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Abstract
BACKGROUND Hybrid imaging FDG PET/CT (18F‑fluordeoxyglucose positron emission tomography/computed tomography) has gained increasing importance in oncology in recent years. DIAGNOSIS A focal increase in FDG uptake in the gastrointestinal tract may be due to colorectal carcinoma. Such a finding requires further clarification. PRIMARY STAGING Staging of the primary and locoregional lymph nodes remains a domain of established imaging modalities as FDG PET/CT does not provide a clear additional benefit. Liver metastases can be detected with high sensitivity by FDG PET/CT, but MRI is superior in small lesions. RADIATION THERAPY PLANNING So far FDG PET/CT plays a subordinate role in the radiation therapy planning of rectal cancer. However, it can potentially contribute to the optimization of planning target volumes. THERAPY MONITORING FDG PET/CT is suitable for monitoring therapy because morphological and metabolic changes of the tumor can be detected in early stages. This enables early detection of nonresponders after beginning neoadjuvant chemoradiation therapy of rectal cancer. FDG PET/CT can also be used for therapy control of liver metastases, especially after local therapeutic procedures. DETECTION OF RECURRENCE With clinical suspicion of local recurrence and increased tumor markers, FDG PET/CT is a valuable tool as tumor recurrence can be detected with high sensitivity and specificity.
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Rahman WT, Wale DJ, Viglianti BL, Townsend DM, Manganaro MS, Gross MD, Wong KK, Rubello D. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother 2019; 117:109168. [PMID: 31334700 PMCID: PMC7104808 DOI: 10.1016/j.biopha.2019.109168] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022] Open
Abstract
Sites of infection and inflammation can be misleading in oncology PET/CT imaging because these areas commonly show 18F-FDG activity. Caution in the interpretation must be taken to avoid the misdiagnosis of malignancy. Utilization of both CT findings as well as patient history can help differentiate benign infectious and inflammatory processes from malignancy, although occasionally additional work-up may be required. This article discusses the mechanism of 18F-FDG uptake in infection and inflammation with illustrative examples.
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Affiliation(s)
- W Tania Rahman
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Daniel J Wale
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA.
| | - Benjamin L Viglianti
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Division of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, USA
| | - Matthew S Manganaro
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Milton D Gross
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Ka Kit Wong
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Interventional Radiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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Abstract
PURPOSE OF REVIEW Metformin has multiple benefits for health beyond its anti-hyperglycemic properties. The purpose of this manuscript is to review the mechanisms that underlie metformin's effects on obesity. RECENT FINDINGS Metformin is a first-line therapy for type 2 diabetes. Large cohort studies have shown weight loss benefits associated with metformin therapy. Metabolic consequences were traditionally thought to underlie this effect, including reduction in hepatic gluconeogenesis and reduction in insulin production. Emerging evidence suggests that metformin-associated weight loss is due to modulation of hypothalamic appetite regulatory centers, alteration in the gut microbiome, and reversal of consequences of aging. Metformin is also being explored in the management of obesity's sequelae such as hepatic steatosis, obstructive sleep apnea, and osteoarthritis. Multiple mechanisms underlie the weight loss-inducing and health-promoting effects of metformin. Further exploration of these pathways may be important in identifying new pharmacologic targets for obesity and other aging-associated metabolic diseases.
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Affiliation(s)
- Armen Yerevanian
- Department of Medicine, Diabetes Unit, Endocrine Division, and Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN6224, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02114, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Alexander A Soukas
- Department of Medicine, Diabetes Unit, Endocrine Division, and Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN6224, Boston, MA, 02114, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, 02114, USA.
- Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA.
