A pancreatite crônica é uma desordem complexa, na qual a interação entre fatores ambientais e genéticos resulta na enfermidade. O presente estudo incluiu 148 pacientes com diagnóstico de pancreatite crônica, 110 etilistas crônicos e 297 controles sadios com o objetivo de investigar a frequência de tabagismo e das mutações N34S e P55S do gene SPINK1 e R254W do gene CTRC nesta população. Foi aplicado questionário presencial e realizada reação de sequenciamento para a pesquisa das mutações genéticas, após assinatura do Termo de Consentimento Livre e Esclarecido. Os portadores de pancreatite crônica possuíam etiologia alcoólica em 74% das vezes e idiopática em 26%. A pancreatite alcoólica apresentou-se de maneira distinta da pancreatite crônica idiopática, sendo que o primeiro grupo é composto por maior prevalência do gênero masculino (88,18% versus 34,21%), por maior média de idade (55,64 anos versus 45,20 anos), menor frequência de caucasianos (63,89% versus 84,21%), menor escolaridade (23,30% concluíram ensino médio ou superior versus 57,89%) e maior frequência de repercussões da doença, como diarréia (54,21% versus 24,24%), emagrecimento (56,07% versus 24,24%), diabete melito (57,94% versus 36,36%) e ocorrência de pseudocistos pancreáticos (31,78% versus 12,12%), repercussões estas que não foram acompanhadas de maior frequência de alterações morfológicas, como calcificações pancreáticas ou dilatação do ducto pancreático principal. A frequência de tabagismo foi significativamente maior em pacientes com pancreatite crônica alcoólica do que em etilistas sem pancreatite crônica, podendo ser considerado cofator de risco para o desenvolvimento da pancreatite crônica entre alcoolistas (p = 0,002); a frequência da mutação N34S do gene SPINK1 em pacientes com pancreatite crônica foi de 3,38%, maior do que a frequência de 0,49% encontrada nos grupos controle (p = 0,016); a frequência de 2,03% da mutação P55S do gene SPINK1 e a frequência de 0,67% da mutação R254W do gene CTRC, encontradas nos pacientes com pancreatite crônica, não diferiram estatisticamente quando comparadas às frequências, de 0,49% de ambas mutações, encontradas nos grupos controle. (p = 0,120 e 0,751). Pela investigação da associação de tabagismo e da mutação N34S do gene SPINK1 com as características clínicas e morfológicas da pancreatite crônica, verificou-se que a mutação N34S não se associou a maior gravidade da apresentação clínica ou morfológica da pancreatite crônica; no entanto o tabagismo associou-se a maior frequência de diabete melito entre os portadores de pancreatite crônica. Concluiuse que o tabagismo e a mutação N34S do gene SPINK1 podem ser considerados cofatores de risco para o desenvolvimento da pancreatite crônica / Chronic pancreatitis is a complex disorder in which the interaction between environmental and genetic factors results in the disease. This study included 148 patients with chronic pancreatitis, 110 chronic alcoholics and 297 healthy controls in order to investigate the frequency of smoking and N34S and P55S mutation of SPINK1 gene and R254W of CTRC gene in this population. A questionnaire was applied and gene sequencing was done, after having the Informed Consent Statement. Those with chronic pancreatitis had alcoholic etiology in 74% of cases and idiopathic in 26%. Alcoholic pancreatitis presented in a distinct way of idiopathic chronic pancreatitis. The first group is composed of a higher prevalence of males (88.18% versus 34.21%), by higher mean age (55.64 years versus 45.20 years), lower frequency of Caucasians (63.89% versus 84.21%), lower education (23.30% completed secondary or higher education versus 57.89%) and worst impact from the disease such as diarrhea (54.21% versus 24.24%), weight loss (56.07% versus 24.24%), diabetes mellitus (57.94% versus 36.36%) and occurrence of pancreatic pseudocysts (31.78% versus 12 , 12%). These effects were not accompanied by increased frequency of morphological changes, such as pancreatic calcifications or dilation of the main pancreatic duct. The frequency of smoking was significantly higher in patients with alcoholic pancreatitis than in alcoholics without chronic pancreatitis, therefore tabagism may be considered as a cofactor for the development of chronic pancreatitis among alcoholics (p = 0.002); the frequency of N34S mutation of SPINK1 gene in patients with