Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.35
Peer-review started: September 3, 2017
First decision: September 27, 2017
Revised: November 23, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: January 7, 2018
Severe acute pancreatitis (SAP) is a debilitating disease with significant morbidity and mortality. Somatostatin analogue octreotide is the most frequently used drug but not all patients can afford its high cost and short half-life in vivo. Guided by the theories of TCM and modern medicine and the compatibility of herbs, we refined the classic prescription Qingyi decoction and combined emodin and baicalein into “Compound Emodin and Baicalein” (CEB, patent No. ZL200310105814.3). This research may provide a novel, safe, effective, and inexpensive drug for SAP treatment in the future.
The aim of this study was to explicate the effect and mechanism of CEB in SAP therapy and provides potential clinical benefits for the future treatment of SAP.
The SAP rats and the isolated pancreatic acinar cells were the main objectives in this study. Meanwhile, they also served as the main objectives of research on SAP at the cellular and organism levels.
Retrograde infusion of 5% sodium taurocholate into the pancreatic duct is the frequently used method for SAP model induction. Serum cytokine levels were determined using enzyme-linked immunosorbent assay. Tissue section were stained using haematoxylin and eosin (H&E) for histopathologic detection. Pancreatic acinar cells were isolated using collagenase digestion and the cell viability was determined using an MTT assay. Cell ultrastructure was observed using a transmission electron microscope. Intracellular Ca2+ concentration was determined using a live cell imaging system. The protein and mRNA levels of IP3R were quantified by RT-PCR and Western blot, respectively.
The results showed that CEB can regulate inflammatory factors, increase cell viability, and inhibit calcium overload, which underlie a preliminary mechanism of CEB in SAP. Although research on CEB remains at the preclinical level, and data on its use in humans are lacking, CEB may be a potential future treatment for SAP, suggesting that further studies are needed.
Emodin and baicalein display synergistic effects on SAP rats. CEB acts on the key aspects of SAP pathogenesis and regulates of inflammatory factors in SAP rats. CEB suppresses IP3R-mediated pancreatic acinar Ca2+ overload via inhibiting IP3R mRNA expression in pancreatic acinar cells. As a non-toxic natural product, CEB is the first to show a therapeutic effect at the cellular and organism levels in SAP. CEB is promising for the treatment of patients with SAP.
From this study, the characteristics of abundance, low cost, and safety of traditional Chinese medicine in SAP therapy should catch our attention. We think that the potential of traditional Chinese medicine in SAP therapy will be the direction of the future research. In our opinion, the SAP animal model and the isolated pancreatic acinar cells will always be the main avenues in this study.