SPINK1 Genetic Variants in Pancreatitis.

Authors

  • Maham Waqar King Edward Medical University Author
  • Prof. David C. Whitcomb MD PhD University of Pittsburgh Author
  • Pr Vinciane Rebours, MD PhD Paris Cité University. AP-HP – Beaujon Hospital, Clichy, FRANCE Author

DOI:

https://doi.org/10.69734/tbx0n188

Keywords:

pancreatitis , spink1 , genetic variants, pancreatic cancer, chronic pancreatitis, genetics, PRSS1, trypsin inhibitor, genetic counseling, medical genetics, precision medicine

Abstract

Genetic variants disrupting the expression or function of the Serine Protease Inhibitor, Kazal Type 1 (SPINK1) gene—encoding the pancreatic secretory trypsin inhibitor (PSTI, also called SPINK1)—elevate the risk of pancreatitis and pancreatic cancer. This review elucidates SPINK1’s role as a key inhibitor of active trypsin, detailing its protective mechanism alongside other regulatory factors. We emphasize human SPINK1 variants, spotlighting the high-risk haplotype tagged by p.N34S (Table 1) and other risk, predisposing or pathogenic variants (Table 2). Additionally, we explore the conditions and co-factors—genetic and environmental—that trigger acute pancreatitis (AP) and progression to chronic pancreatitis (CP), providing a comprehensive framework for understanding SPINK1’s clinical significance

Author Biographies

  • Prof. David C. Whitcomb MD PhD, University of Pittsburgh

    Emeritus Professor of Medicine, Cell Biology & Physiology, Human Genetics
    Chief, Division of Gastroenterology, Hepatology and Nutrition (1999 to 2016)
    University of Pittsburgh and UPMC
    Adjunct Professor of Biomedical Engineering
    Carnegie Mellon University
    Pittsburgh, PA

    Adjunct Professor of Gastroenterology,

    Christian Medical College

    Vellore INDIA
    Co-founder and CSO
    Ariel Precision Medicine
    Pittsburgh, PA

  • Pr Vinciane Rebours, MD PhD, Paris Cité University. AP-HP – Beaujon Hospital, Clichy, FRANCE

    Pancreatology and Digestive Oncology Department - DMU Digest
    INSERM - UMR 1149 - Université Paris-Cité
    National Network for pancreatic rare diseases - Centre de référence des maladies rares du Pancréas - CRMR PaRaDis

    Centre de Référence Européen Tumeurs Neuroendocrines Digestives
    Beaujon Hospital - 100 bld Gal Leclerc 92110 Clichy, France

References

Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16:218-24 D.O.I: 10.1016/j.pan.2016.02.001. PMID: 26924663

Hegyi E, Sahin-Toth M. Genetic Risk in Chronic Pancreatitis: The Trypsin-Dependent Pathway. Dig Dis Sci. 2017;62(7):1692-701 D.O.I: 10.1007/s10620-017-4601-3. PMID: 28536777

Whitcomb DC. Genetic risk factors for pancreatic disorders. Gastroenterology. 2013;144(6):1292-302 D.O.I: 10.1053/j.gastro.2013.01.069. PMID: 23622139

Ogawa M. Pancreatic secretory trypsin inhibitor as an acute phase reactant. Clin Biochem. 1988;21:19-25 D.O.I. PMID: 2449986

Ohmuraya M, Hirota M, Araki M, Mizushima N, Matsui M, Mizumoto T, et al. Autophagic cell death of pancreatic acinar cells in serine protease inhibitor kazal type 3-deficient mice. Gastroenterology. 2005;129(2):696-705 D.O.I. PMID: 16083722

Sun C, Liu M, An W, Mao X, Jiang H, Zou W, et al. Heterozygous Spink1 c.194+2T>C mutant mice spontaneously develop chronic pancreatitis. Gut. 2020;69(5):967-8 D.O.I: 10.1136/gutjnl-2019-318790. PMID: 31142585

Nathan JD, Romac J, Peng RY, Peyton M, Macdonald RJ, Liddle RA. Transgenic expression of pancreatic secretory trypsin inhibitor-I ameliorates secretagogue-induced pancreatitis in mice. Gastroenterology. 2005;128(3):717-27 D.O.I. PMID: 15765407