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Diagnostic and Clinical Impact of Staging 18F-FDG PET/CT in Mantle-Cell Lymphoma: A Two-Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e457-e464. [PMID: 31129112 DOI: 10.1016/j.clml.2019.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging mantle-cell lymphoma has not yet investigated. The aim of this 2-center retrospective study was to investigate the utility of 18F-FDG PET/CT in assessing nodal, splenic, bone marrow (BM), and gastrointestinal (GI) disease compared to CT, BM, and GI endoscopy; and to assess its clinical impact. PATIENTS AND METHODS One hundred twenty-two patients with histologically proven mantle-cell lymphoma were included. PET/CT BM findings were considered positive if isolated/multiple focal uptake in the BM not explained by benign findings and/or diffuse BM uptake higher than liver with/without focal uptakes were present. PET/CT findings were considered positive for GI involvement in the presence of isolated/multiple focal uptake in the GI organ. RESULTS All patients had positive PET/CT showing the presence of at least one hypermetabolic lesion, with the exception of one case. PET/CT results, compared to CT, detected more nodal and/or splenic lesions in 26 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT for BM were 52%, 98%, 97%, 65%, and 74%; for GI 64%, 91%, 69%, 90%, and 85%; and for GI excluding diabetic patients, 78%, 92%, 72%, 94%, and 89%. PET/CT permitted upstaging of 21 cases and downstaging of 2. CONCLUSION 18F-FDG PET/CT showed excellent detection rate in nodal and splenic disease-a rate better than CT. For BM and GI evaluation, in order to reach good accuracy, the selection of patients and the use of specific criteria for evaluation of these organs seems to be crucial. Moreover, PET/CT altered the management and therapeutic approach in about 20% of patients.
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Nowak-Sliwinska P, Scapozza L, Ruiz i Altaba A. Drug repurposing in oncology: Compounds, pathways, phenotypes and computational approaches for colorectal cancer. Biochim Biophys Acta Rev Cancer 2019; 1871:434-454. [PMID: 31034926 PMCID: PMC6528778 DOI: 10.1016/j.bbcan.2019.04.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
The strategy of using existing drugs originally developed for one disease to treat other indications has found success across medical fields. Such drug repurposing promises faster access of drugs to patients while reducing costs in the long and difficult process of drug development. However, the number of existing drugs and diseases, together with the heterogeneity of patients and diseases, notably including cancers, can make repurposing time consuming and inefficient. The key question we address is how to efficiently repurpose an existing drug to treat a given indication. As drug efficacy remains the main bottleneck for overall success, we discuss the need for machine-learning computational methods in combination with specific phenotypic studies along with mechanistic studies, chemical genetics and omics assays to successfully predict disease-drug pairs. Such a pipeline could be particularly important to cancer patients who face heterogeneous, recurrent and metastatic disease and need fast and personalized treatments. Here we focus on drug repurposing for colorectal cancer and describe selected therapeutics already repositioned for its prevention and/or treatment as well as potential candidates. We consider this review as a selective compilation of approaches and methodologies, and argue how, taken together, they could bring drug repurposing to the next level.
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Affiliation(s)
- Patrycja Nowak-Sliwinska
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland; Translational Research Center in Oncohaematology, University of Geneva, Rue Michel Servet 1, 1211 Geneva 4, Switzerland.
| | - Leonardo Scapozza
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - Ariel Ruiz i Altaba
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva 4, Switzerland
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Steenkamp DW, McDonnell ME, Meibom S. Metformin may be associated with false-negative cancer detection in the gastrointestinal tract on PET/CT. Endocr Pract 2019; 20:1079-83. [PMID: 25100379 DOI: 10.4158/ep14127.ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Concurrent therapy with the antihyperglycemic drug metformin can hinder the detection of malignancy in the abdominal and pelvic portions of 18F-fluordeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging performed for the diagnosis or staging of malignancy, as well as for treatment response and radiation therapy planning. This is due to the metformin-induced increase in intestinal FDG radiotracer uptake. We aim to bring this potentially important interaction to the attention of clinicians who care for cancer patients with diabetes. METHODS We searched MEDLINE (from 1970 to January 2014) and Google Scholar for relevant English-language articles using the following search terms: "metformin and FDG/PET, metformin and bowel uptake, metformin, and cancer, metformin and the intestine, metformin pharmacokinetics, hyperglycemia and FDG/PET." We reviewed the reference lists of pertinent articles with respect to metformin gut physiology, impact on FDG uptake and the effect on diagnostic accuracy of abdominalpelvic PET/CT scans with concurrent metformin therapy. RESULTS We reviewed the action of metformin in the intestine, with particular emphasis on the role of metformin in PET/CT imaging and include a discussion of clinical studies on the topic to help refine knowledge and inform practice. Finally, we discuss aspects pertinent to the management of type 2 diabetes (T2D) patients on metformin undergoing PET/CT. CONCLUSIONS Metformin leads to intense, diffusely increased FDG uptake in the colon, and to a lesser degree, the small intestine, which limits the diagnostic capabilities of FDG PET/CT scanning and may mask gastrointestinal malignancies. We suggest that metformin be discontinued 48 hours before FDG PET/CT scanning is performed in oncology patients. More rigorous data are needed to support the widespread generalizability of this recommendation.
