Heavy metals found in tobacco smoke are to blame in the first place for the development of chronic pancreatitis caused by smoking, according to the findings of Semmelweis University, the University of Szeged and the University of Pécs. The research, which was presented today at a conference, is the first to establish the detailed intracellular mechanism of pancreatic damage caused by smoking.

To better understand the relationship between cigarette smoke extract (CSE) and chronic pancreatis (CP), researchers of Semmelweis University, the University of Szeged and the University of Pécs looked at cystic fibrosis transmembrane conductance regulator (CFTR) as its malfunction is correlated with CP.

CFTR is a protein that helps to maintain the balance of salt and water on many surfaces in the body, including the pancreas. When the protein is not working properly, chloride — a component of salt — becomes trapped in cells. Without the proper movement of chloride, water cannot hydrate the cellular surface. This leads the mucus covering the cells to become thick and sticky which, eventually, can cause the pancreatic duct to get clogged.

The researchers measured sweat chloride (Cl–) concentrations in patients with and without CP, both smokers and non-smokers, to assess CFTR activity. Sweat samples from smokers, both with and without CP, showed elevated Cl– concentrations compared to non-smokers, indicating a decrease in CFTR activity due to smoking. Pancreatic tissues from smokers, regardless of CP status, displayed lower CFTR expression than those from non-smokers.

They also determined serum heavy metal levels and tissue cadmium concentrations in smoking and non-smoking patients. Serum levels of cadmium and mercury, as well as pancreatic tissue cadmium were increased in smokers.

“Our findings confirm that smoking impairs pancreatic ductal function and contributes to the development of chronic pancreatis”, says Péter Hegyi, head of the Institute of Pancreatic Diseases at Semmelweis University, corresponding author of the study. “Heavy metals, notably cadmium, play a significant role in the harmful effects of smoking”, he adds.

The findings were presented today at Semmelweis Symposium 2023, a three-day event held by Semmelweis University in Budapest where experts from all over the world share their insights and present scientific work – this year with a focus on the pancreas.

„(Intracellular) damage in the pancreas caused by smoking and CSE is not reversible”, Hegyi points out. „Heavy metals in smoke will irreversibly accumulate in the pancreas causing chronic inflammation. Alcohol has less of an impact which is reversible. This means that low levels of alcohol intake may not (always) be a cause for concern but smoking is”, he adds.

The researchers with further animal studies confirmed the correlations between tobacco smoke and the reduced CTFR function, impaired gastric fluid production and bicarbonate secretion characteristic of patients with chronic pancreatitis.