Nathan JD, Romac J, Peng RY, Peyton M, Rockey DC, Liddle RA. Protection against chronic pancreatitis and pancreatic fibrosis in mice overexpressing pancreatic secretory trypsin inhibitor. Pancreas. 2010;39(1):e24-30 D.O.I: 10.1097/MPA.0b013e3181bc45e9. PMID: 19904222

Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015;17(5):405-24 D.O.I: 10.1038/gim.2015.30. PMID: 25741868

Masson E, Zou WB, Pu N, Rebours V, Genin E, Wu H, et al. Classification of PRSS1 variants responsible for chronic pancreatitis: An expert perspective from the Franco-Chinese GREPAN study group. Pancreatology. 2023;23(5):491-506 D.O.I: 10.1016/j.pan.2023.04.004. PMID: 37581535

Wang QW, Zou WB, Masson E, Ferec C, Liao Z, Chen JM. Genetics and clinical implications of SPINK1 in the pancreatitis continuum and pancreatic cancer. Hum Genomics. 2025;19(1):32 D.O.I: 10.1186/s40246-025-00740-x. PMID: 40140953

Demcsak A, Sahin-Toth M. Heterozygous Spink1 Deficiency Promotes Trypsin-dependent Chronic Pancreatitis in Mice. Cell Mol Gastroenterol Hepatol. 2024;18(3):101361 D.O.I: 10.1016/j.jcmgh.2024.05.009. PMID: 38768901

Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, et al. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nature Genetics. 2000;25(2):213-6 D.O.I. PMID: 10835640

Pfutzer RH, Barmada MM, Brunskill AP, Finch R, Hart PS, Neoptolemos J, et al. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology. 2000;119(3):615-23 D.O.I. PMID: 10982753

Chen J-M, Mercier B, Audrezet M-P, Raguenes O, Quere I, Ferec C. Mutations of the pancreatic secretory trypsin inhibitor (PSTI) gene in idiopathic chronic pancreatitis. Gastroenterology. 2001;120(4):1061-2 D.O.I. PMID:

Kuwata K, Hirota M, Shimizu H, Nakae M, Nishihara S, Takimoto A, et al. Functional analysis of recombinant pancreatic secretory trypsin inhibitor protein with amino-acid substitution. J Gastroenterol. 2002;37(11):928-34 D.O.I: 10.1007/s005350200156. PMID: 12483248

Kereszturi E, Kiraly O, Sahin-Toth M. Minigene analysis of intronic variants in common SPINK1 haplotypes associated with chronic pancreatitis. Gut. 2009;58(4):545-9 D.O.I: gut.2008.164947 [pii]

1136/gut.2008.164947. PMID: 18978175

Fu D, Blobner BM, Greer PJ, Lafyatis R, Bellin MD, Whitcomb DC, et al. Pancreatitis-Associated PRSS1-PRSS2 Haplotype Alters T-Cell Receptor Beta (TRB) Repertoire More Strongly Than PRSS1 Expression. Gastroenterology. 2023;164(2):289-92 e4 D.O.I: 10.1053/j.gastro.2022.09.036. PMID: 36191639

Ward AJ, Cooper TA. The pathobiology of splicing. The Journal of pathology. 2010;220(2):152-63 D.O.I: 10.1002/path.2649. PMID: 19918805

Kume K, Masamune A, Kikuta K, Shimosegawa T. [-215G>A; IVS3+2T>C] mutation in the SPINK1 gene causes exon 3 skipping and loss of the trypsin binding site. Gut. 2006;55(8):1214 D.O.I: 55/8/1214 [pii]

1136/gut.2006.095752. PMID: 16849362

Masamune A, Kume K, Takagi Y, Kikuta K, Satoh K, Satoh A, et al. N34S mutation in the SPINK1 gene is not associated with alternative splicing. Pancreas. 2007;34(4):423-8 D.O.I. PMID: 17446841

