Mean platelet volume (MPV) as prognostic factor in acute pancreatitis (AP)
1
PI-38 Abstract id: 342. L-glutamate secretion in the pancreatic juice involves transport and metabolism of neutral amino acids in exocrine pancreas Selene Araya 1 , Christian Lutz 1 , Evelyne Kuster 1 , Luca Mariotta 1 , Brigitte Herzog 1 , François Verrey 1 , Theresia Reding 2 , Rolf Graf 2 , Simone Camargo 1 . 1 Institute of Physiology and ZIHP, University of Zurich, Zurich, Switzerland 2 Department of Surgery, University Hospital Zurich, Zurich, Switzerland Introduction: The pancreas efficiently absorbs amino acids (AA) for the synthesis of enzymes, but also secrets free AA in the pancreatic juice. Under free protein diet (FPD), the AA release on the pancreatic juice (PJ) may play an important role on the homeostasis maintenance of the small intestine. Aims: The aim of this study was to analyze acinar synthase and secretion of L-glutamate (Glu), the most concentrated AA in PJ. Materials & methods: Expression of enzymes involved in Glu syn- thesis, AA concentration and ptotein localization were performed. Results: Two glutaminase isoforms (gls1 and gls2) are expressed in the pancreas, and the mRNA levels of gls2 and of the alanine aminotransferase 1(gpt) were elevated in animals receiving (FPD). These results suggest Glu may be synthesized in the exocrine pancreas from L-glutamine (Gln) and L-alanine (Ala) and that the dietary protein content can modulate the expression of enzymes involved in the synthesis of Glu. The secretory mechanism of Glu to PJ does not involve zymogen granules vesicles (ZGV). Glu and its precursors were not concentrated in ZGV but were found at high concentrations in the cytoplasmic fraction, suggesting the secretory mechanism does not involve exocytosis. Immunofluorescence of pancre- atic tissue suggested that the Na^ a o-dependent Glu transporter EAAT1 (Slc1a3) localizes proximal to the apical membrane of acinar cells and may be involved in the secretion of Glu. Conclusion: These preliminary results suggest a new mechanism for Glu concentration and secretion on the PJ, as well a recycling of neutral AA (Ala, Gln) and Glu between the pancreas and intestine. PI-39 Abstract id: 340. Characterization of pericytes in adult pancreas tissue sections Verena Barchfeld, Susanne Raulefs, Nadja M€ aritz, Ivonne Regel, Bo Kong, J€ org Kleeff, Christoph W. Michalski. Department of Surgery, Klinikum rechts der Isar der Technischen Universit€ at M€ unchen, M€ unchen, Germany Introduction: Pericytes, the mural cells of blood vessels, are key reg- ulators of vascular morphogenesis and play a role in the development pancreas. Apart from their classical role in stabilizing vascular structures, the recent data suggest that a subset of pericytes have the properties of mesenchymal stem or progenitor cells. The existence of such cells in adult pancreas has not yet been defined. Aims: Several molecular markers for pericytes have been identified. However, the specific marker for pericytes remains unknown. The iden- tification of pericytes in tissue sections relies on the combination of different markers. Materials & methods: To define the distribution of pericytes in the adult pancreas, we used the well established pericyte marker NG2 alone and in combination with the endothelial marker CD31 or the mesenchymal stem cell markers CD90, CD105 or CD146. Results: Our data suggest an existence of a distinct cell pool within the adult pancreas which are double-positive for NG2 and mesenchymal stem cell markers. These data suggest that pericytes may have an additional role other than stabilize the vessels. Conclusion: These descriptive data argue for the heterogeneity of pancreatic pericytes, which may play different roles in pancreatic physiology. PI-40 Abstract id: 37. Continuous regional arterial infusion of dextran 70 and heparin in the treatment of severe acute pancreatitis: Background and design of cohort interventional study Mihailo Bezmarevic 1 , Darko Mirkovic 1 , Sinisa Rusovic 2 , Miroslav Mitrovic 1 , Miodrag Mihajlovic 2 , Milan Jovanovic 1 , Milan Scepanovic 2 . 1 Clinic for General Surgery, Military Medical Academy, Serbia 2 Institute of Radiology, Military Medical Academy, Serbia Introduction: Effects of continuous regional arterial infusion (CRAI) in acute pancreatitis (AP) treatment are reflected in increased tissue concentrations of administered drugs. It was reported a lower mortality rate in severe AP (SAP) when CRAI was applied within 72 hours of dis- ease onset. It is known that hyperosmolar solutions could reduce interstitial and cellular edema, and shown that dextran can improve microcirculatory disorders in SAP. Coagulation disorders, endothelial lesions, vasospasm and the formation of microthrombi in pancreatic microcirculation reduce pancreatic perfusion which is well correlated to the AP severity. Aims:0 Materials & methods: Study will include all patients with