Immune cell infiltration and growth-associated protein 43 expression correlate with pain in chronic pancreatitis.
OBJECTIVE
Changes in innervation pattern and neuropeptide content have been shown in chronic pancreatitis (CP), including increased neuronal expression of growth-associated protein 43 (GAP-43). We used GAP-43 as an established marker of neuronal plasticity and correlated histological findings with pain scores of patients with CP.


METHODS
In tissue samples from 29 patients with CP, the parenchyma-fibrosis ratio, degree of perineural immune cell infiltration, and neuronal GAP-43 immunoreactivity were determined by digitized morphometry and correlated with individual pain scores.


RESULTS
In CP, GAP-43 was significantly increased in pancreatic nerve fibers and intrinsic neurons. GAP-43 expression correlated with individual pain scores. The infiltration of pancreatic nerves by immune cells was significantly correlated with the intensity of pain. Pain scores correlated neither with the degree of pancreatic fibrosis nor with the duration of the disease.


CONCLUSIONS
The results suggest that infiltration of pancreatic nerves by immune cells and neuronal plasticity are pathogenic factors for the generation of pain, whereas the degree of pancreatic fibrosis has no major impact on pain in CP.
Di Sebastiano
P
P
Department of Visceral and Transplantation Surgery, University of Berne, Switzerland.
Fink
T
T
Weihe
E
E
Friess
H
H
Innocenti
P
P
Beger
H G
HG
Büchler
M W
MW
D000293:Adolescent; D000328:Adult; D002465:Cell Movement; D002908:Chronic Disease; D005260:Female; D019922:GAP-43 Protein; D006133:Growth Substances / Q000378:metabolism*; D006801:Humans; D007107:Immune System / Q000473:pathology / Q000503:physiopathology*; D007150:Immunohistochemistry; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism*; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000378:metabolism*; D010146:Pain; D010195:Pancreatitis / Q000276:immunology* / Q000378:metabolism / Q000503:physiopathology*; D013869:Thiolester Hydrolases / Q000378:metabolism; D043222:Ubiquitin Thiolesterase
D019922:GAP-43 Protein; D006133:Growth Substances; D008562:Membrane Glycoproteins; D009419:Nerve Tissue Proteins; D013869:Thiolester Hydrolases; D043222:Ubiquitin Thiolesterase