chronic pancreatitis was 3.38%, higher than the rate of 0.49% found in the control groups (p = 0.016); the frequency of 2.03% of the P55S mutation of SPINK1 gene and the frequency of 0.67% of the CTRC gene R254W mutation found in patients with chronic pancreatitis were not statistically different when compared to the frequencies of 0.49% of both mutations, found in the control groups. (p = 0.120 and 0.751) For the investigation of the association of smoking and N34S mutation of SPINK1 gene with the clinical and morphological features of chronic pancreatitis, it was noticed that the N34S mutation did not determine a greatest severity in the presentation of chronic pancreatitis, however smoking was associated with a higher frequency of diabetes mellitus in patients with chronic pancreatitis. It was concluded that smoking and the N34S mutation of SPINK1 gene are positively correlated with chronic pancreatitis

O infiltrado inflamatório, a perda maciça de células acinares e a fibrose se destacam como alterações da pancreatite alcoólica crônica, o que é reflexo da expressão gênica. O -tocoferol regula a expressão de vários genes, entre eles moduladores de proteínas extracelulares e de inflamação. O presente trabalho teve como intuito avaliar o efeito da suplementação com vitamina E sobre a expressão gênica pancreática de marcadores inflamatórios, em ratos com pancreatite alcoólica crônica induzida por dieta líquida contendo etanol (com ou sem suplementação de -tocoferol), ciclosporina A e ceruleína, por meio da técnica quantitativa de PCR em tempo real. Além disso, foram realizadas determinações de -tocoferol plasmático e hepático, lipídeos totais hepáticos, e análise histopatológica do pâncreas e fígado dos animais submetidos aos diferentes tratamentos (Grupo 1: Controle; Grupo 2: Pancreatite alcoólica crônica; Grupo 3: Pancreatite alcoólica crônica e suplementação com vitamina E). Os animais que receberam suplementação com vitamina E apresentaram maiores valores de -tocoferol plasmático e hepático [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g fígado; 5,1 ± 0,8 nmols/mg lipídeo hepático); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g fígado; 2,8 ± 0,7 nmols/mg lipídeo hepático); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g fígado*; 17,3 ± 8,8 nmols/mg lipídeo hepático*)] (*p<0,01). O pâncreas dos animais do Grupo 1 apresentou histologia normal, ao passo que nos Grupos 2 e 3 apresentou focos de destruição tecidual leve a moderada, presença de infiltrado de células mononucleares (linfócitos e plasmócitos) e proliferação de tecido conjuntivo de sustentação, mostrando um quadro ainda em estágios iniciais de pancreatite alcoólica crônica. O fígado do Grupo 1 apresentou histologia normal, e dos Grupos 2 e 3, esteatose macro e microvesicular em grau variável, entre 30 a 60%. A análise de PCR em tempo real mostrou aumento de expressão de todos os 13 genes biomarcadores do processo inflamatório nos Grupos 2 e 3, provocado pela pancreatite alcoólica crônica, em relação ao Grupo 1 (p<0,01). A suplementação com vitamina E na presença de pancreatite no Grupo 3, em relação ao Grupo 2, diminuiu o número de transcritos para 5 genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), aumentou o número de transcritos para 1 gene (Pap) (p<0,01), e não modificou os 7 genes restantes (Col1a1, IL-4, IL-8, IL-10, MCP-1, Mif, MMP-2) (p>0,05). A suplementação com vitamina E apresentou efeitos anti-inflamatórios e benéficos na expressão gênica pancreática de alguns biomarcadores do processo inflamatório em ratos com pancreatite alcoólica crônica, comprovando sua participação em alguns mecanismos da resposta inflamatória no pâncreas. / The inflammatory infiltrate, the massive loss of acinar cells and fibrosis are highlighted as changes in alcoholic chronic pancreatitis, which is a gene expression reflection. The -tocopherol regulates many genes expression, including extracellular proteins and inflammation modulators. This study was aimed to evaluate the vitamin E supplementation effect on pancreatic gene expression of inflammatory markers in rats with alcoholic chronic pancreatitis induced by liquid diet containing ethanol (with or without -tocopherol supplementation), cyclosporin A and cerulein through the quantitative real time PCR technique. Moreover, -tocopherol content in plasma and liver were