Acute pancreatitis

Maintenance Impact of Large Dose of Vitamin C on Proinflammatory Cytokines, Insulin, and Electrocardiographic Parameters of Wistar Rats Following Partial Pancreatectomy

We investigated serum tumor necrosis factor alpha (TNF-α) and interleukins (IL-6 and IL-8) in rats undergoing pancreatic wound healing after partial pancreatectomy. In addition, we studied the effects of partial pancreatectomy on the insulin and the electrocardiography (ECG). We proposed that vitamin C (VitC) could have maintenance impact on TNF-α, IL-6, IL-8, insulin, and ECG parameters of pancreatic wound healing of Wistar rats that had partial pancreatectomy surgery, if administered in large dose. Thirty-five male adult Wistar rats (180-250 g) were randomized into 7 groups, with 5 rats in each group. Group 1 was control. Groups 2, 3, and 4 (phase 1) received oral 1,000 mg/kg VitC, while groups 5, 6, and 7 (phase 2) received only water and feed ad libitum postoperatively for 14 days. One-quarter (¼) pancreatectomy was performed in groups 2 and 5, half (½) pancreatectomy was performed in groups 3 and 6, and three-quarter (¾) pancreatectomy was performed in groups 4 and 7. Significant (P < 0.5) decrease in IL-6 was observed in phase 1 when compared with the control. Significant increase in IL-6 was observed when compared with control. Significant increase in IL-8 was observed in phase 1 (groups 2 and 3) and phase 2 when compared with the control. Significant decrease in TNF-α was observed in phase 1 when compared with the control. Significant decrease in TNF-α was observed in phase 2 (groups 6 and 7) when compared with the control. Insulin level decreased and increased insignificantly in phase 2 and phase 1, respectively, when compared with the control. Although atrial fibrillation was recorded in phase 2 (group 7), normal ECG was seen in the control and phase 1 (group 2). Large dose vitC may be helpful in the reduction of proinflammatory cytokines as well as elevation of insulin and normalization of ECG in rats that had undergone partial pancreatectomy.

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

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

Beneficial effects of Emblica officinalis in L-arginine-induced acute pancreatitis in rats

Acute necrotizing pancreatitis is characterized by focal macroscopic or diffuse necrosis, hemorrhage, and vascular thrombosis of the pancreas. Current treatment options are limited to supportive and symptomatic interventions. A large amount of experimental work is ongoing to identify novel therapeutic agents for acute pancreatitis. The present study was carried out to explore the beneficial effects of Emblica officinalis, a medicinal plant of India, on acute pancreatitis. Ascorbic acid is one of the major chemical components of E. officinalis, so a vitamin C group was included for comparison. Acute pancreatitis was induced by L-arginine. Rats were divided into the following groups: control (saline), arginine + saline, arginine + E. officinalis, and arginine + vitamin C. Animals in each group were sacrificed at 24 hours and 3, 14, and 28 days after pancreatitis induction for determination of biochemical parameters and histological examination. For rate of DNA synthesis and immunohistochemical studies, animals were sacrificed on Day 3 and Day 7. Drug administration was started 2 hours after the last arginine injection and continued until the day of sacrifice. E. officinalis treatment was found to be beneficial for treating acute pancreatitis. Serum levels of lipase and interleukin-10 were significantly lower than in the arginine group. Nucleic acid content, rate of DNA synthesis, pancreatic proteins, and pancreatic amylase content were significantly improved. Histopathological examination showed significantly lower total scores in the Emblica group. Vitamin C was found to be less efficacious than E. officinalis for all outcome parameters. Thus E. officinalis treatment was found to be beneficial in acute necrotizing pancreatitis.

Therapeutic small-volume resuscitation preserves pancreatic microcirculation in acute experimental pancreatitis of graded severity in rats

BACKGROUND

Microcirculatory disorders play a major part in the pathogenesis of acute pancreatitis. Improvement of microcirculation is hypothesized to open a therapeutic window. The aim of this study was to evaluate the effects of small-volume resuscitation in acute pancreatitis.

METHODS

In rats, acute pancreatitis of graded severity was induced and pancreatic microcirculation was observed in vivo with an epiluminescent microscope. Primary outcome measures were microcirculation, leukocyte adherence, concentration of trypsinogen-activating peptide, amylase activity and histopathologic tissue damage.

RESULTS

In necrotizing pancreatitis patients receiving prophylactic intervention with 7.5% hypertonic saline the functional capillary density was 76%. Postcapillary venular leukocyte adherence was 45% of vein cross-section. The median histopathologic damage scored 8 points. In controls, a complete microcirculatory breakdown was observed, and in the group with therapeutic intervention no significant difference was detected. In intermediate pancreatitis, the number of perfused capillaries remained 55.0 versus 23.3% in controls. Leukocyte adherence was 40.0 versus 51.7%. The histopathologic damage scored 6.0 versus 9.0 points. Trypsinogen-activating peptide concentration was reduced to 164 versus 402 nM in controls. In cerulein pancreatitis, the number of perfused capillaries was equally preserved in both groups.

CONCLUSION

Small-volume resuscitation preserves capillary microcirculation and prevents pancreatic injury in intermediate necrotizing pancreatitis.

