A Thai family with hereditary pancreatitis and increased cancer risk due to a mutation in PRSS1 gene

AIM: To investigate mutation of serine protease 1-cationic trypsinogen (CT, PRSS1) gene in members of a Thai family with hereditary pancreatitis and pancreatic cancer. METHODS: Polymerase chain reaction and direct sequencing were performed to analyze the PRSS1 gene in two members of the family affected by pancreatitis. Allele specific amplification (ASA) method was then developed to detect the mutation of the PRSS1 gene in all available members of the family and normal control subjects. RESULTS: A cytosine (C) to thymine (T) mutation at position 2441 (g.2441C>T) of the PRSS1 gene, which results in a substitution of arginine by cysteine at position 116 (R116C) of CT, was identified by direct sequencing in both clinically affected members of the family but was not found in the unaffected member. This mutation, which might be arising from deamination of methylated cytosine in CpG dinucleotide of codon 116 (CGT>TGT), was also detected by the ASA method in the two affected members and a proband's brother but was not observed in unaffected members and 54 normal control subjects. CONCLUSION: Autosomal dominant pancreatitis with increased cancer risk in the studied Thai family is most likely due to missense (R116C) mutation in the PRSS1 gene.

Hereditary pancreatitis:An updated review in pediatrics

Hereditary Pancreatitis(HP)has emerged as a significant cause of acute,acute recurrent and chronic pancreatitis in the pediatric population.Given that it presents similarly to other causes of pancreatitis,a positive family history and/or isolation of a gene mutation are vital in its designation.Inheritance patterns remain complex,but mutations involving the PRSS1,SPINK1,CFTR and CTRC genes are commonly implicated.Since being first described in 1952,dozens of genetic alterations that modify the action of pancreatic enzymes have been identified.Among children,these variants have been isolated in more than 50%of patients with chronic pancreatitis.Recent research has noted that such mutations in PRSS1,SPINK1 and CFTR genes are also associated with a faster progression from acute pancreatitis to chronic pancreatitis.Patients with HP are at increased risk of developing diabetes mellitus,exocrine pancreatic insufficiency,and pancreatic adenocarcinoma.Management follows a multi-disciplinary approach with avoidance of triggers,surveillance of associated conditions,treatment of pancreatic insufficiency and use of endoscopic and surgical interventions for complications.With significant sequela,morbidity and a progressive nature,a thorough understanding of the etiology,pathophysiologic mechanisms,diagnostic evaluation,current management strategies and future research considerations for this evolving disease entity in pediatrics is warranted.

Novel mutation and polymorphism of PRSS1 gene in the Chinese patients with hereditary pancreatitis and chronic pancreatitis

Background Mutations in the cationic trypsinogen gene （PRSS1） have been detected in patients with hereditary pancreatitis （HP）. This study investigated the prevalence of the R122H （c.365G〉A）, A121T （c.361 G〉A） and D162D （c.488 C〉T） mutations or polymorphisms in the common, non-hereditary forms of chronic pancreatitis and in an HP family.Methods DNA was prepared from blood samples of 54 patients with chronic pancreatitis （35 alcoholic, 17 idiopathic and 2 hereditary） and 120 normal controls. The PRSS1 genes were amplified by polymerase chain reaction （PCR） and their products were analyzed by sequencing and related clinical data were also collected. Results A new polymorphism （c.488 C〉T） of PRSS1 was found in 25 patients with chronic pancreatitis （including one affected member of the HP family） and six members of the normal controls. The C/T genotype was significantly increased in chronic pancreatitis （OR： 16.379, 95% CI： 5.7522-52.3663）, the frequency of c.488 C〉T change was in according with the Hardy-Weinberg equilibrium, but it doesn＇t affect the clinical phenotype. The commonly reported change of R122H （c.365G〉A） was not detected in any of the study subjects, c.361 G〉A was found in 2 affected members and one unaffected carrier in an HP family. One of the affected members of an HP family had c.361 G〉A mutation and polymorphism （c.488 C〉T） in the PRSS1 gene at the same time. The patient＇s clinical values （C3, C4, CA19-9 and HbA1c） were higher than those of the other patients with chronic pancreatitis. The two patients with HP developed diabetes mellitus and their father died with pancreatic cancer. Conclusion A new polymorphism （c.488 C〉T） in the PRSS1 gene is associated with chronic pancreatitis, but it did not affect the clinical phenotype while the A121T （c.361 G〉A） mutation in the gene shows a significant correlation in the patients with HP.

Chronic pancreatitis,pancreatic adenocarcinoma and the black box in-between

Pancreatic cancer is a challenging disease for patients,doctors and researchers who for decades have searched for a cure for this deadly malignancy.Although existing mouse models of pancreatic cancer have shed light on the mecha-nistic basis of the neoplastic conversion of the pancreas,their impact in terms of offering new diagnostics and therapeu-tic modalities remains limited.Chronic pancreatitis is an inflammatory disease of the pancreas that is associated with a gradual damage of the organ and an increased risk of developing neoplastic lesions.In this review,we propose that detailed studies of chronic inflammatory processes in the pancreas will provide insights into the evolution of pancreatic cancer.This information may prove useful in the design of effective therapeutic strategies to battle the disease.

Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer:Untying the Gordian knot

Pancreatic ductal adenocarcinoma is an aggressive tumor with poor long-term outcomes.Chronic pancreatitis(CP)is considered a risk factor for the development of pancreatic cancer(PC).Persistent pancreatic inflammation and activation of pancreatic stellate cells play a crucial role in the pathogenesis of CPrelated PC by activating the oncogene pathway.While genetic mutations increase the possibility of recurrent and persistent pancreatic inflammation,they are not directly associated with the development of PC.Recent studies suggest that early surgical intervention for CP might have a protective role in the development of CP-related PC.Hence,the physician faces the clinical question of whether early surgical intervention should be recommended in patients with CP to prevent the development of PC.However,the varying relative risk of PC in different subsets of CP underlines the complex gene-environment interactions in the disease pathogenesis.Hence,it is essential to stratify the risk of PC in each individual patient.This review focuses on the complex relationship between CP and PC and the impact of surgical intervention on PC risk.The proposed risk stratification based on the genetic and environmental factors could guide future research and select patients for prophylactic surgery.