Pancreatic Enzymes Research Articles

Ayurvedic Management of Pancreatitis

Pancreatitis is the life threatening metabolic pathology of the gastrointestinal system. It progressively damages the pancreas and result in the loss of its functions. The prevalence rate of pancreatitis in India is 7.9 per 10, 0000. For male and female respectively 8.6 and 8 in India. With overall 10 year and 20 year survival rates are estimated to be about 70% to 45% respectively. In the contemporary science the treatment protocol is limited to painkillers, intravenous fluids and pancreatic enzymes. Despite of advance techniques in the allopathic science the prognosis of the disease is unclear. Ayurvedic formulations of mineral complex including a diet and moderate rest have shown excellent result. In this case report a 40 year old male patient a known case of chronic pancreatitis with recurrent abdominal pain which radiates to back, nausea, vomiting, tenderness, anorexia, along with elevated serum amylase level was managed effectively with Ayurvedic medications by the Department of PG Study in Shalyatantra OPD Dr. BRKR Government Ayurvedic Medical College and Hospital, Hyderabad. In Ayurveda this condition can be correlated Agnashayashoth which comes under Pittodara. And it was successfully treated with the medications like Shankha vati, Kravyadi ras, Arogyavardgani vati. Within 4 months of treatment patient become normal. There was no pain abdomen, nausea, vomiting, bloating of abdomen. And serum amylase came to its normal level. This shows that Ayurvedic herbo mineral formulations showing promising result in the management of pancreatitis.

Prevalence of metabolic dysfunction-associated fatty liver disease after pancreatic surgery in a historical Belgian cohort and review of the literature.

Metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported as a complication after pancreatic surgery. The aim of this study is to assess this phenomenon in a Belgian population, specifically in a period in time when less perioperative chemotherapy was given. We performed a retrospective monocentric cohort study with 124 selected patients who underwent pancreatic surgery - pancreaticoduodenectomy (PD), distal pancreatectomy (DP) or total pancreatectomy - between 2005 and 2014. Steatosis was assessed radiologically, using Hounsfield units on liver and spleen. Data on imaging, liver function, weight and other relevant parameters were gathered preoperatively as well as 2 and 6 months, 1 and 2 years after surgery. Thirty-eight (31%) out of 124 patients developed liver steatosis at least at one point in time in the two years following surgery, with a prevalence of 21.0% at 2 months, 28.6% at 6 months, 16.4% at 1 year and 20.8 % at 2 years. A statistically significant association with preoperative AST and ALT values, administration of pancreatic enzyme supplementation as a surrogate for pancreatic exocrine insufficiency (PEI) and weight loss at 2 years was detected. MAFLD is seen in 31% of patients with PD or DP pancreatic resection in this retrospective analysis of a monocentric Belgian cohort. Both early and late onset of MAFLD was observed, implying that long-term follow-up is necessary. Clinical impact as well as a direct correlation with patients' weight and oral enzyme supplements needs to be further investigated.

Pancreatic enzyme prescription following ivacaftor licensing: A retrospective analysis of the US and UK cystic fibrosis registries

BackgroundRelieving gastrointestinal symptoms is a research priority in cystic fibrosis. Emerging evidence highlights effects of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on gastrointestinal function, including pancreatic sufficiency. This study explores ivacaftor licensing and treatment on recorded pancreatic enzyme replacement therapy (PERT) prescription in the US and UK CF registries. MethodsRetrospective longitudinal registry study of recorded pancreatic PERT use between 2008 and 2017. Interrupted time series analysis in propensity-matched cohorts estimated annual change and step change according to ivacaftor eligibility before and after licensing year, 2012. Generalised estimating equations assessed adjusted risk of PERT use in individuals treated with ivacaftor after 2012 compared to untreated individuals. ResultsIn the US CF registry, the difference in annual change in prevalence of PERT use post-2012 between eligible cases and ineligible controls was -5.0 per 1000 people/year (95 %CI -7.6; -2.3, p = 0.001). The step change and annual change in prevalence of PERT use in eligible cases was not significantly different to controls in the UK CF registry. Relative to the relationship in 2013, ivacaftor treatment in the US CF registry was associated with a lower adjusted risk ratio of PERT use compared to untreated individuals by 2016 (0.97, 95 %CI 0.96; 0.99), which was not observed in the UK CF registry. ConclusionsLicensing of ivacaftor was followed by a lower prevalence of PERT use in the eligible US population compared to pre-licensing period, as well as lower risk of PERT use in those who received treatment. Inconsistencies in US and UK CF registries were observed.

