Pancreatitis: Etiology, Pathology, and Treatment

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 5765

Special Issue Editors


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Guest Editor
Professor of Internal Medicine and Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Interests: diagnostic and therapeutic digestive endoscopy; diagnostic and interventional endoscopy ultrasound; pancreatic disease; early diagnosis, staging and endoscopic treatment of digestive neoplasms

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Guest Editor
Department of Biochemistry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Interests: antioxidant activity in neurological disease, atherosclerosis, diabetes and obesity; micronutrients λ markers in gastrointestinal disease; markers of inflammation in iron metabolism; effects of phytocompounds

Special Issue Information

Dear Colleagues,

In recent years, the management of acute and chronic pancreatitis, along with the complications arising from these conditions, has evolved. The acute and chronic injury of the pancreas still represents a clinical challenge, despite significant advancements in imaging, minimally invasive interventions and our enhanced knowledge of the pathophysiological pathways involved in the evolution of these diseases. For the potential evolution of acute pancreatitis, multiple scoring systems and classifications are employed. However, providing personalized treatment according to its causes and emerging complications further raises several clinical questions.

In this Special Issue, we welcome papers that address the wide spectrum of  acute and chronic pancreatitis, including, but not limited to, pathophysiology, autoimmunity,  novel biomarkers for diagnostics and prognosis, improved management, and personalized treatment.

Dr. Laura Gaman
Prof. Dr. Mariana Jinga
Dr. Stoian Irina
Guest Editors

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Keywords

  • acute and chronic pancreatitis
  • pathophysiology
  • autoimmunity
  • novel biomarkers
  • innovative endoscopic
  • personalized treatment

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Published Papers (3 papers)

