lactoferrin and Pancreatitis

Most abdominal disorders present with a limited number of overlapping symptoms. Blood tests are not routinely available for use in diagnosis and so investigation tends to require complex imaging procedures or endoscopy and biopsy. These are invasive for the patient, may be associated with morbidity and mortality and have considerable resource implications. Biochemical tests on a single sample of faeces are therefore a valuable alternative. Measurement of faecal calprotectin has been shown to have a role in the diagnosis of inflammatory bowel disease and in its monitoring. Lactoferrin is also of benefit used in this way. Faecal elastase has been demonstrated to be of use in the diagnosis of pancreatic insufficiency. A number of faecal markers have been explored in colorectal cancer. Faecal occult blood testing is used for population screening, but the metabolomic marker tumour, M2-pyruvate kinase, has potential for use in both diagnosis and screening. DNA testing has advantages in colorectal cancer but the exact applications of such tests require further evaluation.

Topics: Biomarkers; Carcinoma; Colorectal Neoplasms; Enzyme-Linked Immunosorbent Assay; Exocrine Pancreatic Insufficiency; Feces; Humans; Inflammatory Bowel Diseases; Lactoferrin; Leukocyte L1 Antigen Complex; Mass Screening; Metabolome; Occult Blood; Pancreatic Elastase; Pancreatitis; Pyruvate Kinase; Sensitivity and Specificity

Lactoferrin is a protein present in many fluids of the human organism and in the secondary granules of polymorphonuclear cells (PMN). In the blood stream lactoferrin favours the segregation of PMN by mediating and amplifying the immune response, and realizes a negative feedback control on the Colony Forming Unit Granulocyte/Macrophage (CFU-GM) proliferation. At intestinal level it promotes iron absorption and prevents bacterial overgrowth. The antibacterial effect of lactoferrin is used clinically to prevent bacterial infections in neutropenic patients submitted to chemotherapy for leukemic diseases type M1, M2, M4 and M5, according to FAB criteria. In patients affected by chronic pancreatitis the lactoferrin concentration, in duodenal juice, is found to be significantly higher than in normal subjects. This finding suggests a pathogenetic role of the protein in chronic pancreatitis.

Topics: Bacteria; Chronic Disease; Granulocytes; Humans; Lactoferrin; Lipid Peroxidation; Neoplasms; Neutrophils; Pancreatitis

Lactoferrin (LF)--in various quantities--is present in human milk, secretions and polymorphonuclear neutrophils (PMN). LF's significance lies in its bacteriostatic effect on its environment. Probably it prevents bacterial uptake of iron, leads to damage of bacteria and during phagocytosis helps the organism to combat pathogens. Most likely it regulates iron absorption, and during inflammation it takes part in the plasma iron transport. LF is believed to play an important role in the regulation of granulopoiesis in the bone-marrow. From its biological effects it appears that plasma LF determinations may be useful in the clinical diagnosis of leukaemia and other malignant diseases, as well as in the study of iron metabolism.

Topics: Absorption; Animals; Biological Transport; Cell Division; Chronic Disease; Granulocytes; Humans; Inflammation; Iron; Kinetics; Lactoferrin; Lactoglobulins; Leukemia, Myeloid; Milk; Pancreatic Neoplasms; Pancreatitis

Topics: Acute Disease; Alcoholism; Calcinosis; Cholecystitis; Chronic Disease; Enzyme Activation; Humans; Kinins; Lactoferrin; Pancreatitis; Protein Biosynthesis; Protein-Energy Malnutrition; Shock; Trypsin; Trypsinogen

Topics: Biopsy; Carcinoembryonic Antigen; Celiac Artery; Cholangiography; Cholecystokinin; Lactoferrin; Laparoscopy; Mesenteric Arteries; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Tomography, X-Ray Computed; Ultrasonography

Topics: Duodenum; Humans; Immunoelectrophoresis; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatitis

Increased viscosity and raised lactoferrin, trypsin and protein concentrations in selectively aspirated pancreatic secretion, prompted us to try depot secretin therapy in patients with advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pancreatic pseudocysts. The idea behind this approach was that it might "wash out" the sticky, protease-rich secretion. In a randomized double-blind trial we administered depot secretin at doses of 800 CU by subcutaneous injection twice daily for 7 days. Pancreatic secretion from the treatment group had significantly lower viscosities and lactoferrin and trypsin concentrations than in the placebo group. There was also significant pain relief. Depot secretin therapy appears to offer an alternative approach to the management of advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pseudocysts.

Topics: Amylases; Chronic Disease; Clinical Trials as Topic; Delayed-Action Preparations; Double-Blind Method; Female; Humans; Lactoferrin; Male; Middle Aged; Pain; Pancreatic Juice; Pancreatitis; Random Allocation; Recurrence; Secretin; Trypsin; Viscosity

To study the autoimmune response in MRL/Mp mice, which spontaneously develop pancreatitis in the exocrine pancreatic tissue.. Six-week-old female mice were injected intraperitoneally with polyinosinic polycytidylic acid at a dose of 5 mg/kg of body weight twice a week for up to 12 weeks. The mice were serially killed, and the severity of their pancreatitis was graded with a histological scoring system. Immunohistological examinations were performed, and the serum levels of autoantibodies were measured by enzyme-linked immunosorbent assay.. The administration of polyinosinic polycytidylic acid accelerated the development of pancreatitis, with abundant infiltration of B220 B cells and CD138 plasmacytes. Various autoantibodies directed against autoantigens, including carbonic anhydrase II and lactoferrin, were detected but none against glutamic acid decarboxylase. Of these, autoantibodies directed against the pancreatic secretory trypsin inhibitor (PSTI; 91.7%) were more prevalent than those against carbonic anhydrase II (33.3%) or lactoferrin (45.8%). Determination of the epitope of the anti-PSTI antibody showed that most immunoreactivity was directed at the site on PSTI that is active in the suppression of trypsin activity.. The autoimmune response to PSTI protein may induce a failure of PSTI activity, resulting in the activation of trypsinogen and the subsequent disease progression.

