimmune pancreatitis related genes. Results: We detected mutations in 34 out of 70 genes examined; 64/80 patients (80.0%) were positive for mutations in one or more genes, 16/80 patients (20.0%) had no mutations. Mutations in CFTR were detected in 32/80 patients (40.0%) and 22 of them exhibited at least one mutation in genes of other pancreatic pathways. Of the remaining 48 patients, 13/80 (16.3%) had mutations in genes involved in premature activation of trypsinogen and 19/80 (23.8%) had mutations only in genes of the other pathways: 38/64 patients positive for mutations showed variants in two or more genes (59.3%). Conclusions: Our data, although to be extended with functional analysis of novel mutations, suggest a high rate of genetic heterogeneity in chronic pancreatitis and that trans-heterozygosity may predispose to the idiopathic CP phenotype.
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Affiliation(s)
| | - Letizia Da Sacco
- Multifactorial Diseases and Complex Phenotypes Research Area, "Bambino Gesù" Children's Hospital, IRCCS
| | - Cecilia Surace
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Silvia Genovese
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Simona Grotta
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS; Present address: S. Pietro Fatebenefratelli Hospital, UOSD Medical Genetics
| | - Maria Gnazzo
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Laura Ciocca
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Stefano Petrocchi
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Enza Montemitro
- Cystic Fibrosis Unit, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Ausilia Elce
- Ceinge-Biotecnologie avanzate, Naples, Università Telematica Pegaso, Naples, Italy
| | | | - Giuseppe Castaldo
- Ceinge-Biotecnologie avanzate, Naples, Dipartimento di Medicina Molecolare and Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Adriano Angioni
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS, Viale di San Paolo 15, 00146 Rome, Italy, 0668592536
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31
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Common Variants in CLDN2 and MORC4 Genes Confer Disease Susceptibility in Patients with Chronic Pancreatitis. PLoS One 2016; 11:e0147345. [PMID: 26820620 PMCID: PMC4731142 DOI: 10.1371/journal.pone.0147345] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023] Open
Abstract
A recent genome-wide association study (GWAS) identified association with variants in X-linked CLDN2 and MORC4, and PRSS1-PRSS2 loci with chronic pancreatitis (CP) in North American patients of European ancestry. We selected 9 variants from the reported GWAS and replicated the association with CP in Indian patients by genotyping 1807 unrelated Indians of Indo-European ethnicity, including 519 patients with CP and 1288 controls. The etiology of CP was idiopathic in 83.62% and alcoholic in 16.38% of 519 patients. Our study confirmed a significant association of 2 variants in CLDN2 gene (rs4409525-OR 1.71, P = 1.38 x 10-09; rs12008279-OR 1.56, P = 1.53 x 10-04) and 2 variants in MORC4 gene (rs12688220-OR 1.72, P = 9.20 x 10-09; rs6622126-OR 1.75, P = 4.04x10-05) in Indian patients with CP. We also found significant association at PRSS1-PRSS2 locus (OR 0.60; P = 9.92 x 10-06) and SAMD12-TNFRSF11B (OR 0.49, 95% CI [0.31-0.78], P = 0.0027). A variant in the gene MORC4 (rs12688220) showed significant interaction with alcohol (OR for homozygous and heterozygous risk allele -14.62 and 1.51 respectively, P = 0.0068) suggesting gene-environment interaction. A combined analysis of the genes CLDN2 and MORC4 based on an effective risk allele score revealed a higher percentage of individuals homozygous for the risk allele in CP cases with 5.09 fold enhanced risk in individuals with 7 or more effective risk alleles compared with individuals with 3 or less risk alleles (P = 1.88 x 10-14). Genetic variants in CLDN2 and MORC4 genes were associated with CP in Indian patients.
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32
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Shmelev A, Abdo A, Sachdev S, Shah U, Kowdley GC, Cunningham SC. Energetic etiologies of acute pancreatitis: A report of five cases. World J Gastrointest Pathophysiol 2015; 6:243-248. [PMID: 26600983 PMCID: PMC4644889 DOI: 10.4291/wjgp.v6.i4.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/25/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
There are several common causes of acute pancreatitis, principally excessive alcohol intake and gallstones, and there are many rare causes. However, cases of pancreatitis still occur in the absence of any recognizable factors, and these cases of idiopathic pancreatitis suggest the presence of unrecognized etiologies. Five cases of acute pancreatitis in four patients came to attention due to a strong temporal association with exposure to nerve stimulators and energy drinks. Given that these cases of pancreatitis were otherwise unexplained, and given that these exposures were not clearly known to be associated with pancreatitis, we performed a search for precedent cases and for mechanistic bases. No clear precedent cases were found in PubMed and only scant, weak precedent cases were found in public-health databases. However, there was a coherent body of intriguing literature in support of a mechanistic basis for these exposures playing a role in the etiology of pancreatitis.
