Early intracellular premature
trypsinogen activation was interpreted as the key initiator of
pancreatitis. When the balance in the homeostasis of
trypsin and antitrypsin system is disequilibrated, elevated aggressive
enzymes directly attack the pancreatic tissue, which leads to pancreatic destruction and
inflammation. However,
trypsin alone is not enough to cause complications in
pancreatitis, which may play a crucial role in modulating signaling events in the initial phase of the disease. NFκB activation is the major inflammatory pathway involved in the occurrence and development of
pancreatitis and it can be induced by intrapancreatic activation of
trypsinogen. Synthesis of
trypsinogen occurs in endoplasmic reticulum (ER), and ER stress is an important early acinar cell event. Components of ER stress response are known to be able to trigger cell death as well as NFκB signaling cascade. The strongest evidence supporting the
trypsin-centered theory is that gene mutations, which lead to the generation of more
trypsin, or reduce the activity of
trypsin inhibitors or
trypsin degradation, are associated with
pancreatitis. Thus,
trypsin-antitrypsin imbalance may be the first step leading to pancreatic autodigestion and inducing other pathways. Continued experimental studies are necessary to determine the specific relationships between
trypsin-antitrypsin imbalance and genetic heterogeneity in
pancreatitis. In this article, we review the latest advances that contributed to the understanding of the basic mechanisms behind the occurrence and development of
pancreatitis with a focus on the interpretation of
trypsin-antitrypsin imbalance and their relationships with other
inflammation pathways. We additionally highlight
genetic predispositions to
pancreatitis and possible mechanisms associated with them.