Chronic Inflammation in the Pancreas and Salivary Glands - Lessons from Similarities and Differences in Pathophysiology and Treatment Modalities

Zoltan   Rakonczay   Jr; Janos      Vag; Anna      Foldes; Krisztina      Nagy; Akos      Nagy; Peter      Hegyi; Gabor      Varga

Abstract

The pancreas and salivary glands have similar anatomical structures and physiological functions producing bicarbonate-rich fluid containing digestive enzymes and other components to be delivered into the gut. Despite these similarities, the two organs are also different in numerous respects, especially regarding the inflammatory diseases affecting them. This article will summarize the pathophysiology and current and potential pharmacological treatments of chronic inflammatory diseases such as chronic pancreatitis, autoimmune pancreatitis, Sjögren's syndrome and irradiation-induced salivary gland atrophy. Despite the differences, in both organs the inflammatory process is accompanied by epithelial tissue destruction and fibrosis. Both in pancreatic and in salivary research, an important task is to stop or even reverse this process. The utilization of stem/progenitor cell populations previously identified in these organs and the application of mesenchymal stem cells are very promising for such regenerative purposes. In addition, gene therapy and tissue engineering research progressively advance and have already yielded clinically beneficial preliminary results for salivary gland diseases. For the hard-to-access, hard-to-regenerate pancreas these developments may also offer new solutions, especially since salivary and pancreatic progenitors are very similar in characteristics and may be mutually useful to regenerate the respective other organ as well. These novel developments could be of great significance and may bring new hope for patients since currently used therapeutic protocols in salivary and in pancreatic chronic inflammatory diseases offer primarily symptomatic treatments and limited beneficial outcome.

Keywords: Pancreas, salivary gland, inflammation, chronic, development, fibrosis epithelium, mesenchyme, fibrosis, atrophy, stem cell, progenitor, tissue engineering, chronic pancreatitis, artificial gland, autoimmune pancreatitis, Sjögren’s syndrome, radiation therapy, head and neck cancer.