Mitochondrial dysfunction and apoptosis of acinar cells in chronic pancreatitis

Background. The mechanism of acinar cell death in human chronic pancreatitis (CP) remains largely unexplored. Previous studies have demonstrated the role played by apoptosis and necrosis in experimental pancreatitis; however, their relationship with the progression of CP remains unknown. The present study was carried out to elucidate the role and extent of apoptosis in CP tissues with different histopathological scores and to examine the possible apoptotic pathway involved. Methods. Pancreatic tissues (25 CP patients) that had been histopathologically graded (I-III) and ten normal pancreatic tissue samples were evaluated for apoptosis by DNA fragmentation and an in situ TUNEL assay. The expression of various apoptotic and antiapoptotic markers in the tissues were studied by immunohistochemistry and Western blotting. To elucidate the role of the mitochondria in acinar cell death, the mitochondrial membrane potential (AT.) and ATP levels were determined by flow cytometry and a luminometer. Results. The presence of DNA fragmentation and apoptotic nuclei in all CP tissues confirmed the presence of apoptosis. The apoptotic index in CP tissue ranged from 0.09% to 0.86% 0.02% and was highest in grade II (0.7 +/- 0.04%) tissues. Differential upregulation of the apoptotic mediators p53, Bax, cytochrome c, and caspase-3 and -9, and downregulation of antiapoptotic Bcl-2, was observed in CP. Delta Psi(m) on the order of 1.2- to 2.2-fold and ATP depletion in the range of 23%-84% in CP tissues was observed. Conclusions. Apoptosis plays an important role both in the initial stages and during the progression of CP, as evident in all tissue grades. Increased AT, loss of ATP, and activation of caspases suggests the involvement of intrinsic pathways.