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World J Gastroenterol. Dec 7, 2014; 20(45): 16935-16947
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16935
Immunomodulatory therapies for acute pancreatitis
Jing Li, Wen-Juan Yang, Lu-Ming Huang, Cheng-Wei Tang
Jing Li, Lu-Ming Huang, Cheng-Wei Tang, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Jing Li, Wen-Juan Yang, Cheng-Wei Tang, Division of Peptides Related with Human Diseases, Key Laboratory of Biotherapy of Human Diseases, Ministry of Education, Chengdu 610041, Sichuan Province, China
Author contributions: All the authors contributed equally to the manuscript.
Supported by National Natural Science Foundation of China, No. 81170384
Correspondence to: Cheng-Wei Tang, MD, PhD, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu 610041, Sichuan Province, China. shcqcdmed@163.com
Telephone: +86-28-85422383 Fax: +86-28-85582944
Received: February 28, 2014
Revised: April 24, 2014
Accepted: May 26, 2014
Published online: December 7, 2014
Processing time: 284 Days and 17.6 Hours
Abstract

It is currently difficult for conventional treatments of acute pancreatitis (AP), which primarily consist of anti-inflammatory therapies, to prevent the progression of AP or to improve its outcome. This may be because the occurrence and progression of AP, which involves various inflammatory cells and cytokines, includes a series of complex immune events. Considering the complex immune system alterations during the course of AP, it is necessary to monitor the indicators related to immune cells and inflammatory mediators and to develop more individualized interventions for AP patients using immunomodulatory therapy. This review discusses the recent advances in immunomodulatory therapies. It has been suggested that overactive inflammatory responses should be inhibited and excessive immunosuppression should be avoided in the early stages of AP. The optimal duration of anti-inflammatory therapy may be shorter than previously expected (< 24 h), and appropriate immunostimulatory therapies should be administered during the period from the 3rd d to the 14th d in the course of AP. A combination therapy of anti-inflammatory and immune-stimulating drugs would hopefully constitute an alternative to anti-inflammatory drug monotherapy. Additionally, the detection of the genotypes of critical inflammatory mediators may be useful for screening populations of AP patients at high risk of severe infections to enable the administration of early interventions to improve their prognosis.

Keywords: Pancreatitis; Immunomodulatory therapy; Systemic inflammatory response syndrome; Immunosuppression; Immunostimulation

Core tip: In light of the complex immune system alterations that occur in acute pancreatitis (AP), it is necessary to develop more individualized interventions for AP patients by using immunomodulatory therapy instead of inflammatory drug monotherapy. We first suggest how we could monitor the immune status of these patients and identify optimal treatment methods. We also demonstrate for the first time that the detection of the genotypes of critical inflammatory mediators may be useful for screening populations of AP patients at high risk of severe infections.