Trypsin activity governs increased susceptibility to pancreatitis in mice expressing human PRSS1R122H

Currently, an effective targeted therapy for pancreatitis is lacking. Hereditary pancreatitis (HP) is a heritable, autosomaldominant disorder with recurrent acute pancreatitis (AP) progressing to chronic pancreatitis (CP) and a markedly increased risk of pancreatic cancer. In 1996, mutations in PRSS1 were linked to the development of HP. Here, we developed a mouse model by inserting a full-length human PRSS1(R122H) gene, the most commonly mutated gene in human HP, into mice. Expression of PRSS1(R122H) protein in the pancreas markedly increased stress signaling pathways and exacerbated AP. After the attack of AP, all PRSS1(R122H) mice had disease progression to CP, with similar histologic features as those observed in human HP. By comparing PRSS1(R122H) mice with PRSS1(WT) mice, as well as enzymatically inactivated Dead-PRSS1(R122H) mice, we unraveled that increased trypsin activity is the mechanism for R122H mutation to sensitize mice to the development of pancreatitis. We further discovered that trypsin inhibition, in combination with anticoagulation therapy, synergistically prevented progression to CP in PRSS1(R122H) mice. These animal models help us better understand the complex nature of this disease and provide powerful tools for developing and testing novel therapeutics for human pancreatitis.