Extrapancreatic organ impairment during acute pancreatitis induced by bile-pancreatic duct obstruction. Effect of N-acetylcysteine

Multiple organ failure is frequently associated with acute pancreatitis (AP). Our aim was to study pulmonary, hepatic and renal complications developed in the course of AP experimentally induced in rats by bile-pancreatic duct obstruction (BPDO), differentiating the complications caused by AP itself, from those directly caused by bile duct obstruction (BDO), after ligating the choledocus. N-acetylcysteine (NAC) was administered as a therapeutic approach. Myeloperoxidase activity revealed neutrophil infiltration in lungs from 12 h after BDO, even if AP was not triggered. Lactate dehydrogenase (LDH) activity indicated hepatocyte death from 48 h after BDO, and from 24 h following BPDO-induced AP onwards, an effect delayed until 48 h by NAC treatment. Rats with single cholestasis (BDO) and rats with BPDO-induced AP showed a significant increase in plasma aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin concentration from 12 h onwards, whose values were reduced by NAC treatment at early BPDO. No renal failure was found during 120 h of bile-pancreatic obstruction. Our results showed lung and liver impairment as a result of BDO, even if AP does not develop. Pancreatic damage and extrapancreatic complications during AP induced by BPDO were palliated by NAC treatment.

Importance of the liver in systemic complications associated with acute pancreatitis: the role of Kupffer cells

Although its exact nature is still unknown, acute pancreatitis progresses with a local production of inflammatory mediators, eventually leading to systemic inflammatory response syndrome. Knowing that almost all pancreatic mediators released from the pancreas to the bloodstream may pass through the liver before their dilution in the systemic circulation, it would be reasonable to assume a determinant role for this organ in the development of the inflammatory response associated with acute pancreatitis. Thus, recent studies have shown the involvement of the liver in the complex network of events triggering the multiorgan dysfunction associated with the disease. Once pancreatic mediators reach the liver, they strongly activate Kupffer cells, the resident macrophages, greatly amplifying the release of cytokines into the bloodstream and thus contributing to the systemic manifestations of acute pancreatitis. Altogether, these results show that the pancreas is not the only source of mediators that trigger the deleterious effects of acute pancreatitis, but that the liver may orchestrate the final outcome of the disease. The purpose of this review is to discuss progress in understanding the function of the liver in the early stages of the development of systemic organ dysfunction secondary to acute pancreatitis.

Disturbances of the microcirculation in acute pancreatitis

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Pancreatitis causing death in bulimia nervosa

OBJECTIVE

We report the case of a 19-year-old woman with bulimia nervosa who died of acute hemorrhagic pancreatitis. Our objective is to raise awareness that because the symptoms of both conditions are very similar, the pre-existence of an eating disorder should not distract physicians from the possibility that potentially lethal acute pancreatitis may coexist.

METHOD

The study includes autopsy results and a review of the literature.

RESULTS

Pancreatitis usually presents with abdominal pain, nausea, and vomiting.

DISCUSSION

In patients with eating disorders who may already have exhibited these symptoms pancreatitis may not be considered. Elevated serum amylase values may occur in subjects with bulimia nervosa without pancreatitis. If the serum amylase value is elevated, pancreatitis can be confirmed by measuring the levels of serum lipase, trypsinogen, pancreatic isoenzyme of amylase, or by abdominal computerized tomography (CT).

Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms

AIM: To observe the therapeutic efficacy of high-dose Vitamin C (Vit. C) on acute pancreatitis (AP), and to explore its potential mechanisms.

METHODS: Eghty-four AP patients were divided into treatment group and control group, 40 healthy subjects were taken as a normal group. In the treatment group, Vit. C (10 g/d) was given intravenously for 5 d, whereas in the control group, Vit. C (1 g/d) was given intravenously for 5 d. Symptoms, physical signs, duration of hospitalization, complications and mortality rate were monitored. Meanwhile, serum amylase, urine amylase and leukocyte counts were also determined. The concentration of plasma vitamin C (P-VC), plasma lipid peroxide (P-LPO), plasma vitamin E (P-VE), plasma β-carotene (P-β-CAR), whole blood glutathione (WB-GSH) and the activity of erythrocyte surperoxide dimutase (E-SOD) and erythrocyte catalase (E-CAT) as well as T lymphocyte phenotype were measured by spectrophotometry in the normal group and before and after treatment with Vit. C in the treatment and the control group.

RESULTS: Compared with the normal group, the average values of P-VC, P-VE, P-β-CAR, WB-GSH and the activity of E-SOD and E-CAT in AP patients were significantly decreased and the average value of P-LPO was significantly increased, especially in severe acute pancreatitis (SAP) patients (P < 0.05. P-VC, P = 0.045; P-VE, P = 0.038; P = 0.041; P-β-CAR, P = 0.046; WB-GSH, P = 0.039; E-SOD, P = 0.019; E-CAT, P = 0.020; P-LPO, P = 0.038). Compared with the normal group, CD₃ and CD₄ positive cells in AP patients were significantly decreased. The ratio of CD₄/CD₈ and CD₄ positive cells were decreased, especially in SAP patients (P < 0.05. CD₄/CD₈, P = 0.041; CD₄, P = 0.019). Fever and vomiting disappeared, and leukocyte counts and amylase in urine and blood become normal quicker in the treatment group than in the control group. Moreover, patients in treatment group also had a higher cure rate, a lower complication rate and a shorter in-ward days compared with those in he control group. After treatment, the average value of P-VC was significantly higher and the values of SIL-2R, TNF-α, IL-6 and IL-8 were significantly lower in the treatment group than in the control group (P < 0.05 P-VC, P = 0.045; SIL-2R, P = 0.012; TNF-α, P = 0.030; IL-6, P = 0.015; and IL-8, P = 0.043). In addition, the ratio of CD₄/CD₈ and CD₄ positive cells in the patients of treatment group were significantly higher than that of the control group after treatment (P < 0.05. CD₄/CD₈, P = 0.039; CD₄, P = 0.024).

CONCLUSION: High-dose vitamin C has therapeutic efficacy on acute pancreatitis. The potential mechanisms include promotion of anti-oxidizing ability of AP patients, blocking of lipid peroxidation in the plasma and improvement of cellular immune function.

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