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Fan H, Fang N, Yang B, Xian H, Li Z. Fluorescence lifetime imaging of human pancreatic lipase activity using a novel probe for early diagnosis of severe acute pancreatitis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 326:125171. [PMID: 39332173 DOI: 10.1016/j.saa.2024.125171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/30/2024] [Accepted: 09/18/2024] [Indexed: 09/29/2024]
Abstract
Severe Acute Pancreatitis, a serious condition caused by factors such as gallstones and chronic excessive alcohol consumption, with a very high mortality rate. Human pancreatic lipase (hPL) is a key digestive enzyme and abnormal activity levels of this enzyme are important indicators for diagnosing and monitoring pancreatic diseases. A fluorescent probe, LPP, has been developed to monitor the activity of hPL, especially in cases of SAP. The probe is based on cyanine isoindole derivatives, in vitro experiments confirmed the high specificity and sensitivity of the probe, with a detection limit of 0.012 U/mL, reactions completed within 10 min, and effective monitoring of pancreatic lipase activity in various biological samples. The stability and low cytotoxicity of LPP make it suitable for clinical applications, providing new tools and perspectives for the research and treatment of pancreatic diseases and related metabolic abnormalities. In addition, the change in fluorescence lifetime after the reaction of the probe with lipase allows for fluorescence lifetime imaging (FLIM), effectively monitoring the dynamic changes of hPL and enabling early diagnosis and monitoring of pancreatitis. This research not only enhances the understanding of pancreatic lipase activity detection but also has the potential to improve the diagnostics and treatment of pancreatitis.
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Affiliation(s)
- Haowen Fan
- Affiliated Hospital of Nantong University, Nantong University, 226001 Nantong, China
| | - Ning Fang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, No.163 Xianlin Road, Nanjing 210023, China
| | - Bingbing Yang
- Affiliated Hospital of Nantong University, Nantong University, 226001 Nantong, China
| | - Hua Xian
- Affiliated Hospital of Nantong University, Nantong University, 226001 Nantong, China
| | - Zhen Li
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, No.163 Xianlin Road, Nanjing 210023, China.
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Zhu L, Xu Y, Lei J. Molecular mechanism and potential role of mitophagy in acute pancreatitis. Mol Med 2024; 30:136. [PMID: 39227768 PMCID: PMC11373529 DOI: 10.1186/s10020-024-00903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/20/2024] [Indexed: 09/05/2024] Open
Abstract
Acute pancreatitis (AP) is a multifaceted inflammatory disorder stemming from the aberrant activation of trypsin within the pancreas. Despite the contribution of various factors to the pathogenesis of AP, such as trypsin activation, dysregulated increases in cytosolic Ca2+ levels, inflammatory cascade activation, and mitochondrial dysfunction, the precise molecular mechanisms underlying the disease are still not fully understood. Mitophagy, a cellular process that preserves mitochondrial homeostasis under stress, has emerged as a pivotal player in the context of AP. Research suggests that augmenting mitophagy can mitigate pancreatic injury by clearing away malfunctioning mitochondria. Elucidating the role of mitophagy in AP may pave the way for novel therapeutic strategies. This review article aims to synthesize the current research findings on mitophagy in AP and underscore its significance in the clinical management of the disorder.
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Affiliation(s)
- Lili Zhu
- Department of Pathology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha, China
- Department of Pathophysiology, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China
| | - Yunfei Xu
- Department of Pathophysiology, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China.
- Postdoctoral Research Station of Biology, School of Basic Medical Science, Central South University, Changsha, Hunan, China.
| | - Jian Lei
- Department of Pathology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha, China.
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Meyer ML, Gros L, Décosterd N, Tagliamento M, Marinello A, Planchard D, Combarel D, Barlesi F, Remon J, Besse B, Aldea M. Brief Report: Targeted Therapies and Pancreatitis in Patients With Advanced Nonsmall Cell Lung Cancer. Clin Lung Cancer 2024:S1525-7304(24)00194-3. [PMID: 39332921 DOI: 10.1016/j.cllc.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/19/2024] [Accepted: 08/30/2024] [Indexed: 09/29/2024]
Affiliation(s)
- May-Lucie Meyer
- Gustave Roussy Cancer Center, illejuif, France; Tisch Cancer institute, Mount Sinai, New York, NY
| | - Louis Gros
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place New York, NY
| | - Natalie Décosterd
- Gastroenterology, CHUV, Lausanne Universitary Hospital, Lausanne, Switzerland
| | | | - Arianna Marinello
- Gustave Roussy Cancer Center, illejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - David Planchard
- Gustave Roussy Cancer Center, illejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France
| | | | - Fabrice Barlesi
- Gustave Roussy Cancer Center, illejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Jordi Remon
- Gustave Roussy Cancer Center, illejuif, France
| | - Benjamin Besse
- Gustave Roussy Cancer Center, illejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Mihaela Aldea
- Gustave Roussy Cancer Center, illejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France.
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Jiang W, Li X, Zhang Y, Zhou W. Natural Compounds for the Treatment of Acute Pancreatitis: Novel Anti-Inflammatory Therapies. Biomolecules 2024; 14:1101. [PMID: 39334867 PMCID: PMC11430608 DOI: 10.3390/biom14091101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/11/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024] Open
Abstract
Acute pancreatitis remains a serious public health problem, and the burden of acute pancreatitis is increasing. With significant morbidity and serious complications, appropriate and effective therapies are critical. Great progress has been made in understanding the pathophysiology of acute pancreatitis over the past two decades. However, specific drugs targeting key molecules and pathways involved in acute pancreatitis still require further study. Natural compounds extracted from plants have a variety of biological activities and can inhibit inflammation and oxidative stress in acute pancreatitis by blocking several signaling pathways, such as the nuclear factor kappa-B and mitogen-activated protein kinase pathways. In this article, we review the therapeutic effects of various types of phytochemicals on acute pancreatitis and discuss the mechanism of action of these natural compounds in acute pancreatitis, aiming to provide clearer insights into the treatment of acute pancreatitis.
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Affiliation(s)
- Wenkai Jiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, China; (W.J.); (X.L.)
| | - Xiao Li
- The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, China; (W.J.); (X.L.)
| | - Yi Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou 730030, China;
| | - Wence Zhou
- The Second Clinical Medical College, Lanzhou University, Lanzhou 730030, China; (W.J.); (X.L.)
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5
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Wen S, Zhang Y, Zhao G, Zhang K, Cui Y. Development and Validation of a Clinical Predictive Nomogram for Assessing the Risk of Recurrence of Acute Pancreatitis in Combined Hypertriglyceridemia. Dig Dis Sci 2024; 69:3426-3435. [PMID: 39090447 DOI: 10.1007/s10620-024-08578-4] [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] [Received: 12/22/2023] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The objective of this study is to develop and validate a new nomogram-based scoring system for anticipating the recurrence of acute pancreatitis (AP) in combined hypertriglyceridemia (HTG). METHODS A total of 292 patients diagnosed with AP combined with HTG participated in this research. Among them, 201 patients meeting the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Clinical data were collected for all patients. In the training set, predictive indicators were chosen through backward stepwise multivariable logistic regression analysis. Subsequently, a nomogram was developed based on the selected indicators. Finally, the model's performance was validated in both the training and validation sets. RESULTS By employing backward stepwise multivariable logistic regression analysis, we identified diabetes, gallstones, alcohol consumption, and triglyceride levels as predictive indicators. Subsequently, a clinical nomogram that incorporates these four independent risk factors was constructed. Model validation demonstrated an AUC of 0.726 (95% CI 0.644-0.809) in the training set and an AUC of 0.712 (95% CI 0.583-0.842) in the validation set, indicating a good discriminative ability. The Hosmer-Lemeshow test yielded P-values of 0.882 and 0.536 in the training and validation sets, respectively, suggesting good calibration. Calibration curves further confirmed good agreement. Ultimately, decision curve analysis (DCA) emphasized the clinical utility of our model. CONCLUSION We have developed a nomogram for predicting the recurrence of AP combined with HTG in patients, and this nomogram demonstrates good discriminative ability, calibration, and clinical utility. This tool holds the potential to assist clinicians in offering more personalized treatment strategies for AP combined with HTG.
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Affiliation(s)
| | - Yu Zhang
- Tianjin Medical University, Tianjin, 300070, China
| | - Guijie Zhao
- Tianjin Medical University, Tianjin, 300070, China
| | - Kun Zhang
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, 300100, China
| | - Yunfeng Cui
- Tianjin Medical University, Tianjin, 300070, China.
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, 300100, China.
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Tian X, Zhang Y, Peng M, Hou Y. Regulatory axis of circular RNA DTNB, microRNA-485-5p, and myeloid cell leukemia 1 attenuates inflammation and apoptosis in caerulein-treated AR42J cells. Funct Integr Genomics 2024; 24:140. [PMID: 39160285 DOI: 10.1007/s10142-024-01411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024]
Abstract
Acute pancreatitis (AP) is an inflammatory disease of the pancreas and the main cause of hospital admissions for gastrointestinal diseases. Here, the work studied the circular RNA DTNB/microRNA-485-5p/MCL1 axis in AP and hoped to unravel the related mechanism. Caerulein exposure replicated an AP model in AR42J cells, and caerulein-mediated expression of circDTNB, miR-485-5p, and MCL1 was recorded. After exposure, cells were intervened with transfection plasmids and tested for LDH release, apoptosis, and inflammation. To determine the interwork of circDTNB, miR-485-5p, and MCL1, prediction results and verification experiments were conducted. Caerulein exposure reduced circDTNB and MCL1, while elevated miR-485-5p levels in AR42J cells. Upregulating circDTNB protected AR42J cells from caerulein-induced LDH cytotoxicity, apoptosis, and inflammation, but circDTNB upregulation-induced protections could be muffled by inhibiting MCL1. On the contrary, downregulating circDTNB further damaged AR42J cells under caerulein exposure, however, this phenomenon could be partially rescued after silencing miR-485-5p. miR-485-5p was mechanistically verified to be a target of circDTNB to mediate MCL1. Overall, the circDTNB/miR-485-5p/MCL1 axis protects inflammatory response and apoptosis in caerulein-exposed AR42J cells, promisingly identifying circDTNB as a novel molecule for AP treatment.
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Affiliation(s)
- Xiao Tian
- Department of Critical Care Medicine, Zibo Central Hospital, No. 10, Shanghai Road, Zhangdian District, Zibo City, Shangdong Province, 255000, China
| | - Yun Zhang
- Department of Critical Care Medicine, Zibo Central Hospital, No. 10, Shanghai Road, Zhangdian District, Zibo City, Shangdong Province, 255000, China
| | - MiaoMiao Peng
- Department of Critical Care Medicine, Zibo Central Hospital, No. 10, Shanghai Road, Zhangdian District, Zibo City, Shangdong Province, 255000, China
| | - YuXi Hou
- Department of Critical Care Medicine, Zibo Central Hospital, No. 10, Shanghai Road, Zhangdian District, Zibo City, Shangdong Province, 255000, China.
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Luo W, Chen L, Sun H, Zhang S, Dong X, Pan J, Xiao W, Lu G, Wang Y, Xu H. Soat2 inhibitor avasimibe alleviates acute pancreatitis by suppressing acinar cell ferroptosis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:5989-5999. [PMID: 38376541 DOI: 10.1007/s00210-024-03013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Ferroptosis, characterized by lipid peroxidation, plays a significant role in the pathogenesis of acute pancreatitis (AP). While sterol O-acyltransferase 2 (Soat2) is known for its crucial regulatory role in cholesterol homeostasis, its involvement in the development of AP remains unreported. We conducted this study to identify the pivotal role of Soat2 in AP using transcriptomic databases. Subsequently, we confirmed its alterations through both in vitro and in vivo experimental models. Furthermore, we performed intervention with the Soat2 inhibitor avasimibe to evaluate pancreatic tissue pathology and serum enzymatic levels and observe inflammatory cell infiltration through immunohistochemistry. Additionally, changes in indicators related to ferroptosis were also observed. The results showed that in the AP mouse model, the protein and mRNA levels of Soat2 were significantly increased. Following avasimibe administration, there was a decrease in serum amylase levels, reduction in pancreatic tissue pathological damage, and attenuation of inflammatory cell infiltration. Furthermore, avasimibe administration resulted in downregulation of ferroptosis-related indicators. In conclusion, our findings suggest that the Soat2 inhibitor avasimibe protects against AP in mice through inhibition of the ferroptosis.