Topics: Animals; Autoantibodies; Autoimmune Diseases; B-Lymphocytes; Carbonic Anhydrase II; Disease Models, Animal; Disease Progression; Enzyme-Linked Immunosorbent Assay; Epitope Mapping; Female; Immunity, Humoral; Immunoglobulin G; Immunohistochemistry; Lactoferrin; Leukocyte Common Antigens; Mice; Mice, Inbred C57BL; Pancreas; Pancreatitis; Plasma Cells; Poly I-C; Syndecan-1; Trypsin Inhibitor, Kazal Pancreatic

The role of protein components of pancreatic secretions has been controversial in pancreatic stone formation.. To study the lithogenic role of pancreatic stone protein and lactoferrin in stone formation in chronic pancreatitis.. Pancreatic stones were collected from 13 patients with alcoholic (n=6) and nonalcoholic (n=7) chronic calcified pancreatitis.. Pancreatic stone extracts were analyzed for pancreatic stone protein and lactoferrin using enzyme immunoassay. The localization of pancreatic stone protein immunoreactivity in the stone was observed using immunogold staining and scanning electron microscopy.. Immunoreactivities for pancreatic stone protein were detected in the stones from all 13 patients with chronic calcified pancreatitis and for lactoferrin in the stones from five of the 13 patients. Pancreatic stone protein immunoreactivity distributed diffusely from the center to the periphery of the pancreatic stones.. Involvement of pancreatic stone protein seems to be constant from the initial step of the stone formation to subsequent steps of the stone growth. However, pancreatic stone protein is only one of the precipitating proteins in pancreatic secretions such as lactoferrin, trypsinogen, etc.

Topics: Adult; Aged; Calcium-Binding Proteins; Calculi; Chronic Disease; Female; Humans; Lactoferrin; Lithostathine; Male; Middle Aged; Nerve Tissue Proteins; Pancreatitis; Pancreatitis, Alcoholic

We previously reported that autoantibodies against carbonic anhydrase II and lactoferrin are frequently identified in patients with autoimmune-related pancreatitis. To clarify the role of carbonic anhydrase II and lactoferrin, we created animal models of autoimmune pancreatitis by immunizing neonatally thymectomized mice with carbonic anhydrase II and lactoferrin and also by transferring immunized spleen cells to nude mice. Neonatally thymectomized BALB/c mice were immunized with carbonic anhydrase II or lactoferrin followed by three booster injections (n = 10 in each group). We transferred whole, CD4+, or CD8+ spleen cells prepared from immunized neonatally thymectomized mice to nude mice (n = 5 in each group). Gene expression of IFN-gamma and IL-4 was investigated using semiquantitative reverse transcription-polymerase chain reaction. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling staining was used to examine apoptosis. In immunized neonatally thymectomized mice, the prevalence of inflammation was significantly higher in the pancreas. Inflammation was present in all mice receiving whole or CD4+ cells. There was no change in any of the mice receiving CD8+ cells or nonimmunized spleen cells. Carbonic anhydrase II or lactoferrin-immunized mice had apoptotic duct cells or acinar cells, respectively. Expression of the IFN-gamma gene was up-regulated in each group. Similar findings were observed in the salivary glands and liver. An immunologic mechanism against carbonic anhydrase II or lactoferrin is involved in the pathogenesis of these pancreatitis models, in which the effector cells are Th1-type CD4+ T cells.

Topics: Adoptive Transfer; Animals; Autoimmune Diseases; Carbonic Anhydrase II; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Disease Models, Animal; Female; Gene Expression; Immunization; In Situ Nick-End Labeling; Interferon-gamma; Interleukin-4; Lactoferrin; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Pancreas; Pancreatitis; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Salivary Glands; Spleen; Thymectomy

Examination of immunological status in patients with acute destructive pancreatitis with uncomplicated (14 patients) and complicated (infectious-inflammatory processes--18 patients) postoperative period illustrated depression of T- and B-links of immunity, reduction of absolute and relative number of TFU- and TFC-lymphocytes. All the patients demonstrated reliable elevation of phagocytic rate, phagocytic index and number of circulating immune complexes. These changes were more significant in patients with complicated postoperative period. Level of lactoferrin in patients with complicated period was by 10% higher than in patients without complications. Significant elevation of tumor necrosis factor Ia in blood was registered in patients of both groups. During all the periods of examination the level of interleukin-8 was higher in patients with complicated postoperative period than in the patients with favorable postoperative period. This interleukin-8 is a reliable marker of postoperative complications in acute destructive pancreatitis.