Inhibition Effect of Pancreatic Exocrine Insufficiency on Immune Checkpoint Inhibitor Treatment in Pancreatic Cancer: A Retrospective Study.

Chemotherapy combined with immune checkpoint inhibitors (ChIM) is used to treat advanced pancreatic ductal adenocarcinoma (PDAC). However, the efficacy of ChIM is similar to that of chemotherapy alone. To assess potential factors affecting the effectiveness of ChIM, we analyzed the clinical data of 359 patients with PDAC who visited the hospital during June 2017 to December 2022. Surgical resection, diabetes, and ChIM were risk factors for pancreatic exocrine insufficiency (PEI). The adjusted odds ratio of ChIM was 2.63 (95% confidence interval (CI) 1.492-4.626) (P = 0.001). The incidence of PEI in the ChIM group (76.9%) was significantly higher than that of the chemotherapy group (60.2%) (P = 0.004). Survival analysis showed that ChIM did not improve the survival rate of patients with PDAC (hazard ratio (HR) 0.92, 0.707-1.197) (P = 0.534) in comparison with that of the chemotherapy group. However, in patients without PEI, those receiving ChIM showed a higher 1-year overall survival (OS) rate of 70.8% (two-sided, P = 0.045) and a median OS of 22.0 months (95% CI 11.5-32.5). Moreover, pancreatic enzyme replacement therapy significantly improved the OS of patients with PDAC (HR = 0.73, 95% CI = 0.561-0.956) (P = 0.022). Immune checkpoint inhibitors (ICIs) increased the incidence of PEI in patients with PDAC. The OS was not different between patients receiving chemotherapy and ChIM due to irregular PERT treatment. The finding show that pancreatic enzyme replacement therapy may improve the response rate of patients with PDAC to ICIs.

Molecular Docking Studies and In Vitro Activity of Paliurus spina-christi Mill Extracts as Pancreatic Lipase Inhibitors.

Obesity is a risk factor for the onset of chronic diseases. One of the most promising approaches to treating obesity consists of reducing dietary fat absorption using extracts from plants because they contain phenolic compounds, especially flavonoids. Paliurus spina-christi, belonging to the Rhamnaceae family, is one of the five species belonging to the Paliurus genus. Herein, the aerial parts of the plant were extracted with methanol through the pressurized cyclic solid-liquid extraction using the Naviglio extractor®. The extracts were analyzed with High Performance Thin Layer Chromatography and investigated for their in vitro biological potential. The phytochemical analysis revealed that rutin has been shown to be the most abundant flavonoid component. The best antiradical activity was observed for the fruit extract with an IC50 value of 53.41 ± 1.24 µg/mL. This extract also has a better inhibitory capacity on lipid peroxidation evaluated at a different time of incubation. Potent lipase inhibitor activity of the extract from fruits was also demonstrated with in vitro experiments. This property can be attributed to a direct interaction of main components of P. spina-christi extract with the human pancreatic enzyme as demonstrated by the results of molecular docking experiments conducted on the crystallographic structures of lipase.

Chiral D-peptide supramolecular hydrogel for minimizing postoperative pancreatic fistula by devitalizing pancreatic enzymes

Postoperative pancreatic fistula (POPF), is regarded as one of the most challenging complications following pancreatic and intestinal surgeries, posing significant risks to patients due to rapid tissue degradation caused by enzymes such as proteases and lipases released from the pancreas. The incorporation of D-enantiomerism into the backbone-side-chain connectivity and geometry of peptides offers a promising solution to enhance their resistance against proteases and lipases substantially. Therefore, this study successfully developed a chiral D-peptide supramolecular hydrogel known as CDPSH within a supramolecular hydrogel called LPSH. LPSH is composed of two peptides capable of self-assembling into intricate nanofibers that interweave into a mesh-like structure, facilitated by the presence of Ca2+ ions and blood coagulation factor FXIIIa. Remarkably, the hydrogel properties and mechanical characteristics of LPSH remained intact when incorporating D-enantiomerism, leading to the emergence of CDPSH. CDPSH exhibited a novel functionality by effectively inhibiting the enzymatic activities of trypsin, chymotrypsin, and lipase. Functioning as a self-healing physical barrier with resistance against proteolysis, CDPSH successfully encapsulated pancreatic fluid in rats with POPF. Furthermore, it significantly mitigated the inflammation caused by POPF while maintaining an excellent biosafety profile. In conclusion, the use of D-enantiomeric peptides in constructing supramolecular hydrogels not only provides a novel approach for creating biocompatible, biomimetic, and injectable hydrogels through peptide self-assembly but also introduces an innovative strategy for developing highly stable and multifunctional hydrogels with clinical applications.