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Affiliation(s)
- Weiwei Luo
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Lin Chen
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Hui Sun
- Department of General Surgery, Gaoyou People's Hospital, Yangzhou, Jiangsu, China
| | - Siqin Zhang
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiaowu Dong
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Jiajia Pan
- Department of Intensive Care, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Weiming Xiao
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guotao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Gastroenterology, Pancreatic Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yaodong Wang
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Affiliated Hospital of Yangzhou University, Kunshan, Jiangsu, China.
| | - Hongwei Xu
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Affiliated Hospital of Yangzhou University, Kunshan, Jiangsu, China.
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Wang Y, Qian D, Wang X, Zhang X, Li Z, Meng X, Yu L, Yan X, He Z. Biomimetic Trypsin-Responsive Structure-Bridged Mesoporous Organosilica Nanomedicine for Precise Treatment of Acute Pancreatitis. ACS NANO 2024; 18:19283-19302. [PMID: 38990194 DOI: 10.1021/acsnano.4c05369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Developing strategies to target injured pancreatic acinar cells (PACs) in conjunction with primary pathophysiology-specific pharmacological therapy presents a challenge in the management of acute pancreatitis (AP). We designed and synthesized a trypsin-cleavable organosilica precursor bridged by arginine-based amide bonds, leveraging trypsin's ability to selectively identify guanidino groups on arginine via Asp189 at the active S1 pocket and cleave the carboxy-terminal (C-terminal) amide bond via catalytic triads. The precursors were incorporated into the framework of mesoporous silica nanoparticles (MSNs) for encapsulating the membrane-permeable Ca2+ chelator BAPTA-AM with a high loading content (∼43.9%). Mesenchymal stem cell membrane coating and surface modification with PAC-targeting ligands endow MSNs with inflammation recruitment and precise PAC-targeting abilities, resulting in the highest distribution at 3 h in the pancreas with 4.7-fold more accumulation than that of naked MSNs. The outcomes transpired as follows: After bioinspired MSNs' skeleton biodegradation by prematurely and massively activated trypsin, BAPTA-AM was on-demand released in injured PACs, thereby effectively eliminating intracellular calcium overload (reduced Ca2+ level by 81.3%), restoring cellular redox status, blocking inflammatory cascades, and inhibiting cell necrosis by impeding the IκBα/NF-κB/TNF-α/IL-6 and CaMK-II/p-RIP3/p-MLKL/caspase-8,9 signaling pathways. In AP mice, a single dose of the formulation significantly restored pancreatic function (lipase and amylase reduced more by 60%) and improved the survival rate from 50 to 91.6%. The formulation offers a potentially effective strategy for clinical translation in AP treatment.
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Affiliation(s)
- Yanan Wang
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- Sanya Oceanographic Institution, Sanya 572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Deyao Qian
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Xinyuan Wang
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Xue Zhang
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Zerui Li
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Xinlei Meng
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Liangmin Yu
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- Sanya Oceanographic Institution, Sanya 572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Xuefeng Yan
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
| | - Zhiyu He
- Frontiers Science Center for Deep Ocean Multispheres and Earth Systems, Key Laboratory of Marine Chemistry Theory and Technology, Ministry of Education/Sanya Oceanographic Institution, Ocean University of China, Qingdao/Sanya 266100/572024, China
- Sanya Oceanographic Institution, Sanya 572024, China
- College of Chemistry and Chemical Engineering, Ocean University of China, 266100 Qingdao, China
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Liu X, Zheng Y, Meng Z, Wang H, Zhang Y, Xue D. Gene Regulation of Neutrophils Mediated Liver and Lung Injury through NETosis in Acute Pancreatitis. Inflammation 2024:10.1007/s10753-024-02071-w. [PMID: 38884700 DOI: 10.1007/s10753-024-02071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/18/2024] [Accepted: 05/30/2024] [Indexed: 06/18/2024]
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, often resulting in self-digestion, edema, hemorrhage, and even necrosis of pancreatic tissue. When AP progresses to severe acute pancreatitis (SAP), it often causes multi-organ damage, leading to a high mortality rate. However, the molecular mechanisms underlying SAP-mediated organ damage remain unclear. This study aims to systematically mine SAP data from public databases and combine experimental validation to identify key molecules involved in multi-organ damage caused by SAP. Retrieve transcriptomic data of mice pancreatic tissue for AP, lung and liver tissue for SAP, and corresponding normal tissue from the Gene Expression Omnibus (GEO) database. Conduct gene differential analysis using Limma and DEseq2 methods. Perform enrichment analysis using the clusterProfiler package in R software. Score immune cells and immune status in various organs using single-sample gene set enrichment analysis (ssGSEA). Evaluate mRNA expression levels of core genes using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Validate serum amylase, TNF-α, IL-1β, and IL-6 levels in peripheral blood using enzyme-linked immunosorbent assay (ELISA), and detect the formation of neutrophil extracellular traps (NETs) in mice pancreatic, liver, and lung tissues using immunofluorescence. Differential analysis reveals that 46 genes exhibit expression dysregulation in mice pancreatic tissue for AP, liver and lung tissue for SAP, as well as peripheral blood in humans. Functional enrichment analysis indicates that these genes are primarily associated with neutrophil-related biological processes. ROC curve analysis indicates that 12 neutrophil-related genes have diagnostic potential for SAP. Immune infiltration analysis reveals high neutrophil infiltration in various organs affected by SAP. Single-cell sequencing analysis shows that these genes are predominantly expressed in neutrophils and macrophages. FPR1, ITGAM, and C5AR1 are identified as key genes involved in the formation of NETs and activation of neutrophils. qPCR and IHC results demonstrate upregulation of FPR1, ITGAM, and C5AR1 expression in pancreatic, liver, and lung tissues of mice with SAP. Immunofluorescence staining shows increased levels of neutrophils and NETs in SAP mice. Inhibition of NETs formation can alleviate the severity of SAP as well as the levels of inflammation in the liver and lung tissues. This study identified key genes involved in the formation of NETs, namely FPR1, ITGAM, and C5AR1, which are upregulated during multi-organ damage in SAP. Inhibition of NETs release effectively reduces the systemic inflammatory response and liver-lung damage in SAP. This research provides new therapeutic targets for the multi-organ damage associated with SAP.
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Affiliation(s)
- Xuxu Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yi Zheng
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ziang Meng
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Heming Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingmei Zhang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Dongbo Xue
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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10
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Yang K, Song Y, Su Y, Li C, Ding N. Establishment and Validation of an Early Predictive Model for Severe Acute Pancreatitis. J Inflamm Res 2024; 17:3551-3561. [PMID: 38855164 PMCID: PMC11162219 DOI: 10.2147/jir.s457199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/14/2024] [Indexed: 06/11/2024] Open
Abstract
Objective The purpose of this study is to establishment and validation of an early predictive model for severe acute pancreatitis (SAP). Methods From January 2015 to August 2022, 2986 AP patients admitted to Changsha Central Hospital were enrolled in this study. They were randomly divided into a modeling group (n = 2112) and a validation group (n = 874). In the modeling group, identify risk factors through logistic regression models and draw column charts. Use internal validation method to verify the accuracy of column chart prediction. Apply calibration curves to evaluate the consistency between nomograms and ideal observations. Draw a DCA curve to evaluate the net benefits of the prediction model. Results Nine variables including respiratory rate, heart rate, WBC, PDW, PT, SCR, AMY, CK, and TG are the risk factors for SAP. The column chart risk prediction model which was constructed based on these 9 independent factors has high prediction accuracy (modeling group AUC = 0.788, validation group AUC = 7.789). The calibration curve analysis shows that the prediction probabilities of the modeling and validation groups are consistent with the observation probabilities. By drawing a DCA curve, it shows that the model has a wide threshold range (0.01-0.88). Conclusion The study developed an intuitive nomogram containing readily available laboratory parameters to predict the incidence rate of SAP.
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Affiliation(s)
- Kongzhi Yang
- Department of Emergency Medicine, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China
| | - Yaqin Song
- Department of Emergency Medicine, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China
| | - Yingjie Su
- Department of Emergency Medicine, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China
| | - Changluo Li
- Department of Emergency Medicine, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China
| | - Ning Ding
- Department of Emergency Medicine, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China
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Qin X, Xiang S, Li W. Analysis of factors influencing onset and survival of patients with severe acute pancreatitis: A clinical study. Immun Inflamm Dis 2024; 12:e1267. [PMID: 38888384 PMCID: PMC11184643 DOI: 10.1002/iid3.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Acute pancreatitis (AP) is an inflammatory disease of the pancreas, and the prognosis of severe AP (SAP) is poor. The study aimed to identify promising biomarkers for predicting the occurrence and survival outcome of SAP patients. MATERIALS AND METHODS Two hundred and forty AP patients were retrospectively recruited, in which 72 cases with SAP. Blood test was done for collection of laboratory indicators. After treatment, the mortality of patients was recorded. RESULTS Patients in the SAP group had higher intensive care unit admissions and longer hospital stays (p < .001). Among laboratory parameters, significantly high values of C-reactive protein (CRP), triglycerides and glucose (TyG) index, Von willebrand factor antigen (vWF:Ag) and D-dimer were found in SAP groups relative to non-SAP ones. Receiver operating characteristic curve indicated the good performance of CRP, TyG index, vWF:Ag and D-dimer in SAP diagnosis. Among all SAP cases, 51 survived while 21 died. TyG index (odds ratio [OR] = 6.914, 95% confidence interval [CI] = 1.193-40.068, p = .028), vWF:Ag (OR = 7.441, 95% CI = 1.236-244.815, p = .028), and D-dimer (OR = 7.987, 95% CI = 1.251-50.997, p = .028) were significantly related to survival outcome of SAP patients by multiple logistic regression analysis. Both TyG index and vWF showed favorable efficiency in predicting overall prognosis. The area under the curve for the multivariate model (PRE = -35.908 + 2.764 × TyG + 0.021 × vWF:Ag) was 0.909 which was greater than 0.9, indicating its excellent performance in prognosis prediction. CONCLUSION CRP, TyG index, vWF:Ag, and D-dimer values on admission may be potential clinical predictors of the development of SAP. Moreover, TyG index and vWF:Ag may be helpful to predict survival outcome.
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Affiliation(s)
- Xiaoli Qin
- Gastroenterology DepartmentThe Third Affiliated Hospital of CQMUChongqingChina
| | - Shili Xiang
- Gastroenterology DepartmentThe Third Affiliated Hospital of CQMUChongqingChina
| | - Wenjing Li
- Gastroenterology DepartmentThe Third Affiliated Hospital of CQMUChongqingChina
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12
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Xu M, Feng Y, Xiang X, Liu L, Tang G. MZB1 regulates cellular proliferation, mitochondrial dysfunction, and inflammation and targets the PI3K-Akt signaling pathway in acute pancreatitis. Cell Signal 2024; 118:111143. [PMID: 38508349 DOI: 10.1016/j.cellsig.2024.111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) is a pathological condition characterized by the premature release and activation of trypsinogens and other enzyme precursors. In severe cases, the mortality rates are in the range of 20-30% and may even be as high as 50%. Though various prophylaxes are available for AP, the mechanism of its progression is unclear. Marginal zone B and B-1 cell-specific protein 1 (MZB1) is found in the endoplasmic reticulum (ER) where it is expressed exclusively in the B cells there. MZB1 promotes proliferation, inhibits apoptosis, invasion, and inflammation, and mitigates mitochondrial damage in cells. However, the importance of MZB1 in AP has not yet been determined. METHODS Differentially expressed genes (DEGs) between healthy pancreatic cells and those affected by AP were identified using datasets from Gene Expression Omnibus (GEO) datasets. Relative differences in MZB1 expression between normal and diseased tissues and cells were validated in vivo using a rat AP model induced with 4% (w/v) sodium taurocholate and in vitro using the AR42J rat pancreatic cell line exposed to caerulein (CAE). Cell Counting Kit-8 (CCK-8) and 5-ethynyl-2`-deoxyuridine (EdU) assays were performed to detect and compare normal and pathological cell proliferation. Flow cytometry was employed to assess and compare cellular apoptosis. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blot (WB) were applied to evaluate the apoptotic factors Bax and Bcl. The inflammatory factors interleukin (IL)-6 and IL-1β were quantified using Enzyme-linked immunosorbent assay (ELISA) and qRT-PCR techniques. Mitochondrial function was evaluated using assays for reactive oxygen species (ROS) and tetramethylrhodamine methyl ester (TMRM). WB and qRT-PCR were utilized to measure the expression levels of the PI3K-Akt signaling pathway, followed by a rescue experiment involving the inhibitor of wortmannin. RESULTS MZB1 was upregulated in the AP cases screened from the GEO datasets, the rat AP model, and the AR42J cells exposed to CAE. Overexpression of MZB1 enhanced the growth and supressed the cell death of AR42J cells while also activating the PI3K-Akt signaling pathway. MZB1 knockdown led to mitochondrial dysfunction and exacerbated inflammation. The rescue experiment demonstrated that MZB1 enhanced proliferation and inhibited apoptosis, mitochondrial dysfunction, and inflammation in pancreatic cells through the PI3K-Akt pathway. CONCLUSIONS AP cells and tissues exhibited markedly elevated levels of MZB1 expression compared to their healthy counterparts. MZB1 overexpression promoted proliferation and supressed apoptosis, mitochondrial dysfunction, and inflammation in pancreatic cells through the positive regulation of the PI3K-Akt signaling pathway.
