Lu X, Zeng Y, Li L, Liu JQ, Zhou X, Jin XN, Jiang CL, Li Z. Endogenous metabolites as active drivers of acute pancreatitis: Mechanisms and advances in targeted therapy. World J Gastroenterol 2026; 32(47): 122664 [DOI: 10.3748/wjg.122664]
Corresponding Author of This Article
Zhi Li, MD, PhD, Professor, Department of Spleen and Stomach Diseases, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182 Chunhui Road, Longmatan District, Luzhou 646000, Sichuan Province, China. lizhi-scholar@swmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Lu X, Zeng Y, Li L, Liu JQ, Zhou X, Jin XN, Jiang CL, Li Z. Endogenous metabolites as active drivers of acute pancreatitis: Mechanisms and advances in targeted therapy. World J Gastroenterol 2026; 32(47): 122664 [DOI: 10.3748/wjg.122664]
World J Gastroenterol. Dec 21, 2026; 32(47): 122664 Published online Dec 21, 2026. doi: 10.3748/wjg.122664
Endogenous metabolites as active drivers of acute pancreatitis: Mechanisms and advances in targeted therapy
Xiang Lu, Yu Zeng, Li Li, Jian-Qin Liu, Xin Zhou, Xiao-Ning Jin, Chao-Li Jiang, Zhi Li
Xiang Lu, Yu Zeng, Li Li, Jian-Qin Liu, Xin Zhou, Xiao-Ning Jin, Chao-Li Jiang, Zhi Li, Department of Spleen and Stomach Diseases, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Zhi Li, School of Integrated Traditional Chinese and Western Clinical Medicine, North Sichuan Medical College, Luzhou 646000, Sichuan Province, China
Co-first authors: Xiang Lu and Yu Zeng.
Author contributions: Lu X and Zeng Y contributed equally to this work, as co-first authors; Lu X and Zeng Y conceptualized and designed the study, performed the literature search, data analysis and interpretation, and drafted the manuscript; Li L, Liu JQ and Zhou X participated in data collection and critical revision of the manuscript; Jin XN and Jiang CL contributed to the creation of figures and tables, and provided technical or material support; Li Z supervised the study, obtained funding, and gave final approval of the version to be submitted; all authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by the Science and Technology Project of Sichuan Administration of Traditional Chinese Medicine, No. 2024zd035; Sichuan University and Luzhou Municipal People’s Government Strategic cooperation projects, No. 2020CDLZ-18; and Southwest Medical University Technology Program, No. 2023ZYQJ03.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Corresponding author: Zhi Li, MD, PhD, Professor, Department of Spleen and Stomach Diseases, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182 Chunhui Road, Longmatan District, Luzhou 646000, Sichuan Province, China. lizhi-scholar@swmu.edu.cn
Received: April 27, 2026 Revised: June 22, 2026 Accepted: August 28, 2026 Published online: December 21, 2026 Processing time: 186 Days and 3.6 Hours
Core Tip
Core Tip: Acute pancreatitis still has no therapy directed at its core mechanisms, and treatment remains supportive. Metabolomic studies have revealed widespread disturbance of metabolic pathways during the disease, and accumulating evidence indicates that these changes are not merely markers but active contributors to acinar injury, inflammatory amplification, and immune dysregulation. This review classifies the relevant metabolites by origin host enzymes, gut microbes, or the cooperation of both and examines eight pathways together with the interventions being tested for each. It treats the mitochondrion as a point where several injurious pathways converge and the gut as a source of metabolites that act on the pancreas from a distance. As the contribution of each pathway shifts as the disease evolves, it also considers how interventions might be matched to the disease phase. As the evidence is still largely preclinical, the framework is meant to guide further study rather than current treatment.