Topics: Acute Disease; Antigen-Antibody Complex; B-Lymphocytes; Data Interpretation, Statistical; Humans; Immune System Diseases; Immunoglobulins; Interleukin-8; Lactoferrin; Lymphocyte Count; Pancreatitis; Postoperative Period; T-Lymphocytes; Time Factors; Tumor Necrosis Factor-alpha

Although autoimmunity may be involved in some cases of pancreatitis, the mechanism is still unknown. To clarify this, we studied serum autoantibodies, subsets of lymphocytes, and the Th1/Th2 balance of cellular immune responses in patients with autoimmune-related pancreatitis (AIP).. Seventeen patients with AIP (8 men and 9 women; age, 53.2 +/- 13.0 years) were studied. Autoantibodies including antilactoferrin (ALF) or carbonic anhydrase II antibody (ACA-II) were examined using the enzyme-linked immunosorbent assay (ELISA) or the indirect fluorescein antibody method. Intracellular cytokines (interferon gamma and interleukin 4) and subtypes of peripheral blood lymphocytes were examined by flow cytometry and ELISA.. More than one autoantibody was observed in all 17 patients. Serum antinuclear antibody was detected in 13 of 17 patients, ALF antibody in 13, ACA-II antibody in 10, rheumatoid factor in 5, and anti-smooth muscle antibody in 3, but antimitochondrial antibody in none. The serum levels of ACA-II and LF antibody were not correlated. HLA-DR(+)CD8(+) and HLA-DR(+)CD4(+) cells were significantly increased in peripheral blood (P < 0.05). CD4(+) cells producing interferon gamma and the secreted levels were significantly increased compared with those in controls (P < 0.05), but interleukin 4 was not increased.. An autoimmune mechanism against CA-II or LF, and Th1-type immune response, may be involved in AIP.

Topics: Adult; Aged; Antibody Formation; Autoantibodies; Autoimmune Diseases; Carbonic Anhydrases; Cytokines; Female; Humans; Lactoferrin; Lymphocyte Subsets; Male; Middle Aged; Pancreatitis; Th1 Cells; Th2 Cells

Several investigators have reported on autoimmune-related pancreatitis, but the clinical findings and pathophysiology still remain unclear. To clarify it, we analyzed eight patients with autoimmune pancreatitis.. We evaluated clinical findings in eight patients (four men and four women) with autoimmune-related pancreatitis. Patients were aged 45-73 yr (mean, 57.5 yr). We examined blood chemistry and immunological studies, including autoantibodies against lactoferrin or carbonic anhydrase II, and compared ERCP images with clinical findings. In two patients, we studied the subset of lymphocytes infiltrating in the pancreas by immunohistochemistry and flow cytometry.. Four of eight patients had jaundice, two had renal dysfunction, two had abdominal pain, and two had back pain. Three patients were complicated with other autoimmune diseases. Three patients showed abnormal pancreatic exocrine function by an N-benzoyl-L-tyrosyl-para-aminobenzoic acid excretion test. Antinuclear antibody was detected in four of eight patients, antilactoferrin antibody in three of six, anticarbonic anhydrase II antibody in two of six, antismooth muscle antibody in two of seven, and rheumatoid factor in one of eight. All eight patients showed segmental stenosis of the main pancreatic duct by ERCP. Four patients showed stenosis of the common bile duct as well as the pancreatic duct. Microscopic findings showed infiltration of CD4-positive lymphocytes around the pancreatic duct, and HLA-DR was expressed on both CD4-positive cells and pancreatic duct cells. In two patients, stenosis of the pancreatic duct improved by prednisolone.. Autoimmune mechanism may be involved in some patients with idiopathic pancreatitis associated with hypergammaglobulinemia.

Topics: Aged; Autoantibodies; Autoimmune Diseases; Carbonic Anhydrases; Cholangiopancreatography, Endoscopic Retrograde; Female; Flow Cytometry; Humans; Hypergammaglobulinemia; Lactoferrin; Lymphocyte Subsets; Male; Middle Aged; Pancreas; Pancreatitis

Lactoferrin and pancreatic stone protein (PSP) are thought to be closely related to pancreatic stone formation in chronic pancreatitis. However, the results reported so far have not been conclusive. To reevaluate the pathological importance of PSP in chronic pancreatitis, compared to lactoferrin, levels of PSP were determined by applying an immunoassay specific to PSP to pure pancreatic juice taken from a total of 52 patients. The patients consisted of 16 controls, 19 chronic pancreatitis patients (13 noncalcified and 6 calcified), and 17 probable cases of pancreatitis. The monoclonal antibody PSP antagonist used in the study recognizes both forms of the protein, PSP S1 and S2-5, with equal effectiveness. No significant reduction of PSP was observed in either calcified (mean +/- SEM, 111 +/- 30 micrograms/mg and 24 +/- 3 micrograms/mg protein) or noncalcified (305 +/- 133 and 97 +/- 47) chronic pancreatitis patients compared with controls (85 +/- 23 and 34 +/- 16). PSP levels did not decrease, at least not in the complete forms of the protein found in chronic pancreatitis. PSP antibody and assay results indicated that a reduction of PSP S2-5 alone could not be ruled out in chronic pancreatitis either.

