New Insights Into the Mechanisms of Pancreatitis

Abstract

from zymogen granules from the apical pole to the basolateral regions of the acinar cell. 3 How this reduction in secretion might relate to the pathogenesis of acute pancreatitis has not been explored fully, but 2 mechanisms have been suggested. First, the retention of activated enzymes, particularly proteases, in the acinar cell might be required to cause disease. Thus, if the barriers to acinar cell secretion can be overcome, the damaging effects of activated enzymes might be averted. The observation that cyclic adenosine monophosphate agonists enhance secretion from the acinar cell under pancreatitis conditions and that these cells are protected from injury is consistent with this hypothesis. 4 In this context, the beneficial effects of secretin in pancreatitis shown in preliminary studies might be due to its stimulation of secretion of intracellular activated enzymes from the acinar cell. Second, the redirection of pancreatic enzyme secretion from the apical to the basolateral domain of the acinar cell may deliver enzymes and enzymes precursors to the interstitial space. 3 Neither mechanism has been fully explored.