APACHE II score10 calculated within the first 48 hours after AP onset. In the next 48 hours, through micro-catheter placed in the celiac artery a CRAI of 500 mL of dextran 70 with 5000 IU of heparin (CRAI-DH) will be infused in a rate of 40 mL/h, in addition to standard therapy. After catheter removal a standard therapy will be continued. Intervention group will be compared with a retrospective control group of 30 patients with SAP treated without CRAI, in regard to the volume of pancreatic necrosis. A total sample size of 17 patients was calculated to demonstrate that CRAI-DH combined with standard therapy for AP can reduce the volume of pancreatic necrosis at least 30% compared to the control group with 80% power at 5% alfa. Results:0 Conclusion: This study is designed to reveal a reduction of pancreatic necrosis by CRAI-DH combined with standard therapy in comparison with standard therapy alone in patients with SAP. PI-41 Abstract id: 269. Mean platelet volume (MPV) as prognostic factor in acute pancreatitis (AP) Neven Franji c, Ivana Mikola sevi c, Davor Stimac. Division of Gastroenterology, Department of Internal Medicine, University Hospital Rijeka, Croatia Introduction: Mean platelet volume (MPV) is a machine-calculated measurement of the average size of platelets and is typically included in blood tests as part of the complete blood count. Vascular thrombosis and systemic hypercoagulable states are well documented complications of acute pancreatitis (AP). Higher values of MPV have been associated with thrombotic disorders. According to the literature, only few studies have investigated the association between AP and MPV. Aims: To determine whether the value of MPV at admission correlates with the occurrence of local and systemic complications of AP; lethal outcomes; and severe form of AP, according to modified Atlanta criteria. Patients & methods: 53 patients (35 male and 18 female) were enrolled in this retrospective study. MPV values were obtained on an automated hematology analyzer (Olympus AU 640, Tokio, Japan). Student’s t-test was used for statistical analysis. Results: There were no statistically significant differences in the average values of MPV regarding local complications (7.510.99 vs. 7.911.24, p¼0.22), systemic complications (7.601.05 vs. 7.721.22, p¼0.76), severe form of AP (7.470.97 vs. 7.941.22, p¼0.13) or lethal outcomes (7.581.03 vs. 7.971.38, p¼0.41). Conclusion: Our study did not confirm the value of MPV in predicting complications in the course of AP. Abstracts / Pancreatology 13 (2013) S2–S98 S31
Transcript of Mean platelet volume (MPV) as prognostic factor in acute pancreatitis (AP)
ology
PI-38 Abstract id: 342.
L-glutamate secretion in the pancreatic juice involves transport andmetabolism of neutral amino acids in exocrine pancreas
Selene Araya 1, Christian Lutz 1, Evelyne Kuster 1, Luca Mariotta 1, BrigitteHerzog 1, François Verrey 1, Theresia Reding 2, Rolf Graf 2, SimoneCamargo 1.
1 Institute of Physiology and ZIHP, University of Zurich, Zurich,Switzerland2Department of Surgery, University Hospital Zurich, Zurich,Switzerland
Introduction: The pancreas efficiently absorbs amino acids (AA) forthe synthesis of enzymes, but also secrets free AA in the pancreatic juice.Under free protein diet (FPD), the AA release on the pancreatic juice (PJ)may play an important role on the homeostasis maintenance of the smallintestine.
Aims: The aim of this study was to analyze acinar synthase andsecretion of L-glutamate (Glu), the most concentrated AA in PJ.
Materials & methods: Expression of enzymes involved in Glu syn-thesis, AA concentration and ptotein localization were performed.
Results: Two glutaminase isoforms (gls1 and gls2) are expressed in thepancreas, and the mRNA levels of gls2 and of the alanine aminotransferase1 (gpt) were elevated in animals receiving (FPD). These results suggest Glumay be synthesized in the exocrine pancreas from L-glutamine (Gln) andL-alanine (Ala) and that the dietary protein content can modulate theexpression of enzymes involved in the synthesis of Glu. The secretorymechanism of Glu to PJ does not involve zymogen granules vesicles (ZGV).Glu and its precursors were not concentrated in ZGV but were found athigh concentrations in the cytoplasmic fraction, suggesting the secretorymechanism does not involve exocytosis. Immunofluorescence of pancre-atic tissue suggested that the Naao-dependent Glu transporter EAAT1(Slc1a3) localizes proximal to the apical membrane of acinar cells and maybe involved in the secretion of Glu.
Conclusion: These preliminary results suggest a new mechanism forGlu concentration and secretion on the PJ, as well a recycling of neutral AA(Ala, Gln) and Glu between the pancreas and intestine.
PI-39 Abstract id: 340.
Characterization of pericytes in adult pancreas tissue sections
Verena Barchfeld, Susanne Raulefs, Nadja M€aritz, Ivonne Regel, BoKong, J€org Kleeff, Christoph W. Michalski.