Inhibition of Pancreatic Lipase by Flavonoid Derivatives: In Vitro and In Silico Investigations.

Obesity, characterized by excessive adipose tissue accumulation, has emerged as a crucial determinant for a wide range of chronic medical conditions. The identification of effective interventions for obesity is of utmost importance. Widely researched antiobesity agents focus on pancreatic lipase, a significant therapeutic target. This study presented the evaluation of ten flavonoid compounds in terms of their inhibitory activities against pancreatic lipase, utilizing both in vitro and in silico approaches. The results indicated that all tested compounds demonstrated modest and weaker inhibitory activities compared to the reference compound, orlistat. Among the compounds investigated, F01 exhibited the highest potency, with an IC50 value of 17.68 ± 1.43 µM. The enzymatic inhibition kinetic analysis revealed that F01 operated through a competitive inhibition mechanism with a determined Ki of 7.16 μM. This value suggested a moderate binding affinity for the pancreatic lipase enzyme. Furthermore, the associated Vmax value was quantified at 0.03272 ΔA·min-1. In silico studies revealed that F01 displayed a binding mode similar to that of orlistat, despite lacking an active functional group capable of forming a covalent bond with Ser152 of the catalytic triad. However, F01 formed a hydrogen bond with this crucial amino acid. Furthermore, F01 interacted with other significant residues at the enzyme's active site, particularly those within the lid domain. Based on these findings, F01 demonstrates substantial potential as a candidate for further investigations.

Grapefruit (Citrus paradisi Mcfad.) and its phytochemical inhibits pancreatic lipase enzyme and modulates the saturated fat-induced obesity model

The prevalence of obesity has reached epidemic proportions and warrants numerous interventions, mostly using functional foods or medicinal plants to combating obesity. This review focuses on medicinal plants that elicit anti-obesity effect targeting pancreatic lipase enzyme (PLE). However, the putative processes of the plants targeting PLE and its consequential effects on triglyceride breakdown remains elusive. The effect of aqueous methanolic extracts, fractions and isolates of selected plants on PLE was tested in-vitro. The potent plant extract was examined for its effect on triglyceride levels in rats administered using saturated fat-rich coconut milk versus non-fat milk model in-vivo. Our observations illustrates that the Citrus paradisi aqueous methanolic extract (CPAME) inhibits PLE and modulate the saturated fat-induced weight gain and triglyceride levels. Whilst, the hesperidin isolated from CPAME has shown potential to inhibit PLE, the observations warrant further investigations on flavonoid and other compounds in grape fruit. Therefore, CPAME could be a promising target in combating obesity by inhibiting PLE.

Evaluation of the efficiency of nanomicellar formulation of fat-soluble vitamins in patients with cystic fibrosis: the study protocol for a randomized controlled trial

BackgroundCystic fibrosis is an inherited disease, which is caused by the CFTR protein defects due to mutations in the CFTR gene. Along with CFTR dysfunction, exocrine pancreatic insufficiency plays a key role in persistent fat malabsorption in CF patients; therefore, deficiency of fat-soluble vitamins (A, D, E, and K) is still a therapeutic challenge. Even with efficient pancreatic enzyme medication and CF-specific vitamins, many patients with CF have fat-soluble vitamins deficiency. The present study aims to evaluate the efficiency of nanomicelle formulation of fat-soluble vitamins in children with CF in order to achieve the appropriate serum levels of these vitamins.MethodsThis prospective, single-blind control trial will be conducted at the Akbar Children’s Hospital in Mashhad, Iran. Patients with CF will be enrolled based on the eligibility criteria. The control group will receive the standard formulation of fat-soluble vitamins similar to the routine CF treatment, and for the intervention group, the nanomicelle formulation of fat-soluble vitamins will be administered for 3 months. The primary outcome of this study is the measurement of serum levels of fat-soluble vitamins. The secondary outcomes are clinical assessment by the Shwachman-Kulczycki score, anthropometrics, and quality of life. Outcomes will be assessed before and after 3 months.DiscussionDue to persistent fat-soluble vitamin deficiency in CF disease, the nanomicelle formulation could be proposed as a new delivery method of fat-soluble vitamins in the treatment of cystic fibrosis.Trial registrationIranian Registry of Clinical Trials IRCT20220415054541N1. Registered on July 23, 2022.