analyzed, total lipid content in liver, and pancreas and liver histopathology of animals subjected to different treatments (Group 1: Control, Group 2: Alcoholic chronic pancreatitis, Group 3: Alcoholic chronic pancreatitis and vitamin E supplementation). The animals that received vitamin E supplementation had higher -tocopherol amounts in plasma and liver [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g liver; 5,1 ± 0,8 nmols/mg liver lipid); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g liver; 2,8 ± 0,7 nmols/mg liver lipid); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g liver*; 17,3 ± 8,8 nmols/mg liver lipid*)] (*p<0,01). The pancreas of animals in Group 1 had normal histology, whereas in Groups 2 and 3 presented tissue destruction foci with mild to moderate mononuclear cells infiltration (lymphocytes and plasma cells) and connective tissue proliferation, showing an early stage occurrence of alcoholic chronic pancreatitis. The Group 1 liver showed normal histology, and Groups 2 and 3, macro and microvesicular steatosis in varying degrees, from 30 to 60%. The quantitative real time PCR analysis showed increased expression of all 13 inflammatory biomarkers genes in Groups 2 and 3, caused by alcoholic chronic pancreatitis, compared to Group 1 (p<0,01). Vitamin E supplementation in the presence of pancreatitis in Group 3, compared to Group 2, decreased the transcripts number for five genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), increased the transcripts number for one gene (Pap) (p<0,01), and did not alter the seven remaining genes (Col1a1, IL-4, IL-8, IL-10, MCP-1 , Mif, MMP-2) (p>0,05). Vitamin E supplementation showed anti-inflammatory and beneficial effects on pancreatic gene expression of some inflammation biomarkers in rats with alcoholic chronic pancreatitis, confirming its participation in the inflammatory response mechanisms in the pancreas.

Pancreatic acinar cells display plasticity to acquire distinct differentiation programs, being involved in diseases as chronic pancreatitis and pancreatic ductal adenocarcinoma. This work shows that acinar cells cultured in suspension undergo dedifferentiation, acquiring a pancreatic embryonic progenitor phenotype. Dedifferentiated cells turn on a senescent program, associated with activation of p53 and Ras pathways. A similar progenitor‐like phenotype with activation of senescence is present in experimental chronic pancreatitis. Acinar cultures lacking p53 overcome growth arrest and lose the pancreatic phenotype, undergoing an epithelial‐mesenchymal transition, while maintaining the expression of pre‐pancreatic endoderm and stem cell markers. In experimental acute pancreatitis, absence of p53 results in increased acinar cell proliferation and delayed regeneration. Our findings support a role for acinar cell dedifferentiation in the initiation of pancreatic diseases. A p53‐ dependent control of cell growth and epithelial differentiation constitutes a tumor suppressive mechanism that may limit PDAC development. / Las células pancreáticas acinares poseen plasticidad que les permite adquirir distintos programas de diferenciación, estando implicadas en enfermedades como la pancreatitis crónica y el adenocarcinoma ductal pancreático. En este trabajo hemos demostrado que las células acinares cultivadas en suspensión se desdiferencian, adquiriendo un fenotipo de progenitores pancreáticos embrionarios. En estas células se induce un programa de senescencia asociado con la activación de las vías de p53 y Ras. Un fenotipo similar se evidencia en modelos de pancreatitis crónica experimental. Cultivos acinares en los que se ha inactivado p53 sobrepasan el bloqueo de crecimiento y pierden el fenotipo pancreático, presentando una transición epitelio‐mesenquimal y manteniendo la expresión de marcadores de endodermo pre‐pancreático y de células madre. Durante la inducción de una pancreatitis aguda experimental, la ausencia de p53 resulta en un incremento de la proliferación acinar y en un retraso en la regeneración. Nuestros resultados demuestran que la desdiferenciación de las células acinares participa en el desarrollo de enfermedades pancreáticas. El control del crecimiento celular y de la diferenciación pancreática epitelial dependiente de p53 constituye un mecanismo de supresión tumoral que puede limitar el desarrollo del PDAC.

