Breaking the Calcium Overload Cycle in Acute Pancreatitis: Emerging Pharmacological Strategies

PURPOSE: To analyze current experimental and clinical studies regarding the role of calcium dysregulation in the pathogenesis of AP and to evaluate the efficacy of various pharmacological approaches to its correction. METHODS: A literature review was conducted using PubMed, Scopus, and Google Scholar databases up to October 2025. Included were in vitro, in vivo, and clinical studies addressing the mechanisms of calcium imbalance in AP and the effects of different pharmacological agents targeting calcium regulation. RESULTS: Key molecular targets for calcium-targeted therapy were identified, including IP3 and ryanodine receptors, SOC/CRAC channels, TMEM16A, the PI3K/Akt pathway, and the calcineurin/NFAT signaling cascade. Therapeutic compounds such as caffeine, dantrolene, docosahexaenoic acid (DHA), Orai1 channel inhibitors (CM4620/Auxora, GSK-7975A), TMEM16A inhibitors, insulin, calcium chelators (BAPTA-AM), calcineurin inhibitors (cyclosporin A, tacrolimus), and microRNAs (e.g., miR-26a) demonstrated the ability to reduce cytosolic calcium overload, suppress zymogen activation, stabilize mitochondrial function, and attenuate inflammation. Some of these agents are already used in other medical fields or are undergoing clinical trials as candidate treatments for AP. CONCLUSIONS: Pharmacological modulation of calcium homeostasis represents a promising pathogenetic approach to the treatment of acute pancreatitis. Existing evidence supports the need for further multicenter clinical studies to confirm the safety and efficacy of calcium-targeted strategies in routine clinical practice.