Investigation of lipid digestion by fungal and porcine lipase supplements for severe pancreatic insufficiency using the in vitro dynamic TIM model

Abstract

Exocrine pancreaticinsufficiency (EPI) is caused by insufficient secretion or limited activity ofpancreatic enzymes, especially lipase. Chronic pancreatitis (CP) is the mostcommon EPI disease. CP patients suffer from gastrointestinal symptoms such asdiarrhea, abdominal pain, and decreased uptake of nutrients as a consequence ofinadequate food digestion. To improve their nutritional status, pancreaticenzyme supplements can be orally administered, known as pancreatic enzymereplacement therapy (PERT). PERT is commonly based on oral porcinepreparations, despite their pH sensitivity which results in a limited timeframefor optimal activity. Instead, fungal enzymes could be used to prolong enzymeactivity duration, since they are active over a wide pH range. The performanceof fungal enzymes was compared to porcine enzymes by measuring total fattyacids under severe pancreatic insufficiency conditions in the tiny-TIMsgdynamic in vitro gastrointestinal model. Administration of 14.000 fungallipase units (Nortase) led to similar lipid digestion compared to 20.000porcine lipase units (Kreon and Pangrol). Additionally, opening the Nortasecapsules had no negative effect on fungal lipase activity. This workdemonstrates that fungal lipases, administered as capsules or powder, can beused as an alternative treatment for EPI patients.