Immune imbalance in AP progression. In AP, macrophages often shift towards the M1 phenotype, but this trend can be countered with supplements such as Bifidobacterium, lactate, TMAO and butyrate. The FFAR2 on ILC3 recognizes SCFAs, leading to IL-22 secretion which promotes epithelial growth, mucus production, and

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... the early stage of AP, systemic inflammatory response syndrome (SIRS) is dominant, with excessive inflammatory activation and cascade amplification injuring the pancreas and intestines; subsequently, SIRS enters a remission period, where anti-inflammatory responses gradually take over, leading to compensatory anti-inflammatory response syndrome (CARS), allowing intestinal bacterial translocation to other organs and resulting in secondary infections, thus transforming the intestine from a victim into an accomplice [12,79,80]. The gut microbiota and its derivatives can act as PAMPs, which are specifically recognized by PRRs, participating in innate and adaptive immunity and amplifying the inflammatory response in AP ( Figure 2). In AP, macrophages often shift towards the M1 phenotype, but this trend can be countered with supplements such as Bifidobacterium, lactate, TMAO and butyrate. ...