Apoptosis in the peripheral blood mononuclear cells as a self-limitation process in human acute pancreatitis

Acute pancreatitis is primed and sustained by a chain of immuno-inflammatory factors. In this study, we investigated the possible existence of peripheral blood mononuclear cell apoptosis as a self-limitation mechanism in acute pancreatitis.

Peripheral blood mononuclear cell apoptosis was determined cytofluorometrically daily for 10 days from the onset of the illness in 27 consecutive patients (18 having mild uncomplicated acute pancreatitis and 9 having pancreatitis with complications) and was related to peripheral blood counts, including reticulocytes and reticulocyte fractions, and albumin, fibrinogen, and C-reactive protein levels.

In the 18 patients with uncomplicated acute pancreatitis, the rate of peripheral blood apoptosis increased progressively until days 5-6 and then decreased. The 9 patients who developed complications showed levels of peripheral blood apoptosis stable across the five periods and lower than those with uncomplicated disease during the first four periods. This difference was statistically significant (p = 0.002) only on days 7-8. On days 9-10, the patients with complications showed higher levels of peripheral blood apoptosis than those with mild uncomplicated acute pancreatitis (p = 0.0005). Peripheral blood apoptosis was not significantly related to the other laboratory parameters, but there was a trend towards an inverse relation to reticulocytes and total leucocytes (p < 0.09).

Peripheral blood apoptosis may act as a mechanism of self-limitation of the process of acute pancreatitis. Its effects, however, seem to be hampered and delayed by the presence of complications.