Topics: Adult; Aged; Calcium-Binding Proteins; Chronic Disease; Female; Humans; Immunoenzyme Techniques; Lactoferrin; Lithostathine; Male; Middle Aged; Nerve Tissue Proteins; Pancreas; Pancreatic Juice; Pancreatitis

To evaluate pathophysiological roles of proteins in pancreatic secretion, immunoreactive lactoferrin (LF) and secretory component (SC) were measured in the first fraction of the pure pancreatic juice obtained endoscopically from 17 control, 21 suspected (SCP), 14 noncalcified (NCP), and 14 calcified chronic pancreatitis (CCP) subjects. The protein and amylase tended to decrease both in concentration and output from control to CCP. LF concentration was elevated in CCP (18.0 +/- 4.9 micrograms/ml) when compared with controls (2.3 +/- 0.2 micrograms/ml), and LF output in NCP (12.3 +/- 3.8 micrograms/min) was increased from controls (3.8 +/- 0.6 micrograms/min). The combination of high LF concentration with low protein output was observed in 10/14 in CCP but 0/14 in NCP and can be a biochemical discriminator of CCP from NCP. SC concentrations were also elevated in NCP (8.5 +/- 2.0 micrograms/ml) and CCP (5.6 +/- 1.6 micrograms/ml) from controls (1.2 +/- 0.2 micrograms/ml). SC outputs in SCP (9.8 +/- 3.1 micrograms/min) and NCP (21.1 +/- 4.8 micrograms/min) were increased from controls (1.7 +/- 0.3 micrograms/min), but there was no further increase in CCP. Hypersecretion of LF and SC in chronic pancreatitis is different, especially in CCP, although the mechanisms for hypersecretion are unknown.

Topics: Adult; Aged; Amylases; Calcinosis; Chronic Disease; Humans; Lactoferrin; Middle Aged; Pancreatic Juice; Pancreatitis; Proteins; Secretory Component

In rats we studied the effects of lactoferrin on experimental acute pancreatitis caused by a single subcutaneous injection of 100 micrograms/kg body weight of caerulein. Lactoferrin isolated from human milk was given intraperitoneally to rats immediately after the injection of caerulein. The injection of 100 mg/kg body weight of lactoferrin significantly reduced the elevation of the serum amylase level and pancreatic wet weight; histological alterations of the pancreas were markedly suppressed. These results suggested that lactoferrin had a protective effect on the biochemical and histological alterations in this model.

Topics: Acute Disease; Amylases; Animals; Ceruletide; Female; Humans; Injections, Intraperitoneal; Iron; Lactoferrin; Male; Milk, Human; Pancreas; Pancreatitis; Rats; Rats, Wistar

The immunohistochemical detection of lactoferrin was carried out with the PAP technique on pancreatic tissue samples of 23 patients, operated for acute (13) or chronic (4) pancreatitis as well as for adenocarcinomas (6). In order to control our immunohistochemical technique and the antisera produced by us we studied some tissue samples of human mammary gland and parotis. We detected lactoferrin in the glands of parotis and mammae as well as of their secretions. In the pancreatic tissue we found a positive reaction only in granulocytes of inflammatory areas with the exception of a luminal reaction on the surface of acinar cells in one case of pancreatic adenocarcinoma. We would like to interpret our results with the hypothesis of granulocytic origin of immunochemically detectable lactoferrin in the pancreatic juice of patients, especially in cases of chronic pancreatitis.

Topics: Adenocarcinoma; Adult; Aged; Breast; Female; Humans; Immunohistochemistry; Lactoferrin; Male; Middle Aged; Milk, Human; Pancreas; Pancreatic Neoplasms; Pancreatitis; Parotid Gland

In 29 patients with chronic pancreatitis, 15 patients with malignant tumours of the pancreas and in 30 controls lactoferrin in fluid aspirated from the duodenum was assessed during the cholecystokinin-secretin (CCK-S) test. As compared with the control group, its concentration is significantly higher in patients with chronic pancreatitis, but not in patients with malignant tumours of the pancreas. It is probable that estimation of lactoferrin in the CCK-S test may prove helpful in the differential diagnosis of pancreatic disease.

Topics: Chronic Disease; Diagnosis, Differential; Duodenum; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatic Neoplasms; Pancreatitis

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 micrograms/ml; asymptomatic alcoholics, 5.5 +/- 1.5 micrograms/ml; alcoholics who had recovered from acute pancreatitis, 7.4 +/- 0.8 micrograms/ml; and alcoholics with chronic pancreatitis 7.1 +/- 1.9 micrograms/ml. The three groups of alcoholics each had a greater lactoferrin concentration than the normals (P less than 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 micrograms/kg/hr; asymptomatic alcoholics, 25.7 +/- 7.4 micrograms/kg/hr; alcoholics recovered from acute pancreatitis, 80.1 +/- 27 micrograms/kg/hr; and alcoholics with chronic pancreatitis, 90.9 +/- 32 micrograms/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.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alcoholism; Chymotrypsin; Duodenum; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatitis

Lactoferrin, as measured in the pancreatic juice, has been thought to be of diagnostic value in chronic pancreatitis, but due to the hazards in cannulation of the pancreatic duct in the acute phase of pancreatitis the behavior of lactoferrin has remained obscure. In this study, lactoferrin levels were studied in pancreas tissue specimens obtained in ablative surgery for acute necrotizing pancreatitis (ANP) and in serum samples. A higher pancreatic lactoferrin content was found in ANP than in normal pancreas. Lactoferrin seemed not to leak from a necrotic pancreas in any considerable amounts into the circulation, as no differences were found in serum lactoferrin concentrations between ANP and controls. It remains an open question whether the lactoferrin increase is only an unspecific reaction in inflammation or is something specific for pancreatitis.