Abstract A076: Spatial genomic expression profiling reveals metastatic gene markers in mucinous cystic carcinoma of the pancreas and regional lymph nodes

Abstract Pancreatic cancer is a highly lethal disease characterized by low detectability in its early stages, leading to limited treatment options in advanced stages. Mucinous cystic carcinoma (MCC) is a rare subtype of pancreatic cancer that produces mucin. In this study, we investigated the genetic characteristics of MCC and its metastatic potential. Using spatial genomic analysis, we observed the upregulation of several genes in MCC, including CPA1 and CPB1, which encode carboxypeptidases produced by the pancreas. These genes were highly expressed in both the pancreatic tumor and regional lymph nodes, suggesting their potential as gene markers for the metastatic potential of MCC. Moreover, we observed co-localization and upregulation of genes encoding chymotrypsin-like-elastase in both the pancreatic tissue and lymph nodes, indicating their potential involvement in metastasis. Furthermore, we observed significant elevation in the expression of pancreatic enzymes encoded by PRSS1, PRSSA, CLPS, and PLAG2GA in both the pancreatic tissue and lymph nodes. The presence of PRSS1 and PRSSA in the lymph node suggests the presence of cancer cells in the lymphatic system, which in turn promotes tumor growth, invasion, and metastasis. Additionally, elevated expression of CLPS in the lymph nodes may be associated with altered lipid metabolism and the breakdown of fat molecules in the tumor microenvironment. This upregulation was accompanied by increased levels of SPARC, an extracellular matrix protein, in both tissues, emphasizing the correlation between metastatic potential and tumorigenesis. Notably, commonly observed tumor markers for pancreatic cancer, such as SMAD4, did not exhibit upregulation in our MCC case, indicating alternative mechanisms of tumor development in this particular subtype. Additionally, we noted heightened expression of the CA 19-9 antigen, a valuable marker for monitoring the progression of pancreatic cancer. In conclusion, our findings reveal the upregulation of several gene markers in this rare subtype of pancreatic cancer and regional lymph nodes. Understanding the expression patterns of these markers can aid in identifying potential therapeutic targets and detecting metastatic potential at an early stage for MCC. Citation Format: Chirag S. Gopinath, Arshia Ghodrati, Lusine Demirkhanyan, Manu Gnanamony, Joseph A. Norton, Sonia T. Orcutt, Christopher S. Gondi. Spatial genomic expression profiling reveals metastatic gene markers in mucinous cystic carcinoma of the pancreas and regional lymph nodes [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A076.

Improving the functional characteristics of thymol-loaded pullulan and whey protein isolate-based electrospun nanofiber

The encapsulation of thymol blends was examined for two distinct food polymers, pullulan and whey protein isolate at a concentration of 80:20 (PUL:WPI w/w) through coaxial electrospinning. Scanning electron microscopy (SEM) presented clear illustrations of successful thymol encapsulation in nanofibers with bead-like structures and increased diameter as compared to nanofibers without thymol. The maximum encapsulation efficiency (87.05 ± 1.18%) and loading capacity (17.41 ± 0.24%) of thymol (2%) in (80:20) PUL:WPI nanofibers (THY-WP-NF) have been achieved. The attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) peaks indicated the presence of thymol within the nanofibers, while X-ray diffraction results demonstrated that the thymol existed in an amorphous state within the nanofibers. Furthermore, the encapsulation process led to an increase in the stability (under light and temperature) of thymol, as well as facilitated targeted release in the small intestine. THY-PW-NF exhibited better in-vitro inhibition activity against alpha-amylase (66.44%), alpha-glucosidase (80.37%) and pancreatic lipase enzymes (65.60%), along with DPPH and ABTS radicals. Conclusively, THY-PW-NF can be utilized in food and pharmaceutical products owing to a large surface area with improved water solubility, antioxidant activity, high-temperature stability and antidiabetic activity of thymol.

