Acute pancreatitis (AP) remains a challenging clinical problem, particularly in patients with severe disease. Despite its disease burden, therapy remains supportive at best coupled with removal of precipitating factors that may include alcohol or biliary obstructing calculi. We showed a protective effect and therapeutic role of hemin (hemoglobin prosthetic moiety that upregulates hemeoxygenase-1, HO-1) in experimental AP via recruitment of HO-1+ F4/80+ cells to the pancreas. Moreover, we also elucidated mechanism for beneficial effects of HO-1 downstream effectors. Given these results, we propose to test the hypothesis that there is shift in immune response during recovery from AP as compare to acute phases of AP and we propose here to understand these mechanisms in order to improve our understanding of immune pathways that promote recovery and resolution of the inflammation.
The specific aims of our proposal are:
Aim 1 : Phenotypic and functional assessment. Here we will test the hypothesis that resolution of AP is associated with an increased adaptive and decreased monocyte/macrophage recruitment as compared to acute phase of AP.
Aim 2 : Cellular cross talk in the pathogenesis of acute pancreatitis. Here we will test the hypothesis that activated pancreatic stellate cells secrete factors that alter pro-inflammatory macrophages recruited during acute phase of AP into suppressive macrophages that promote recovery.
Aim 3 : Innate immune activation and cell damage associated signals in pancreatitis. Here we will test the hypothesis that unlike macrophages in acute phase of AP, macrophages during recovery mediate recovery by suppressing T cell activation and proliferation. During severe or acute phase of AP however, macrophages sense cellular damage components and activate pathways that perpetuate pro-inflammatory cytokine release. Findings from this project will allow for a better understanding of immune responses and infiltrates associated with acute phases of AP and recovery. In addition to the gained understanding of immune mechanisms that mediate and/or allow progression of AP and recovery, the potential impact of this project is of great clinical significance, as our studies may lead to the development of novel therapies that can alter clinical practice in a disease for which no active therapy is available.

Public Health Relevance

Acute pancreatitis (AP) remains a challenging clinical problem and despite its disease burden, therapy remains supportive at best. AP is one the most common cause of gastrointestinal related hospital admission and in those with severe disease can have a complicated course with high mortality. Despite the frequency and morbidity associated with the disease no active therapy for the condition exists. Our study proposes to examine the immune responses associated with progression and during recovery in order to better understand pathogenic mechanisms that lead to disease progression and protective mechanisms that promote resolution. Using experimental models of acute pancreatitis, we characterize the immune responses and determine pathways that can be targeted to improve disease outcome. Our preliminary results identify some of the important immune mechanisms involved and highlight the possibility of interfering with these immune pathways to confer protection against the disease and promote recovery.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
2R01DK092421-06A1
Application #
9402547
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Serrano, Jose
Project Start
2011-09-20
Project End
2021-03-31
Budget Start
2017-07-07
Budget End
2018-03-31
Support Year
6
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94304
Zhao, Qinglan; Wei, Yi; Pandol, Stephen J et al. (2018) STING Signaling Promotes Inflammation in Experimental Acute Pancreatitis. Gastroenterology 154:1822-1835.e2
Gukovskaya, Anna S; Gukovsky, Ilya; Alg├╝l, Hana et al. (2017) Autophagy, Inflammation, and Immune Dysfunction in the Pathogenesis of Pancreatitis. Gastroenterology 153:1212-1226
Xue, Jing; Zhao, Qinglan; Sharma, Vishal et al. (2016) Aryl Hydrocarbon Receptor Ligands in Cigarette Smoke Induce Production of Interleukin-22 to Promote Pancreatic Fibrosis in Models of Chronic Pancreatitis. Gastroenterology 151:1206-1217
Habtezion, Aida; Nguyen, Linh P; Hadeiba, Husein et al. (2016) Leukocyte Trafficking to the Small Intestine and Colon. Gastroenterology 150:340-54
Habtezion, Aida; Edderkaoui, Mouad; Pandol, Stephen J (2016) Macrophages and pancreatic ductal adenocarcinoma. Cancer Lett 381:211-6
Chang, Marisol; Xue, Jing; Sharma, Vishal et al. (2015) Protective role of hemeoxygenase-1 in gastrointestinal diseases. Cell Mol Life Sci 72:1161-73
Xue, Jing; Sharma, Vishal; Hsieh, Michael H et al. (2015) Alternatively activated macrophages promote pancreatic fibrosis in chronic pancreatitis. Nat Commun 6:7158
Habtezion, Aida (2015) Inflammation in acute and chronic pancreatitis. Curr Opin Gastroenterol 31:395-9
Kambhampati, Swetha; Park, Walter; Habtezion, Aida (2014) Pharmacologic therapy for acute pancreatitis. World J Gastroenterol 20:16868-80
Xue, Jing; Sharma, Vishal; Habtezion, Aida (2014) Immune cells and immune-based therapy in pancreatitis. Immunol Res 58:378-86

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