Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis

Kawa, Shigeyuki; Okazaki, Kazuichi; Notohara, Kenji; Watanabe, Mamoru; Shimosegawa, Tooru

doi:10.1007/s00535-014-1012-5

Cited by 32 publications

(38 citation statements)

References 30 publications

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“…Aside from accumulating evidence for a crucial role of Th17 cells in IBD, clinical data also connects IBD to AIP. Especially, type 2 AIP is often complicated by IBD [58].…”

Section: Discussionmentioning

confidence: 99%

Potential role of Th17 cells in the pathogenesis of type 2 autoimmune pancreatitis

et al. 2015

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Th17 cells have been shown to play an important role in the pathogenesis of a variety of autoimmune diseases. The aim of this study was to investigate the potential role of Th17 cells in autoimmune pancreatitis (AIP). Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to determine gene expression of the signature cytokines of Th17 cells IL-17A and IL-21 and of the Th17 lineage-specific transcription factor retinoic acid receptor-related orphan receptor C (RORC) in human tissue specimens of AIP, classical chronic pancreatitis (CP), and normal pancreas (NP). Infiltrating immune cells were characterized by immunohistochemistry (IHC). Gene expression of IL-17A, IL-21, and RORC were found to be significantly increased in AIP. Accordingly, the number of Th17 cells was significantly increased in AIP compared to NP or CP. Both gene expression analysis and IHC revealed a clear difference between type 1 and 2 AIP. In the periductal compartment of type 2 AIP, which is characterized by granulocytic epithelial lesions (GELs), the number of infiltrating Th17 cells and neutrophilic granulocytes was significantly increased compared to type 1 AIP. Our data suggest that Th17 cells play a role in the pathogenesis of AIP, in particular of type 2 AIP. Cross-talk between Th17 cells and neutrophilic granulocytes mediated via IL-17A may be a potential mechanism by which neutrophils are recruited to the duct and acinar cells with subsequent destruction, a process that is pathognomonic for type 2 AIP.

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“…Aside from accumulating evidence for a crucial role of Th17 cells in IBD, clinical data also connects IBD to AIP. Especially, type 2 AIP is often complicated by IBD [58].…”

Section: Discussionmentioning

confidence: 99%

Potential role of Th17 cells in the pathogenesis of type 2 autoimmune pancreatitis

et al. 2015

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“…Type 1 AIP is the pancreatic manifestation of immunoglobulin G4 (IgG4)-related disease [16,17], and often develops in older males and is accompanied by systemic, inflammatory, sclerosing lesions, such as those seen in sclerosing cholangitis, interstitial pneumonia and nephritis, dacryoadenitis, and sialadenitis [4]. Type 2 AIP is more common among young or middle-aged patients, and is often associated with ulcerative colitis and rarely with Crohn's disease [18][19][20][21]. Serum markers, including immunoglobulin G4 (IgG4), antinuclear antibody, and rheumatoid factor, are frequently elevated in type 1 AIP [12,13,22].…”

Section: Introductionmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

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Autoimmune pancreatitis (AIP), a unique subtype of pancreatitis, is often accompanied by systemic inflammatory disorders. AIP is classified into two distinct subtypes on the basis of the histological subtype: immunoglobulin G4 (IgG4)-related lymphoplasmacytic sclerosing pancreatitis (type 1) and idiopathic duct-centric pancreatitis (type 2). Type 1 AIP is often accompanied by systemic lesions, biliary strictures, hepatic inflammatory pseudotumors, interstitial pneumonia and nephritis, dacryoadenitis, and sialadenitis. Type 2 AIP is associated with inflammatory bowel diseases in approximately 30% of cases. Standard therapy for AIP is oral corticosteroid administration. Steroid treatment is generally indicated for symptomatic cases and is exceptionally applied for cases with diagnostic difficulty (diagnostic steroid trial) after a negative workup for malignancy. More than 90% of patients respond to steroid treatment within 1 month, and most within 2 weeks. The steroid response can be confirmed on clinical images (computed tomography, ultrasonography, endoscopic ultrasonography, magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography). Hence, the steroid response is included as an optional diagnostic item of AIP. Steroid treatment results in normalization of serological markers, including IgG4. Short- and long-term corticosteroid treatment may induce adverse events, including chronic glycometabolism, obesity, an immunocompromised status against infection, cataracts, glaucoma, osteoporosis, and myopathy. AIP is common in old age and is often associated with diabetes mellitus (33–78%). Thus, there is an argument for corticosteroid therapy in diabetes patients with no symptoms. With low-dose steroid treatment or treatment withdrawal, there is a high incidence of AIP recurrence (24–52%). Therefore, there is a need for long-term steroid maintenance therapy and/or steroid-sparing agents (immunomodulators and rituximab). Corticosteroids play a critical role in the diagnosis and treatment of AIP.

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“…[3][4][5] Compared with Western countries, type 2 AIP is extremely rare in Japan. [6][7][8] The world's first clinical diagnostic criteria for AIP were released by the Japan Pancreas Society in 2002. 9 Subsequently, diagnostic criteria for AIP have been proposed in several other countries.…”

mentioning

confidence: 99%

Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study

Kanno

Masamune

Fujishima

et al. 2016

Gastrointestinal Endoscopy

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115

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Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis

Cited by 32 publications

References 30 publications

Potential role of Th17 cells in the pathogenesis of type 2 autoimmune pancreatitis

Potential role of Th17 cells in the pathogenesis of type 2 autoimmune pancreatitis

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study

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