Lactoferrin secretion in alcoholic pancreatic disease

Abstract

Lactoferrin, a nonenzyme protein normally secreted in small amounts in pancreatic juice, has been reported by several investigators to be secreted in large amounts in chronic pancreatitis. Whether this increased secretion first occurs at an early or late stage of alcoholic pancreatic disease is unknown. In this study we measured lactoferrin and enzyme outputs in duodenal juice from 10 healthy subjects and three groups of alcoholic subjects: asymptomatic chronic alcoholics without evidence, clinically or biochemically, of pancreatitis (10), those recovered from acute pancreatitis (8), and those with established chronic pancreatitis (8). A multilumen, marker-perfused duodenal catheter was used to aspirate basal pancreatic secretions at the ligament of Treitz. The mean (±se) lactoferrin concentration in duodenal juice for the four groups of subjects was: healthy, 0.7±0.1 μglml; asymptomatic alcoholics, 5.5±1.5 μgl; alcoholics who had recovered from acute pancreatitis, 7.4±0.8 μg/ml; and alcoholics with chronic pancreatitis 7.1± 1.9 μg/ml. The three groups of alcoholics each had a greater lactoferrin concentration than the normals (P<0.005). The output of lactoferrin in the four groups paralleled the concentration in that the three groups of alcoholics had a significantly greater output: healthy subjects, 3.4±0.5 μg/kg/hr; asymptomatic alcoholics, 25.7±7.4 μg/kg/hr; alcoholics recovered from acute pancreatitis, 80.1±27 μg/kg/hr; and alcoholics with chronic pancreatitis, 90.9±32 μg/kg/hr. The output of chymotrypsin and trypsin in the four groups of subjects revealed increased secretory rates in the asymptomatic alcoholics and the alcoholics recovered from acute pancreatitis: normal chymotrypsin output, 1.0±0.2 mglkglhr; asymptomatic alcoholics, 2.2±0.4 mglkglhr; alcoholics recovered from acute pancreatitis, 3.3±0.7 mglkglhr (P<0.05 vs healthy subjects). Alcoholics with chronic pancreatitis had a low chymotrypsin output, 0.2±0.1 μg/kg/hr (P<0.05). These findings suggest that chronic alcohol consumption increases the interdigestive pancreatic secretion of lactoferrin and enzymes prior to the development of symptomatic and chronic pancreatic disease.