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World J Gastroenterol. Jul 7, 2021; 27(25): 3825-3836
Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3825
Autoimmune pancreatitis and pancreatic cancer: Epidemiological aspects and immunological considerations
Dimitri Poddighe
Dimitri Poddighe, Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
Dimitri Poddighe, Department of Pediatrics, National Research Institute for Maternal and Child Health (NRCMCH), University Medical Center (UMC) Nur-Sultan 010000, Kazakhstan
Author contributions: Poddighe D conceived and wrote this manuscript.
Conflict-of-interest statement: The author declares no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitri Poddighe, MD, MSc, PhD-Eq., Associate Professor, Department of Medicine, School of Medicine, Nazarbayev University, Kerei-Zhanibek Str. 5/1, Nur-Sultan 010000, Kazakhstan. dimitri.poddighe@nu.edu.kz
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: April 5, 2021
Revised: April 13, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 7, 2021
Processing time: 148 Days and 11.5 Hours
Abstract

Ordinary chronic pancreatitis is a well-known risk factor for pancreatic cancer, whereas such an association with autoimmune pancreatitis (AIP) is widely debated. Due to the rarity of the latter disorder, there are few specific clinical and epidemiological studies investigating the relation between AIP and pancreatic cancer, which do not seem to support it. However, these studies are affected by several limitations and, therefore, a link between AIP (and, specifically, type 1 AIP) and pancreatic cancer cannot be ruled out definitively on this basis. Moreover, several immunopathological aspects of type 1 AIP and, in general, immunoglobulin G4-related disease can create an immunological context that may impair the tumoral immunosurveillance and promote the pancreatic carcinogenesis and its progression. In detail, Th2 immunological dominance, type 2 macrophage polarization and basophil infiltration observed in type 1 AIP, may play a permissive role in creating a favorable immunological environment for pancreatic carcinogenesis, in addition to the immunosuppressive therapies that can be used in these patients.

Keywords: Autoimmune pancreatitis, Chronic pancreatitis, Pancreatic cancer, Immunoglobulin G4-related disease, Epidemiology, Immunology, Basophils, Macrophages, Th2 cells, Systemic lupus erythematosus

Core Tip: This mini-review discusses the debated issue of autoimmune pancreatitis (type 1) as a potential risk factor for pancreatic cancer. After summarizing the few available (low-quality) epidemiological evidence that does not clearly support this role, the immunopathological characteristics of type 1 autoimmune pancreatitis (including Th2 immunological dominance, type 2 macrophage polarization and basophil infiltration) are discussed as potential factors that may actually create a tolerogenic immunological environment favorable to pancreatic carcinogenesis and/or tumor progression.