Role of cholecystokinin in pancreatic exocrine response to intraluminal amino acids and fat

Controversy continues over the relative contributions made by hormonal and neural mechanisms in the exocrine pancreatic response to ingested food. The recent description of the drug proglumide as a specific, competitive cholecystokinin (CCK)/gastrin receptor antagonist has permitted reevaluation of the role of CCK in this process. In chronic pancreatic fistula dogs, dose-response studies were performed to determine the effect of proglumide on the pancreatic responses to octapeptide of CCK (CCK-OP), intravenous bethanechol, intraduodenal amino acids, and intraduodenal fat. Pancreatic volume, protein, and bicarbonate outputs to all doses of CCK-OP were inhibited significantly (P less than 0.05) in a competitive manner, consistent with the proposed mode of action of proglumide. In contrast, proglumide caused only minor and insignificant inhibition of the output responses to intravenous bethanechol. Virtually complete inhibition to all doses of intraduodenal amino acids and fat was observed with proglumide administration. If indeed proglumide is a specific CCK receptor antagonist, these results support the hypothesis that CCK is the major mediator of the intestinal phase of exocrine pancreatic secretion.