Nutrition challenges following total pancreatectomy with islet autotransplantation.

Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical treatment option for patients with chronic pancreatitis who have not responded to other therapies. TP offers pain relief whereas IAT preserves beta cell mass to reduce endocrine insufficiency. During the surgical procedure, the entire pancreas is removed. Islet cells from the pancreas are then isolated, purified, and infused into the liver via the portal vein. Successful TPIAT relieves pain for a majority of patients but is not without obstacles, specifically gastrointestinal, exocrine, and endocrine challenges. The postoperative phase can be complicated by gastrointestinal symptoms causing patients to have difficulty regaining adequate oral intake. Enteral nutrition is frequently provided as a bridge to oral diet. Patients undergoing TPIAT must be monitored for macronutrient and micronutrient deficiencies following the procedure. Exocrine insufficiency must be treated lifelong with pancreatic enzyme replacement therapy. Endocrine function must be monitored and exogenous insulin provided in the postoperative phase; however, a majority of patients undergoing TPIAT require little or no long-term insulin. Although TPIAT can be a successful option for patients with chronic pancreatitis, nutrition-related concerns must be addressed for optimal recovery.

Gastrointestinal involvement in STEC-associated hemolytic uremic syndrome: 10 years in a pediatric center

BackgroundThe gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement.MethodsA total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated.ResultsSix patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement.ConclusionsDuring STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting.Graphical abstractA higher resolution version of the Graphical abstract is available asSupplementary information

Influence of vasoactive intestinal polypeptide on growth performance, nutrient digestibility, nitrogen balance, and digestive enzyme activity in lambs.

This study evaluated if vasoactive intestinal polypeptide (VIP) influences growth performance, nutrient digestibility, nitrogen balance, and digestive enzyme activity. Sixteen wether lambs (69.6 ± 1.9kg) were housed in individual pens, adapted to a corn grain-based diet, and randomly assigned to 2 treatment groups. Lambs were injected intraperitoneally every other day for 28 d with saline (0.9% NaCl) containing no VIP (n = 8; control) or containing VIP (n = 8; 1.3 nmol/kg body weight [BW]). All lambs were transferred to individual metabolic crates for the final 7 d of the experiment to measure nitrogen balance and nutrient digestibility. At the end of the treatment period, lambs were slaughtered, and pancreatic tissue, small intestinal tissue, and rumen fluid were collected for protein, digestive enzymes, ruminal pH, and volatile fatty acid (VFA) analyses. Lambs treated with VIP had greater final BW, average daily gain, and gain:feed (P = 0.01, 0.05, 0.03, respectively). No differences between treatment groups were observed (P ≥ 0.25) for nutrient intake, digestibility, nitrogen retention, ruminal pH, and VFA concentrations. Moreover, VIP treatment did not influence (P ≥ 0.19) plasma glucose, urea N, and insulin concentrations. Treatment with VIP increased (P = 0.03) relative cecum weight (g/kg BW) and decreased (P = 0.05) relative brain weight. Pancreatic and intestinal digestive enzyme activities, except for duodenal maltase (P = 0.02), were not influenced (P ≥ 0.09) by VIP treatment. These data suggest that the administration of VIP may have potential to improve average daily gain and gain:feed in lambs fed grain-based diets.

Expanding the scope of self-assembled supramolecular biosensors: a highly selective and sensitive enzyme-responsive AIE-based fluorescent biosensor for trypsin detection and inhibitor screening.