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Affiliation(s)
- Mengtao Xu
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Yong Feng
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xuelian Xiang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Li Liu
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Guodu Tang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Zeng Y, Liu X, Yi Q, Qiao G, Wang L, Chen L, Fan L, Li Y, Duan L, Huang L, Zhuang Q, Zhou Y, Xiong Y. Free total rhubarb anthraquinones protect intestinal mucosal barrier of SAP rats via inhibiting the NLRP3/caspase-1/GSDMD pyroptotic pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117873. [PMID: 38346523 DOI: 10.1016/j.jep.2024.117873] [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: 10/31/2023] [Revised: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rhubarb is the peeled and dried roots of Rheum palmatum L. and Rheum tanguticum Maxim. ex Balf. or Rheum officinale Baill. Free total rhubarb anthraquinones (FTRAs) were isolated and extracted from rhubarb. Previous studies have revealed that the early administration of FTRAs protects the intestinal mucosal barrier in rats with severe acute pancreatitis (SAP), the mechanism of which is not yet clear. However, we observed an enhanced expression of intestinal pyroptotic factors in rats treated with SAP, which may be related to the mechanism of intestinal barrier protection by FTRAs. AIM OF THE STUDY The main objective of this study was to investigate the mechanism by which FTRAs protect the intestinal mucosal barrier in SAP rats, focusing on the classical pyroptosis pathway. MATERIALS AND METHODS SAP was induced in rats through retrograde injection of sodium taurocholate via the pancreaticobiliary duct. Subsequently, FTRAs (22.5, 45, and 90 mg/kg), rhubarb (900 mg/kg, positive control), and saline (control) were administered at 0 h (immediately), 12 h, and 24 h post-surgery. Pancreatic and intestinal tissue injury, positive PI staining rate, and expression levels of various factors in intestinal tissues were compared across different groups. These factors include diamine oxidase (DAO), lactate dehydrogenase (LDH), high mobility group box chromosomal protein 1(HMGB1) and pro-inflammatory factors in intestinal and serum, pyroptosis-associated factors, toll-like receptor 4 (TLR-4), nuclear factor kappa-B (NF-kB), apoptosis-associated speck-like protein (ASC), NOD-like receptor protein 3 (NLRP3), cysteine protease-1 (caspase-1) and Gasdermin (GSDMD). RESULTS The findings indicated that FTRAs protected the damaged intestine and pancreas and restored the expression of intestinal epithelial junction proteins in SAP rats. Additionally, it reduced intestinal and serum levels of DAO, interleukin 1, interleukin 18, HMGB1, and LDH, attenuated intestinal Positive PI staining rate, and significantly decreased the expressions of TLR-4, NF-kB, ASC, NLRP3, caspase-1 and GSDMD in SAP rats. CONCLUSIONS The results suggest that FTRAs inhibited pyroptosis through down-regulation of the NLRP3-Caspase-1-GSDMD and TLR-4- NF-kB signaling pathways of intestinal tissues., thereby protecting the intestinal barrier of SAP rats.
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Affiliation(s)
- Yue Zeng
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China; Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, 618000, China
| | - Xingyu Liu
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Qing Yi
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Gan Qiao
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Lulu Wang
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Li Chen
- Department of Pharmacy, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Ling Fan
- Department of Pharmacy, People's Hospital of Ya'an, Ya'an, 625000, China
| | - Yao Li
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Lingjing Duan
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Liqiang Huang
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China; Department of Pharmacy, Second People's Hospital of Yibin, Yibin, 644000, China
| | - Qian Zhuang
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Yejiang Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
| | - Yuxia Xiong
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China.
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Zhu J, Wu L, Wang Y, Fang M, Liu Q, Zhang X. Predictive value of the Ranson and BISAP scoring systems for the severity and prognosis of acute pancreatitis: A systematic review and meta-analysis. PLoS One 2024; 19:e0302046. [PMID: 38687745 PMCID: PMC11060534 DOI: 10.1371/journal.pone.0302046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To systematically assess and compare the predictive value of the Ranson and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems for the severity and prognosis of acute pancreatitis (AP). METHODS PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until February 15, 2023. Outcomes in this analysis included severity and prognosis [mortality, organ failure, pancreatic necrosis, and intensive care unit (ICU) admission]. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the quality of diagnostic accuracy studies. The threshold effect was evaluated for each outcome. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve (AUC) as well as 95% confidence intervals (CI) were calculated. The DeLong test was used for AUC comparisons. For the outcome evaluated by over 9 studies, publication bias was assessed using the Deeks' funnel plot asymmetry test. RESULTS Totally 17 studies of 5476 AP patients were included. For severity, the pooled sensitivity of the Ranson and BISAP was 0.95 (95%CI: 0.87, 0.98) and 0.67 (95%CI: 0.27, 0.92); the pooled specificity of the Ranson and BISAP was 0.74 (0.52, 0.88) and 0.95 (95%CI: 0.85, 0.98); the pooled AUC of the Ranson and BISAP was 0.95 (95%CI: 0.93, 0.97) and 0.94 (95%CI: 0.92, 0.96) (P = 0.480). For mortality, the pooled sensitivity of the Ranson and BISAP was 0.89 (95%CI: 0.73, 0.96) and 0.77 (95%CI: 0.58, 0.89); the pooled specificity of the Ranson and BISAP was 0.79 (95%CI: 0.68, 0.87) and 0.90 (95%CI: 0.86, 0.93); the pooled AUC of the Ranson and BISAP was 0.91 (95%CI: 0.88, 0.93) and 0.92 (95%CI: 0.90, 0.94) (P = 0.480). For organ failure, the pooled sensitivity of the Ranson and BISAP was 0.84 (95%CI: 0.76, 0.90) and 0.78 (95%CI: 0.60, 0.90); the pooled specificity of the Ranson and BISAP was 0.84 (95%CI: 0.63, 0.94) and 0.90 (95%CI: 0.72, 0.97); the pooled AUC of the Ranson and BISAP was 0.86 (95%CI: 0.82, 0.88) and 0.90 (95%CI: 0.87, 0.93) (P = 0.110). For pancreatic necrosis, the pooled sensitivity of the Ranson and BISAP was 0.63 (95%CI: 0.35, 0.84) and 0.63 (95%CI: 0.23, 0.90); the pooled specificity of the Ranson and BISAP was 0.90 (95%CI: 0.77, 0.96) and 0.93 (95%CI: 0.89, 0.96); the pooled AUC of the Ranson and BISAP was 0.87 (95%CI: 0.84, 0.90) and 0.93 (95%CI: 0.91, 0.95) (P = 0.001). For ICU admission, the pooled sensitivity of the Ranson and BISAP was 0.86 (95%CI: 0.77, 0.92) and 0.63 (95%CI: 0.52, 0.73); the pooled specificity of the Ranson and BISAP was 0.58 (95%CI: 0.55, 0.61) and 0.84 (95%CI: 0.81, 0.86); the pooled AUC of the Ranson and BISAP was 0.92 (95%CI: 0.81, 1.00) and 0.86 (95%CI: 0.67, 1.00) (P = 0.592). CONCLUSION The Ranson score was an applicable tool for predicting severity and prognosis of AP patients with reliable diagnostic accuracy in resource and time-limited settings. Future large-scale studies are needed to verify the findings.
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Affiliation(s)
- Jianpeng Zhu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Linfei Wu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yue Wang
- Zhejiang University of Medicine, Hangzhou, Zhejiang, China
| | - Mengdie Fang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiang Liu
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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15
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Zheng P, Li XY, Yang XY, Wang H, Ding L, He C, Wan JH, Ke HJ, Lu NH, Li NS, Zhu Y. Comparative transcriptomic analysis reveals the molecular changes of acute pancreatitis in experimental models. World J Gastroenterol 2024; 30:2038-2058. [PMID: 38681131 PMCID: PMC11045495 DOI: 10.3748/wjg.v30.i14.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Acute pancreatitis (AP) encompasses a spectrum of pancreatic inflammatory conditions, ranging from mild inflammation to severe pancreatic necrosis and multisystem organ failure. Given the challenges associated with obtaining human pancreatic samples, research on AP predominantly relies on animal models. In this study, we aimed to elucidate the fundamental molecular mechanisms underlying AP using various AP models. AIM To investigate the shared molecular changes underlying the development of AP across varying severity levels. METHODS AP was induced in animal models through treatment with caerulein alone or in combination with lipopolysaccharide (LPS). Additionally, using Ptf1α to drive the specific expression of the hM3 promoter in pancreatic acinar cells transgenic C57BL/6J- hM3/Ptf1α(cre) mice were administered Clozapine N-oxide to induce AP. Subsequently, we conducted RNA sequencing of pancreatic tissues and validated the expression of significantly different genes using the Gene Expression Omnibus (GEO) database. RESULTS Caerulein-induced AP showed severe inflammation and edema, which were exacerbated when combined with LPS and accompanied by partial pancreatic tissue necrosis. Compared with the control group, RNA sequencing analysis revealed 880 significantly differentially expressed genes in the caerulein model and 885 in the caerulein combined with the LPS model. Kyoto Encyclopedia of Genes and Genomes enrichment analysis and Gene Set Enrichment Analysis indicated substantial enrichment of the TLR and NOD-like receptor signaling pathway, TLR signaling pathway, and NF-κB signaling pathway, alongside elevated levels of apoptosis-related pathways, such as apoptosis, P53 pathway, and phagosome pathway. The significantly elevated genes in the TLR and NOD-like receptor signaling pathways, as well as in the apoptosis pathway, were validated through quantitative real-time PCR experiments in animal models. Validation from the GEO database revealed that only MYD88 concurred in both mouse pancreatic tissue and human AP peripheral blood, while TLR1, TLR7, RIPK3, and OAS2 genes exhibited marked elevation in human AP. The genes TUBA1A and GADD45A played significant roles in apoptosis within human AP. The transgenic mouse model hM3/Ptf1α(cre) successfully validated significant differential genes in the TLR and NOD-like receptor signaling pathways as well as the apoptosis pathway, indicating that these pathways represent shared pathological processes in AP across different models. CONCLUSION The TLR and NOD receptor signaling pathways play crucial roles in the inflammatory progression of AP, notably the MYD88 gene. Apoptosis holds a central position in the necrotic processes of AP, with TUBA1A and GADD45A genes exhibiting prominence in human AP.
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Affiliation(s)
- Pan Zheng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xue-Yang Li
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yu Yang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Huan Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ling Ding
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Cong He
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jian-Hua Wan
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hua-Jing Ke
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Nong-Hua Lu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Nian-Shuang Li
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yin Zhu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
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16
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Dai JJ, He Y, Ma G, Hu YY, Jiang MJ. Insulin Use Is Associated With Improved Outcomes in Critically Ill Patients With Acute Pancreatitis: A Retrospective Matched Cohort Study. J Intensive Care Med 2024; 39:368-373. [PMID: 37877179 DOI: 10.1177/08850666231210237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Severe acute pancreatitis (SAP) has a mortality of 30% with no current targeted therapy. The potential protective effect of insulin on AP has been reported and needs to be confirmed. Thus, we aim to examine the effect of insulin treatment on the outcome of AP patients. METHODS A retrospective study was performed using data from the Medical Information Mart for Intensive Care (MIMIC) database. Kruskal-Wallis test, t-tests, and Pearson's chi-squared test were used to compare differences between groups. Propensity score matching and further nearest neighbor matching were used to construct a matched cohort. Cox proportional hazards regression analyses, logistic regression analyses, and the doubly robust estimation method were used to assess the relationship between insulin use and mortality. RESULTS Nine hundred patients were enrolled in the final analysis. Insulin was associated with better outcomes in AP patients admitted to ICU, and could act as an independent predictor for 30-day mortality (HR = 0.36, 95% CI = 0.24-0.55). Subgroup analysis showed that AP patients with heart failure or without kidney disease or respiratory failure may not benefit from insulin treatment. CONCLUSIONS Insulin treatment is independently associated with lower 30-day mortality in AP patients, except for those with heart failure or without kidney disease or respiratory failure.
