Pancreatic Disease

pp 24-35

Immunological Mechanisms in Acute Pancreatitis

  • J. Schölmerich

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In recent years it has become evident that both the intrapancreatic events and, even more, the extrapancreatic manifestations of severe acute pancreatitis (septic inflammatory response syndrome, whole-body inflammation) depend on immunological mechanisms. Thus far, this has not led to diagnostic or therapeutic consequences, with the exception of clinical trials with a PAF antagonist, lexipafant [1, 2]. In the following, the evidence for the importance of immunological mechanisms in the pathophysiology of severe acute pancreatitis will be presented. First the role of mediators in inflammation in general will be discussed, thereafter the role of cytokines in the pancreas itself during initial organ attack, then the role of cytokines as effectors in the systemic manifestations of acute pancreatitis, and finally possible conse quences for diagnosis and treatment.