Abstract
Bovine milk contains a native lipoprotein lipase (LPL) that preferentially acts on emulsified substrates at water–oil interfaces and several esterases that preferentially act on soluble ester substrates. The lipase is by far the most abundant, most studied, best characterized, and of most practical significance. It is synthesized in the mammary gland and transported to the milk where, under certain circumstances, it catalyzes the hydrolysis of triacylglycerols to free fatty acids and mono- and diacylglycerols. It is mostly bound to the casein micelles but can move to the milk fat globule membrane under conditions that induce lipolysis of the globular fat. It is a glycoprotein of molecular mass 100 kDa and requires lipoproteins or apolipoproteins for full activity. By contrast, the esterases in milk are not well characterized. They are present in low concentrations except in abnormal milks such as colostrum and mastitic milks. The types reported include arylesterases, carboxylesterases, and cholinesterases. They seem to have no significant technological importance in milk. Human milk contains a relatively high concentration of a bile salt-stimulated lipase, in addition to LPL, which does not appear to be present in bovine milk. It has a role in the digestion of milk fat in neonates.
Encyclopedia of Dairy Sciences (Second Edition)
Pages 304-307
Monday
White and green tea polyphenols inhibit pancreatic lipase in vitro
Abstract
Green, white and black teas were assayed for inhibition of pancreatic lipase activity in vitro. White tea proved to be more effective than green tea with black tea showing little inhibition even at 200 μg GAE/ml. The EC50 values for inhibition were 22 μg/ml for white tea and 35 μg/ml for green tea; both easily achievable from normal infusions of tea. Liquid chromatography-mass spectroscopy analysis showed that white and green teas had essentially equal amounts of flavan-3-ols but green tea had higher levels of flavonols. White tea had higher levels of 5-galloyl quinic acid, digalloyl glucose, trigalloyl glucose and the tannin, strictinin.
After chromatography on Sephadex LH-20, the main inhibitory fraction was enriched in strictinin and fractions enriched in other components were ineffective. This suggests that strictinin content may be crucial for inhibition of pancreatic lipase. However, the possibility of synergies between the polyphenols cannot be disregarded.
Anais Gondoina, Dominic Grussua, Derek Stewarta and Gordon J. McDougall
Green, white and black teas were assayed for inhibition of pancreatic lipase activity in vitro. White tea proved to be more effective than green tea with black tea showing little inhibition even at 200 μg GAE/ml. The EC50 values for inhibition were 22 μg/ml for white tea and 35 μg/ml for green tea; both easily achievable from normal infusions of tea. Liquid chromatography-mass spectroscopy analysis showed that white and green teas had essentially equal amounts of flavan-3-ols but green tea had higher levels of flavonols. White tea had higher levels of 5-galloyl quinic acid, digalloyl glucose, trigalloyl glucose and the tannin, strictinin.
After chromatography on Sephadex LH-20, the main inhibitory fraction was enriched in strictinin and fractions enriched in other components were ineffective. This suggests that strictinin content may be crucial for inhibition of pancreatic lipase. However, the possibility of synergies between the polyphenols cannot be disregarded.
Anais Gondoina, Dominic Grussua, Derek Stewarta and Gordon J. McDougall
Wednesday
Gut Wall Compromise in the Presence of Pancreatic Enzymes Causes Circulatory Shock
ABSTRACT
Pancreatic proteolytic enzymes (PEs) in the ischemic intestine play a central role in multisystem organ failure, which can be prevented by protease inhibition in the small intestine lumen. PEs, if allowed to circulate systemically may also result in shock. However, it is unclear whether enzyme liberation in an intestine with increased permeability alone leads to shock. To test this idea the non-ischemic rat small intestinal lumen was perfused for two hours with either (A) PEs, (B) interventions designed to increase lumenal permeability (N-acetylcysteine (NAC) + atropine + increased flow) or (C) both, and animals were observed for shock and organ failure. PEs perfused (Groups A and C) included trypsin, chymotrypsin, elastase, amylase and lipase at concentrations 2 log greater than baseline values. Group A (n=6) maintained baseline blood pressures as did other groups perfused with single enzymes alone. However all animals in Group C (n=6) developed hypotension, significant increases in gut permeability (p<0.001) and died (p<0.001). Group B (n=6) developed mild hypotension (NS) and increased gut permeability (p<0.05) compared to controls but there were no deaths. These experiments demonstrate for the first time that increased gut permeability in the presence of lumenal PEs is sufficient to induce shock. PEs, if allowed to penetrate the gut wall result in multiorgan failure and death. Supported by NIH Grant GM085072
