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. 2024 Nov-Dec;37(6):734-741.
doi: 10.20524/aog.2024.0922. Epub 2024 Oct 23.

Cytokine signatures in post-endoscopic retrograde cholangiopancreatography pancreatitis: a pilot study

Jorge D Machicado  1 , Peter J Lee  2 , Stacey Culp  3 , Kimberly Stello  4 , Phil A Hart  2 , Mitchell Ramsey  2 , Adam Lacy-Hulbert  5 , Cate Speake  6 , Zobeida Cruz-Monserrate  7 , B Joseph Elmunzer  8 , David C Whitcomb  9   10 , Georgios I Papachristou  2
Affiliations

Cytokine signatures in post-endoscopic retrograde cholangiopancreatography pancreatitis: a pilot study

Jorge D Machicado et al. Ann Gastroenterol. 2024 Nov-Dec.

Abstract

Background: Following endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) is the most common complication. The host's innate immune response to periprocedural pancreatic injury is the hallmark of its pathogenesis. Investigating cytokine signatures associated with PEP and its risk factors can guide understanding of PEP immunopathogenesis.

Methods: We conducted a single-center, prospective, observational pilot study in adults at high-risk for PEP. Seven serum cytokines relevant to early acute pancreatitis pathogenesis, angiopoietin-2, hepatocyte growth factor (HGF), interleukin-6 (IL-6), IL-8, monocyte chemotactic protein-1, resistin, and soluble tumor necrosis factor-α receptor 1, were measured in sera collected 2 h pre- and post-ERCP. Levels were compared among healthy controls and ERCP participants who either did or did not develop PEP. Heat maps were constructed to perform a multidimensional exploratory analysis that aimed to determine the cytokine signatures associated with PEP and its participant-related risk factors (female sex, young age, and obesity).

Results: A total of 65 participants were enrolled (36 undergoing ERCP and 29 healthy controls). Eight of the 36 (22.2%) ERCP participants developed PEP. Baseline IL-8 levels measured before ERCP were elevated in participants who developed PEP (7.5 vs. 14.8 pg/mL, P=0.02), and most strongly upregulated in women under 40 years of age. HGF levels post-ERCP were higher in participants with PEP (738.0 vs. 556.6 pg/mL, P=0.04), and most strongly upregulated in obese participants.

Conclusions: Pre-ERCP IL-8 and post-ERCP HGF are associated with the development of PEP. Findings from this pilot study can inform the design of translational work in the immunopathogenesis of PEP.

Keywords: Acute pancreatitis; endoscopic retrograde cholangiopancreatography; pathogenesis; post-ERCP pancreatitis.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Heatmaps demonstrating cytokine signatures: (A) 2 h before ERCP for clinical risk factors in 3 ERCP outcome groups (no hospital admission, hospital admission with pain but not PEP, PEP); (B) 2 h after ERCP for clinical risk factors in 3 ERCP outcome groups ERCP, endoscopic retrograde cholangiopancreatography, PEP, post-ERCP pancreatitis
See this image and copyright information in PMC

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