Topics: Acute Disease; Alkaline Phosphatase; Amylases; Humans; Lactoferrin; Lactoglobulins; Necrosis; Pancreas; Pancreatitis

To evaluate the clinical value of lactoferrin determination in duodenal contents in patients with chronic pancreatitis, three different studies were performed. No significant difference in meal stimulated output or secretion pattern was found between seven patients with chronic pancreatitis and six controls. After a meal test in 88 patients suspected for pancreatitis no correlation between concentration of lactoferrin and amylase was found. No correlation was found between degree of obstruction at endoscopic retrograde pancreaticography and duodenal concentration of lactoferrin. We conclude that the diagnostic value of lactoferrin determinations in chronic pancreatitis is doubtful.

Topics: Adult; Aged; Amylases; Chronic Disease; Duodenum; Female; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreatic Ducts; Pancreatitis

Lactoferrin (LF), chymotrypsin and lipase activity were measured in duodenal juice during pancreatic stimulation. Secretin (0.5 CU/kg/h) plus cerulein (75 ng/kg/h) were infused intravenously in 98 subjects: 33 patients without organic diseases (C), 40 patients affected by chronic pancreatitis (CP), and 25 patients with different gastrointestinal diseases (GID). LF was determined by means of a new noncompetitive immunoenzymatic assay with a sensitivity in the duodenal juice of 5 ng/ml. Duodenal LF concentrations were significantly higher in CP than in C or GID (p less than 0.001). LF was in a normal range in acute relapsing pancreatitis due to biliary stones or pancreas divisum. In the diagnosis of the chronic pancreatitis, LF/lipase ratios showed a specificity of 93% and a sensitivity of 95%. Our results show that LF immunoassay in duodenal juice is a sensitive and accurate assay to apply in pancreatic function tests involving duodenal content analysis.

Topics: Adult; Body Fluids; Ceruletide; Chronic Disease; Chymotrypsin; Duodenum; Female; Gastrointestinal Diseases; Humans; Lactoferrin; Lactoglobulins; Lipase; Male; Middle Aged; Pancreatitis; Secretin

To test the discriminatory potential of certain indices of pancreatic function we performed duodenal perfusion studies and measured trypsin, bicarbonate, and lactoferrin outputs, and plasma concentrations of pancreatic polypeptide and motilin in the basal state and during continuous intravenous stimulation with 100 ng kg-1h-1 Ceruletide and 1 CU kg-1h-1 secretin. The following groups were studied: 12 normal volunteers (NV), seven patients with chronic pancreatitis with steatorrhea (CPS), and seven without steatorrhea (CP). Stimulated trypsin outputs, after 45 min of stimulation, were the best discriminant among the groups (NV versus CPS, p less than 0.0005; NV versus CP, p less than 0.005; CP versus CPS, p less than 0.05). Basal trypsin outputs showed similar patterns but failed to discriminate between NV and CP. Bicarbonate outputs were less discriminatory than trypsin outputs. Lactoferrin outputs failed to discriminate, but transient high peak outputs occurred in the initial stimulation period in all four patients with calcific chronic pancreatitis, suggesting a washout phenomenon. Basal motilin levels were elevated in both groups of pancreatitis (p less than 0.05). Stimulated pancreatic polypeptide levels were lower in CPS (NV versus CPS, p less than 0.05) but higher in CP (NV versus CP, p less than 0.005). These differences were also apparent in the basal state. We conclude that the best discrimination among the three groups was achieved by measurement of trypsin outputs, after 45 min of stimulation. In addition, the pancreatic polypeptide response may be used as a marker of residual pancreatic function in chronic pancreatitis.

Topics: Adult; Aged; Bicarbonates; Celiac Disease; Ceruletide; Chronic Disease; Female; Humans; Islets of Langerhans; Lactoferrin; Male; Middle Aged; Motilin; Pancreas; Pancreatic Polypeptide; Pancreatitis; Secretin; Trypsin

Forty five cases of chronic pancreatitis have been diagnosed between January 1966 to July 1983 in the Hospital A. Posadas. The diagnosis was confirmed by the presence of one or more of the following data: pancreatic calcifications positive in 35, abnormal secretin test 37, ultrasonography and computed tomography pathological findings 10. Surgical operations were carried out in 25 patients and biopsy taken in 5. Thirty nine (86.6%) were males, 6 (13.3%) females, the mean age in each group was 47.4 and 39.8 years. Chronic alcoholism was certain in 41 (91.9) patients, in the remainder 4 no other etiologic factors were found. The main clinical data were: Weight loss 38 (84.4%) diabetes 34 (75.5%) pain 33 (73.3% in 7 as acute pancreatitis) Steatorrhea 23 (51.1%) jaundice 16 (35.5%- 11 by extrahepatic biliary tree obstruction, 5 by hepatic cirrhosis) pseudocysts 12 (26.6%). The more common associated diseases were: hepatic cirrhosis 6, fatty liver 2 (17.7%) gastroduodenal ulcer 6 (13.3%) cancer 4 (8.8%--gastric 1, pancreatic 3). In order to study the frequency of the clinical data the patients were grouped according to the presence or absence of calcifications and the etiologic factor Symptoms and signs were matched and statistic analysis (coefficient association phi) was made. Only a moderate association between acute pancreatitis in no calcified group and diabetes in calcified group were found. The chronologic study of certains clinical data shows that acute pancreatitis, jaundice, pseudo-cyst and surgical operations were significative more frequent in the first five years while diabetes has little more frequency in the second five year period. Twenty six surgical operations were carried out in 25 patients; 20 (76.9%) due to complications, 6 (23.1%) secondary to pain (pancreatic resection 3, pancreatoyeyunostomy 2, exploration 1). Twenty three patients were lost to follow-up, 12 died and 10 are still alive. This last group was followed at regular period, 8 remained asymptomatic and 2 have intermittent abdominal pain related to alcoholic ingestion.

