Pathophysiology of chronic pancreatitis

Figure 3 A scheme representing the role of digestive enzymes in normal pancreatic tissue and in the case of pancreatitis. A: In a normal pancreas, SPINK1 (first line of defense) and mesotrypsin (second line of defense) inhibit the generation of trypsin resulting from auto-activation of trypsinogen. These defense mechanisms prevent the pancreas from activating the pancreatic enzyme cascade and auto-digestion; B: If mutations are present in the SPINK1 and/or in the mesotrypsin gene, they losses their ability to inhibit the generation of trypsin resulting in activation of enzyme cascade and subsequent pancreatic auto-digestion leading to pancreatitis. SPINK1: Serine protease inhibitor, kazal type 1, gene (encodes for pancreatic secretory trypsin inhibitor).