A pancreatite crônica é uma desordem complexa, na qual a interação entre fatores ambientais e genéticos resulta na enfermidade. O presente estudo incluiu 148 pacientes com diagnóstico de pancreatite crônica, 110 etilistas crônicos e 297 controles sadios com o objetivo de investigar a frequência de tabagismo e das mutações N34S e P55S do gene SPINK1 e R254W do gene CTRC nesta população. Foi aplicado questionário presencial e realizada reação de sequenciamento para a pesquisa das mutações genéticas, após assinatura do Termo de Consentimento Livre e Esclarecido. Os portadores de pancreatite crônica possuíam etiologia alcoólica em 74% das vezes e idiopática em 26%. A pancreatite alcoólica apresentou-se de maneira distinta da pancreatite crônica idiopática, sendo que o primeiro grupo é composto por maior prevalência do gênero masculino (88,18% versus 34,21%), por maior média de idade (55,64 anos versus 45,20 anos), menor frequência de caucasianos (63,89% versus 84,21%), menor escolaridade (23,30% concluíram ensino médio ou superior versus 57,89%) e maior frequência de repercussões da doença, como diarréia (54,21% versus 24,24%), emagrecimento (56,07% versus 24,24%), diabete melito (57,94% versus 36,36%) e ocorrência de pseudocistos pancreáticos (31,78% versus 12,12%), repercussões estas que não foram acompanhadas de maior frequência de alterações morfológicas, como calcificações pancreáticas ou dilatação do ducto pancreático principal. A frequência de tabagismo foi significativamente maior em pacientes com pancreatite crônica alcoólica do que em etilistas sem pancreatite crônica, podendo ser considerado cofator de risco para o desenvolvimento da pancreatite crônica entre alcoolistas (p = 0,002); a frequência da mutação N34S do gene SPINK1 em pacientes com pancreatite crônica foi de 3,38%, maior do que a frequência de 0,49% encontrada nos grupos controle (p = 0,016); a frequência de 2,03% da mutação P55S do gene SPINK1 e a frequência de 0,67% da mutação R254W do gene CTRC, encontradas nos pacientes com pancreatite crônica, não diferiram estatisticamente quando comparadas às frequências, de 0,49% de ambas mutações, encontradas nos grupos controle. (p = 0,120 e 0,751). Pela investigação da associação de tabagismo e da mutação N34S do gene SPINK1 com as características clínicas e morfológicas da pancreatite crônica, verificou-se que a mutação N34S não se associou a maior gravidade da apresentação clínica ou morfológica da pancreatite crônica; no entanto o tabagismo associou-se a maior frequência de diabete melito entre os portadores de pancreatite crônica. Concluiuse que o tabagismo e a mutação N34S do gene SPINK1 podem ser considerados cofatores de risco para o desenvolvimento da pancreatite crônica / Chronic pancreatitis is a complex disorder in which the interaction between environmental and genetic factors results in the disease. This study included 148 patients with chronic pancreatitis, 110 chronic alcoholics and 297 healthy controls in order to investigate the frequency of smoking and N34S and P55S mutation of SPINK1 gene and R254W of CTRC gene in this population. A questionnaire was applied and gene sequencing was done, after having the Informed Consent Statement. Those with chronic pancreatitis had alcoholic etiology in 74% of cases and idiopathic in 26%. Alcoholic pancreatitis presented in a distinct way of idiopathic chronic pancreatitis. The first group is composed of a higher prevalence of males (88.18% versus 34.21%), by higher mean age (55.64 years versus 45.20 years), lower frequency of Caucasians (63.89% versus 84.21%), lower education (23.30% completed secondary or higher education versus 57.89%) and worst impact from the disease such as diarrhea (54.21% versus 24.24%), weight loss (56.07% versus 24.24%), diabetes mellitus (57.94% versus 36.36%) and occurrence of pancreatic pseudocysts (31.78% versus 12 , 12%). These effects were not accompanied by increased frequency of morphological changes, such as pancreatic calcifications or dilation of the main pancreatic duct. The frequency of smoking was