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Panhematin provides a therapeutic benefit in experimental pancreatitis
  1. Aida Habtezion2,
  2. Raymond Kwan1,
  3. Ehsaan Akhtar2,
  4. Stephen P Wanaski3,
  5. Stephen D Collins3,
  6. Ronald J Wong4,
  7. David K Stevenson4,
  8. Eugene C Butcher5,
  9. M Bishr Omary1
  1. 1University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, Michigan, USA
  2. 2Stanford University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Stanford, California, USA
  3. 3NeuroTherapeutics Pharma, Inc., Chicago, Illinois, USA
  4. 4Stanford University School of Medicine, Department of Pediatrics, Stanford, California, USA
  5. 5Stanford University School of Medicine, Department of Pathology, Stanford, California, USA
  1. Correspondence to Dr Aida Habtezion, Stanford University School of Medicine, Department of Medicine, Division of Gastroenterology & Hepatology, 300 Pasteur Drive, Stanford, CA 94305, USA; aidah{at}stanford.edu

Abstract

Background and aim Acute pancreatitis (AP) can result in pancreatic necrosis and inflammation, with subsequent multi-organ failure. AP is associated with increased neutrophil recruitment and a rise in pro-inflammatory cytokines such as TNFα. Pretreatment with haemin, results in recruitment of haem-oxygenase-1 (HO-1)+ macrophages and protects against experimental pancreatitis. It is not clear whether modulation of HO-1 after onset of disease has a protective role. In this study, we tested the utility of Panhematin, a water-soluble haemin formulation, in activating and inducing pancreatic HO-1, and as a therapeutic agent in treating mouse acute pancreatitis.

Methods We defined the distribution of radiolabelled haemin, then used in vivo HO-1–luciferase bioluminescence imaging and the CO-release assay to test Panhematin-induced upregulation of HO-1 transcription and activity, respectively. Using two well-defined AP murine models, we tested the therapeutic benefit of Panhematin, and quantified cytokine release using a luminex assay.

Results Intravenously administered Panhematin induces rapid recruitment of HO-1+ cells to the pancreas within 2 h and de novo splenic HO-1 transcription by 12 h. Despite high baseline spleen HO-1 activity, the pancreas is particularly responsive to Panhematin-mediated HO-1 induction. Panhematin-treated mice, at various time points after AP induction had significant reduction in mortality, pancreatic injury, together with upregulation of HO-1 and downregulation of pro-inflammatory cytokines and CXCL1, a potent neutrophil chemoattractant.

Conclusions Despite AP-associated mortality and morbidity, no effective treatment other than supportive care exists. We demonstrate that Panhematin leads to: (i) rapid induction and activation of pancreatic HO-1 with recruitment of HO-1+ cells to the pancreas, (ii) amelioration of AP even when given late during the course of disease, and (iii) a decrease in leucocyte infiltration and pro-inflammatory cytokines including CXCL1. The utility of Panhematin at modest doses as a therapeutic in experimental pancreatitis, coupled with its current use and safety in humans, raises the potential of its applicability to human pancreatitis.

  • Acute pancreatitis
  • haem-oxygenase 1
  • CXCL1

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Footnotes

  • Funding This work was supported by NIH grants DK073909, DK47918 and by Ovation Pharmaceuticals (to MBO), and NIH Digestive Disease Center grants DK56339 to Stanford University and DK34933 to the University of Michigan.

  • Competing interests The supplier of Panhematin (formerly called Ovation Pharmaceuticals) provided support for this study and has a pending patent application for the possible use of Panhematin in human pancreatitis.

  • Ethics approval All animal protocols were approved by the Institutional Animal Care and Use Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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