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Affiliation(s)
- Devin W Steenkamp
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School
| | - Sara Meibom
- Section of Nuclear Medicine, Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts
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FDG-PET/CT for Detecting an Infection Focus in Patients With Bloodstream Infection: Factors Affecting Diagnostic Yield. Clin Nucl Med 2019; 44:99-106. [PMID: 30516689 DOI: 10.1097/rlu.0000000000002381] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the diagnostic performance of F-fluoro-2-deoxy-D-glucose (FDG) PET/ CT for the detection of an infection focus in patients with a bloodstream infection (BSI) and to identify factors influencing the diagnostic yield of FDG-PET/CT. METHODS This retrospective single-center study included 185 consecutive patients with a BSI who underwent an FDG-PET/CT scan for the detection of an infection focus between 2010 and 2017. The final diagnosis at hospital discharge was used as reference standard. Diagnostic performance of FDG-PET/CT for the detection of an infection focus was assessed, and logistic regression analyses were performed to identify factors associated with FDG-PET/CT yield. RESULTS An infection focus was identified on FDG-PET/CT in 120 (64.8%) of 185 patients. FDG-PET/CT achieved a sensitivity of 80.2%, specificity of 79.6%, positive predictive value of 90.8%, and a negative predictive value of 61.4% for detecting an infection focus in patients with a BSI. Blood cultures positive for enterococci (odds ratio, 0.14; P = 0.019) and days of antibiotic treatment before FDG-PET/CT (odds ratio, 0.94 per day increase; P = 0.014) were statistically significant independent predictors of a lower odds of detecting an infection focus on FDG-PET/CT. In patients who received antibiotics for less than 7 days before FDG-PET/CT, an infection focus was found in 71% (56/79). In patients who received antibiotics for 8 to 14 days before FDG-PET/CT, an infection focus was found in 52% (22/42). After 15 to 21 days of antibiotic treatment, an infection focus was found in 61% (8/13), and for 22 days or more, this declined to 38% (5/13). CONCLUSIONS FDG-PET/CT is a useful method for detecting an infection focus in patients with BSI. However, longer duration of antibiotic treatment before FDG-PET/CT and bacteremia with enterococci reduce the diagnostic yield of FDG-PET/CT. These factors should be taken into account when considering an FDG-PET/CT scan for this indication.