significantly higher in patients with alcoholic pancreatitis than in alcoholics without chronic pancreatitis, therefore tabagism may be considered as a cofactor for the development of chronic pancreatitis among alcoholics (p = 0.002); the frequency of N34S mutation of SPINK1 gene in patients with chronic pancreatitis was 3.38%, higher than the rate of 0.49% found in the control groups (p = 0.016); the frequency of 2.03% of the P55S mutation of SPINK1 gene and the frequency of 0.67% of the CTRC gene R254W mutation found in patients with chronic pancreatitis were not statistically different when compared to the frequencies of 0.49% of both mutations, found in the control groups. (p = 0.120 and 0.751) For the investigation of the association of smoking and N34S mutation of SPINK1 gene with the clinical and morphological features of chronic pancreatitis, it was noticed that the N34S mutation did not determine a greatest severity in the presentation of chronic pancreatitis, however smoking was associated with a higher frequency of diabetes mellitus in patients with chronic pancreatitis. It was concluded that smoking and the N34S mutation of SPINK1 gene are positively correlated with chronic pancreatitis

O infiltrado inflamatório, a perda maciça de células acinares e a fibrose se destacam como alterações da pancreatite alcoólica crônica, o que é reflexo da expressão gênica. O -tocoferol regula a expressão de vários genes, entre eles moduladores de proteínas extracelulares e de inflamação. O presente trabalho teve como intuito avaliar o efeito da suplementação com vitamina E sobre a expressão gênica pancreática de marcadores inflamatórios, em ratos com pancreatite alcoólica crônica induzida por dieta líquida contendo etanol (com ou sem suplementação de -tocoferol), ciclosporina A e ceruleína, por meio da técnica quantitativa de PCR em tempo real. Além disso, foram realizadas determinações de -tocoferol plasmático e hepático, lipídeos totais hepáticos, e análise histopatológica do pâncreas e fígado dos animais submetidos aos diferentes tratamentos (Grupo 1: Controle; Grupo 2: Pancreatite alcoólica crônica; Grupo 3: Pancreatite alcoólica crônica e suplementação com vitamina E). Os animais que receberam suplementação com vitamina E apresentaram maiores valores de -tocoferol plasmático e hepático [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g fígado; 5,1 ± 0,8 nmols/mg lipídeo hepático); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g fígado; 2,8 ± 0,7 nmols/mg lipídeo hepático); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g fígado*; 17,3 ± 8,8 nmols/mg lipídeo hepático*)] (*p<0,01). O pâncreas dos animais do Grupo 1 apresentou histologia normal, ao passo que nos Grupos 2 e 3 apresentou focos de destruição tecidual leve a moderada, presença de infiltrado de células mononucleares (linfócitos e plasmócitos) e proliferação de tecido conjuntivo de sustentação, mostrando um quadro ainda em estágios iniciais de pancreatite alcoólica crônica. O fígado do Grupo 1 apresentou histologia normal, e dos Grupos 2 e 3, esteatose macro e microvesicular em grau variável, entre 30 a 60%. A análise de PCR em tempo real mostrou aumento de expressão de todos os 13 genes biomarcadores do processo inflamatório nos Grupos 2 e 3, provocado pela pancreatite alcoólica crônica, em relação ao Grupo 1 (p<0,01). A suplementação com vitamina E na presença de pancreatite no Grupo 3, em relação ao Grupo 2, diminuiu o número de transcritos para 5 genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), aumentou o número de transcritos para 1 gene (Pap) (p<0,01), e não modificou os 7 genes restantes (Col1a1, IL-4, IL-8, IL-10, MCP-1, Mif, MMP-2) (p>0,05). A suplementação com vitamina E apresentou efeitos anti-inflamatórios e benéficos na expressão gênica pancreática de alguns biomarcadores do processo inflamatório em ratos com pancreatite alcoólica crônica, comprovando sua participação em alguns mecanismos da resposta inflamatória no pâncreas. / The inflammatory infiltrate, the massive loss of acinar cells and fibrosis are highlighted