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Affiliation(s)
- Juan-Juan Dai
- Department of Intensive Care Unit, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan He
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Ma
- Department of Intensive Care Unit, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yang-Yang Hu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Ming-Jie Jiang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Liu W, Wang X, Zhao S, Yang S, Zheng X, Gong F, Pei L, Xu D, Li R, Yang Z, Mao E, Chen E, Chen Y. Unraveling the immunological landscape in acute pancreatitis progression to sepsis: insights from a Mendelian randomization study on immune cell traits. Front Immunol 2024; 15:1374787. [PMID: 38601150 PMCID: PMC11004341 DOI: 10.3389/fimmu.2024.1374787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Background Acute pancreatitis (AP) is a severe digestive system disorder with a significant risk of progressing to sepsis, a major cause of mortality. Unraveling the immunological pathways in AP is essential for developing effective treatments, particularly understanding the role of specific immune cell traits in this progression. Methods Employing a bidirectional two-sample Mendelian Randomization (MR) approach, this study first examined the causal relationship between AP and 731 immune cell traits to identify those significantly associated with AP. Subsequently, we explored the causal associations between 731 immune cell traits and sepsis. The analysis utilized extensive genome-wide association studies (GWAS) summary datasets, with a focus on identifying common immune cell traits with statistically significant causal associations between AP and sepsis. Results Our investigation identified 44 immune cell traits unidirectionally associated with AP and 36 traits unidirectionally associated with sepsis. Among these, CD127 on CD28+ CD45RA- CD8+ T cells emerged as a common mediator, accounting for 5.296% of the increased risk of sepsis in AP patients. This finding highlights the significant role of specific memory CD8+ T cells in the pathophysiology of AP and its progression to sepsis. Conclusion This study elucidates the critical role of specific immune cell traits, particularly CD127hi memory CD8+ T cells, in the progression of AP to sepsis. Our findings provide a foundation for future research into targeted immune-modulatory therapies, potentially improving patient outcomes in AP-related sepsis and offering new insights into the complex immunological dynamics of this condition.
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Affiliation(s)
- Wenbin Liu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanzhi Zhao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangtao Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangchen Gong
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Pei
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Xu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ranran Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang L, Larki NR, Dobkin J, Salgado S, Ahmad N, Kaplan DE, Yang W, Yang YX. A Clinical Prediction Model to Assess Risk for Pancreatic Cancer Among Patients With Acute Pancreatitis. Pancreas 2024; 53:e254-e259. [PMID: 38266222 PMCID: PMC11214820 DOI: 10.1097/mpa.0000000000002295] [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: 01/26/2024]
Abstract
OBJECTIVES We aimed to develop and validate a prediction model as the first step in a sequential screening strategy to identify acute pancreatitis (AP) individuals at risk for pancreatic cancer (PC). MATERIALS AND METHODS We performed a population-based retrospective cohort study among individuals 40 years or older with a hospitalization for AP in the US Veterans Health Administration. For variable selection, we used least absolute shrinkage and selection operator regression with 10-fold cross-validation to identify a parsimonious logistic regression model for predicting the outcome, PC diagnosed within 2 years after AP. We evaluated model discrimination and calibration. RESULTS Among 51,613 eligible study patients with AP, 801 individuals were diagnosed with PC within 2 years. The final model (area under the receiver operating curve, 0.70; 95% confidence interval, 0.67-0.73) included histories of gallstones, pancreatic cyst, alcohol use, smoking, and levels of bilirubin, triglycerides, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and albumin. If the predicted risk threshold was set at 2% over 2 years, 20.3% of the AP population would undergo definitive screening, identifying nearly 50% of PC associated with AP. CONCLUSIONS We developed a prediction model using widely available clinical factors to identify high-risk patients with PC-associated AP, the first step in a sequential screening strategy.
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Affiliation(s)
- Louise Wang
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Navid Rahimi Larki
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jane Dobkin
- Columbia Irving Medical Center, New York City, NY
| | - Sanjay Salgado
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Nuzhat Ahmad
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
| | - David E. Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA
| | - Yu-Xiao Yang
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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19
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Wang LJ, Jin YL, Pei WL, Li JC, Zhang RL, Wang JJ, Lin W. Amuc_1100 pretreatment alleviates acute pancreatitis in a mouse model through regulating gut microbiota and inhibiting inflammatory infiltration. Acta Pharmacol Sin 2024; 45:570-580. [PMID: 38012292 PMCID: PMC10834448 DOI: 10.1038/s41401-023-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023] Open
Abstract
Amuc_1100 is a membrane protein from Akkermansia muciniphila, which has been found to play a role in host immunological homeostasis in the gastrointestinal tract by activating TLR2 and TLR4. In this study we investigated the effects and underlying mechanisms of Amuc_1100 on acute pancreatitis (AP) induced in mice by intraperitoneal injection of caerulein and lipopolysaccharide (LPS). The mice were treated with the protein Amuc_1100 (3 μg, i.g.) for 20 days before caerulein injection. Cecal contents of the mice were collected for 16S rRNA sequencing. We found that pretreatment with Amuc_1100 significantly alleviated AP-associated pancreatic injury, reduced serum amylase and lipase. Amuc_1100 pretreatment significantly inhibited the expression of proinflammatory cytokines (TNF-α, IL-1β, IFN-γ and IL-6) in spleen and pancreas through inhibiting NF-κB signaling pathway. Moreover, Amuc_1100 pretreatment significantly decreased the inflammatory infiltration, accompanied by the reduction of Ly6C+ macrophages and neutrophils in the spleen of AP mice. Gut microbiome analysis showed that the abundance of Bacteroidetes, Proteobacteria, Desulfobacterota and Campilobacterota was decreased, while the proportion of Firmicutes and Actinobacteriota was increased in AP mice pretreated with Amuc_1100. We further demonstrated that Amuc_1100 pretreatment restored the enrichment of tryptophan metabolism, which was mediated by intestinal flora. These results provide new evidence that Amuc_1100 lessens the severity of AP through its anti-inflammatory properties with a reduction of macrophages and neutrophil infiltration, as well as its regulation of the composition of intestinal flora and tryptophan metabolism.
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Affiliation(s)
- Li-Juan Wang
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Yuan-Ling Jin
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Wen-Long Pei
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Jia-Cong Li
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Rui-Lin Zhang
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jia-Ju Wang
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Wei Lin
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China.
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
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20
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Li X, Zhang Y, Wang W, Meng Y, Chen H, Chu G, Li H, Qi X. An inflammation-based model for identifying severe acute pancreatitis: a single-center retrospective study. BMC Gastroenterol 2024; 24:63. [PMID: 38317108 PMCID: PMC10840143 DOI: 10.1186/s12876-024-03148-4] [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: 07/07/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND AIMS Severe acute pancreatitis (SAP) is potentially lethal. Considering the role of inflammation in the progression of acute pancreatitis (AP), this study aims to develop a model based on inflammatory indexes for identifying the presence of SAP. METHODS Overall, 253 patients with AP who were consecutively admitted between July 2018 and November 2020 were screened, of whom 60 had SAP. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-platelet ratio (NPR), systemic inflammation response index (SIRI), platelet-to-albumin ratio (PAR), C-reactive protein-to-albumin ratio (CAR), C-reactive protein-to-lymphocyte ratio (CLR), and triglyceride glucose (TyG) index were calculated. Multivariate logistic regression analyses were performed to identify independent risk factors of SAP. Then, inflammation-based models were established. Receiver operating characteristics (ROC) curve analyses were performed. Area under ROC curve (AUROC) was calculated. RESULTS Diabetes mellitus, fatty liver, high white blood cell count (WBC), C-reactive protein (CRP), red blood cell distribution width (RDW), procalcitonin (PCT), SII, NLR, NPR, CAR, CLR, and TyG index, and a low LMR were significantly associated with SAP. Considering the collinearity among these variables, 10 multivariate logistic regression analyses were separately performed. Finally, four independent inflammation-based models were established. Of them, the best one, which was calculated as follows: 1.204*fatty liver (yes = 1; no = 0) + 0.419*PCT + 0.005*CLR - 2.629, had an AUROC of 0.795 with a specificity of 73.4% and a sensitivity of 71.7%. CONCLUSION The inflammation-based model consisting of fatty liver, PCT, and CLR has a good diagnostic performance for SAP.
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Affiliation(s)
- Xiaotong Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Yiyan Zhang
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Weiwei Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Yao Meng
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Huimin Chen
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Guiyang Chu
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Information Section of Medical Security Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China.
- Postgraduate College, China Medical University, Shenyang, China.
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
- Postgraduate College, Dalian Medical University, Dalian, China.
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China.
- Postgraduate College, China Medical University, Shenyang, China.
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
- Postgraduate College, Dalian Medical University, Dalian, China.
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21
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Zhou R, Wu Q, Yang Z, Cai Y, Wang D, Wu D. The Role of the Gut Microbiome in the Development of Acute Pancreatitis. Int J Mol Sci 2024; 25:1159. [PMID: 38256232 PMCID: PMC10816839 DOI: 10.3390/ijms25021159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
With the explosion research on the gut microbiome in the recent years, much insight has been accumulated in comprehending the crosstalk between the gut microbiota community and host health. Acute pancreatitis (AP) is one of the gastrointestinal diseases associated with significant morbidity and subsequent mortality. Studies have elucidated that gut microbiota are engaged in the pathological process of AP. Herein, we summarize the major roles of the gut microbiome in the development of AP. We then portray the association between dysbiosis of the gut microbiota and the severity of AP. Finally, we illustrate the promises and challenges that arise when seeking to incorporate the microbiome in acute pancreatitis treatment.
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Affiliation(s)
- Ruilin Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (R.Z.); (Z.Y.); (Y.C.)
| | - Qingyang Wu
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (Q.W.); (D.W.)
| | - Zihan Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (R.Z.); (Z.Y.); (Y.C.)
| | - Yanna Cai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (R.Z.); (Z.Y.); (Y.C.)
| | - Duan Wang
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (Q.W.); (D.W.)
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (R.Z.); (Z.Y.); (Y.C.)
- Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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22
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Hong J, Li Q, Wang Y, Xiang L, Zhou Y, Fan M, Lin R. Comparison of Fluid Resuscitation with Lactate Ringer's Versus Normal Saline in Acute Pancreatitis: An Updated Meta-Analysis. Dig Dis Sci 2024; 69:262-274. [PMID: 38015322 DOI: 10.1007/s10620-023-08187-7] [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] [Received: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Fluid resuscitation is one of the main therapies for acute pancreatitis (AP). There is still no consensus on the type of fluid resuscitation. This study investigated the differences between lactate Ringer's (LR) and normal saline (NS) in treating AP. METHODS Two authors systematically searched Web of Science, Embase (via OVID), Cochrane Library, and PubMed to find all published research before July, 2023. The odds of moderately severe/severe AP and intensive care unit (ICU) admission are set as primary endpoints. RESULTS This meta-analysis included 5 RCTs and 4 observational studies with 1424 AP patients in LR (n = 651) and NS (n = 773) groups. The results suggested that the odds of moderately severe/severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001) and ICU admission (OR 0.37; 95%Cl 0.16 to 0.87; P = 0.02) were lower in the LR group compared to NS group. In addition, the LR group had lower rates of local complications (OR 0.54; 95%Cl 0.32 to 0.92; P = 0.02), lower level of CRP, as well as a shorter hospital stay (WMD, - 1.09 days; 95%Cl - 1.72 to - 0.47 days; P < 0.001) than the NS group. Other outcomes, such as mortality, the rate of organ failure, SIRS, acute fluid collection, pancreatic necrosis, pseudocysts, and volume overload, did not differ significantly between two groups (P > 0.05). CONCLUSIONS LR is preferred over NS as it decreases the odds of moderately severe/severe AP, the rate of ICU admission, local complication, and length of hospital stay. However, large-scale RCT are lacking to support these evidence.
