SPINK1 is a serine protease inhibitor with dual roles in normal physiology and disease. In pancreatic tissue, SPINK1 functions as pancreatic secretory trypsin inhibitor, protecting the pancreas by inhibiting prematurely activated trypsin 1. SPINK1 is synthesized primarily in pancreatic acinar cells and acts as an acute-phase reactant 2. SPINK1 is implicated in multiple diseases. Genetic variants—including c.-4141G > T, c.194 + 2T > C, and Alu insertions—are causative of chr5 pancreatitis, with common CFTR haplotypes modulating disease susceptibility in SPINK1 mutation carriers 13. SPINK1 mutations represent likely etiological factors in tropical calcific pancreatitis, prevalent in southern India 4. Beyond pancreatic disease, SPINK1 demonstrates oncogenic functions across multiple cancers. SPINK1 is a molecular subtype classifier in prostate cancer 5. In hepatocellular carcinoma, SPINK1 overexpression drives tumor dedifferentiation and chemoresistance via EGFR-ERK-CDK4/6-E2F2 signaling, with SPINK1 depletion dampening cancer growth 6. SPINK1 acts as a growth factor and apoptosis inhibitor, with elevated serum SPINK1 predicting aggressive disease and serving as a prognostic biomarker 2. Diffuse SPINK1 expression distinguishes oxyntic gland neoplasms from normal tissue 7, and SPINK1 variants may increase pancreatic ductal adenocarcinoma risk 1.