Trypsin, a pancreatic enzyme associated with diseases like pancreatic cancer and cystic fibrosis, requires effective diagnostic tools. Current detection systems seldom utilize macrocyclic molecules and tetraphenyl ethylene (TPE) derivative-based supramolecular assemblies, known for their biocompatibility and aggregation-induced emission (AIE) properties, for trypsin detection. This study presents an enzyme-responsive, AIE-based fluorescence 'Turn-On' sensing platform for trypsin detection, employing sulfated-β-cyclodextrin (S-βCD), an imidazolium derivative of TPE (TPE-IM), and protamine sulfate (PrS). The anionic S-βCD and cationic TPE-IM formed a strongly fluorescent supramolecular aggregation complex in an aqueous buffer. However, PrS suppresses fluorescence because of its strong binding affinity with S-βCD. The non-fluorescent TPE-IM/S-βCD/PrS supramolecular assembly system exhibits trypsin-responsive properties, as PrS is a known trypsin substrate. Trypsin restores fluorescence in the TPE-IM/S-βCD system through the enzymatic cleavage of PrS, correlating linearly with trypsin catalytic activity in the 0-10 nM concentration range. The limit of detection is 10 pM. This work contributes to the development of self-assembled supramolecular biosensors using charged TPE derivatives and β-cyclodextrin-based host-guest chemistry, offering an innovative fluorescence 'Turn-On' trypsin sensing platform. The sensing system is highly stable under various conditions, selective for trypsin, and demonstrates potential for biological analysis and disease diagnosis in human serum. Additionally, it shows promise for the screening of trypsin inhibitors.

Thymol, a bioactive component of ocimum gratissimum linn. leaf ameliorated diabetes-induced exocrine pancreas insufficiency in male wistar rats

Background and aims: Exocrine pancreas insufficiency characterized by decreased pancreatic enzyme activity is one of the conditions associated with prolonged diabetes mellitus. Anti-diabetic activity of Ocimum gratissimum linn. leaf in experimental animals is well documented and using gas chromatography mass spectroscopy analysis, thymol has been identified as one of its bioactive components. This study investigated the effect of thymol on pancreatic alpha amylase activities and oxidative stress biomarkers in streptozotocin-induced diabetic rats. Methods: Twenty-four male Wistar rats grouped into four as Control, THY, DIA, and DIA+THY were used. Animals in DIA and DIA+THY were diabetic orally administered distilled water and thymol (20 mg/kg), respectively, while control and THY were normal rats treated similarly for 14 days. Fasting blood glucose (FBG), liver function, lipid profile, and oxidative stress biomarkers were determined in the blood while the pancreas was obtained for amylase activities. Results: Thymol treatment in the DIA+THY decreased FBG (119.75 ± 20.10 mg/dl), cholesterol (129.22 ± 8.34 mg/dl), triglycerides (116.41 ± 8.34 mg/dl), and low-density lipoprotein (101.89 ± 8.28 mg/dl) when compared with the DIA (209.25 ± 46.88 mg/dl, 156.31 ± 16.21 mg/dl, 143.13 ± 14.81 mg/dl, and 131.23 ± 13.38 mg/dl, respectively). Increased alanine transaminase and alkaline phosphatase observed in DIA were reversed in the Dia+THY. Pancreatic amylase activity was reduced in DIA (3.01 ± 0.50 Activity/mg.protein) compared with control (6.4 ± 0.42 Activity/mg.protein) and this was increased in DIA+THY (6.73 ± 0.39 Activity/mg.protein) relative to DIA. Increased plasma malondialdehyde and decreased catalase activity were observed in the DIA group and these were reversed in the DIA+THY group Conclusions: Thymol has hypoglycemic properties and stimulates pancreatic alpha-amylase activity through a mechanism that may be linked to its antioxidant properties.

Acute pancreatitis complicated with diabetic ketoacidosis following COVID-19 mRNA vaccination: a case report.

Objective: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination has substantially reduced mortality and hospitalization rates worldwide, with rare adverse events reported in clinical settings. Herein, we present a case of acute pancreatitis complicated by diabetic ketoacidosis (DKA) following the third COVID-19 vaccination dose. Patient: A 72-year-old male with a history of diabetes mellitus developed generalized fatigue, mild epigastric pain, nausea, and frequent vomiting after receiving the COVID-19 vaccine. Results: Blood analysis revealed elevated levels of pancreatic enzymes, hyperglycemia, and acidemia. Computed tomography revealed evidence of acute pancreatitis, leading to a diagnosis of both DKA and acute pancreatitis. Treatment with a large volume of saline and intravenous insulin improved both DKA and acute pancreatitis. After a thorough examination, no other factors capable of causing acute pancreatitis were identified. Hence, we concluded that acute pancreatitis was induced by COVID-19 vaccination. Conclusion: Acute pancreatitis is a rare but potentially life-threatening adverse event associated with COVID-19 vaccination. Delaying the treatment or diagnosis of acute pancreatitis can increase mortality risk in patients with both acute pancreatitis and DKA. Hence, it is crucial for healthcare professionals to consider the potential occurrence of acute pancreatitis and DKA following COVID-19 vaccination.