Erik B. Kistler1,2 and Geert W. Schmid-Schonbein1
1 Department of Bioengineering
2 Department of Anesthesia, University of California, San Diego, San Diego, CA
Pancreatic proteolytic enzymes (PEs) in the ischemic intestine play a central role in multisystem organ failure, which can be prevented by protease inhibition in the small intestine lumen. PEs, if allowed to circulate systemically may also result in shock. However, it is unclear whether enzyme liberation in an intestine with increased permeability alone leads to shock. To test this idea the non-ischemic rat small intestinal lumen was perfused for two hours with either (A) PEs, (B) interventions designed to increase lumenal permeability (N-acetylcysteine (NAC) + atropine + increased flow) or (C) both, and animals were observed for shock and organ failure. PEs perfused (Groups A and C) included trypsin, chymotrypsin, elastase, amylase and lipase at concentrations 2 log greater than baseline values. Group A (n=6) maintained baseline blood pressures as did other groups perfused with single enzymes alone. However all animals in Group C (n=6) developed hypotension, significant increases in gut permeability (p<0.001) and died (p<0.001). Group B (n=6) developed mild hypotension (NS) and increased gut permeability (p<0.05) compared to controls but there were no deaths. These experiments demonstrate for the first time that increased gut permeability in the presence of lumenal PEs is sufficient to induce shock. PEs, if allowed to penetrate the gut wall result in multiorgan failure and death. Supported by NIH Grant GM085072
Erik B. Kistler1,2 and Geert W. Schmid-Schonbein1
1 Department of Bioengineering
2 Department of Anesthesia, University of California, San Diego, San Diego, CA
Thursday
Inhibition of Pancreatic Lipase and the Renin Angiotensin System Synergistically Decreases Body Fat
We have recently demonstrated that mice lacking renin are lean, and excrete more fat in the feces, which is associated with less than 20 % expression of pancreatic lipase and colipase. Treating wild type (WT) mice with an angiotensin receptor blocker losartan (ARB) or an angiotensin converting enzyme (ACE) inhibitor enalapril does not affect body weight, body fat, fecal fat excretion and pancreatic lipase expression, although their colipase expression in the pancreas is decreased to the low levels of the Ren1c–/– mice. Because colipase is necessary for activation of lipase, we hypothesized that inhibition of both pancreatic lipase and colipase by combination of ARB or ACE inhibitor and lipase inhibitor (orlistat) more effectively decreases body weight and body fat than either of them alone. Treating WT mice with both losartan (0.45g/L in drinking water) and orlistat (200 mg/kg diet) for two weeks reduced the body fat significantly more than mice treated with losartan alone or orlistat alone (control 12.5±1.42 %, losartan 8.7±1.9 %, orlistat 3.8±0.8 %, losartan + orlistat 0.2±2.5 %).
The fecal fat content in mice treated with losartan and orlistat is also significantly higher than that of mice treated with losartan alone or orlistat alone (control 46.1±6.2 mg/day, losartan 32.0±4.0 mg/day, orlistat 137.1±9.6 mg/day, losartan + orlistat 186.0±39.6 mg/day). We conclude that inhibiting pancreatic lipase and colipase by using combination of lipase inhibitor and ARB or ACE inhibitor is a promising treatment of the metabolic syndrome.
Feng Li; Nobuyuki Takahashi
Univ of North Carolina at CH, Chapel Hill, NC
This research has received full or partial funding support from the American Heart Association, Mid-Atlantic Affiliate (Maryland, North Carolina, South Carolina, Virginia & Washington, DC
The fecal fat content in mice treated with losartan and orlistat is also significantly higher than that of mice treated with losartan alone or orlistat alone (control 46.1±6.2 mg/day, losartan 32.0±4.0 mg/day, orlistat 137.1±9.6 mg/day, losartan + orlistat 186.0±39.6 mg/day). We conclude that inhibiting pancreatic lipase and colipase by using combination of lipase inhibitor and ARB or ACE inhibitor is a promising treatment of the metabolic syndrome.
Feng Li; Nobuyuki Takahashi
Univ of North Carolina at CH, Chapel Hill, NC
This research has received full or partial funding support from the American Heart Association, Mid-Atlantic Affiliate (Maryland, North Carolina, South Carolina, Virginia & Washington, DC
Tuesday
A Study of Pancreatic Function among Subjects over Ninety Years of Age
Pancreatology 2009;9:240-244 (DOI: 10.1159/000212090)
Background: Among the various studies of pancreatic function in the elderly published so far, none have dealt with subjects over 90 years of age. The aim of this study was to examine pancreatic function in healthy individuals over 90 years old.
Methods: Sixty-eight healthy noninstitutionalized elderly persons, aged 91-104 years, with a mean age of 95 years, and 63 younger controls were studied. Pancreatic function was studied by determining fecal elastase 1 concentration. In addition to this test, we also measured serum amylase, pancreatic isoamylase and lipase in 53 of the 68 elderly subjects.
