Zusammenfassung
Die Autoimmunpankreatitis ist eine Sonderform der chronischen Pankreatitis, definiert durch typische klinische Manifestation mit obstruktiver Gelbsucht, gegebenenfalls mit Nachweis einer tumorösen Läsion, gutes therapeutisches Ansprechen auf Steroide und ihr histologisches Bild mit lymphoplasmazellulären Infiltraten und Fibrose. Wenngleich die genauen Mechanismen der Krankheitsentstehung bislang ungeklärt sind, ist von einer Th1-mediierten Entzündungsreaktion auszugehen, die sich gegen Gangstrukturen und Azini richtet, offenbar unter dem Einfluss von unterschiedlichen Autoantikörpern. Prädisponierende genetische Veränderungen wurden beschrieben, ferner scheinen ethnische bzw. regionale Faktoren Einfluss zu nehmen. Analog zu chronischen Pankreatitiden anderer Ursache stellen Autoimmunpankreatitiden einen Risikofaktor für die Entstehung duktaler Pankreaskarzinome dar.
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Literatur
Chari ST, Klöppel G, Zhang L, Notohara K, Lerch MM, Shimosegawa T, Autoimmune Pancreatitis International Cooperative Study Group (APICS) (2010) Histopathologic and clinical subtypes of autoimmune pancreatitis: the Honolulu consensus document. Pancreas 39(5): 549–554. doi: 10.1097/MPA.0b013e3181e4d9e5
Deshpande V, Gupta R, Sainani N, Sahani DV, Virk R, Ferrone C, Khosroshahi A, Stone JH, Lauwers GY (2011) Subclassification of autoimmune pancreatitis: a histologic classification with clinical significance. Am J Surg Pathol 35(1): 26–35. doi: 10.1097/PAS.0b013e3182027717
Detlefsen S, Bräsen JH, Zamboni G, Capelli P, Klöppel G (2010) Deposition of complement C3c, immunoglobulin (Ig)G4 and IgG at the basement membrane of pancreatic ducts and acini in autoimmune pancreatitis. Histopathology 57(6): 825–835. doi: 10.1111/j.1365-2559.2010.03717.x
Detlefsen S, Zamboni G, Frulloni L, Feyerabend B, Braun F, Gerke O, Schlitter AM, Esposito I, Klöppel G (2012) Clinical features and relapse rates after surgery in type 1 autoimmune pancreatitis differ from type 2: a study of 114 surgically treated European patients. Pancreatology 12(3): 276–283. doi: 10.1016/j.pan.2012.03.055
Esposito I, Born D, Bergmann F, Longerich T, Welsch T, Giese NA, Büchler MW, Kleeff J, Friess H, Schirmacher P (2008) Autoimmune pancreatocholangitis, non-autoimmune pancreatitis and primary sclerosing cholangitis: a comparative morphological and immunological analysis. PLoS One 3(7):e2539. doi: 10.1371/journal.pone.0002539
Finkelberg DL, Sahani D, Deshpande V, Brugge WR (2006) Autoimmune pancreatitis. N Engl J Med 355(25): 2670–2676
Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Clain JE, Pearson RK, Pelaez-Luna M, Petersen BT, Vege SS, Farnell MB (2007) Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol 102(8): 1646–1653
Gupta R, Khosroshahi A, Shinagare S, Fernandez C, Ferrone C, Lauwers GY, Stone JH, Deshpande V (2013) Does autoimmune pancreatitis increase the risk of pancreatic carcinoma? A retrospective analysis of pancreatic resections. Pancreas 42(3): 506–510. doi: 10.1097/MPA.0b013e31826bef91
Hart PA, Kamisawa T, Brugge WR, Chung JB, Culver EL, Czakó L, Frulloni L, Go VL, Gress TM, Kim MH, Kawa S, Lee KT, Lerch MM, Liao WC, Löhr M, Okazaki K, Ryu JK, Schleinitz N, Shimizu K, Shimosegawa T, Soetikno R, Webster G, Yadav D, Zen Y, Chari ST (2012) Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut Dec 11 [Epub ahead of print]
Kamisawa T, Chari ST, Giday SA, Kim MH, Chung JB, Lee KT, Werner J, Bergmann F, Lerch MM, Mayerle J, Pickartz T, Lohr M, Schneider A, Frulloni L, Webster GJ, Reddy DN, Liao WC, Wang HP, Okazaki K, Shimosegawa T, Klöppel G, Go VL (2011) Clinical profile of autoimmune pancreatitis and its histological subtypes: an international multicenter survey. Pancreas 40(6): 809–814. doi: 10.1097/MPA.0b013e3182258a15