Pancreatic panniculitis associated with periampullary duodenal diverticulum

Introduction. Pancreatic panniculitis (PP) is a rare type of lobular panniculitis that manifests as painful erythematous nodules on the skin of the lower extremities. Subcutaneous fat necrosis caused by the release of pancreatic enzymes is the underlying cause of the disease, affecting around 2?3% of patients with pancreatic diseases. Case report. We present a case of a 58-year-old male patient who was admitted to our clinic due to the appearance of painful erythematous nodules on the lower extremities and trunk. Laboratory results revealed increased levels of pancreatic enzymes, amylase, and lipase, as well as heightened levels of glucose and inflammation markers. The histological analysis of the skin lesion biopsy revealed the presence of predominantly lobular panniculitis in the hypodermis, with areas of fatty tissue necrosis/saponification and remnants of adipocytes (?ghost cells?). Abdominal computed tomography scan demonstrated peri-ampullary diverticulum (PD) of the duodenum, with no signs of pancreatitis or other pancreatic abnormalities. Esophagogastroduodenoscopy showed a wide opening of PD in the D2 segment of the duodenum. The patient was successfully treated with pancreatin therapy, resulting in a significant reduction of skin lesions and decreased levels of pancreatic enzymes. Conclusion. Duodenal PDs can be the cause of PP, most likely due to the pressure they exert on the pancreatic duct, which can lead to elevated values of pancreatic enzymes. Depending on the individual characteristics of the patient, symptomatic duodenal PD may be treated with operative or non-operative measures. Treatment of PP primarily involves addressing any underlying medical condition.

Analysis of a Case of Intractable Pancreatogenic Diarrhoea after Pancreatic Cancer Surgery Treated with Jiawei Wumei Pill Combined with Pancreatic Enzyme Preparation and Other Agents

Analysis of a Case of Intractable Pancreatogenic Diarrhoea after Pancreatic Cancer Surgery Treated with Jiawei Wumei Pill Combined with Pancreatic Enzyme Preparation and Other Agents

MiR-605-3p may affect caerulein-induced ductal cell injury and pyroptosis in acute pancreatitis by targeting the DUOX2/NLRP3/NF-κB pathway.

Acute pancreatitis (AP) is a sudden-onset disease of the digestive system caused by abnormal activation of pancreatic enzymes. Dual oxidase 2 (DUOX2) has been found to be elevated in the progression of a variety of inflammatory diseases. Therefore, we analyzed the specific roles of DUOX2 in AP development. Blood samples were collected from of AP patients and healthy people, and the caerulein- stimulated human pancreatic duct cells (H6C7) were utilized to establish an AP cell model. Cell growth and apoptosis were measured using an MTT assay and TUNEL staining. Additionally, RT-qPCR and western blot assays were conducted to assess the RNA and protein expressions of the cells. ELISA kits were used to determine TNF-α, IL-6, IL-8, and IL-1β levels. The interaction between DUOX2 and miR-605-3p was predicted using the Targetscan database and confirmed by dual-luciferase report assay. We found that DUOX2 increased while miR-605-3p decreased in the blood of AP patients and caerulein-stimulated H6C7 cells. DUOX2 was targeted by miR-605-3p. Furthermore, DUOX2 knockdown or miR-605-3p overexpression promoted cell viability, decreased the TNF-α, IL-6, IL-8, and IL-1β levels, and inhibited apoptosis rate in caerulein-stimulated H6C7 cells. DUOX2 knockdown or miR-605-3p overexpression also increased the Bcl-2 protein levels and down-regulated Bax, cleaved-caspase-1, NLRP3 and p-p65. Interestingly, DUOX2 overexpression reversed the miR-605-3p mimic function in the caerulein-treated H6C7 cells. In conclusion, our research demonstrated that DUOX2 knockdown relieved the injury and inflammation in caerulein-stimulated H6C7 cells.