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33
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Sun C, Liu MY, Liu XG, Hu LH, Xia T, Liao Z, Li ZS. Serine Protease Inhibitor Kazal Type 1 (SPINK1) c.194+2T > C Mutation May Predict Long-term Outcome of Endoscopic Treatments in Idiopathic Chronic Pancreatitis. Medicine (Baltimore) 2015; 94:e2046. [PMID: 26632706 PMCID: PMC5058975 DOI: 10.1097/md.0000000000002046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endoscopic interventional is a commonly used treatment method for idiopathic chronic pancreatitis. Serine protease inhibitor Kazal type 1 (SPINK1) 194+2T>C mutation is most frequently observed in Chinese pancreatitis patients and influences the clinical course of idiopathic chronic pancreatitis patients. We conducted this study to determine the impacts of this mutation on the outcome of endoscopic treatments.In this study, we enrolled 423 patients. Among them, 101 idiopathic chronic pancreatitis patients without other relevant mutations had a successful endoscopic procedure and completed follow-up. Clinical characteristics including Izbicki pain score, exocrine and endocrine function, were evaluated. Genetic sequencing was conducted to detect SPINK1 194+2T>C mutations.The c.194+2T>C mutation was found in 58 (57.43%) patients. Factors relevant to pain relief are c.194+2T>C mutation (P = 0.011), severe pain before treatment (P = 0.005), and necessary subsequent endoscopic treatments (P < 0.001). More patients with the intronic mutation had deteriorated endocrine function (P = 0.001) relative to those patients without the mutation.Patients carrying the c.194+2T>C mutation were less likely to achieve pain relief through endoscopic treatments. They also have a higher risk of endocrine function deterioration. SPINK1 c.194+2T>C mutation may be applied as a pretreatment predictor in idiopathic chronic pancreatitis patients.
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Affiliation(s)
- Chang Sun
- From the Department of Gastroenterology, Changhai Hospital, Second Military Medical University (CS, M-YL, L-HH, TX, ZL, Z-SL); and Changhai Hospital, Second Military Medical University Shanghai, China (X-GL)
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34
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Report of 2 CTRC Intronic Mutations Associated With Acute or Chronic Pancreatitis and Delineation of Their Pathogenic Molecular Mechanisms. Pancreas 2015; 44:999-1001. [PMID: 26166474 DOI: 10.1097/mpa.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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35
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Ruiz-Navas P, Contreras-Ramirez M, Montero-Carvajalino A, Castaño-Jaramillo L, Orozco-Forero J. SPINK1 mutation in a pediatric patient with chronic pancreatitis: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2015. [DOI: 10.1016/j.rgmxen.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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36
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Ruiz-Navas P, Contreras-Ramirez M, Montero-Carvajalino AE, Castaño-Jaramillo LM, Orozco-Forero JP. SPINK1 mutation in a pediatric patient with chronic pancreatitis: A case report. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2015; 80:223-225. [PMID: 25981115 DOI: 10.1016/j.rgmx.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/29/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Affiliation(s)
- P Ruiz-Navas
- Departamento de gastroenterología pediátrica, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - M Contreras-Ramirez
- Departamento de gastroenterología pediátrica, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | - J P Orozco-Forero
- Departamento de Pediatría, Universidad Pontificia Bolivariana, Medellín Colombia
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37
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Koziel D, Gluszek S, Kowalik A, Chlopek M, Pieciak L. Genetic mutations in SPINK1, CFTR, CTRC genes in acute pancreatitis. BMC Gastroenterol 2015; 15:70. [PMID: 26100556 PMCID: PMC4476205 DOI: 10.1186/s12876-015-0302-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 06/16/2015] [Indexed: 12/29/2022] Open
Abstract
Background Explanation of the ultimate causes of acute and chronic pancreatitis is challenging. Hence, it is necessary to seek various etiological factors, including genetic mutations that may be of importance in triggering recurrence and progression of acute to chronic pancreatitis. The aim of this study was to determine the frequency of genetic mutations in patients with acute pancreatitis and to investigate their relationship with the etiology and clinical course. Methods The study included 221 patients treated for acute pancreatitis and 345 healthy subjects as a control group. Peripheral blood samples were collected from each study participant and genomic DNA was isolated. Genotyping of common mutations in the SPINK1 (p.N34S and p.P55S) and CTRC (p.I259V, p.V235I, p.K247_R254del, p.E225A) genes was performed using the high-resolution melting method. Mutations in the CFTR p.F508del (delF508_CTT) were genotyped using allele-specific amplification polymerase chain reaction. All detected mutations were confirmed with direct capillary DNA sequencing. Results Mutations in SPINK 1, CFTR and CTRC were detected in 6.3 %, 2.3 % and 1.8 % of patients with acute pancreatitis versus 3.2 %, 3.8 % and 1.2 % of volunteers in the control group. No relationship was found between the detected mutations and severity of acute pancreatitis: mild acute pancreatitis, mutation of CFTR in 4 (2.8 %) and CTRC in 2 (1.4 %) patients; severe acute pancreatitis, mutation of CFTR and CTRC in 1 (2.6 %) case each. The SPINK1 mutation was significantly more frequent in 8 (10.4 %) severe cases than in 6 (4.2 %) mild cases (P < 0.05), and was observed in 5/70 (7.1 %) patients with alcohol-related AP, 5/81 (6.2 %) with biliary AP, and 4/63 (6.3 %) in those without any established cause of the disease. Conclusions Mutation p.N34S in SPINK1 may predispose patients to acute pancreatitis, especially in those abusing alcohol, and may promote a more severe course of the disease.
