Aim and methods:  Recurrent pancreatitis is a common complication of severe hypertriglyceridaemia (HTG) often seen in patients carrying various gene mutations in lipoprotein lipase (LPL). This study investigates a possible pathogenic mechanism of cell damage in isolated mouse pancreatic acinar cells and of pancreatitis in LPL‐deficient and in wild type mice.

Results:  Addition of free fatty acids (FFA) or of chylomicrons to isolated pancreatic acinar cells caused stimulation of amylase release, and at higher concentrations it also caused cell damage. This effect was decreased in the presence of the lipase inhibitor orlistat. Surprisingly, pancreatic lipase whether in its active or inactive state could act like an agonist by inducing amylase secretion, increasing cellular cGMP levels and converting cell damaging sustained elevations of [Ca²⁺]_cyt to normal Ca²⁺ oscillations. Caerulein increases the levels of serum amylase and caused more severe inflammation in the pancreas of LPL‐deficient mice than in wild type mice.

Conclusion:  We conclude that high concentrations of FFA as present in the plasma of LPL‐deficient mice and in patients with HTG lead to pancreatic cell damage and are high risk factors for the development of acute pancreatitis. In addition to its enzymatic effect which leads to the generation of cell‐damaging FFA from triglycerides, pancreatic lipase also prevents Ca²⁺ overload in pancreatic acinar cells and, therefore, counteracts cell injury.