Abstract
Pancreatic stones from 25 patients were compared by morphological and/or radiological examination. Twenty patients, mostly alcoholics, had calcified stones. Five (four nonalcoholic women) had radiolucent stones. Aspect and consistency of calcified stones varied from compact and resistant to coralliform and brittle but were identical in the same patient. In the coralliform type, organic fibrils with a diameter up to 10 μm and a length up to a few centimeters were observed, strongly attached to mineral crystals. The lithostathine (formerly called pancreatic stone protein, PSP) content was estimated in each stone significantly lower in the populations with larger stone mass, compared to populations with small amounts of stones. Transparent stones were built up of an amorphous material solubilized at acidic pH and corresponding to degraded forms of lithostathine-S (S for secretory). In one patient, we followed over seven years the evolution of a radiolucent calculus. We observed that the radiolucent core occurred first, and was secondarily wrapped in a calcified shell. We conclude that morphological differences observed in this study among pancreatic stones suggest that different mechanisms have been involved in their formation. Among them, lithostathine transformation into insoluble polypeptides may provide different types of protein aggregates, some of them being able to promote CaCO3 apposition and others having no affinity for calcium.
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Bernades P, Belghiti J, Athonel M, Mallardo N, Breil P, Fekete F: Histoire naturelle de la pancreatite chronique. Etude de 120 cas. Gastroenterol Clin Biol 7:8–13, 1983
Ammann RW, Akoubiantz A, Largiader F, Schueler G: Course and outcome of chronic pancreatitis. Longitudinal study of a mixed-surgical series of 245 patients. Gastroenterology 86:820–828, 1984
Edmondson HA, Bullock WK, Mehl JW: Chronic pancreatitis and lithiasis. Am J Pathol 26:37–55, 1950
Sarles H: Etiopathogenesis and definition of chronic pancreatitis. Dig Dis Sci 31:91S-107S, 1986
Tasso F, Stemmelin N, Sarles H, Clop J: Comparative morphometric study of the human pancreas in its normal state and in primary chronic calcifying pancreatitis. Biomedicine 18:134–144, 1973
Multigner L, Mariani A, Sahel J, De Caro A, Sarles H: Occurrence of calcium carbonate (calcite) crystals in normal and pathologic pancreatic juice. Digestion 38:A44, 1987
Harada H, Ueda O, Yasuoka M, Nakamura T, Hayashi T, Kobayashi T, Kimura I: Scanning electron microscopic studies on protein plugs obtained from patients with chronic pancreatitis. Gastroenterol Jpn 17:98–101, 1982
Kern HF, Warshaw AL, Scheele GA: Fine structure of protein precipitations in acinar lumina of the normal human pancreas and in chronic pancreatitis.In Pancreatitis. Concepts and Classification. KE Gyr, MV Singer, H Sarles (eds). Amsterdam, Elsevier, 1984, pp 101–105
Guy O, Robles Diaz G, Adrich Z, Sahel J, Sarles H: Protein content of precipitates present in pancreatic juice of alcoholic subjects and patients with chronic calcifying pancreatitis. Gastroenterology 84:102–107, 1983
De Caro A, Bonicel JJ, Rouimi P, De Caro J, Sarles H, Rovery M: Complete amino acid sequence of an immunoreactive form of human pancreatic stone protein isolated from pancreatic juice. Eur J Biochem 168:201–207, 1987
Multigner L, Sarles H, Lombardo D, De Caro A: Pancreatic stone protein II. Implication in stone formation during the course of chronic calcifying pancreatitis. Gastroenterology 2:686–687, 1986