Results: All but 1 of the 68 elderly subjects had normal elastase 1 values; the one who did not had a value slightly below normal. No significant difference with controls was found.
Serum pancreatic enzymes were normal in almost all of the 53 elderly studied; 3 had a mild elevation only of amylase and 1 had a persistent elevation of amylase, pancreatic isoamylase and lipase. Conclusions: In subjects over 90 years of age, exocrine pancreatic function continues to be normal; if an impairment occurs, it is mild and not significant for digestion of food.
In addition, serum pancreatic enzymes remain within normal limits in the vast majority of cases.
Lucio Gulloa, Patrizia Simonia, Marina Miglioria, Laura Lucrezioa, Michela Bassia, Franca Fraua, Pier Lorenzo Costaa, Vincenzo Nesticòb
aInstitute of Internal Medicine, University of Bologna, St. Orsola Hospital, Bologna, and
bInstitute of Internal Medicine, Civile Hospital, Catanzaro, Italy
Address of Corresponding Author
Background: Among the various studies of pancreatic function in the elderly published so far, none have dealt with subjects over 90 years of age. The aim of this study was to examine pancreatic function in healthy individuals over 90 years old.
Methods: Sixty-eight healthy noninstitutionalized elderly persons, aged 91-104 years, with a mean age of 95 years, and 63 younger controls were studied. Pancreatic function was studied by determining fecal elastase 1 concentration. In addition to this test, we also measured serum amylase, pancreatic isoamylase and lipase in 53 of the 68 elderly subjects.
Results: All but 1 of the 68 elderly subjects had normal elastase 1 values; the one who did not had a value slightly below normal. No significant difference with controls was found.
Serum pancreatic enzymes were normal in almost all of the 53 elderly studied; 3 had a mild elevation only of amylase and 1 had a persistent elevation of amylase, pancreatic isoamylase and lipase. Conclusions: In subjects over 90 years of age, exocrine pancreatic function continues to be normal; if an impairment occurs, it is mild and not significant for digestion of food.
In addition, serum pancreatic enzymes remain within normal limits in the vast majority of cases.
Lucio Gulloa, Patrizia Simonia, Marina Miglioria, Laura Lucrezioa, Michela Bassia, Franca Fraua, Pier Lorenzo Costaa, Vincenzo Nesticòb
aInstitute of Internal Medicine, University of Bologna, St. Orsola Hospital, Bologna, and
bInstitute of Internal Medicine, Civile Hospital, Catanzaro, Italy
Address of Corresponding Author
Thursday
Ruptured ectopic pregnancy mimicking acute pancreatitis.
Mitura K, Romanczuk M.
Department of General Surgery, Siedlce Hospital, Siedlce, Poland.
INTRODUCTION: Ectopic pregnancy may lead to massive haemorrhage, infertility or death. Prompt diagnosis and treatment are crucial to save patients who would otherwise die. Serum amylase and lipase measurements are known biochemical markers of pancreatic inflammation and a recognized finding that may help diagnose acute pancreatitis. To the best of our knowledge (Medline, Pubmed, Cochrane Library have been researched) the following study presents the first case of ruptured ectopic pregnancy accompanied by markedly elevated amylase and lipase levels mimicking acute pancreatitis ever reported.
CASE REPORT: A previously healthy, nulliparous 35-year-old woman was admitted to hospital with a 2-day history of abdominal pain and vomiting. Her last menstrual period was 7 weeks before presentation. At the admission, the patient was hemodynamically stable. The abdomen was soft with tenderness in its mesogastric area. Blood tests revealed markedly elevated activities of the pancreatic enzymes. Acute pancreatitis was the early clinical diagnosis and subsequent therapy was initiated. After 12 hours the condition of the patient suddenly worsened. She was clinically shocked with pallor, hypotension and tachycardia. Laboratory tests revealed anaemia and increased activities of pancreatic enzymes. An ultrasound examination demonstrated an accumulation of intraperitoneal fluid in the pelvis. Subsequently, the patient was subjected to immediate laparotomy. The peritoneal cavity contained large amount of blood. A cystic mass was found and extracted from the ruptured and bleeding right fallopian tube. Histological examination confirmed a rupture of an ectopic pregnancy of a 6-week-old foetus with an intact gestational sac. The patient made an uneventful recovery and was discharged from hospital after 8 days.
CONCLUSIONS: Our case proves that a misdiagnosed ruptured ectopic pregnancy in the event of elevated activities of pancreatic enzymes may lead to delayed diagnosis of haemorrhage to peritoneum, resulting in hemodynamic instability
Department of General Surgery, Siedlce Hospital, Siedlce, Poland.
