Early events in acute pancreatitis.

Studies using experimental models indicate that the earliest changes in acute pancreatitis involve intra-acinar cell events including the co-localization of lysosomal hydrolases with digestive enzyme zymogens. This co-localization phenomenon leads to trypsinogen activation and subsequent cell injury. Following acinar cell injury, a series of extra-acinar cell changes determine the severity of pancreatitis by promoting or reducing the inflammatory response and by influencing cell death events. Most patients with pancreatitis are diagnosed when acinar cell injury has already occurred. Therapies designed to modify the subsequent extra-acinar cell inflammatory process may prove useful in the management of clinical pancreatitis.