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Affiliation(s)
- Jiaze Hong
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qingyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiran Wang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lizhi Xiang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifu Zhou
- Department of Neurosurgery, Affiliated Hospital, Shaoxing University, Shaoxing, China
| | - Mengke Fan
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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23
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Kanaparthy NS, Loza AJ, Hauser RG. Crawling toward obsolescence: The extended lifespan of amylase for pancreatitis. PLoS One 2023; 18:e0296180. [PMID: 38127992 PMCID: PMC10734915 DOI: 10.1371/journal.pone.0296180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The correlation between hyperamylasemia and acute pancreatitis was discovered in 1929, yet another test, lipase, was shown to provide better diagnostic performance in the late 1980s and early 1990s. Subsequent studies demonstrated co-ordering amylase with lipase did not provide additional benefit, only added cost. We sought to investigate the impact of studies advocating for the obsolescence of amylase on its clinical demand. We reviewed 1.3 million reportable results for amylase over 14 years (2009-2022). The trend in utilization of amylase over this period declined by 66% along a linear trajectory (R2 = 0.97). Despite demand for amylase decreasing by an average of 17,003 tests per year, the last year of the study (2022) recorded over 100,000 results for amylase. By interpolating the decline of amylase until the utilization reached zero, we calculated amylase orders will continue for 6 more years until 2028. Tests for creatinine and lipase changed <3% over the same period. Despite a multitude of studies advocating for the obsolescence of amylase, robust demand continues. Many important clinical guidelines, a source many practicing physicians rely on, have yet to acknowledge the preference for lipase over amylase. They frequently treat the two tests as equivalent, neglecting their head-to-head comparison studies and subsequent studies advocating against co-ordering both tests simultaneously. To expedite the obsolescence of amylase, which we anticipate lasting 46 years in our case study from its initial call for obsolescence to the last orders placed, metrics created specifically to monitor the utilization of unnecessary tests are also needed.
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Affiliation(s)
- Naga Sasidhar Kanaparthy
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Veterans Affairs Connecticut Healthcare, West Haven, Connecticut, United States of America
| | - Andrew J. Loza
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Veterans Affairs Connecticut Healthcare, West Haven, Connecticut, United States of America
| | - Ronald George Hauser
- Veterans Affairs Connecticut Healthcare, West Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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24
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Wang J, Xu C, Xu H, Wang R, Su T, Zhao S. Single-Cell RNA Sequencing Reveals Roles of Fibroblasts During Intestinal Injury and Repair in Rats with Severe Acute Pancreatitis. J Inflamm Res 2023; 16:6073-6086. [PMID: 38107381 PMCID: PMC10725699 DOI: 10.2147/jir.s436511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To explore the molecular mechanisms of intestinal injury and treatment by analyzing changes in cellular heterogeneity and composition in rat ileal tissue during injury and treatment processes. Methods We constructed a rat model of SAP and evaluated treatment with an injected of monoacylglycerol lipase (MAGL) inhibitor (JZL184) solution using three experimental groups: healthy male Sprague-Dawley (SD) rats injected with vehicle (CON), male SD SAP model rats injected with vehicle (SAP), and male SAP rats injected with JZL184. We obtained and prepared a single-cell suspension of ileal tissue of each rat for single-cell transcriptome sequencing. Results This project classified changes in cellular heterogeneity and composition in rat ileal tissue during SAP-induced intestinal injury and MAGL treatment. We found that the number of fibroblast clusters was decreased in the SAP group relative to the CON group, and increased after JZL184 treatment. Further analysis of differences in gene expression between cell clusters in each group reveals that fibroblasts had the greatest number of differentially expressed genes. Most notably, expression of genes involved in communication between cells was found to vary during SAP-induced intestinal injury and JZL184 treatment. Among these changes, the degree of difference in expression of genes involved in communication between fibroblasts and other cells was the highest, indicating that fibroblasts in rat ileal tissue affect intestinal injury and repair through cell-to-cell communication. In addition, our results reveal that differentially expressed RNA-binding proteins in fibroblasts may affect their functions in intestinal injury and treatment by affecting the expression of genes regulating communication between cells. Conclusion These findings emphasize the importance of understanding the interactions between fibroblasts and other cells in the context of intestinal injury, providing valuable insights for further exploring molecular mechanisms and insight for discovering new treatment targets and strategies.
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Affiliation(s)
- Jing Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Changqin Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Hongwei Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Ruixia Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Tong Su
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
| | - Shulei Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China
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25
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Niu M, Zhang X, Wu Z, Li B, Bao J, Dai J, Yang Z, Zeng Y, Li L, Pandol S, Sutton R, Wen L. Neutrophil-specific ORAI1 Calcium Channel Inhibition Reduces Pancreatitis-associated Acute Lung Injury. FUNCTION 2023; 5:zqad061. [PMID: 38020066 PMCID: PMC10666672 DOI: 10.1093/function/zqad061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Acute pancreatitis is initiated within pancreatic exocrine cells and sustained by dysregulated systemic inflammatory responses mediated by neutrophils. Store-operated Ca2+ entry (SOCE) through ORAI1 channels in pancreatic acinar cells triggers acute pancreatitis, and ORAI1 inhibitors ameliorate experimental acute pancreatitis, but the role of ORAI1 in pancreatitis-associated acute lung injury has not been determined. Here, we showed mice with pancreas-specific deletion of Orai1 (Orai1ΔPdx1, ∼70% reduction in the expression of Orai1) are protected against pancreatic tissue damage and immune cell infiltration, but not pancreatitis-associated acute lung injury, suggesting the involvement of unknown cells that may cause such injury through SOCE via ORAI1. Genetic (Orai1ΔMRP8) or pharmacological inhibition of ORAI1 in murine and human neutrophils decreased Ca2+ influx and impaired chemotaxis, reactive oxygen species production, and neutrophil extracellular trap formation. Unlike pancreas-specific Orai1 deletion, mice with neutrophil-specific deletion of Orai1 (Orai1ΔMRP8) were protected against pancreatitis- and sepsis-associated lung cytokine release and injury, but not pancreatic injury in experimental acute pancreatitis. These results define critical differences between contributions from different cell types to either pancreatic or systemic organ injury in acute pancreatitis. Our findings suggest that any therapy for acute pancreatitis that targets multiple rather than single cell types is more likely to be effective.
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Affiliation(s)
- Mengya Niu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Xiuli Zhang
- Center for Biomarker Discovery and Validation, National Infrastructures for Translational Medicine (PUMCH), Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Zengkai Wu
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Bin Li
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Jingpiao Bao
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Juanjuan Dai
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Zihan Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Yue Zeng
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Liang Li
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Stephen Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Li Wen
- Center for Biomarker Discovery and Validation, National Infrastructures for Translational Medicine (PUMCH), Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- State Key Laboratory of Complex, Severe, and Rare Diseases, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
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26
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Cammarata F, Rovati L, Fontana P, Gambitta P, Armellino A, Aseni P. Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review. Diagnostics (Basel) 2023; 13:3256. [PMID: 37892077 PMCID: PMC10606009 DOI: 10.3390/diagnostics13203256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/24/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP's enigma and advancing diagnostic and therapeutic strategies.
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Affiliation(s)
- Francesco Cammarata
- Department of General Surgery, Ospedale Luigi Sacco, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Lucrezia Rovati
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Paola Fontana
- Department of Gastroenterology, ASST Ovest Milanese, 20025 Legnano, Italy; (P.F.); (P.G.)
| | - Pietro Gambitta
- Department of Gastroenterology, ASST Ovest Milanese, 20025 Legnano, Italy; (P.F.); (P.G.)
| | - Antonio Armellino
- Endoscopy Division, Ospedale San Leopoldo Mandic di Merate, ASST Lecco, 23807 Lecco, Italy;
| | - Paolo Aseni
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy
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27
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Bischof MCM, Stadelmann MIE, Janett S, Bianchetti MG, Camozzi P, Goeggel Simonetti B, Lava SAG, Milani GP. Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review. J Clin Med 2023; 12:6044. [PMID: 37762984 PMCID: PMC10531745 DOI: 10.3390/jcm12186044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Long-term medication with valproic acid has been associated with acute pancreatitis. The purpose of this report is to gain insight into the features of this pancreatitis. A preregistered literature search (CRD42023438294) was performed on the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar. Patients with alcohol abuse disorder, gallstone disease, hypertriglyceridemia or hypercalcemia, patients with acute valproic acid intoxication, and patients with a pre-existing pancreatitis were excluded. For the final analysis, we retained 73 reports published between 1979 and 2023, which described 125 subjects (83 children and 42 adults predominantly affected by an epilepsy) with an acute pancreatitis related to valproic acid. The diagnosis was made 11 (3.0-24) months (median and interquartile range) after starting valproic acid. One hundred and five cases (84%) recovered and twenty (16%) died. Sex, age, dosage or circulating level of valproic acid, latency time, prevalence of intellectual disability, and antiepileptic co-medication were similar in cases with and without a lethal outcome. Nineteen subjects were rechallenged with valproic acid after recovery: sixteen (84%) cases developed a further episode of pancreatitis. In conclusion, pancreatitis associated with valproic acid presents at any time during treatment and has a high fatality rate.
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Affiliation(s)
- Monica C. M. Bischof
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Mariana I. E. Stadelmann
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Simone Janett
- Department of Pneumology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Sleep Center, Neurocenter of the Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Mario G. Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Pietro Camozzi
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Barbara Goeggel Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011 Lausanne, Switzerland;
- Clinical Pharmacology & Therapeutics Group, University College London, London WC1N 3JH, UK
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Guo J, Hong J, He Y, Li Q, Huang T, Lou D, Zhang J. Comparison of early aggressive versus nonaggressive fluid resuscitation in acute pancreatitis: a meta-analysis. Therap Adv Gastroenterol 2023; 16:17562848231192144. [PMID: 37655061 PMCID: PMC10467253 DOI: 10.1177/17562848231192144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background Early fluid resuscitation is one of the main therapeutic strategies for acute pancreatitis (AP). This study investigated the effects of early aggressive and nonaggressive hydration on AP. Objectives The aim of this meta-analysis is to investigate the differences between aggressive and nonaggressive intravenous fluid resuscitation in AP. Design This study was based on publicly available data, all of which have been extracted from previous ethically approved studies. Data sources and methods Two authors systematically searched PubMed, Embase (via OVID), Web of Science, and Cochrane Library to find all published research before February 2023. In-hospital mortality were set as primary endpoints. Results This meta-analysis included seven randomized controlled trials (RCTs) and eight cohort studies with 4072 individuals in nonaggressive (n = 2419) and aggressive (n = 1653) hydration groups. The results showed that patients in the nonaggressive group had a lower mortality rate than those in the aggressive hydration group [relative risks (RR), 0.66; p = 0.02]. Subgroup analysis results showed that patients in the nonaggressive hydration group had lower mortality rates in RCTs (RR, 0.39; p = 0.001), studies conducted in Eastern countries (RR, 0.63; p = 0.002), and studies with severe pancreatitis (RR, 0.65; p = 0.02). In addition, the nonaggressive hydration group had lower rates of infection (RR, 0.62; p < 0.001), organ failure (RR, 0.65; p = 0.02), and shock (RR, 0.21; p = 0.02), as well as a shorter hospital stay (weighted mean difference, -1.63; p = 0.001) than the aggressive hydration group. Conclusions Early nonaggressive fluid resuscitation is associated with lower mortality, lower risk of organ failure and infection, and shorter hospital stays than aggressive fluid resuscitation. Registration prospero registration number CRD42023396388.
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Affiliation(s)
- Jian Guo
- Intensive Care Unit, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, Zhejiang, China
| | - Jiaze Hong
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qingyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tongmin Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Dandi Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jie Zhang
- Emergency Department, Zhuji People’s Hospital, No.9, Jianmin Road, Taozhu Street, Shaoxing, Zhejiang 311899, China
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Chen Y, Tao H, Chen R, Pan Y, Wang J, Gao R, Chen J, Yang J. Biomimetic Nanoparticles Loaded with Ulinastatin for the Targeted Treatment of Acute Pancreatitis. Mol Pharm 2023; 20:4108-4119. [PMID: 37349264 DOI: 10.1021/acs.molpharmaceut.3c00238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Ulinastatin is commonly used in the clinic to treat acute pancreatitis (AP), but its therapeutic effect was limited by the presence of the blood-pancreas barrier (BPB) and low specificity. Here, we prepared a macrophage biomimetic nanoparticle (MU) that delivered ulinastatin to address the above issues. Macrophage membrane was used as a shell for a mixture of PEG-PLGA and ulinastatin. It was found that MU showed good stability and biocompatibility in vitro and in vivo. According to in vivo fluorescence imaging, MU displayed a great inflammation targeting effect both in a subcutaneous inflammation model and in situ pancreatitis mouse model, which was ascribed to the presence of adhesion proteins. In vitro and in vivo results demonstrated that MU have a superior AP treatment effect by inhibiting pro-inflammatory factors and keeping cells viability. It was suggested the MU could provide a new strategy for targeted AP treatment.