Wu H, Lin JH, Tang XY, Marenne G, Zou WB, Schutz S, et al. Combining full-length gene assay and SpliceAI to interpret the splicing impact of all possible SPINK1 coding variants. Hum Genomics. 2024;18(1):21 D.O.I: 10.1186/s40246-024-00586-9. PMID: 38414044

Boulling A, Le Marechal C, Trouve P, Raguenes O, Chen JM, Ferec C. Functional analysis of pancreatitis-associated missense mutations in the pancreatic secretory trypsin inhibitor (SPINK1) gene. Eur J Hum Genet. 2007 D.O.I. PMID: 17568390

Kiraly O, Wartmann T, Sahin-Toth M. Missense mutations in pancreatic secretory trypsin inhibitor (SPINK1) cause intracellular retention and degradation. Gut. 2007;56 Epub .(10):1433-8 D.O.I. PMID: 17525091

Masson E, Le Marechal C, Levy P, Chuzhanova N, Ruszniewski P, Cooper DN, et al. Co-inheritance of a novel deletion of the entire SPINK1 gene with a CFTR missense mutation (L997F) in a family with chronic pancreatitis. Mol Genet Metab. 2007;92(1-2):168-75 D.O.I: 10.1016/j.ymgme.2007.06.006. PMID: 17681820

Tandon RK, Garg PK. Tropical pancreatitis. Dig Dis. 2004;22(3):258-66 D.O.I: 10.1159/000082797. PMID: 15753608

Cohn JA, Noone PG, Jowell PS. Idiopathic pancreatitis related to CFTR: complex inheritance and identification of a modifier gene. J Investig Med. 2002;50(5):247S-55S D.O.I. PMID: 12227654

Midha S, Khajuria R, Shastri S, Kabra M, Garg PK. Idiopathic chronic pancreatitis in India: phenotypic characterisation and strong genetic susceptibility due to SPINK1 and CFTR gene mutations. Gut. 2010;59(6):800-7 D.O.I: 59/6/800 [pii]

1136/gut.2009.191239. PMID: 20551465

Schneider A, Larusch J, Sun X, Aloe A, Lamb J, Hawes R, et al. Combined Bicarbonate Conductance-Impairing Variants in CFTR and SPINK1 Variants Are Associated With Chronic Pancreatitis in Patients Without Cystic Fibrosis. Gastroenterology. 2011;140(1):162-71 D.O.I: S0016-5085(10)01554-4 [pii]

1053/j.gastro.2010.10.045. PMID: 20977904

Ru N, Xu XN, Cao Y, Zhu JH, Hu LH, Wu SY, et al. The Impacts of Genetic and Environmental Factors on the Progression of Chronic Pancreatitis. Clin Gastroenterol Hepatol. 2022;20(6):e1378-e87 D.O.I: 10.1016/j.cgh.2021.08.033. PMID: 34461303

Nikkola A, Makela KA, Herzig KH, Mutt SJ, Prasannan A, Seppanen H, et al. Pancreatic Secretory Trypsin Inhibitor (SPINK1) Gene Mutation in Patients with Acute Alcohol Pancreatitis (AAP) Compared to Healthy Controls and Heavy Alcohol Users without Pancreatitis. Int J Mol Sci. 2022;23(24) D.O.I: 10.3390/ijms232415726. PMID: 36555366

Muller N, Sarantitis I, Rouanet M, de Mestier L, Halloran C, Greenhalf W, et al. Natural history of SPINK1 germline mutation related-pancreatitis. EBioMedicine. 2019;48:581-91 D.O.I: 10.1016/j.ebiom.2019.09.032. PMID: 31628023

Greenhalf W, Levy P, Gress T, Rebours V, Brand RE, Pandol S, et al. International consensus guidelines on surveillance for pancreatic cancer in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology. 2020;20(5):910-8 D.O.I: 10.1016/j.pan.2020.05.011. PMID: 32624419

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Published

2025-03-31 — Updated on 2025-05-21

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How to Cite

Waqar, M., Whitcomb, D., & Rebours, V. (2025). SPINK1 Genetic Variants in Pancreatitis. SMART-MD Journal of Precision Medicine, 2(1), e93 - e101. https://doi.org/10.69734/tbx0n188 (Original work published 2025)