as changes in alcoholic chronic pancreatitis, which is a gene expression reflection. The -tocopherol regulates many genes expression, including extracellular proteins and inflammation modulators. This study was aimed to evaluate the vitamin E supplementation effect on pancreatic gene expression of inflammatory markers in rats with alcoholic chronic pancreatitis induced by liquid diet containing ethanol (with or without -tocopherol supplementation), cyclosporin A and cerulein through the quantitative real time PCR technique. Moreover, -tocopherol content in plasma and liver were analyzed, total lipid content in liver, and pancreas and liver histopathology of animals subjected to different treatments (Group 1: Control, Group 2: Alcoholic chronic pancreatitis, Group 3: Alcoholic chronic pancreatitis and vitamin E supplementation). The animals that received vitamin E supplementation had higher -tocopherol amounts in plasma and liver [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g liver; 5,1 ± 0,8 nmols/mg liver lipid); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g liver; 2,8 ± 0,7 nmols/mg liver lipid); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g liver*; 17,3 ± 8,8 nmols/mg liver lipid*)] (*p<0,01). The pancreas of animals in Group 1 had normal histology, whereas in Groups 2 and 3 presented tissue destruction foci with mild to moderate mononuclear cells infiltration (lymphocytes and plasma cells) and connective tissue proliferation, showing an early stage occurrence of alcoholic chronic pancreatitis. The Group 1 liver showed normal histology, and Groups 2 and 3, macro and microvesicular steatosis in varying degrees, from 30 to 60%. The quantitative real time PCR analysis showed increased expression of all 13 inflammatory biomarkers genes in Groups 2 and 3, caused by alcoholic chronic pancreatitis, compared to Group 1 (p<0,01). Vitamin E supplementation in the presence of pancreatitis in Group 3, compared to Group 2, decreased the transcripts number for five genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), increased the transcripts number for one gene (Pap) (p<0,01), and did not alter the seven remaining genes (Col1a1, IL-4, IL-8, IL-10, MCP-1 , Mif, MMP-2) (p>0,05). Vitamin E supplementation showed anti-inflammatory and beneficial effects on pancreatic gene expression of some inflammation biomarkers in rats with alcoholic chronic pancreatitis, confirming its participation in the inflammatory response mechanisms in the pancreas.

Background Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation. Methods A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). Results A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%. Conclusions PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.

Background Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation. Methods A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). Results A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%. Conclusions PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.

Chronic pancreatitis (CP) is a heterogeneous disease defined as chronic inflammatory changes of the pancreatic tissue caused by variety of aetiologies. Oxidative stress accompanying the inflammatory processes has been suggested as an important factor contributing to CP development. The aim of this study was to determine levels of lipid peroxidation products malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), together with nitrites, the total antioxidant capacity, cytokines, biochemical and haematological parameters in the plasma of patients with CP and control subjects. Levels of MDA and 4-HNE were analyzed using high-performance liquid chromatography. The total antioxidant capacity of plasma against peroxyl radicals was evaluated using chemiluminescence determination. Nitrites were determined using Griess reaction. Cytokines - TNF-alfa; TNF RI; PDGF-AB; TGF-beta, together with myeloperoxidase and hyaluronan were determined using ELISA Kits. Biochemical and haematological parameters were measured by standard methods.

