Clinical Studies of Human Pancreatic Enzyme Synthesis

Very little is known of the effects of diet and disease on panceratic enzyme syntheis in humans as conventional tests measure the secretory response to secreagogues, such as CCK, and secretion may be unrelated to synthesis because of the masking effect of a large intracellular pool of stored enzymes (zymogens). In order to obtain information on enzyme synthesis, as well as secretion, we have measured the incorporation characteristics of isotopically labelled amino acids (e.g., (14)C or (13)C leucine tracer) into amylase and trypsin protein, extracted by affinity chromatography from duodenal secretions during pancreatic stimulation with CCK-8 The results of our studies in healthy volunteers and patients have suggested that (a) it takes between 75 and 101 min for the participation of newly synthesized pancreatic enzymes in the digestive process, and that zymogen stores are replaced at a rate of between 12 percent and 47 percent per hour in normal healthy subjects, (b) the synthesis and production rates of trypsin and amylase are parallel in healthy subjects, but can diverge under stressful conditions such as hypersecretory states, post-acute pancreatitis and protein malnutrition, (c) hyperphagia stimulates the synthesis of enzymes whilst malnutrition diminishes the synthesis of trypsin to a greater extent than amylase, (d) intravenous glucose and amino acids exert negative feedback control on the synthesis and release of amylase and trypsin, and (e) the decreased secretion of pancreatic enzymes in Type 1 insulin-dependent diabetics is more a consequence of defective enzyme release from zymogen stores than defective synthesis. In conclusion, our results indicate that changes in pancreatic enzyme secretion noted in patients do not always reflect changes in enzyme synthesis, and that the production of individual enzymes may diverge under certain circumstances. Based on the methodology described, it should be possible to develop more sensitive clinical tests of pancreatic function that provide information not only on the abiltiy of the pancreas to secrete enzymes under certain disease states, but also information on the gland's synthetic activity