Disordered lysosomal/autophagy pathways initiate and drive
pancreatitis, but the underlying mechanisms and links to disease pathology are poorly understood. Here, we show that the
mannose-6-phosphate (M6P) pathway of
hydrolase delivery to lysosomes critically regulates pancreatic acinar cell
cholesterol metabolism. Ablation of the Gnptab gene encoding a key
enzyme in the M6P pathway disrupted acinar cell
cholesterol turnover, causing accumulation of nonesterified
cholesterol in lysosomes/autolysosomes, its depletion in the plasma membrane, and upregulation of
cholesterol synthesis and uptake. We found similar dysregulation of acinar cell
cholesterol, and a decrease in GNPTAB levels, in both WT experimental
pancreatitis and human disease. The mechanisms mediating pancreatic
cholesterol dyshomeostasis in Gnptab-/- and experimental models involve a disordered endolysosomal system, resulting in impaired
cholesterol transport through lysosomes and blockage of autophagic flux. By contrast, in Gnptab-/- liver the endolysosomal system and
cholesterol homeostasis were largely unaffected. Gnptab-/- mice developed spontaneous
pancreatitis. Normalization of
cholesterol metabolism by pharmacologic means alleviated responses of experimental
pancreatitis, particularly
trypsinogen activation, the disease hallmark. The results reveal the essential role of the M6P pathway in maintaining exocrine pancreas homeostasis and function, and implicate
cholesterol disordering in the pathogenesis of
pancreatitis.