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Kitajima K, Nakajo M, Kaida H, Minamimoto R, Hirata K, Tsurusaki M, Doi H, Ueno Y, Sofue K, Tamaki Y, Yamakado K. Present and future roles of FDG-PET/CT imaging in the management of gastrointestinal cancer: an update. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 79:527-543. [PMID: 29238109 PMCID: PMC5719212 DOI: 10.18999/nagjms.79.4.527] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) integrated with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) is a useful tool for acquisition of both glucose metabolism and anatomic imaging data, as only a single device and one diagnostic session is required, thus opening a new field in clinical oncologic imaging. FDG-PET/CT has been successfully used for initial staging, restaging, assessment of early treatment response, evaluation of metastatic disease response, and prognostication of intestinal cancer as well as various malignant tumors. We reviewed the current status and role of FDG-PET/CT for management of patients with esophageal cancer, gastric cancer, and colorectal cancer, with focus on both its usefulness and limitations.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masatoyo Nakajo
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hayato Kaida
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Ryogo Minamimoto
- Department of Radiology, Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Hiroshi Doi
- Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, Izumo, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
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Novel imaging techniques in staging oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:17-25. [PMID: 30551852 DOI: 10.1016/j.bpg.2018.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
The survival of oesophageal cancer is poor as most patients present with advanced disease. Radiological staging of oesophageal cancer is complex but is fundamental to clinical management. Accurate staging investigations are vitally important to guide treatment decisions and optimise patient outcomes. A combination of baseline computed tomography (CT), endoscopic ultrasound (EUS) and positron emission tomography (PET) are currently used for initial treatment decisions. The potential value of these imaging modalities to re-stage disease, monitor response and alter treatment is currently being investigated. This review presents an essential update on the accuracy of oesophageal cancer staging investigations, their use in re-staging after neo-adjuvant therapy and introduces evolving imaging techniques, including novel biomarkers that have clinical potential in oesophageal cancer.
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Enhanced intestinal 2-deoxy-2-[18F]fluoro-D-glucose uptake under metformin is not fully suppressed by loperamide. Endocr Regul 2018; 52:185-191. [PMID: 31517614 DOI: 10.2478/enr-2018-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study investigated whether the metformin (Met)-induced enhanced intestinal uptake of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) is reduced by loperamide, a long-acting anti-diarrheal agent. METHODS Mean 18F-FDG uptake in the mouse small intestine and colon with Met exposure was compared with that in control mice. In the Met group, high-dose (1.0 mg/kg body weight) and low-dose (0.1 mg/kg body weight) loperamide were introduced, and 18F-FDG uptake in the small intestine and colon was compared with that of control mice administered high-dose loperamide. The percent injected dose of 18F-FDG per gram of tissue (%ID/g) in the extracted tissues was then determined. RESULTS 18F-FDG uptake increased significantly in the small intestine (0.64±0.06 vs. 1.01±0.15, p=0.040) and, especially, the colon (0.46±0.13 vs. 2.16±0.51, p<0.001) after Met exposure. Neither high-dose nor low-dose loperamide significantly reduced 18F-FDG uptake in the small intestine (0.82±0.31 vs. 0.84±0.22, p=0.93 and 0.78±0.25 vs. 0.70±0.15, p=0.13, respectively) or colon (2.13±0.41 vs. 1.67±0.55, p=0.063 and 1.77±0.39 vs. 1.80±0.25, p=0.56, respectively). The colonic %ID/g was significantly higher in Met groups irrespective of loperamide introduction than in control group, whereas the significant difference in the small intestine was observed only between Met and control groups. CONCLUSION Metformin increased 18F-FDG uptake in intestines especially in colon. Loperamide administration partially, but not sufficiently, suppresses the Met-induced increased colonic uptake of 18F-FDG.
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Affiliation(s)
- Steve Y Cho
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, 1111 Highland Ave, WIMR1, Room 7139, Madison, WI 53705