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Affiliation(s)
- Yunlong Chen
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Research Laboratory for Biomedical Optics and Molecular Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Haisu Tao
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang 832000, China
| | - Rui Chen
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Biliary Surgical Department of West China Hospital, Sichuan University, Chengdu, Sichuan 610064, China
| | - Yingying Pan
- Research Laboratory for Biomedical Optics and Molecular Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Junfeng Wang
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Rongkang Gao
- Research Laboratory for Biomedical Optics and Molecular Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jingqin Chen
- Research Laboratory for Biomedical Optics and Molecular Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jian Yang
- Department of Hepatobiliary Surgery I, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
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Jiang W, Du Y, Xiang C, Li X, Zhou W. Age-period-cohort analysis of pancreatitis epidemiological trends from 1990 to 2019 and forecasts for 2044: a systematic analysis from the Global Burden of Disease Study 2019. Front Public Health 2023; 11:1118888. [PMID: 37361161 PMCID: PMC10288197 DOI: 10.3389/fpubh.2023.1118888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Pancreatitis poses a serious medical problem worldwide. This study aims to explore the epidemiological trends of pancreatitis from 1990 to 2019, analyze the association between disease burden and age, period and birth cohort, and subsequently present a forecast of pancreatitis incidence and deaths. Methods Epidemiologic data were gathered from the Global Health Data Exchange query tool. Joinpoint regression model was used to calculate the average annual percentage changes (AAPCs). Age-period-cohort analysis was utilized to estimate the independent effects of age, period and birth cohort. We also predicted the global epidemiological trends to 2044. Results Globally, the incident cases and deaths of pancreatitis increased 1.63-and 1.65-fold from 1990 to 2019, respectively. Joinpoint regression analysis showed that the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) decreased over the past three decades. The age effect indicates that older people have higher age-specific incidence and death rates. The period effect on incidence and deaths showed downward trends from 1990 to 2019. The cohort effect demonstrated that incidence and death risk peaked in the earlier birth cohort and were lower in the latest birth cohort. Incident cases and deaths of pancreatitis may significantly increase in the next 25 years. The ASIRs were predicted to slightly increase, while the ASDRs were predicted to decrease. Conclusion Epidemiologic patterns and trends of pancreatitis across age, period and birth cohort may provide novel insight into public health. Limitations of alcohol use and prevention strategies for pancreatitis are necessary to reduce future burden.
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Affiliation(s)
- Wenkai Jiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yan Du
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Caifei Xiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Xin Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Wence Zhou
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
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31
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He K, Gao L, Yang Z, Zhang Y, Hua T, Hu W, Wu D, Ke L. Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials. Chin Med J (Engl) 2023; 136:1166-1173. [PMID: 37185290 PMCID: PMC10278702 DOI: 10.1097/cm9.0000000000002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP. METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions. RESULTS A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions. CONCLUSION For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.
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Affiliation(s)
- Kun He
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lin Gao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210010, China
| | - Zihan Yang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuelun Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tianrui Hua
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wenmo Hu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lu Ke
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210010, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210010, China
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Zheng Z, Cao F, Ding YX, Lu JD, Fu YQ, Liu L, Guo YL, Liu S, Sun HC, Cui YQ, Li F. Acinous cell AR42J-derived exosome miR125b-5p promotes acute pancreatitis exacerbation by inhibiting M2 macrophage polarization via PI3K/AKT signaling pathway. World J Gastrointest Surg 2023; 15:600-620. [PMID: 37206078 PMCID: PMC10190724 DOI: 10.4240/wjgs.v15.i4.600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The incidence rate of acute pancreatitis (AP), which is a pathophysiological process with complex etiology, is increasing globally. miR-125b-5p, a bidirectional regulatory miRNA, is speculated to exhibit anti-tumor activity. However, exosome-derived miR-125b-5p in AP has not been reported.
AIM To elucidate the molecular mechanism of exosome-derived miR-125b-5p promoting AP exacerbation from the perspective of the interaction between immune cells and acinar cells.
METHODS Exosomes derived from AR42J cells were isolated and extracted in active and inactive states by an exosome extraction kit, and were verified via transmission electron microscopy, nanoparticle tracking analysis, and western blotting. RNA sequencing assay technology was used to screen differentially expressed miRNAs in active and inactive AR42J cell lines, and bioinformatics analysis was used to predict downstream target genes of miR-125b-5p. The expression level of miR-125b-5p and insulin-like growth factor 2 (IGF2) in the activated AR42J cell line and AP pancreatic tissue were detected by quantitative real-time polymerase chain reaction and western blots. The changes in the pancreatic inflammatory response in a rat AP model were detected by histopathological methods. Western Blot was used to detect the expression of IGF2, PI3K/AKT signaling pathway proteins, and apoptosis and necrosis related proteins.
RESULTS miR-125b-5p expression was upregulated in the activated AR42J cell line and AP pancreatic tissue, while that of IGF2 was downregulated. In vitro experiments confirmed that miR-125b-5p could promote the death of activated AR42J cells by inducing cell cycle arrest and apoptosis. In addition, miR-125b-5p was found to act on macrophages to promote M1 type polarization and inhibit M2 type polarization, resulting in a massive release of inflammatory factors and reactive oxygen species accumulation. Further research found that miR-125b-5p could inhibit the expression of IGF2 in the PI3K/AKT signaling pathway. Additionally, in vivo experiments revealed that miR-125b-5p can promote the progression of AP in a rat model.
CONCLUSION miR-125b-5p acts on IGF2 in the PI3K/AKT signaling pathway and promotes M1 type polarization and inhibits M2 type polarization of macrophage by inhibiting IGF2 expression, resulting in a large release of pro-inflammatory factors and an inflammatory cascade amplification effect, thus aggravating AP.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiong-Di Lu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuan-Qiao Fu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou 014040, Inner Mongolia Autonomous Region, China
| | - Yu-Lin Guo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Shuang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hai-Chen Sun
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ye-Qing Cui
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Zhu Z, Bhatia M. Inflammation and Organ Injury the Role of Substance P and Its Receptors. Int J Mol Sci 2023; 24:ijms24076140. [PMID: 37047113 PMCID: PMC10094202 DOI: 10.3390/ijms24076140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Tightly controlled inflammation is an indispensable mechanism in the maintenance of cellular and organismal homeostasis in living organisms. However, aberrant inflammation is detrimental and has been suggested as a key contributor to organ injury with different etiologies. Substance P (SP) is a neuropeptide with a robust effect on inflammation. The proinflammatory effects of SP are achieved by activating its functional receptors, namely the neurokinin 1 receptor (NK1R) receptor and mas-related G protein-coupled receptors X member 2 (MRGPRX2) and its murine homolog MRGPRB2. Upon activation, the receptors further signal to several cellular signaling pathways involved in the onset, development, and progression of inflammation. Therefore, excessive SP-NK1R or SP-MRGPRX2/B2 signals have been implicated in the pathogenesis of inflammation-associated organ injury. In this review, we summarize our current knowledge of SP and its receptors and the emerging roles of the SP-NK1R system and the SP-MRGPRX2/B2 system in inflammation and injury in multiple organs resulting from different pathologies. We also briefly discuss the prospect of developing a therapeutic strategy for inflammatory organ injury by disrupting the proinflammatory actions of SP via pharmacological intervention.
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Affiliation(s)
- Zhixing Zhu
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8140, New Zealand
| | - Madhav Bhatia
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8140, New Zealand
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Hidalgo NJ, Pando E, Mata R, Fernandes N, Villasante S, Barros M, Herms D, Blanco L, Balsells J, Charco R. Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients. BMC Gastroenterol 2023; 23:81. [PMID: 36949385 PMCID: PMC10035222 DOI: 10.1186/s12876-023-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Barcelona, Spain.
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain.
| | - Rodrigo Mata
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Nair Fernandes
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Sara Villasante
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Marta Barros
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Daniel Herms
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Laia Blanco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Ramon Charco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
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Li XW, Wang CH, Dai JW, Tsao SH, Wang PH, Tai CC, Chien RN, Shao SC, Lai ECC. Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis. Crit Care 2023; 27:122. [PMID: 36949459 PMCID: PMC10035244 DOI: 10.1186/s13054-023-04401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Current practice guidelines for optimal infusion rates during early intravenous hydration in patients with acute pancreatitis (AP) remain inconsistent. This systematic review and meta-analysis aimed to compare treatment outcomes between aggressive and non-aggressive intravenous hydration in severe and non-severe AP. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs) on November 23, 2022, and hand-searched the reference lists of included RCTs, relevant review articles and clinical guidelines. We included RCTs that compared clinical outcomes from aggressive and non-aggressive intravenous hydration in AP. Meta-analysis was performed using a random-effects model for participants with severe AP and non-severe AP. Our primary outcome was all-cause mortality, and several secondary outcomes included fluid-related complications, clinical improvement and APACHE II scores within 48 h. RESULTS We included a total of 9 RCTs with 953 participants. The meta-analysis indicated that, compared to non-aggressive intravenous hydration, aggressive intravenous hydration significantly increased mortality risk in severe AP (pooled RR: 2.45, 95% CI: 1.37, 4.40), while the result in non-severe AP was inconclusive (pooled RR: 2.26, 95% CI: 0.54, 9.44). However, aggressive intravenous hydration significantly increased fluid-related complication risk in both severe (pooled RR: 2.22, 95% CI 1.36, 3.63) and non-severe AP (pooled RR: 3.25, 95% CI: 1.53, 6.93). The meta-analysis indicated worse APACHE II scores (pooled mean difference: 3.31, 95% CI: 1.79, 4.84) in severe AP, and no increased likelihood of clinical improvement (pooled RR:1.20, 95% CI: 0.63, 2.29) in non-severe AP. Sensitivity analyses including only RCTs with goal-directed fluid therapy after initial fluid resuscitation therapy yielded consistent results. CONCLUSIONS Aggressive intravenous hydration increased the mortality risk in severe AP, and fluid-related complication risk in both severe and non-severe AP. More conservative intravenous fluid resuscitation protocols for AP are suggested.
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Affiliation(s)
- Xiu-Wei Li
- Division of Hepatogastroenterology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ho Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jhih-Wei Dai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shu-Han Tsao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hsi Wang
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rong-Nan Chien
- Division of Hepatogastroenterology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
- Center for Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Guan L, Ding L, Wan J, Xia L, He W, Xiong H, Luo L, Lu N, Zhu Y. Serum triglyceride levels are associated with recurrence in patients with acute hypertriglyceridemic pancreatitis. Front Med (Lausanne) 2023; 10:1079637. [PMID: 37007797 PMCID: PMC10050706 DOI: 10.3389/fmed.2023.1079637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] Open
Abstract
AimTo analyze the clinical profile of patients with acute hypertriglyceridemic pancreatitis (HTGP) and explore risk factors for recurrence.MethodsA retrospective observational study was conducted in patients who experienced an attack of HTGP for the first time. Patients were followed until the recurrence of acute pancreatitis (AP) or 1 year. The detailed clinical profile was compared between patients with or without recurrence. Multivariate logistic regression analysis was conducted to explore independent risk factors for recurrence.ResultsA total of 108 HTGP patients were included in this study with 73.1% being male, and the median age being 37 (interquartile range, IQR, 30.3–44.8) years. Recurrence occurred in 70 patients (64.8%). Compared with the nonrecurrent group, serum triglyceride (TG) levels before discharge [4.1 (2.8,6.3) mmol/L vs. 2.9 (2.2,4.2) mmol/L; p = 0.002], at 1 month [3.7 (2.3,9.7) mmol/L vs. 2.0 (1.4,2.7) mmol/L; p = 0.001], at 6 months [6.1 (3.1,13.1) mmol/L vs. 2.5 (1.1,3.5) mmol/L; p = 0.003] and 12 months [9.6 (3.5,20.0) mmol/L vs. 2.7 (1.6,5.5) mmol/L; p = 0.001] after discharge were higher in the recurrent group. Poor control of TG levels (TG > 3.1 mmol/l) at the 1-month follow-up after discharge and a high Charlson’s Comorbidity Index score (≥ 2 points) increased the risk of recurrence of HTGP.ConclusionHigh TG levels during follow-up and Charlson’s Comorbidity Index score were independently associated with recurrence in patients with HTGP.
