Clinical variations in cystic fibrosis of the pancreas.
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Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that encodes a small conductance cAMP-activated chloride ion channel. In the CF pancreatic duct, mutations in CFTR cause a reduction in bicarbonate secretion. This is thought to result from CFTR operating in parallel with a chloride-bicarbonate (Cl(-)/HCO(-)(3)) exchanger, located in the apical membrane of pancreatic duct cells. The molecular basis of this Cl(-)/HCO(-)(3) exchanger has not been identified. A combination of screening cDNA libraries, RNase protection, and 5' RACE analysis was used to identify Cl(-)/HCO(-)(3) exchangers in human fetal pancreas. An AE2 Cl(-)/HCO(-)(3) exchanger was shown to be expressed in human fetal pancreas from the midtrimester of gestation, at a time when CF-associated pathology commences. In addition, an AE1 Cl(-)/HCO(3) was identified in fetal pancreas but was absent from the adult pancreas and cultured ductal epithelial cells from fetal and adult pancreas.
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Using the gastric insufflation method, 5 cases of pancreatic calcification have been detected in a series of 60 patients with cystic fibrosis. All patients were over 5 years of age. Four of them showed a diabetic curve at glucose tolerance test and 2 have recently developed frank diabetes mellitus. The value of gastric distension by gas in the radiological detection of pancreatic calcification and the relatively high frequency of such calcification in cystic fibrosis are emphasized. The pathogenesis of the calcific change and its clinical significance are briefly discussed.
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