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Hamidizadeh R, Eftekhari A, Wiley EA, Wilson D, Alden T, Bénard F. Metformin Discontinuation prior to FDG PET/CT: A Randomized Controlled Study to Compare 24- and 48-hour Bowel Activity. Radiology 2018; 289:418-425. [PMID: 30106348 DOI: 10.1148/radiol.2018180078] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the relationship of 24- and 48-hour metformin discontinuation to bowel uptake of fluorine 18 fluorodeoxyglucose (FDG) on PET/CT scans. Materials and Methods Patients with diabetes who were treated with metformin and referred for FDG PET/CT were randomized to three equal groups based on duration of metformin discontinuation: 24 hours, 48 hours, and no discontinuation (control group). Two interpreters blinded to the study groups assessed FDG uptake in multiple segments of small and large bowel qualitatively and semiquantitatively by using maximum standardized uptake values (SUVsmax). Differences in age, sex, weight, dose of metformin, duration of metformin treatment, blood glucose levels, and FDG dose injected were assessed. Data were analyzed with analysis of variance when passing normality, and by nonparametric testing when not. Results Ninety study participants (62 male, 28 female; median age, 70 years) were enrolled from July 2010 through March 2012. There were no differences between study groups in weight, blood glucose levels 3 days prior to scanning, or normal organ uptake. Large bowel SUVmax was lower after 24 hours (4.10 ± 2.00 vs 5.42 ± 2.36; P = .020) and 48 hours (2.63 ± 0.88 vs 5.42 ± 2.36; P ˂ .001) of metformin discontinuation than for no discontinuation (control), and for 48 hours versus 24 hours of discontinuation (P = .0015). Small bowel SUVmax was lower after 24 hours (2.86 ± 0.67 vs 3.73 ± 1.08 [control]; P ˂ .001) and 48 hours (2.78 ± 0.73 vs 3.73 ± 1.08 [control]; P ˂ .001) of metformin discontinuation versus no metformin discontinuation, but not for 48 hours versus 24 hours of discontinuation (P = .57). Examination-day blood glucose levels increased after 48-hour withdrawal of metformin (8.41 mmol/L ± 2.86 vs 6.83 mmol/L ± 2.13 [control]; P = .002). Conclusion Metformin discontinuation for 48 hours prior to PET/CT was associated with lower accumulation of fluorodeoxyglucose in the bowel, compared to when there was no discontinuation (control group) or 24-hour discontinuation of metformin. © RSNA, 2018.
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Affiliation(s)
- Ramin Hamidizadeh
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Arash Eftekhari
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - E Ashley Wiley
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Don Wilson
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Tina Alden
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - François Bénard
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
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Out M, Top WMC, Lehert P, Schalkwijk CA, Stehouwer CDA, Kooy A. Long-term treatment with metformin in type 2 diabetes and vitamin D levels: A post-hoc analysis of a randomized placebo-controlled trial. Diabetes Obes Metab 2018; 20:1951-1956. [PMID: 29667290 DOI: 10.1111/dom.13327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/03/2018] [Accepted: 04/13/2018] [Indexed: 01/02/2023]
Abstract
AIMS To study the effects of metformin, as compared to placebo, on serum levels of vitamin D (25-hydroxyvitamin D [25(OH)D]) in patients with advanced type 2 diabetes. MATERIALS AND METHODS In the HOME trial, a randomized placebo-controlled trial, 390 insulin-treated patients with type 2 diabetes were treated with 850 mg metformin or placebo thrice daily for 52 months. In a post-hoc analysis, we examined changes in the combined levels of 25(OH)D2 and 25(OH)D3 at 4 and 16 months during the study. RESULTS Mean combined 25(OH)D at baseline was 68.2 nmoL/L (95% confidence interval [CI]: 65.5-71.1). In mixed model analysis, metformin, as compared to placebo, had no effect on 25(OH)D levels during 16 months (coefficient: 1.002 per month, multiplicative model; 95% CI: 0.998-1.006, P = .30). Metformin was associated with a small increase of 25(OH)D2 (coefficient: 1.012 per month; 95% CI: 1.003-1.021, P = .008). However, 25(OH)D2 is only a very small fraction (3%) of 25(OH)D. Seasonal variation had the biggest impact on 25(OH)D levels. Vitamin B12 levels were not associated with the levels of 25(OH)D. CONCLUSION Metformin had no effect on serum 25(OH)D during 16 months in the setting of a clinical randomized controlled trial in patients with type 2 diabetes. Our results show that metformin doesn't lead to vitamin D deficiency.
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Affiliation(s)
- Mattijs Out
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Wiebe M C Top
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
| | - Philippe Lehert
- Department of Statistics, Faculty of Economics, Facultés Universitaires Catholiques de Mons, Louvain Academy, Mons, Belgium
| | - Casper A Schalkwijk
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Adriaan Kooy
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Maniar K, Singh V, Chakrabarti A, Bhattacharyya R, Banerjee D. High dose targeted delivery on cancer sites and the importance of short-chain fatty acids for metformin's action: Two crucial aspects of the wonder drug. Regul Toxicol Pharmacol 2018; 97:15-16. [PMID: 29857113 DOI: 10.1016/j.yrtph.2018.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 01/20/2023]
Abstract
Metformin is a popular anti-diabetic drug currently being explored for its role in cancer and gut microbiome amongst other areas. Recently, Adak T et al. explicatively reviewed metformin's effects as an anti-cancer drug and a gut microbiome modulator. We feel that the authors have not adequately addressed some of the key concerns around metformin in their report and in this correspondence, we seek to add some of the issues that need to be addressed by researchers.
