SKT LECTURE 

DEPARTMENT OF BIOMEDICAL ENGINEERING

Autodigestion in Metabolic Disease, Physiological Shock and Death

Geert W. Schmid-Schoenbein, Ph.D.

Department of Bioengineering, University of California San Diego, La Jolla, CA, USA

Abstract

Did you ever ask the question: 

How do I digest food in the intestine but not digest my own intestine?  

The answer may be a key to understand many diseases and even mechanisms that lead to death.  During a meal the pancreas releases a set of powerful digestive enzymes into the small intestine to degrade food as requirement for nutrition. Digestive enzymes are usually contained inside the lumen of the small intestine by the mucosal barrier, an epithelial cell sheet with a mucus layer that is virtually impermeable to molecules the size of digestive enzymes.  But systematic analysis shows that this containment can fail; digestive enzymes are then transported into the systemic circulation where they degrade plasma proteins and membrane receptors.  The process causes numerous cell dysfunction and depending on the magnitude of enzyme escape may cause even multi-organ failure and death.  We will present the current evidence for a severe form of autodigestion in hemorrhagic and septic shock as well as a milder form in the metabolic disease and discuss how to bioengineer new approaches to reduce autodigestion.