INTRODUCTION: Ectopic pregnancy may lead to massive haemorrhage, infertility or death. Prompt diagnosis and treatment are crucial to save patients who would otherwise die. Serum amylase and lipase measurements are known biochemical markers of pancreatic inflammation and a recognized finding that may help diagnose acute pancreatitis. To the best of our knowledge (Medline, Pubmed, Cochrane Library have been researched) the following study presents the first case of ruptured ectopic pregnancy accompanied by markedly elevated amylase and lipase levels mimicking acute pancreatitis ever reported.
CASE REPORT: A previously healthy, nulliparous 35-year-old woman was admitted to hospital with a 2-day history of abdominal pain and vomiting. Her last menstrual period was 7 weeks before presentation. At the admission, the patient was hemodynamically stable. The abdomen was soft with tenderness in its mesogastric area. Blood tests revealed markedly elevated activities of the pancreatic enzymes. Acute pancreatitis was the early clinical diagnosis and subsequent therapy was initiated. After 12 hours the condition of the patient suddenly worsened. She was clinically shocked with pallor, hypotension and tachycardia. Laboratory tests revealed anaemia and increased activities of pancreatic enzymes. An ultrasound examination demonstrated an accumulation of intraperitoneal fluid in the pelvis. Subsequently, the patient was subjected to immediate laparotomy. The peritoneal cavity contained large amount of blood. A cystic mass was found and extracted from the ruptured and bleeding right fallopian tube. Histological examination confirmed a rupture of an ectopic pregnancy of a 6-week-old foetus with an intact gestational sac. The patient made an uneventful recovery and was discharged from hospital after 8 days.
CONCLUSIONS: Our case proves that a misdiagnosed ruptured ectopic pregnancy in the event of elevated activities of pancreatic enzymes may lead to delayed diagnosis of haemorrhage to peritoneum, resulting in hemodynamic instability
Monday
The level and clinical significance of pancreatic enzymes in survivors of acute paraquat poisoning
INTRODUCTION: Acute paraquat poisoning is often fatal. When ingested, paraquat affects multiple organs including the lung, gastrointestinal tract, pancreas, kidney, heart, and central nervous system. Our center previously found that initial pancreatic function was related to the prognosis of patients with acute paraquat poisoning. However, pancreatic injury after paraquat intoxication has been incompletely studied.
METHODS: This study analyzed the clinical outcome and extent of pancreatic injury in 34 survivors of acute paraquat poisoning. Paraquat exposure was assessed based on a quantitative measure of the plasma level of paraquat by high-performance liquid chromatography. The subsequent variations in the level of pancreatic enzymes, clinical symptoms, and abdominal computed tomography were obtained. Outcomes after acute paraquat poisoning were categorized as pancreatic enzyme elevation group (elevation group: amylase >160 IU/L and lipase >100 IU/L) and nonelevation group.
RESULTS: Pancreatic enzyme elevations occurred in seven cases (20.6%), and the level of pancreatic enzymes peaked at day 7. The elevation in pancreatic enzymes after paraquat ingestion was positively correlated with the plasma paraquat level (p < 0.05 at days 4 and 7). Creatinine was higher in the elevation group. Abdominal computed tomography of the seven cases showed no evidence of pancreatitis, and significant abdominal pain was not observed.
DISCUSSION: Pancreatic enzyme elevation reflects the systemic toxicity and multiorgan involvement following acute paraquat poisoning. CONCLUSIONS: Pancreatic injury was subtle and the elevation of pancreatic enzymes in survivors is clinically benign.
Gil HW, Yang JO, Lee EY, Hong SY.
Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
METHODS: This study analyzed the clinical outcome and extent of pancreatic injury in 34 survivors of acute paraquat poisoning. Paraquat exposure was assessed based on a quantitative measure of the plasma level of paraquat by high-performance liquid chromatography. The subsequent variations in the level of pancreatic enzymes, clinical symptoms, and abdominal computed tomography were obtained. Outcomes after acute paraquat poisoning were categorized as pancreatic enzyme elevation group (elevation group: amylase >160 IU/L and lipase >100 IU/L) and nonelevation group.
RESULTS: Pancreatic enzyme elevations occurred in seven cases (20.6%), and the level of pancreatic enzymes peaked at day 7. The elevation in pancreatic enzymes after paraquat ingestion was positively correlated with the plasma paraquat level (p < 0.05 at days 4 and 7). Creatinine was higher in the elevation group. Abdominal computed tomography of the seven cases showed no evidence of pancreatitis, and significant abdominal pain was not observed.
DISCUSSION: Pancreatic enzyme elevation reflects the systemic toxicity and multiorgan involvement following acute paraquat poisoning. CONCLUSIONS: Pancreatic injury was subtle and the elevation of pancreatic enzymes in survivors is clinically benign.
Gil HW, Yang JO, Lee EY, Hong SY.
Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
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