Acute pancreatitis is an inflammatory disease of the exocrine pancreas that carries considerable morbidity and mortality; its pathophysiology remains poorly understood. Recent findings from experimental models and genetically altered mice summarized in this review reveal that autophagy, the principal cellular degradative pathway, is impaired in pancreatitis and that one cause of autophagy impairment is defective function of lysosomes. We propose that the lysosomal/autophagic dysfunction is a key initiating event in pancreatitis and a converging point of multiple deranged pathways. There is strong evidence supporting this hypothesis. Investigation of autophagy in pancreatitis has just started, and many questions about the "upstream" mechanisms mediating the lysosomal/autophagic dysfunction and the "downstream" links to pancreatitis pathologies need to be explored. Answers to these questions should provide insight into novel molecular targets and therapeutic strategies for treatment of pancreatitis. macroautophagy; lysosome; cathepsin; lysosome-associated membrane protein; pancreatic acinar cell; trypsin AUTOPHAGY ENCOMPASSES SEVERAL intracellular pathways of lysosome-driven degradation and recycling of organelles and long-lived proteins. Recent studies have begun to elucidate the role of autophagy in the normal function of the exocrine pancreas and in pancreatitis, the most common disease of this organ. The purpose of this review is threefold: 1) to provide basic information on the process of autophagy for pancreatologists entering the field, 2) to discuss the recent findings and their implications, and 3) to delineate perspective directions for research. Thus we only give a brief background on autophagy, necessary for the discussion of its role in pancreatitis. A number of recent reviews (4,20,29,50,54,59,62,68,70,71,73,83,101,106,113), especially on the role of autophagy in the liver and pancreas (12), describe in detail the function and mechanisms of autophagy, as well as methods used in autophagy research.
The Process of Autophagy: A Brief IntroductionAutophagic pathways. Living cells undergo continuous renewal during which old components are recycled and replaced with new ones. The degradation of macromolecules and organelles to generate new "building blocks" is necessary to maintain cellular homeostasis. Two major systems in eukaryotic cells degrade cellular components: the ubiquitin-proteasome system and autophagy. The former mainly degrades short-lived proteins, which are tagged by ubiquitin to be recognized and degraded by the proteasome (30). By contrast, autophagy degrades long-lived proteins, lipids, and cytoplasmic organelles through a lysosome-driven process (12,20,29,71,101). Autophagy occurs at a basal rate in most cells, where it acts as a quality control mechanism to eliminate protein aggregates and damaged or unneeded organelles. Equally important, autophagy constitutes a major protective mechanism that allows cells to survive and adapt to fluctuations in external conditions. In particular, nut...