Topics: Alcohol Drinking; Alcoholism; Calcinosis; Chronic Disease; Female; Humans; Lactoferrin; Male; Pancreatic Juice; Pancreatitis; Secretin; Sex Factors; Tomography, X-Ray Computed; Ultrasonography

Lactoferrin as assayed by a radial immunodiffusion technique was studied in pure pancreatic juice collected at endoscopic retrograde cholangiopancreatography from 23 patients with chronic pancreatitis, 12 with acute pancreatitis, 21 with pancreatic cancer, and 29 cases of nonpancreatic gastrointestinal disease. No clear difference between lactoferrin concentrations in the chronic pancreatitis patients and other groups was found. Moreover, most lactoferrin levels were below the limit of detection in our assay. In addition, lactoferrin total protein ratios did not appear to be of value in the differential diagnosis of chronic pancreatitis. These results seem to be in contrast to the findings of other authors, who measured lactoferrin in duodenal fluid--which is unreliable, in our opinion--or who mainly studied chronic pancreatitis patients and few other pancreatic diseases. Lactoferrin might well be a nonspecific marker for serious pancreatic inflammation.

Topics: Acute Disease; Cholelithiasis; Chronic Disease; Female; Humans; Immunodiffusion; Lactoferrin; Lactoglobulins; Male; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis

Topics: Duodenum; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatitis

Topics: Arthritis; Humans; Iron; Lactoferrin; Lactoglobulins; Pancreatitis

The diagnostic relevance of measuring calcium and lactoferrin in duodenal juice collected after stimulation is unclear. Concentration and output of these compounds were therefore analyzed after maximal stimulation of the pancreas according to Ribet, the duodenal juice being collected during an endoscopic procedure as described earlier. Kinetics of secretion showed a maximum within the first 10 minutes. Values of calcium and lactoferrin were not statistically different in normal persons (n = 32) and patients with chronic pancreatitis (n = 11). There was a good correlation to concentration of bilirubin (p less than 0.001), however no correlation to concentrations of immunoreactive trypsin and lipase. It must be assumed, that calcium and lactoferrin in duodenal juice are not only of pancreatic origin. These measurements are therefore useless in the diagnosis of pancreatitis.

Topics: Adult; Calcium; Chronic Disease; Duodenum; Female; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreatitis

A sandwich enzyme immunoassay was developed for human lactoferrin using polystyrene balls coated with specific IgG fraction as the first antibody and peroxidase labelled IgG fraction as the second antibody. The detection limit was 1 microgram/l. A good parallelism was observed with the curves obtained from standard lactoferrin (purified from mammary gland), plasma lactoferrin (mainly derived from granulocytes), and pancreatic lactoferrin demonstrating that the assay may be used to measure the level of the protein in different biological materials. The simplicity and the sensitivity of this assay may permit the follow-up of patients with chronic calcifying pancreatitis (in which an increase of pancreatic lactoferrin has already been demonstrated) and a study of the protein in various circumstances leading to a better understanding of its biological role.

Topics: Adult; Body Fluids; Chronic Disease; Duodenum; Humans; Immunoenzyme Techniques; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatitis; Reference Values

Topics: Albumins; Chronic Disease; Diagnosis, Differential; Humans; Immunodiffusion; Lactoferrin; Pancreatic Juice; Pancreatitis; Spectrophotometry

In a prospective study we have measured the lactoferrin level of duodenal juice under secretin plus caerulein pancreatic stimulation in 78 subjects. Subjects was divided in 4 groups as follows: 27 controls, 11 pancreatic disease without chronic pancreatitis (CP), 17 CP and 23 suspicions of CP. Lactoferrin was assayed by radial immunodiffusion and the level was referred to lipase activity. The test was considered as positive when lactoferrin (microgram/ml) X 100/lipase (U/ml) greater than 0.1. No one control subject had a positive test, 2 pancreatic cancers out of 4, 1 acute pancreatitis out of 7, 12 CP out of 17 had a positive test. The sensitivity (0.71) and the specificity (0.92) of the test do not allow us to propose this test as unequivocal in the diagnosis of CP.

Topics: Body Fluids; Chronic Disease; Duodenum; Humans; Lactoferrin; Lactoglobulins; Pancreatitis

Lactoferrin is a nonenzymatic secretory protein of human pancreas specifically increased in the external pancreatic secretion of patients with chronic calcifying pancreatitis. The possibility of an elevated concentration of plasma lactoferrin level in these patients needed to be explored even if the low pancreatic concentration of the protein did not favor this hypothesis. As expected, no increase could be observed between the plasma lactoferrin level of 16 patients with chronic calcifying pancreatitis (131 +/- 15 micrograms/l), compared to 17 controls (166 +/- 11 micrograms/l) and 15 patients with different organic diseases (187 +/- 18 micrograms/l).