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Affiliation(s)
- Dorota Koziel
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland.
| | - Stanislaw Gluszek
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland. .,Clinic General Oncological and Endocrinological Surgery, Regional Hospital, Kielce, Poland.
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Centre, Kielce, Poland.
| | - Malgorzata Chlopek
- Department of Molecular Diagnostics, Holy Cross Cancer Centre, Kielce, Poland.
| | - Liliana Pieciak
- Department of Molecular Diagnostics, Holy Cross Cancer Centre, Kielce, Poland.
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38
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Nakano E, Masamune A, Niihori T, Kume K, Hamada S, Aoki Y, Matsubara Y, Shimosegawa T. Targeted next-generation sequencing effectively analyzed the cystic fibrosis transmembrane conductance regulator gene in pancreatitis. Dig Dis Sci 2015; 60:1297-307. [PMID: 25492507 DOI: 10.1007/s10620-014-3476-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cystic fibrosis transmembrane conductance regulator (CFTR) gene, responsible for the development of cystic fibrosis, is known as a pancreatitis susceptibility gene. Direct DNA sequencing of PCR-amplified CFTR gene segments is a first-line method to detect unknown mutations, but it is a tedious and labor-intensive endeavor given the large size of the gene (27 exons, 1,480 amino acids). Next-generation sequencing (NGS) is becoming standardized, reducing the cost of DNA sequencing, and enabling the generation of millions of reads per run. We here report a comprehensive analysis of CFTR variants in Japanese patients with chronic pancreatitis using NGS coupling with target capture. METHODS Exon sequences of the CFTR gene from 193 patients with chronic pancreatitis (121 idiopathic, 46 alcoholic, 17 hereditary, and nine familial) were captured by HaloPlex target enrichment technology, followed by NGS. RESULTS The sequencing data covered 91.6 % of the coding regions of the CFTR gene by ≥ 20 reads with a mean read depth of 449. We could identify 12 non-synonymous variants including three novel ones [c.A1231G (p.K411E), c.1753G>T (p.E585X) and c.2869delC (p.L957fs)] and seven synonymous variants including three novel ones in the exonic regions. The frequencies of the c.4056G>C (p.Q1352H) and the c.3468G>T (p.L1156F) variants were higher in patients with chronic pancreatitis than those in controls. CONCLUSIONS Target sequence capture combined with NGS is an effective method for the analysis of pancreatitis susceptibility genes.
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Affiliation(s)
- Eriko Nakano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Lin K, Gao F, Chen Q, Liu Q, Chen S. Framework for interpretation of trypsin-antitrypsin imbalance and genetic heterogeneity in pancreatitis. Saudi J Gastroenterol 2015; 21:198-207. [PMID: 26228362 PMCID: PMC4542417 DOI: 10.4103/1319-3767.161643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Early intracellular premature trypsinogen activation was interpreted as the key initiator of pancreatitis. When the balance in the homeostasis of trypsin and antitrypsin system is disequilibrated, elevated aggressive enzymes directly attack the pancreatic tissue, which leads to pancreatic destruction and inflammation. However, trypsin alone is not enough to cause complications in pancreatitis, which may play a crucial role in modulating signaling events in the initial phase of the disease. NFκB activation is the major inflammatory pathway involved in the occurrence and development of pancreatitis and it can be induced by intrapancreatic activation of trypsinogen. Synthesis of trypsinogen occurs in endoplasmic reticulum (ER), and ER stress is an important early acinar cell event. Components of ER stress response are known to be able to trigger cell death as well as NFκB signaling cascade. The strongest evidence supporting the trypsin-centered theory is that gene mutations, which lead to the generation of more trypsin, or reduce the activity of trypsin inhibitors or trypsin degradation, are associated with pancreatitis. Thus, trypsin-antitrypsin imbalance may be the first step leading to pancreatic autodigestion and inducing other pathways. Continued experimental studies are necessary to determine the specific relationships between trypsin-antitrypsin imbalance and genetic heterogeneity in pancreatitis. In this article, we review the latest advances that contributed to the understanding of the basic mechanisms behind the occurrence and development of pancreatitis with a focus on the interpretation of trypsin-antitrypsin imbalance and their relationships with other inflammation pathways. We additionally highlight genetic predispositions to pancreatitis and possible mechanisms associated with them.
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Affiliation(s)
- Kun Lin
- Department of Laboratory Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Gao
- Department of Pathology, The First Affiliated Hospital, Fuzhou, China,Address for correspondence: Dr. Feng Gao, Department of Pathology, The First Affiliated Hospital, Fujian Medical University, Fuzhou - 350005, China. E-mail:
| | - Qingquan Chen
- Department of Laboratory Medicines, The First Affiliated Hospital, Fuzhou, China
| | - Qicai Liu
- Department of Laboratory Medicines, The First Affiliated Hospital, Fuzhou, China
| | - Shu Chen
- Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou, China
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