Abstract
Acute pancreatitis (AP) is a complex and potentially severe inflammatory disorder of the pancreas and is one of the most common causes of gastrointestinal hospitalization. Although environmental risk factors such as alcohol and gallstones are well recognized, only a subset of exposed individuals develop AP, suggesting that intrinsic factors, including genetic susceptibility, influence disease onset and progression. Endoplasmic reticulum (ER) stress has emerged as a key mechanism in AP pathogenesis, because ER is essential for protein synthesis, folding, degradation and secretion (proteostasis). Mesencephalic astrocyte-derived neurotrophic factor (MANF), an ER stress-inducible protein highly expressed in the pancreas, plays a critical role in maintaining proteostasis, yet its involvement in AP remains unclear. To investigate the functional role of MANF in AP, we generated pancreas-specific MANF knockout (MANF-KO) mice using the Cre/loxP system and subjected them to moderate experimental AP, that is caerulein- or alcohol-induced AP in mice. In the caerulein model, MANF deficiency exacerbated pancreatic injury in both sexes, as indicated by increased apoptosis (cleaved caspase-3, caspase-12), ER stress markers (eIF2α, p-eIF2α, GRP78), inflammation (IL-6, TNFα), regenerative activity (Ki67), and pancreatic lipase levels. Notably, male MANF-KO mice exhibited enhanced inflammation (HMGB1), macrophage infiltration (CD68), and oxidative stress (DNP, HNE), which were not observed in females. In the alcoholic AP model, both male and female MANF-KO mice showed increased ER stress (p-IRE1, p-eIF2α, GRP78), apoptosis, inflammation, macrophage infiltration, regeneration, and lipase levels, whereas elevated HMGB1 expression and oxidative stress again predominantly occurred in male MANF-KO mice. Together, these findings reveal a critical and sex-specific role for MANF in regulating pancreatic stress responses and inflammatory injury, supporting its potential contribution as a genetic factor in AP pathogenesis.