Topics: Calcinosis; Chronic Disease; Humans; Lactoferrin; Lactoglobulins; Pancreatitis

Lactoferrin is present in pancreatic juice, and greatly increased concentrations are found in the pancreatic juice of patients with chronic pancreatitis. It is not known whether these high levels of lactoferrin represent a genetically determined defect predisposing to the later development of chronic pancreatitis or are simply a consequence of the disease. In view of the morphological and functional similarities between the pancreatic and parotid glands, we have measured the immunoreactive lactoferrin concentration in pure parotid saliva of 30 patients with chronic calcific pancreatitis, 26 controls, 5 patients with proven pancreatic cancer, 2 patients with Sjögren's disease and 2 patients with chronic recurrent parotitis. No difference in the lactoferrin concentration was detected between control subjects and patients with chronic pancreatitis or pancreatic cancer. Raised levels were found in the 4 patients with parotid gland disease. These findings suggest that increased lactoferrin secretion is confined to the exocrine pancreas in patients with chronic pancreatitis and is thus probably a phenomenon secondary to the disease.

Topics: Calcinosis; Chronic Disease; Humans; Lactoferrin; Lactoglobulins; Pancreatic Neoplasms; Pancreatitis; Parotid Gland; Parotitis; Radioimmunoassay; Saliva; Sjogren's Syndrome; Specimen Handling

Topics: Adult; Aged; Bicarbonates; Catheterization; Chymotrypsin; Duodenum; Female; Humans; Intestinal Secretions; Lactoferrin; Lipase; Male; Middle Aged; Pancreatic Juice; Pancreatitis

To investigate the role of lactoferrin in intraductal protein precipitates in chronic pancreatitis, lactoferrin was measured in pure pancreatic juice collected by endoscopic retrograde pancreatic cannulation using a sensitive and specific radioimmunoassay. Significant gradual increase in the lactoferrin concentration and output was observed in chronic pancreatitis (mean +/- SE = 1.13 +/- 0.04 microgram/ml, 1.61 +/- 0.44 microgram/min for five controls; 4.73 +/- 0.70 microgram/ml, 14.1 +/- 2.86 micrograms/min for 15 patients with noncalcified mild chronic pancreatitis; 23.6 +/- 4.7 micrograms/ml, 28.4 +/- 13.4 micrograms/min for four with chronic pancreatitis with visible protein plugs or calculi). The total protein in the juice gradually decreased in chronic pancreatitis (12.8 +/- 1.48 mg/ml for control, 7.6 +/- 1.37 for noncalcified, 5.2 +/- 1.27 for patients with plugs or calculi). Lactoferrin appears to rise as the disease progresses and although this may be important etiologically, it may also just be an accompanying protein which increases as the disease progresses.

Topics: Adult; Chronic Disease; Female; Humans; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis

Saliva from one parotid gland was collected under citric acid stimulation in three groups consisting of 69 control subjects and two groups consisting of 25 patients with chronic and relapsing chronic pancreatitis. Mixed saliva was collected under mechanical stimulation from 10 patients and 6 control subjects. Flow rates and the contents of bicarbonate, amylase and protein were determined. In a subgroup of patients and controls albumin and lactoferrin were measured. Wide inter- and intraindividual variations of secretory values were observed and normal values (which are reported in detail) were highly dependent from conditions of stimulation. Secretory patterns were not significantly different between patients and control subjects. It is concluded that the alterations leading to an elevation of albumin and lactoferrin and a fall in other secretory values are restricted to the exocrine pancreas and do not affect salivary glands in chronic pancreatitis.

Topics: Adult; Aged; Albumins; Chronic Disease; Female; Humans; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreatitis; Parotid Gland; Saliva

Topics: Chronic Disease; Cross Reactions; Humans; Lactoferrin; Lactoglobulins; Pancreatitis; Radioimmunoassay

Lactoferrin is a non-enzymatic secretory protein of human pancreas and is specifically increased in pancreatic juice of patients with chronic pancreatitis. Duodenal contents being easier to obtain than pure pancreatic juice, the possibility of using lactoferrin measurement in duodenal juice as a diagnosis test for chronic pancreatitis was explored. Forty-eight patients were studied. Duodenal juice was obtained devoid of salivary contamination by a special double lumen tube. Under these conditions lactoferrin secretion (concentration and output) is increased in patients with chronic pancreatitis. When expressed as the ratio of lactoferrin to lipase units, there was no overlap between chronic pancreatitis and other pancreatic disease or controls. The simplicity and the reproducibility of the technique on a material as readily available as duodenal juice confirms the diagnostic value of lactoferrin measurement in the assessment of patients with suspected pancreatic disease.

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Duodenum; Female; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Lipase; Male; Middle Aged; Pancreatitis; Phospholipases

Topics: Calculi; Chronic Disease; Duodenum; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Pancreatic Diseases; Pancreatitis; Radioimmunoassay

Lactoferrin and albumin concentrations in pure pancreatic juice were studied by radial immunodiffusion in 81 patients. Lactoferrin concentration (% of total protein) was specifically increased in patients suffering from chronic calcifying pancreatitis (mean +/- SE: 0.169 +/- 0.024) and no overlap was observed with patients suffering from other pancreatic diseases (0.008 +/- 0.001), organic nonpancreatic diseases (0.011 +/- 0.001) and without organic disease (0.01 +/- 0.001). Lactoferrin concentration was not found to be correlated with chronic alcohol consumption or pancreatic insufficiency. Albumin concentration (% of total protein) was increased in patients suffering from chronic calcifying pancreatitis (5.55 +/- 0.49) and other pancreatic diseases (5.45 +/- 1.02). These values were significantly higher (P less than 0.001) than the corresponding values in patients with organic nonpancreatic diseases (1.66 +/- 0.16) and patients without organic diseases (1.46 +/- 0.22). Measuring lactoferrin and albumin in pancreatic juice may aid in the diagnosis of pancreatic disease and in the differentiation of chronic calcifying pancreatitis, even in the earliest stage, from other pancreatic diseases such as pancreatic carcinoma or acute pancreatitis.