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Strum WB, Boland CR. Advances in acute and chronic pancreatitis. World J Gastroenterol 2023; 29:1194-1201. [PMID: 36926670 PMCID: PMC10011955 DOI: 10.3748/wjg.v29.i7.1194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023] Open
Abstract
Acute pancreatitis (AP) and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States. This review of articles published between 2019-2022 (December) from international sources identified four categories of crucial new findings: The report includes (1) New genetic pathogenic mutations (TRPV6); expected genetic outcomes in a Northern European population; (2) a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol; explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis, staging, and treatment; (3) innovations in timing of per os low-fat, solid food intake immediately on admission; resolution of concepts of aggressive parenteral fluid intake; dramatic shifts to non-operative from operative treatment of infected pancreatic necrosis. Each modification reduced interventions, complications, and lengths-of-stay; and (4) authoritarian recommendations for medical treatment of chronic pain. These advances offer opportunities to initiate newly proven treatments to enhance outcomes, alter the natural history, and envision the future of two diseases that have no known cure.
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Affiliation(s)
- Williamson B Strum
- Department of Gastroenterology, Scripps Clinic, La Jolla, CA 92037, United States
| | - Clement Richard Boland
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States
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Mehler PS, Anderson K, Bauschka M, Cost J, Farooq A. Emergency room presentations of people with anorexia nervosa. J Eat Disord 2023; 11:16. [PMID: 36759897 PMCID: PMC9909152 DOI: 10.1186/s40337-023-00742-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
People with anorexia nervosa (AN) tend to shy away from engaging in typical primary care provider relationships in order to avoid detection. Therefore, they may seek care for their medical concerns through a local emergency department (ED). Inherently, AN is associated with a litany of medical complications, which become more prevalent as the severity of their eating disorder increases. Notwithstanding the typical young age at the onset of AN, no body system is immune to these medical complications. Thus, ED providers may need to pursue a medical diagnosis in order to explain presenting symptoms in people with AN. In addition to the medical issues, AN is also a serious mental illness with high mortality rates, including deaths by suicide. Therefore, ED providers also need to be familiar with relevant mental health issues for these people.
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Affiliation(s)
- Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA. .,University of Colorado School of Medicine, Denver, CO, USA.
| | - Kristin Anderson
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeana Cost
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,Eating Recovery Center, Denver, CO, USA
| | - Asma Farooq
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
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Qu Y, Ding Y, Lu J, Jia Y, Bian C, Guo Y, Zheng Z, Mei W, Cao F, Li F. Identification of key microRNAs in exosomes derived from patients with the severe acute pancreatitis. Asian J Surg 2023; 46:337-347. [PMID: 35691812 DOI: 10.1016/j.asjsur.2022.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Exosomes have been identified as important carriers of various genetic materials, including microRNAs (miRNAs). Increasing evidence indicates that the course of severe acute pancreatitis (SAP) is associated with miRNAs transported by exosomes. We aimed to identify the signature miRNAs as biomarkers of SAP. METHODS We obtained exosomes from the SAP patients' blood. After separation, purification, and identification, we performed high-throughput sequencing and screened the differentially expressed(DE) miRNAs in the exosomes. Bioinformatics analysis was performed to identified the target genes of the miRNAs and the pathways enriched based on Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses, and selected the key miRNAs related to SAP. Total RNA was extracted from patient serum exosomes to detect the expression levels of the selected miRNAs in exosomes of three experimental groups (mild -, moderately severe -, and severe AP) and a control group, using Real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS 272 DE miRNAs were identified between SAP and control group. Using bioinformatics analysis, we determined that the functions of the target genes were enriched in six signaling pathways including focal adhesion. Based on this, seven candidate signature miRNAs were selected: miR-603, miR-548ad-5p, miR-122-5p, miR-4477a, miR-192-5p, miR-215-5p, and miR-583. The RT-qPCR results of the seven miRNAs in the SAP group were consistent with the sequencing results. CONCLUSION Exosome-derived miR-603, miR-548ad-5p, miR-122-5p, miR-4477a, miR-192-5p, miR-215-5p, miR-583 are positively correlated with SAP, which might provide new insights into the pathogenesis of SAP and serve as the biomarkers of SAP.
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Affiliation(s)
- Yuanxu Qu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Yixuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Jiongdi Lu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Yuchen Jia
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Chunjing Bian
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Yulin Guo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Wentong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China.
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, PR China.
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Integration of scRNA-Seq and Bulk RNA-Seq Reveals Molecular Characterization of the Immune Microenvironment in Acute Pancreatitis. Biomolecules 2022; 13:biom13010078. [PMID: 36671463 PMCID: PMC9855877 DOI: 10.3390/biom13010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. The pathogenesis of AP is still unclear, and there is currently no specific treatment. A variety of immune cells infiltrate in AP, which may play an important role in the progression of the disease. In this study, for the first time, scRNA-Seq and Bulk RNA-Seq data were used to show the characteristics of immune cell infiltration in AP, and to explore the specific molecular markers of different cell types. The present study also investigated cell-to-cell communication networks using the CellChat package, and AP-specific gene signatures (Clic1, Sat1, Serpina3n, Atf3, Lcn2, Osmr, Ccl9, Hspb1, Anxa2, Krt8, Cd44, Cd9, Hsp90aa1, Tmsb10, Hmox1, Fxyd5, Plin2, Pnp) were identified through integrative analysis of multiple sequencing datasets. We also defined disease-specific associated genes in different cell types, revealing dynamic changes through cell trajectory and pseudo-time analysis using the Monocle2 package. The results showed that macrophages were significantly increased in acute pancreatitis, and the number of interactions and interaction weight/strength of the macrophages in AP were significantly higher than those in the controls. The activities of various signaling pathways were abnormally regulated such as apoptosis, oxidative stress, lysosome, autophagy, ferroptosis, and inflammatory responses signaling pathways. In conclusion, this study comprehensively depicted the immune microenvironment of AP, explored the interaction network between different cell types, and defined AP-specific gene signatures, providing many new directions for basic research in AP.
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Wang LL, Dobkin J, Salgado S, Kaplan DE, Yang YX. Development and validation of case-finding algorithms to identify acute pancreatitis in the Veterans Health Administration. Pharmacoepidemiol Drug Saf 2022; 31:1294-1299. [PMID: 36222554 PMCID: PMC9729430 DOI: 10.1002/pds.5549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/19/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Acute pancreatitis (AP) is a frequently encountered adverse drug reaction. However, the validity of diagnostic codes for AP is unknown. We aimed to determine the positive predictive value (PPV) of a diagnostic code-based algorithm for identifying patients with AP within the US Veterans Health Administration and evaluate the value of adding readily available structured laboratory information. METHODS We identified patients with possible AP events first based on the presence of a single hospital discharge ICD-9 or ICD-10 diagnosis of AP (Algorithm 1). We then expanded Algorithm 1 by including relevant laboratory test results (Algorithm 2). Specifically, we considered amylase or lipase serum values obtained between 2 days before admission and the end of the hospitalization. Medical records of a random sample of patients identified by the respective algorithms were reviewed by two separate gastroenterologists to adjudicate AP events. The PPV (95% confidence interval [CI]) for the algorithms were calculated. RESULTS Algorithm 2, consisting of one ICD-9 or ICD-10 hospital discharge diagnosis of AP and the addition of lipase serum value ≥200 U/L, had a PPV 89.1% (95% CI 83.0%-95.2%), improving from the PPV of algorithm 1 (57.9% [95% CI 46.8-69.0]). CONCLUSIONS An algorithm consisting of an ICD-9 or ICD-10 diagnosis of AP with a lipase value ≥200 U/L achieved high PPV. This simple algorithm can be readily implemented in any electronic health records (EHR) systems and could be useful for future pharmacoepidemiologic studies on AP.
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Affiliation(s)
- Louise L. Wang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Dobkin
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sanjay Salgado
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David E. Kaplan
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medicine Services, GI Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medicine Services, GI Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
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Azevedo BRDMS, Fagundes DJ. DIFFERENTIAL DIAGNOSIS BETWEEN BILIARY AND NONBILIARY ACUTE PANCREATITIS: WHAT IS THE IMPORTANCE OF LABORATORY TESTS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1694. [PMID: 36449864 PMCID: PMC9704852 DOI: 10.1590/0102-672020220002e1694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The differential diagnosis of the causal factors of acute pancreatitis is fundamental for its clinical follow-up, becoming relevant to establishing laboratory criteria that elucidate the difference between biliary and nonbiliary causes. AIM The aim of this study was to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and nonbiliary causes and to identify laboratory tests with sufficient sensitivity to propose the creation of an algorithm for differential diagnosis between the causes. METHODS The research consisted of observational analysis, with a cross-sectional design of laboratory tests of two groups of patients with acute pancreatitis: group A: nonbiliary cause and group B: biliary cause. Hematocrit, white blood cell count, lactate dehydrogenase, glucose, lipase, amylase, total bilirubin, oxalacetic transaminase, pyruvic transaminase, gamma-glutamyltransferase, and alkaline phosphatase were investigated. Data were submitted to nonparametric tests and receiver operating characteristics. RESULTS Hematocrit values, number of leukocytes, lactate dehydrogenase, and glucose showed no significant difference between the groups (p>0.1). Lipase, amylase, total bilirubin, oxalacetic transaminase, pyruvic transaminase, gamma-glutamyltransferase, and alkaline phosphatase values showed a significant difference between groups (p<0.05). The oxalacetic transaminase, pyruvic transaminase, and alkaline phosphatase tests were most sensitive in determining the biliary cause, allowing the establishment of a cutoff point by the receiver operating characteristic test: pyruvic transaminase: 123.0 U/L (sensitivity: 69.2%; specificity: 81.5%), oxalacetic transaminase: 123.5 U/L (sensitivity: 57.3%; specificity: 78.8%), and alkaline phosphatase: 126.5 U/L (sensitivity: 66.1%; specificity: 69.4%), from which the probability of a correct answer increases. CONCLUSION It was possible to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and nonbiliary origin; however, the tests did not show enough sensitivity to propose the creation of an algorithm for differential diagnosis between the same causes.
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Affiliation(s)
| | - Djalma José Fagundes
- Universidade Federal de São Paulo, Operative Technique and Experimental Surgery – São Paulo (SP), Brazil
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Cryo-EM structures reveal the activation and substrate recognition mechanism of human enteropeptidase. Nat Commun 2022; 13:6955. [PMID: 36376282 PMCID: PMC9663175 DOI: 10.1038/s41467-022-34364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Enteropeptidase (EP) initiates intestinal digestion by proteolytically processing trypsinogen, generating catalytically active trypsin. EP dysfunction causes a series of pancreatic diseases including acute necrotizing pancreatitis. However, the molecular mechanisms of EP activation and substrate recognition remain elusive, due to the lack of structural information on the EP heavy chain. Here, we report cryo-EM structures of human EP in inactive, active, and substrate-bound states at resolutions from 2.7 to 4.9 Å. The EP heavy chain was observed to clamp the light chain with CUB2 domain for substrate recognition. The EP light chain N-terminus induced a rearrangement of surface-loops from inactive to active conformations, resulting in activated EP. The heavy chain then served as a hinge for light-chain conformational changes to recruit and subsequently cleave substrate. Our study provides structural insights into rearrangements of EP surface-loops and heavy chain dynamics in the EP catalytic cycle, advancing our understanding of EP-associated pancreatitis.
