EFFECT OF MICROCIRCULATORY PERFUSION ON DISTRIBUTION OF TRYPSINOGEN ACTIVATION PEPTIDES IN ACUTE EXPERIMENTAL PANCREATITIS

Extraintestinal trypsinogen activation peptides (TAP) have been shown to correlate with severity of acute pancreatitis in humans as well as in various animal models. Ischemia superimposed on experimental pancre atitis, however, increases acinar cell injury without increasing TAP i n plasma. We speculated that TAP generated in the pancreas might not r each the circulation in necrotizing pancreatitis due to decreased panc reatic perfusion. To test the hypothesis that generation of TAP in pla sma is related to pancreatic perfusion and that plasma TAP may therefo re underestimate acinar cell injury in necrotizing disease, we correla ted TAP in pancreatic tissue and body fluids with capillary pancreatic blood flow in necrotizing and edematous pancreatitis. The ratio betwe en necrosis and TAP in tissue was similar in both models; the ratio be tween TAP in plasma and tissue, however, was significantly lower in ne crotizing pancreatitis, indicating that a certain amount of TAP genera ted in the pancreas did not reach the circulation. Decreased pancreati c perfusion found in necrotizing pancreatitis was consistent with this finding. Our data suggest that TAP in tissue is most reliable to indi cate severity of acute pancreatitis, whereas plasma TAP may underestim ate pancreatic injury in necrotizing disease due to decreased pancreat ic perfusion.