Kawa S, Ota M, Yoshizawa K, Horiuchi A, Hamano H, Ochi Y, Nakayama K, Tokutake Y, Katsuyama Y, Saito S, Hasebe O, Kiyosawa K (2002) HLA DRB10405-DQB10401 haplotype is associated with autoimmune pancreatitis in the Japanese population. Gastroenterology 122(5): 1264–1269
Löhr JM, Faissner R, Koczan D, Bewerunge P, Bassi C, Brors B, Eils R, Frulloni L, Funk A, Halangk W, Jesenofsky R, Kaderali L, Kleeff J, Krüger B, Lerch MM, Lösel R, Magnani M, Neumaier M, Nittka S, Sahin-Tóth M, Sänger J, Serafini S, Schnölzer M, Thierse HJ, Wandschneider S, Zamboni G, Klöppel G (2010) Autoantibodies against the exocrine pancreas in autoimmune pancreatitis: gene and protein expression profiling and immunoassays identify pancreatic enzymes as a major target of the inflammatory process. Am J Gastroenterol 105(9): 2060–2071. doi: 10.1038/ajg.2010.141
Mogler C, Flechtenmacher C, Schirmacher P, Bergmann F (2012) Schnellschnittdiagnostik in der Viszeralchirurgie. Leber, Gallenwege und Pankreas. Pathologe 33(5): 413–423. doi: 10.1007/s00292-012-1602-z
Okazaki K, Uchida K, Ohana M, Nakase H, Uose S, Inai M, Matsushima Y, Katamura K, Ohmori K, Chiba T (2000) Autoimmune-related pancreatitis is associated with autoantibodies and a Th1/Th2-type cellular immune response. Gastroenterology 118(3): 573–581
Ota M, Ito T, Umemura T, Katsuyama Y, Yoshizawa K, Hamano H, Kawa S (2011) Polymorphism in the KCNA3 gene is associated with susceptibility to autoimmune pancreatitis in the Japanese population. Dis Markers 31(4): 223–229. doi: 10.3233/DMA-2011-0820
Sah RP, Chari ST (2011) Serologic issues in IgG4-related systemic disease and autoimmune pancreatitis. Curr Opin Rheumatol 23(1): 108–113. doi: 10.1097/BOR.0b013e3283413469
Seleznik GM, Reding T, Romrig F, Saito Y, Mildner A, Segerer S, Sun LK, Regenass S, Lech M, Anders HJ, McHugh D, Kumagi T, Hiasa Y, Lackner C, Haybaeck J, Angst E, Perren A, Balmer ML, Slack E, MacPherson A, Manz MG, Weber A, Browning JL, Arkan MC, Rülicke T, Aguzzi A, Prinz M, Graf R, Heikenwalder M (2012) Lymphotoxin β receptor signaling promotes development of autoimmune pancreatitis. Gastroenterology 143(5): 1361–1374. doi: 10.1053/j.gastro.2012.07.112
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, Kim MH, Klöppel G, Lerch MM, Löhr M, Notohara K, Okazaki K, Schneider A, Zhang L; International Association of Pancreatology (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40(3): 352–358. doi: 10.1097/MPA.0b013e3182142fd2
Smyk DS, Rigopoulou EI, Koutsoumpas AL, Kriese S, Burroughs AK, Bogdanos DP (2012) Autoantibodies in autoimmune pancreatitis. Int J Rheumatol 2012: 940831. doi: 10.1155/2012/940831
Stone JH, Zen Y, Deshpande V (2012) IgG4-related disease. N Engl J Med 366(6): 539–551. doi: 10.1056/NEJMra1104650
Takuma K, Kamisawa T, Igarashi Y (2011) Autoimmune pancreatitis and IgG4-related sclerosing cholangitis. Curr Opin Rheumatol 23(1): 80–87. doi: 10.1097/BOR.0b013e3283412f60.
Umemura T, Ota M, Hamano H, Katsuyama Y, Kiyosawa K, Kawa S (2006) Genetic association of Fc receptor-like 3 polymorphisms with autoimmune pancreatitis in Japanese patients. Gut 55(9): 1367–1368
Zamboni G, Lüttges J, Capelli P, Frulloni L, Cavallini G, Pederzoli P, Leins A, Longnecker D, Klöppel G (2004) Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch 445(6): 552–563
Zen Y, Nakanuma Y (2010) IgG4-related disease: a cross-sectional study of 114 cases. Am J Surg Pathol 34(12): 1812–1819. doi: 10.1097/PAS.0b013e3181f7266b
Zhang L, Chari S, Smyrk TC, Deshpande V, Klöppel G, Kojima M, Liu X, Longnecker DS, Mino-Kenudson M, Notohara K, Rodriguez-Justo M, Srivastava A, Zamboni G, Zen Y (2011) Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas 40(8): 1172–1179. doi: 10.1097/MPA.0b013e318233bec5
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Bergmann, F. (2013). Pathogenese der Autoimmunpankreatitis. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_29
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