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Research

14 pages, 3089 KiB  
Article
Dexamethasone’s Clinical Efficacy in Experimental Autoimmune Pancreatitis Correlates with a Unique Transcriptomic Signature, Whilst Kinase Inhibitors Are Not Effective
by Ottavia Agrifoglio, Anika Kasprick, Natalie Gross, Marc Wahlig, Emilia Kauffold, Aline Woitas, Artem Vorobyev, Luise Ehlers, Ralf J. Ludwig, Katja Bieber and Robert Jaster
Biomedicines 2024, 12(11), 2480; https://doi.org/10.3390/biomedicines12112480 - 29 Oct 2024
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Abstract
(1) Background: Autoimmune pancreatitis (AIP) is mainly treated with steroids. Using an AIP mouse model, we investigated two potential alternatives, the transforming growth factor-β-activated kinase 1 inhibitor, takinib, and the Janus kinase inhibitor, tofacitinib. (2) Methods: In a multicenter preclinical study, MRL/MpJ mice [...] Read more.
(1) Background: Autoimmune pancreatitis (AIP) is mainly treated with steroids. Using an AIP mouse model, we investigated two potential alternatives, the transforming growth factor-β-activated kinase 1 inhibitor, takinib, and the Janus kinase inhibitor, tofacitinib. (2) Methods: In a multicenter preclinical study, MRL/MpJ mice were injected with polyinosinic/polycytidylic acid (poly I:C) for two weeks to induce AIP. They were then treated for four weeks with either takinib (25, 50, or 75 mg/kg body weight), tofacitinib (5, 10 or 15 mg/kg), dexamethasone (1 mg/kg), or solvent, while the poly I:C injections were continued. The severity of AIP was assessed histopathologically. Flow cytometry was used to examine lymphocyte subtypes in the spleen and mesenteric lymph nodes. The pancreatic gene expression profiles were analyzed by RNA sequencing. (3) Results: Poly I:C-treated mice developed severe AIP with inflammation, destruction of acinar tissue, and fibrosis. Dexamethasone significantly attenuated the disease, while takinib or tofacitinib had no effects. Dexamethasone also antagonized the effects of poly I:C on the relative frequencies of the AIP-associated lymphocyte subtypes CD4/CD69, CD8/CD44high, and CD4/CD25/FoxP3 in the spleen. In the principal component analysis of pancreatic transcriptomics, poly I:C-injected mice treated with tofacitinib, takinib, or solvent clustered together, while untreated and dexamethasone-treated mice formed separate, unique clusters. (4) Conclusions: Dexamethasone effectively reduced AIP severity, while takinib and tofacitinib were ineffective. The unique gene expression profile in dexamethasone-treated mice may provide a basis for identifying new drug targets for AIP treatment. Full article
(This article belongs to the Special Issue Pancreatitis: Etiology, Pathology, and Treatment)
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13 pages, 1204 KiB  
Article
Alcoholic Acute Pancreatitis, a Retrospective Study about Clinical Risk Factors and Outcomes—A Seven-Year Experience of a Large Tertiary Center
by Deniz Gűnșahin, Andrei Vicențiu Edu, Mihai Radu Pahomeanu, Tudor Ștefan Mitu, Andreea Irina Ghiță, Anamaria Simona Odorog, Carmen Monica Preda and Lucian Negreanu
Biomedicines 2024, 12(6), 1299; https://doi.org/10.3390/biomedicines12061299 - 12 Jun 2024
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Abstract
(1) Background: Alcohol consumption is one of the main causes of acute pancreatitis. (2) Material and Methods: In this unicentric retrospective cohort study, we selected 1855 patients from the Bucharest Acute Pancreatitis Index (BUC-API) who presented with acute pancreatitis. We investigated correlations between [...] Read more.
(1) Background: Alcohol consumption is one of the main causes of acute pancreatitis. (2) Material and Methods: In this unicentric retrospective cohort study, we selected 1855 patients from the Bucharest Acute Pancreatitis Index (BUC-API) who presented with acute pancreatitis. We investigated correlations between Alcoholic Acute Pancreatitis (AAP) and the rate of complications, cost, length of hospitalization and rate of recurrence. (3) Results: We found a moderately strong association between AAP and recurrence (p < 0.01) and observed that the disease is likelier to evolve with pseudocysts and walled-off necrosis than other forms of AP. Patients with AAP are less likely to have a morphologically normal pancreas than patients suffering from AP of other causes (p < 0.01), but a low probability of requiring intensive care unit admission (p < 0.01) significantly lowers daily cost (Md = 154.7 EUR compared to Md = 204.4 EUR) (p < 0.01). (4) Conclusions: This study’s data show that patients with AAP have a greater rate of pseudocyst occurrence, lower intensive care unit admittance rate and lower cost of hospitalization than patients with AP of other causes. Typical Sketch: A middle-aged male tobacco smoker with recurrent AP, lower risk of in-hospital mortality and complications such as pseudocysts; treated in a gastroenterological ward and discharged at-will. Full article
(This article belongs to the Special Issue Pancreatitis: Etiology, Pathology, and Treatment)
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15 pages, 2050 KiB  
Article
Ferritin and Ferritin-to-Hemoglobin Ratio as Promising Prognostic Biomarkers of Severity in Acute Pancreatitis—A Cohort Study
by Mihaela Cristina Pavalean, Florentina Ionita-Radu, Mariana Jinga, Raluca Simona Costache, Daniel Vasile Balaban, Mihaita Patrasescu, Mirela Chirvase, Ionela Maniu, Laura Gaman and Sandica Bucurica
Biomedicines 2024, 12(1), 106; https://doi.org/10.3390/biomedicines12010106 - 4 Jan 2024
Cited by 3 | Viewed by 2966
Abstract
Background: Acute pancreatitis is an inflammation of the pancreas with variable outcomes depending on its severity. Multiple systems of prediction have been proposed, each with variable specificity and sensitivity and with uneven clinical use. Ferritin is a versatile protein associated with various acute [...] Read more.
Background: Acute pancreatitis is an inflammation of the pancreas with variable outcomes depending on its severity. Multiple systems of prediction have been proposed, each with variable specificity and sensitivity and with uneven clinical use. Ferritin is a versatile protein associated with various acute and chronic conditions. Aims: In our study, we aimed to assess the association of serum ferritin and the ferritin-to-hemoglobin ratio (FHR) with the severity of acute pancreatitis. Methods: A retrospective study was conducted in our hospital from January 2020 to September 2022 and included 116 patients with acute pancreatitis (graded according to the revised Atlanta classification). Serum ferritin and FHR were determined next to established laboratory parameters in the first 24 h following admission (hematological parameters, amylase, lipase, C-reactive protein, D-dimers, lactate dehydrogenase). We performed a receiver operating characteristic curve analysis for potential predictors. Also, we made correlations and conducted univariate and multivariate analyses for all potential severity biomarkers. Results: The median values of serum ferritin and FHR differed significantly between patients with severe acute pancreatitis and mild cases (serum ferritin: 352.40 vs. 197.35 ng/mL, p = 0.011; FHR: 23.73 vs. 13.74, p = 0.002) and between patients with organ failure and those without organ failure (serum ferritin: 613.45 vs. 279.65 ng/mL, p = 0.000; FHR: 48.12 vs. 18.64, p = 0.000). The medians of the serum ferritin and FHR levels were significantly higher in non-survivors compared with survivors (serum ferritin: 717.71 vs. 305.67 ng/mL, p = 0.013; FHR: 52.73 vs. 19.58, p = 0.016). Serum ferritin and FHR were good predictors for organ failure and mortality, next to D-dimers and procalcitonin (AUC > 0.753 for organ failure and AUC > 0.794 for mortality). In univariate regression analysis, serum ferritin and FHR were independent variables for moderate–severe forms of acute pancreatitis. Still, adjusting the multivariate analysis, only FHR remained a significant predictor. The cut-offs for serum ferritin and FHR for predicting organ failure were 437.81 ng/mL (sensitivity, 71%; specificity, 75%) and 45.63 (sensitivity, 61%; specificity, 88%), and those for mortality during hospitalization were 516 ng/mL (sensitivity, 83%; specificity, 74%) and 51.58 (sensitivity, 66%; specificity, 86%). Conclusions: Serum ferritin and the ferritin-to-hemoglobin ratio stood out in this study as valuable and accessible predictors of disease severity in the early assessment of acute pancreatitis, next to established severity serum markers (CRP, fibrinogen, D-dimers). Full article
(This article belongs to the Special Issue Pancreatitis: Etiology, Pathology, and Treatment)
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