Topics: Adult; Albumins; Alcohol Drinking; Chronic Disease; Female; Humans; Immunodiffusion; Lactoferrin; Lactoglobulins; Lipase; Male; Middle Aged; Pancreatic Diseases; Pancreatic Juice; Pancreatitis

Topics: Adult; Chronic Disease; Humans; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis

Topics: Animals; Calcinosis; Chronic Disease; Humans; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatitis; Rats

Levels of immunoreactive trypsin were measured in pure pancreatic juice obtained endoscopically from 44 patients with suspected pancreatic disease. Patients with pancreatic cancer all had low trypsin concentrations (median 3.6 micrograms/ml, range 0.6--12.0), but those with chronic pancreatitis had very variable levels (median 14.2 micrograms/ml, range 3.2--76.8), showing a considerable overlap with patients without pancreatic disease (median 37.1 micrograms/ml, range 10.4--66.0). When levels of lactoferrin in pancreatic juice were measured, all patients with chronic pancreatitis were found to have much higher levels (all greater than 900 ng/ml) than control subjects or patients with pancreatic cancer (all less than 400 ng/ml). The combined measurement of trypsin and lactoferrin in pure pancreatic juice appeared to be more promising than any other currently available test for the separation of patients with pancreatic cancer from those with chronic pancreatitis.

Topics: Chronic Disease; Clinical Enzyme Tests; Diagnosis, Differential; Humans; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radioimmunoassay; Trypsin

As compared to 20 controls, 14 patients with chronic pancreatitis showed a significantly higher lactoferrin level in pure pancreatic secretion. The determination of lactoferrin levels in pure pancreatic secretion is an important parameter in the diagnosis of chronic pancreatitis.

Topics: Adult; Chronic Disease; Female; Humans; Lactoferrin; Lactoglobulins; Male; Pancreatic Ducts; Pancreatic Juice; Pancreatitis

Lactoferrin, a protein present in pancreatic juice and other exocrine secretions, was measured by radioimmunoassay in pure pancreatic juice obtained by endoscopic cannulation of the pancreatic duct. Lactoferrin concentrations were high in pancreatic juice from patients with chronic pancreatitis, but they were considerably lower in juice from control subjects and patients with carcinoma of the pancreas. The measurement of lactoferrin concentrations in pure pancreatic juice may be useful in the diagnosis of pancreatic diseases.

Topics: Chronic Disease; Diagnosis, Differential; Humans; Lactoferrin; Lactoglobulins; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radioimmunoassay

Topics: Chronic Disease; Evaluation Studies as Topic; Humans; Immunodiffusion; Lactoferrin; Lactoglobulins; Male; Pancreatic Juice; Pancreatitis; Radioimmunoassay

Topics: Diagnosis, Differential; Humans; Lactoferrin; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis

The protein composition of normal human pancreatic juice and pancreatic juice of men with chronic calcifying pancreatitis (CCP) were compared using immuno-diffusion techniques. An additional protein was found in pathological pancreatic juice and this protein has been identified as lactoferrin. Its concentration has been determined. The indirect immunofluorescence method was used to detect and localize lactoferrin in 9 samples of human pancreas from 3 patients with CCP and 6 patients without CCP. The fluorescence was found in all samples. Lactoferrin staining was localized in lumen acinar and in the cytoplasm of the acinar cells. The fluorescence was stronger in the apical zone of acinar cells. When lactoferrin antiserum was incubated with lactoferrin insolubilized by glutaraldehyde, no fluorescence staining was detected. The differences between our results obtained by immunodiffusion and immunofluorescence techniques are explained by the different sensitivity of the two techniques and these results indicate that lactoferrin is a protein of pancreatic secretion.

Topics: Chronic Disease; Fluorescent Antibody Technique; Humans; Lactoferrin; Lactoglobulins; Pancreas; Pancreatic Juice; Pancreatitis

We have shown the presence of lactoferrin in the pancreatic juice of patients with chronic calcifying pancreatitis (CCP) and its absence in controls. In this work, lactoferrin has been found in saliva, but neither in gastric juice nor in bile. Therefore, a technique for collecting the human duodenal juice with a rubber tube and preventing its contamination with saliva is described. In the duodenal juice of 15 patients with CCP, 52 controls without evident pancreatic diseases, and 9 cases of pancreatic diseases other than CCP, lactoferrin has been searched for by immunological methods before and after an intravenous injection of CCK-PZ (3 U CHR) + secretin ( C U). The lactoferrin test in positive in 5, inconclusive in 6, and negative in 41 cases, and in the 9 cases of non-CCP pancreatic diseases it is negative. The use of this test in the diagnosis of CCP is proposed.

Topics: Adolescent; Adult; Aged; Bile; Child; Child, Preschool; Chronic Disease; Duodenum; Female; Gastric Juice; Humans; Intestinal Secretions; Lactoferrin; Lactoglobulins; Male; Middle Aged; Pancreatitis; Saliva

Topics: Animals; Calcium; Calculi; Chromatography, Gel; Chronic Disease; Chymotrypsin; Electrophoresis, Polyacrylamide Gel; Immunodiffusion; Immunoelectrophoresis; Lactoferrin; Lactoglobulins; Male; Molecular Weight; Pancreas; Pancreatitis; Potentiometry; Rabbits; Spectrophotometry, Ultraviolet