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Tang Q, Yang Q, Yu X, Liu Y, Tong Z, Li B, Chen Y, Yu EY, Li W. Association of demographic and clinical factors with risk of acute pancreatitis: An exposure-wide Mendelian randomization study. Mol Genet Genomic Med 2022; 11:e2091. [PMID: 36345251 PMCID: PMC9834139 DOI: 10.1002/mgg3.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/27/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The incidence of acute pancreatitis (AP) is increasing over years, which brings enormous economy and health burden. However, the aetiologies of AP and underlying mechanisms are still unclear. Here, we performed a two-sample Mendelian randomization (MR) analysis to investigate the associations between all reported possible risk factors and AP using publicly available genome-wide association study summary statistics. METHODS A series of quality control steps were taken in our analysis to select eligible instrumental single nucleotide polymorphisms which were strongly associated with exposures. To make the conclusions more robust and reliable, we utilized several analytical methods (inverse-variance weighting, MR-PRESSO method, weighted median, MR-Egger regression) that are based on different assumptions of two-sample MR analysis. The MR-Egger intercept test, radial regression and leave-one-out sensitivity analysis were performed to evaluate the horizontal pleiotropy, heterogeneities, and stability of these genetic variants on each exposure. A two-step MR method was applied to explore mediators in significant associations. RESULTS Genetic predisposition to cholelithiasis (effect estimate: 17.30, 95% CI: 12.25-22.36, p = 1.95 E-11), body mass index (0.32, 95% CI: 0.13-0.51, p < 0.001), body fat percentage (0.57, 95% CI: 0.31-0.83, p = 1.31 E-05), trunk fat percentage (0.36, 95% CI: 0.14-0.59, p < 0.005), ever smoked (1.61, 95% CI: 0.45-2.77, p = 0.007), and limbs fat percentage (0.55, 95% CI: 0.41-0.69, p < 0.001) were associated with an increased risk of AP. In addition, whole-body fat-free mass (-0.32, 95% CI: -0.55 to -0.10, p = 0.004) was associated with a decrease risk of AP. CONCLUSION Genetic predisposition to cholelithiasis, obesity and smoking could be causally associated with an increased risk of AP, and whole body fat-free mass could be associated with a decreased risk of AP.
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Affiliation(s)
- Qiu‐Yi Tang
- Medical School of Southeast UniversityNanjingChina
| | - Qi Yang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care MedicineJinling HospitalNanjingChina
| | | | - Yu‐Xiu Liu
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care MedicineJinling HospitalNanjingChina
| | - Zhi‐Hui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care MedicineJinling HospitalNanjingChina
| | - Bai‐Qiang Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care MedicineJinling HospitalNanjingChina
| | - Ya‐Ting Chen
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology & Biostatistics, School of Public HealthSoutheast UniversityNanjingChina
| | - Evan Yi‐Wen Yu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology & Biostatistics, School of Public HealthSoutheast UniversityNanjingChina,CAPHRI Care and Public Health Research Institute, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Wei‐Qin Li
- Medical School of Southeast UniversityNanjingChina,Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care MedicineJinling HospitalNanjingChina
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Hydrogen Sulfide: A Gaseous Mediator and Its Key Role in Programmed Cell Death, Oxidative Stress, Inflammation and Pulmonary Disease. Antioxidants (Basel) 2022; 11:antiox11112162. [PMID: 36358533 PMCID: PMC9687070 DOI: 10.3390/antiox11112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Hydrogen sulfide (H2S) has been acknowledged as a novel gaseous mediator. The metabolism of H2S in mammals is tightly controlled and is mainly achieved by many physiological reactions catalyzed by a suite of enzymes. Although the precise actions of H2S in regulating programmed cell death, oxidative stress and inflammation are yet to be fully understood, it is becoming increasingly clear that H2S is extensively involved in these crucial processes. Since programmed cell death, oxidative stress and inflammation have been demonstrated as three important mechanisms participating in the pathogenesis of various pulmonary diseases, it can be inferred that aberrant H2S metabolism also functions as a critical contributor to pulmonary diseases, which has also been extensively investigated. In the meantime, substantial attention has been paid to developing therapeutic approaches targeting H2S for pulmonary diseases. In this review, we summarize the cutting-edge knowledge on the metabolism of H2S and the relevance of H2S to programmed cell death, oxidative stress and inflammation. We also provide an update on the crucial roles played by H2S in the pathogenesis of several pulmonary diseases. Finally, we discuss the perspective on targeting H2S metabolism in the treatment of pulmonary diseases.
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de-Madaria E, Buxbaum JL, Maisonneuve P, García García de Paredes A, Zapater P, Guilabert L, Vaillo-Rocamora A, Rodríguez-Gandía MÁ, Donate-Ortega J, Lozada-Hernández EE, Collazo Moreno AJR, Lira-Aguilar A, Llovet LP, Mehta R, Tandel R, Navarro P, Sánchez-Pardo AM, Sánchez-Marin C, Cobreros M, Fernández-Cabrera I, Casals-Seoane F, Casas Deza D, Lauret-Braña E, Martí-Marqués E, Camacho-Montaño LM, Ubieto V, Ganuza M, Bolado F. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med 2022; 387:989-1000. [PMID: 36103415 DOI: 10.1056/nejmoa2202884] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited. METHODS At 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer's solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient's clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients. RESULTS A total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P = 0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P = 0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group. CONCLUSIONS In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. (Funded by Instituto de Salud Carlos III and others; WATERFALL ClinicalTrials.gov number, NCT04381169.).
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Affiliation(s)
- Enrique de-Madaria
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - James L Buxbaum
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Patrick Maisonneuve
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Ana García García de Paredes
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Pedro Zapater
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Lucía Guilabert
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alicia Vaillo-Rocamora
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Miguel Á Rodríguez-Gandía
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Jesús Donate-Ortega
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Edgard E Lozada-Hernández
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alan J R Collazo Moreno
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alba Lira-Aguilar
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Laura P Llovet
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Rajiv Mehta
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Raj Tandel
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Pablo Navarro
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Ana M Sánchez-Pardo
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Claudia Sánchez-Marin
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Marina Cobreros
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Idaira Fernández-Cabrera
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Fernando Casals-Seoane
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Diego Casas Deza
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Eugenia Lauret-Braña
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Eva Martí-Marqués
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Laura M Camacho-Montaño
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Verónica Ubieto
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Mikel Ganuza
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Federico Bolado
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Bao J, Zhang X, Li B, Niu M, Wu Z, Song P, Guo X, Husain SZ, Hu G, Li L, Wen L. AXL and MERTK receptor tyrosine kinases inhibition protects against pancreatic necrosis via selectively limiting CXCL2-related neutrophil infiltration. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166490. [PMID: 35841983 DOI: 10.1016/j.bbadis.2022.166490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) was initiated within pancreatic parenchymal cells and sustained by uncontrolled inflammatory responses. AXL and MERTK receptor tyrosine kinases play a crucial role in negatively regulating the innate immunity. Therefore, this study aimed to investigate the role and underlying mechanism of AXL and MERTK in AP. METHODS Experimental AP was induced by ten hourly intraperitoneal administration of caerulein in global, hematopoietic- and pancreas-specific Axl and Mertk deficient mice. Pancreatitis severity was assessed biochemically and histologically. Pancreatic transcriptomics and pancreatic infiltrating immune cells were profiled. Some mice were given R428, an antagonist of AXL and MERTK. AXL and MERTK in peripheral leukocytes were measured by flow cytometry. FINDINGS The levels of AXL and MERTK in pancreatic tissue and pancreatic CD45+ cells were dynamically altered at 6 h and 12 h after the 1st injection of caerulein. Global and hematopoietic-specific, but not pancreas-specific deletion of Axl and Mertk protected against pancreatic necrosis and trypsinogen activation. Pancreatic transcriptomic analysis revealed that differentially expressed gene signatures were mainly related to metabolic and inflammatory pathways. Furthermore, deletion or inhibition of Axl and Mertk selectively inhibited pancreatic neutrophil infiltration, which was primarily related to CXCL2 secreted by pro-inflammatory macrophages. Increased levels of MERTK in peripheral leukocytes were correlated with more severe form of AP. INTERPRETATION Our findings reveal that specific AXL/MERTK antagonist may be a novel and potential early treatment for AP and the levels of MERTK in peripheral leukocytes may be a promising biomarker for predicting pancreatic severity in patients with AP. FUNDING National Natural Science Foundation of China, Shanghai Natural Science Foundation, a Shanghai Young Talent Award and a Shanghai Young Orient Scholar Award. RESEARCH IN CONTEXT Evidence before this study Acute pancreatitis (AP) is a common inflammatory disorder of the exocrine pancreas, the severity of which was determined by the extent of pancreatic necrosis, with no targeted therapy. AP was initiated by signals within pancreatic parenchymal cells and sustained by uncontrolled innate immune responses. One of the three crucial regulatory roles for AXL and MERTK is to negatively regulate innate immune responses. Added value of this study Global and hematopoietic-, but not pancreas-specific Axl and Mertk deficiency protected against pancreatitis, primarily pancreatic necrosis. Deletion of Axl and Mertk selectively inhibited pancreatic neutrophil infiltration that was related to CXCL2 secreted by pro-inflammatory macrophages. AXL and MERTK antagonist similarly reduced pancreatitis severity via limiting CXCL2-mediated pancreatic neutrophil infiltration. Higher levels of MERTK, but not AXL in peripheral leukocytes were correlated with more severe form of acute pancreatitis. Implications of all the available evidence A specific AXL/MERTK antagonist may be a novel and potential early treatment for AP. The level of MERTK on peripheral leukocytes may be a promising biomarker for predicting disease severity in patients with AP.
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Affiliation(s)
- Jingpiao Bao
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuli Zhang
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengya Niu
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zengkai Wu
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengli Song
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Guo
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Sohail Z Husain
- Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Guoyong Hu
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Liang Li
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li Wen
- Department of Gastroenterology and Shanghai Key Laboratory of Pancreatic Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
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Zhang GF, Yu XQ, Hu YP, Yang Q, Li WQ. Progress in research of acute pancreatitis in pregnancy. Shijie Huaren Xiaohua Zazhi 2022; 30:541-546. [DOI: 10.11569/wcjd.v30.i12.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis in pregnancy (APIP) is a rare and severe complication of pregnancy, which is characterized by rapid onset, rapid progression, many complications, and high mortality. According to previous studies, the incidence of APIP is about 1/10000-1/1000 and increases with gestational age. Due to the differences in genetic background and dietary habits between Asian and European populations, the incidence of APIP in China is as high as 1.14‰-2.27‰, significantly higher than that in Western countries. The lack of specific clinical symptoms of APIP often leads to misdiagnosis or missed diagnosis, which greatly increases the difficulty of diagnosis and treatment. Despite the deepening of the research on APIP, its pathogenesis is still unclear. This paper will give a systematical review of APIP.
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Affiliation(s)
- Guo-Fu Zhang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xian-Qiang Yu
- Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yue-Peng Hu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qi Yang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China,Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China,Department of Critical Care Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, Jiangsu Province, China
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Drug D, a Diosgenin Derive, Inhibits L-Arginine-Induced Acute Pancreatitis through Meditating GSDMD in the Endoplasmic Reticulum via the TXNIP/HIF-1α Pathway. Nutrients 2022; 14:nu14132591. [PMID: 35807771 PMCID: PMC9268286 DOI: 10.3390/nu14132591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis (AP) is one of the most common causes of hospitalization for gastrointestinal diseases, with high morbidity and mortality. Endoplasmic reticulum stress (ERS) and Gasdermin D (GSDMD) mediate AP, but little is known about their mutual influence on AP. Diosgenin has excellent anti-inflammatory and antioxidant effects. This study investigated whether Diosgenin derivative D (Drug D) inhibits L-arginine-induced acute pancreatitis through meditating GSDMD in the endoplasmic reticulum (ER). Our studies were conducted in a mouse model of L-arginine-induced AP as well as in an in vitro model on mouse pancreatic acinar cells. The GSDMD accumulation in ER was found in this study, which caused ERS of acinar cells. GSDMD inhibitor Disulfiram (DSF) notably decreased the expression of GSDMD in ER and TXNIP/HIF-1α signaling. The molecular docking study indicated that there was a potential interaction between Drug D and GSDMD. Our results showed that Drug D significantly inhibited necrosis of acinar cells dose-dependently, and we also found that Drug D alleviated pancreatic necrosis and systemic inflammation by inhibiting the GSDMD accumulation in the ER of acinar cells via the TXNIP/HIF-1α pathway. Furthermore, the level of p-IRE1α (a marker of ERS) was also down-regulated by Drug D in a dose-dependent manner in AP. We also found that Drug D alleviated TXNIP up-regulation and oxidative stress in AP. Moreover, our results revealed that GSDMD-/- mitigated AP by inhibiting TXNIP/HIF-1α. Therefore, Drug D, which is extracted from Dioscorea zingiberensis, may inhibit L-arginine-induced AP by meditating GSDMD in the ER by the TXNIP /HIF-1α pathway.
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