Bernard JP, Adrich Z, Sarles H, De Caro A: TheN-terminal eleven amino acid-glycopeptide released by trypsin from pancreatic stone protein carries the inhibitory activity on calcium carbonate crystal growth. Gastroenterology 96:A40, 1989
Rouimi P, Bonicel J, Rovery M, De Caro A: Cleavage of the Arg-Ile bond in the native polypeptide chain of the human pancreatic stone protein. FEBS Lett 216:195–199, 1987
Mallet-Guy P, Vérine H: Etude radiocristallographique des calculs pancreatiques et d'un calcul salivaire d'origine humaine. CR Soc Biol. 163:1838–1841, 1969
De Caro A, Lohse J, Sarles H: Characterization of a protein isolated from pancreatic calculi of men suffering from CCP. Biochem Biophys Res Commun 87:1176–1182, 1979
Bockman DE, Kennedy R, Multigner L, De Caro A, Sarles H: Fine structure of the organic matrix of human pancreatic stones. Pancreas 1:204–210, 1986
Harada H, Takeda M, Tanaka J, Ochi K, Kumura I: The fine structure of pancreatic stones as shown by scanning electron microscopy and x-ray probe microanalyser. Gastroenterol Jpn 18:530–537, 1983
De Caro A, Multigner L, Lafont H, Lombardo D, Sarles H: The molecular characteristics of a human pancreatic acidic phosphoprotein that inhibits calcium carbonate crystal growth. Biochem J 222:669–677, 1984
Provansal-Cheylan M, Bernard JP, Mariani A, Dupuy P, Sarles H: Pancreatic stone protein: Quantification in pancreatic juice by enzyme-linked immunosorbent assay and comparison with other methods. Pancreas 4:680–689, 1989
Sarles H, Dagorn JC, Giorgi D, Bernard JP: Remaining pancreatic stone protein as “lithostathine”. Gastroenterology 99:900–905, 1990
Gross J, Carlson R, Brauer AW, Michael N, Margolies N, Warshaw AL, Wands JR: Isolation, characterization and distribution of an unusual pancreatic human secretory protein. J Clin Invest 76:2115–2126, 1985
Giorgi D, Bernard JP, Rouquier S, Iovanna J, Sarles H, Dagorn JC: Secretory pancreatic stone protein mRNA: Nucleotide sequence and expression in chronic calcifying pancreatitis. J Clin Invest 84:100–106, 1989
Lechene de la Porte P, Iovanna J, Odaira C, Choux R, Sarles H, Berger Z: Involvement of tubular complexes in pancreatic regeneration after acute necrohemorrhagic pancreatitis. Pancreas, (in press)
Schmiegel W, Burchert M, Kalthoff H, Roeder C, Butzow G, Grimm H, Kremer B, Soehendra N, Schreiber H, Thiele H, Greten H: Immunochemical characterization and quantitative distribution of pancreatic stone protein in sera pancreatic secretions in pancreatic disorders. Gastroenterology 99:1421–1430, 1990
Sarles H, DeCaro A, Multigner L, Martin E: Giant pancreatic stones in teetotal woman due to absence of the “stone protein”? Lancet 2:714–715, 1982
Multigner L, Mariani A, Daudon M, Schmiegel WH, Sarles H, DeCaro A: Pancreatic stone protein and radiolucent pancreatic stones. Digestion 38:A53, 1987
Gullo L, Sarles H, Mott CB, Tiscornia OM, Pauli AM, Pastor J: Pancreatic secretion of calcium in healthy subjects and various diseases of the pancreas. Rend Gastroenterol 6:35–44, 1974
Uscanga L, Kennedy RH, Choux R, Druguet M, Grimaud J, Sarles H: Sequential connective matrix changes in experimental acute pancreatitis. Immuno-histochemical and Biochemical assessment in the rat. Int J Pancreatol 2:33–45, 1987
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Mariani, A., Bernard, J.P., Provansal-Cheylan, M. et al. Differences of pancreatic stone morphology and content in patients with pancreatic lithiasis. Digest Dis Sci 36, 1509–1516 (1991). https://doi.org/10.1007/BF01296390
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DOI: https://doi.org/10.1007/BF01296390