Toxicology of the pancreas

The pancreas of mammals is capable of biotransforming drugs and other chemicals and subject to toxic injury by the resultant reactive metabolites. In the case of experimental animals, especially rodents, numerous chemical toxicants have been identified for the exocrine pancreas and, to a lesser degree, the endocrine component. These include alcohol, alloxan, azaserine, dimethylbenzo[a]anthracene, ethionine, 4-hydroxyaminoquinoline-1-oxide, beta-oxidized derivatives of dipropylnitrosamine, oleic acid, and streptozotocin. Depending on the toxicant, the cellular effects span the gamut from acute injury and death, to hyperplasia, metaplasia, and malignant transformation. In contrast to the well-established toxic effects of chronic alcohol abuse on the human pancreas, its susceptibility to toxic injury by therapeutic drugs has become clinically apparent more recently. A drug should be considered as toxic only when it induces acute pancreatitis documented by clinical findings and laboratory tests; the condition improves when the drug is discontinued and worsens when the patient is challenged by readministration of the drug. At present, only 8 therapeutic drugs have fulfilled these criteria and are classified as toxic for pancreas. These are, azathioprine, estrogens, furosemide, methyldopa, pentamidine, procainamide, sulfonamides, and thiazide diuretics. Controlled exposure to cultured component cells of pancreas may be of potential value in identifying such drugs, documenting their toxicity, and allowing for biochemical and toxicologic investigation of the mechanisms involved.