Die Hämoxygenase-1 (HO-1) ist das geschwindigkeitsbestimmende Enzym des Hämabbaus und ist wichtiger Regulator inflammatorischer Prozesse. Der Verlauf einer experimentellen akuten Pankreatitis (AP) konnte im Tiermodell durch HO-1 Induktion abgemildert werden. Die Aktivierung und Proliferation pankreatischer Stellatum Zellen (PSC) wird durch eine experimentelle HO-1 Induktion inhibiert und kann so möglicherweise vor der Fibrosierung des Pankreasparenchyms bei chronischer Pankreatitis (CP) schützen. Die Transkription der HO-1 wird durch einen GT-Repeat beeinflusst, der im Promoter lokalisiert ist. Diese Arbeit untersuchte, ob Varianten des GT-Repeat oder weitere genetische Varianten der HO-1 mit verschiedenen Pankreatitisformen assoziiert sind. Der GT-Repeat und der SNP rs2071746 wurden mit fluoreszensmarkierten Primern bzw. mit Schmelzkurvenanalyse bei 285 Patienten mit AP, bei 208 Patienten mit alkoholischer CP (ACP), bei 207 mit idiopathischer/hereditärer CP (ICP/HCP), 147 Patienten mit Alkoholischer Leberzirrhose (ALZ) und bei 289 Kontrollen untersucht. Bei den ACP Patienten wurde die GT-Repeat Analyse auf insgesamt 446 Patienten erhöht. Zusätzlich wurden die kodierenden HO-1 Abschnitte mittels DNA-Sequenzierung bei 145 Patienten mit ACP, 138 Patienten mit ICP/HCP, 147 Patienten mit ALZ und bei 151 Kontrollen analysiert. Das Exon 3 wurde darüber hinaus bei zusätzlichen ICP/HP Patienten und Kontrollen untersucht. Die Längenverteilungen des GT-Repeat, die Allelverteilung des SNP rs2071746 und die Verteilung der bei der DNA-Sequenzierung gefundenen synonymen und nicht synonymen Varianten waren bei allen untersuchten Gruppen nicht signifikant unterschiedlich. Obwohl die funktionellen Daten einen Einfluss von HO-1 Varianten auf die Pathogenese der verschiedenen Pankreatitis-Formen nahelegen, konnte unsere umfangreiche genetische Analyse keine Assoziation nachweisen. Genetische Varianten der HO-1 haben keinen Einfluss auf die Entwicklung einer AP, ACP, ICP/HCP und ALZ.:Inhaltsverzeichnis Vorbemerkung ..................................................................................................... 3 Bibliographische Beschreibung.......................................................................... 4 Abkürzungen/Abbildungen ................................................................................ 6 1. Einleitung........................................................................................................9 1.1 Akute Pankreatitis ......................................................................................................................... 9 1.2 Chronische Pankreatitis ............................................................................................................... 11 1.3 Genetische Aspekte der Chronischen Pankreatitis ...................................................................... 12 1.3.1 Kationisches Trypsinogen (PRSS1) ...................................................................................... 12 1.3.2 Anionisches Trypsinogen (PRSS2) ....................................................................................... 14 1.3.3 Serinproteaseinhibitor, Kazal Typ1 (SPINK1)..................................................................... 14 1.3.4 Chymotrypsin C (CTRC) ...................................................................................................... 15 1.3.5 CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) ...................................... 15 1.4 Hämoxygenase-1 ......................................................................................................................... 16 1.4.1 Physiologische Bedeutung der Hämoxygenase-1 (HO-1) .................................................... 16 1.4.2 Genetische Varianten der Hämoxygenase-1 ........................................................................ 18 1.4.3 Hämoxygenase-1 und Pankreatitis....................................................................................... 20 1.5 Hypothese/Fragestellung ............................................................................................................. 21 2. Publikation ..................................................................................................... 22 3. Zusammenfassung der Arbeit ...................................................................... 23 4. Literaturverzeichnis...................................................................................... 28 5. Danksagung.................................................................................................... 35 6. Erklärung über die eigenständige Abfassung der Arbeit .......................... 36 7. Lebenslauf ...................................................................................................... 37

Abnormalities of lipid metabolism are considered risk factors for cardiovascular, metabolic, nephrologic diseases amd some malignancies, as well. Nowadays, a lot of effort is devoted to study new risk factors and surrogate markers of conditions mentioned above to improve their prognosis and decrease mortality. The aim of this thesis was to provide a comprehensive survey of lipid metabolism, characteristics of different lipid compounds in health and diseases and of possibilities of utilization of selected lipid parameters in the diagnostics of pathological conditions listed above. Selected lioid parameters were observed in several studies, focused on specific pathological conditions. Besides conventional lipid analytes, the composition of fatty acids in plasma lipid pools was studied in healthy controls, and in the patients suffering from metabolic syndrome, chronic pancreatitis, and pancreatic cancer, as well. Markers of an oxidative stress (oxidatively modified LDL particles and conjugated dienes in precipitated LDL) were assessed in healthy controls, patients with metabolic syndrome, chronic pancreatitis, pancreatic cancer, and in the patients with different concentrations of plasma apoB-48, too. LDL particles subfraction were investigated in healthy controls, in the patients with different...