Department of Surgery, Klinikum rechts der Isar der TechnischenUniversit€at M€unchen, M€unchen, Germany
Introduction: Pericytes, the mural cells of blood vessels, are key reg-ulators of vascular morphogenesis and play a role in the developmentpancreas. Apart from their classical role in stabilizing vascular structures,the recent data suggest that a subset of pericytes have the properties ofmesenchymal stem or progenitor cells. The existence of such cells in adultpancreas has not yet been defined.
Aims: Several molecular markers for pericytes have been identified.However, the specific marker for pericytes remains unknown. The iden-tification of pericytes in tissue sections relies on the combination ofdifferent markers.
Materials & methods: To define the distribution of pericytes in theadult pancreas, we used the well established pericyte marker NG2 aloneand in combinationwith the endothelial marker CD31 or themesenchymalstem cell markers CD90, CD105 or CD146.
Results: Our data suggest an existence of a distinct cell pool within theadult pancreas which are double-positive for NG2 and mesenchymal stemcell markers. These data suggest that pericytes may have an additional roleother than stabilize the vessels.
Conclusion: These descriptive data argue for the heterogeneity ofpancreatic pericytes, whichmay play different roles in pancreatic physiology.
Abstracts / Pancreat
PI-40 Abstract id: 37.
Continuous regional arterial infusion of dextran 70 and heparin in thetreatment of severe acute pancreatitis: Background and design ofcohort interventional study
Mihailo Bezmarevic 1, Darko Mirkovic 1, Sinisa Rusovic 2, MiroslavMitrovic 1, Miodrag Mihajlovic 2, Milan Jovanovic 1, Milan Scepanovic 2.
1 Clinic for General Surgery, Military Medical Academy, Serbia2 Institute of Radiology, Military Medical Academy, Serbia
Introduction: Effects of continuous regional arterial infusion (CRAI)in acute pancreatitis (AP) treatment are reflected in increased tissueconcentrations of administered drugs. It was reported a lower mortalityrate in severe AP (SAP) when CRAI was applied within 72 hours of dis-ease onset. It is known that hyperosmolar solutions could reduceinterstitial and cellular edema, and shown that dextran can improvemicrocirculatory disorders in SAP. Coagulation disorders, endotheliallesions, vasospasm and the formation of microthrombi in pancreaticmicrocirculation reduce pancreatic perfusion which is well correlated tothe AP severity.
Aims: 0Materials & methods: Study will include all patients with APACHE II
score�10 calculated within the first 48 hours after AP onset. In the next 48hours, through micro-catheter placed in the celiac artery a CRAI of 500 mLof dextran 70with 5000 IU of heparin (CRAI-DH) will be infused in a rate of40mL/h, in addition to standard therapy. After catheter removal a standardtherapy will be continued. Intervention group will be compared with aretrospective control group of 30 patients with SAP treated without CRAI,in regard to the volume of pancreatic necrosis. A total sample size of 17patients was calculated to demonstrate that CRAI-DH combined withstandard therapy for AP can reduce the volume of pancreatic necrosis atleast 30% compared to the control group with 80% power at 5% alfa.
Results: 0Conclusion: This study is designed to reveal a reduction of pancreatic
necrosis by CRAI-DH combined with standard therapy in comparison withstandard therapy alone in patients with SAP.
PI-41 Abstract id: 269.
Mean platelet volume (MPV) as prognostic factor in acute pancreatitis(AP)
Neven Franji�c, Ivana Mikola�sevi�c, Davor �Stimac.
Division of Gastroenterology, Department of Internal Medicine,University Hospital Rijeka, Croatia
Introduction: Mean platelet volume (MPV) is a machine-calculatedmeasurement of the average size of platelets and is typically included inblood tests as part of the complete blood count. Vascular thrombosis andsystemic hypercoagulable states are well documented complications ofacute pancreatitis (AP). Higher values of MPV have been associated withthrombotic disorders. According to the literature, only few studies haveinvestigated the association between AP and MPV.
Aims: To determine whether the value of MPV at admission correlateswith the occurrence of local and systemic complications of AP; lethaloutcomes; and severe form of AP, according to modified Atlanta criteria.
Patients & methods: 53 patients (35 male and 18 female) wereenrolled in this retrospective study. MPV values were obtained on anautomated hematology analyzer (Olympus AU 640, Tokio, Japan). Student’st-test was used for statistical analysis.
Results: There were no statistically significant differences in theaverage values of MPV regarding local complications (7.51�0.99 vs.7.91�1.24, p¼0.22), systemic complications (7.60�1.05 vs. 7.72�1.22,p¼0.76), severe form of AP (7.47�0.97 vs. 7.94�1.22, p¼0.13) or lethaloutcomes (7.58�1.03 vs. 7.97�1.38, p¼0.41).
Conclusion: Our study did not confirm the value of MPV in predictingcomplications in the course of AP.
13 (2013) S2–S98 S31