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Affiliation(s)
- Kunal Maniar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vandana Singh
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Chakrabarti
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Boursi B, Werner TJ, Gholami S, Houshmand S, Mamtani R, Lewis JD, Wu GD, Alavi A, Yang YX. Functional imaging of the interaction between gut microbiota and the human host: A proof-of-concept clinical study evaluating novel use for 18F-FDG PET-CT. PLoS One 2018; 13:e0192747. [PMID: 29447210 PMCID: PMC5813966 DOI: 10.1371/journal.pone.0192747] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/30/2018] [Indexed: 12/19/2022] Open
Abstract
Recent data comparing germ-free to conventionally-raised mice demonstrated that energy homeostasis of colonocytes is dependent on gut microbiota through regulation of short chain fatty acids (SCFA) production and glucose utilization. We sought to evaluate 18F-FDG PET-CT as a novel technique for functional imaging of alterations in glucose metabolism as a result of the interaction between the gut microbiota and the human host. We conducted a prospective study in healthy humans that underwent 18F-FDG PET-CT and sampling of the gut microbiota before and after orally administered broad-spectrum antibiotics. The primary outcomes were total and regional physiologic colonic 18F-FDG uptake (measured as the mean and max standardized uptake values [SUVmean and SUVmax]). The study demonstrated significant increases in physiologic colonic 18F-FDG uptake in all study participants following antibiotic treatment and a 4-5log reduction of gut bacterial load. The mean increase in SUVmax was 0.63±0.37 SD (p = 0.004) and the median increase was 0.42 with an IQR of 0.40–0.81. The mean increase in SUVmean was 0.31±0.24 SD (p = 0.01) and the median increase was 0.41 with an IQR of 0.06–0.55. A likely explanation for this phenomenon is a shift in colonocyte metabolism to glycolysis due to a shortage of SCFA.
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Affiliation(s)
- Ben Boursi
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- * E-mail:
| | - Thomas J. Werner
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Saeid Gholami
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sina Houshmand
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ronac Mamtani
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James D. Lewis
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gary D. Wu
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Abass Alavi
- Department of Nuclear Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Abstract
Colorectal Cancer (CRC) is one of the most frequently encountered neoplasms in humans. The incidence of CRC has been increasing and new strategies for prevention, including chemoprevention, are required to lower its incidence and associated mortality. Metformin is a biguanide compound commonly used for the treatment of diabetes mellitus. Many recent basic research, epidemiological and clinical trial studies have indicated that metformin has benefits not only in diabetes treatment, but also in lowering the risk of developing cancer (including CRC). These studies indicate that metformin may be a candidate chemoprevention agent for CRC. This review article shall discuss the present evidence of metformin treatment and CRC, as well as outline our challenge in the investigation of metformin use in chemoprevention therapy for colorectal tumors.
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Brønden A, Albér A, Rohde U, Rehfeld JF, Holst JJ, Vilsbøll T, Knop FK. Single-Dose Metformin Enhances Bile Acid-Induced Glucagon-Like Peptide-1 Secretion in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2017; 102:4153-4162. [PMID: 28938439 DOI: 10.1210/jc.2017-01091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/15/2017] [Indexed: 12/31/2022]
Abstract
CONTEXT Despite a position as the first-line pharmacotherapy in type 2 diabetes, the glucose-lowering mechanisms of metformin remain to be fully clarified. Gut-derived modes of action, including suppression of bile acid reabsorption and a resulting increase in glucagon-like peptide-1 (GLP-1) secretion, have been proposed. OBJECTIVE The aim of this study was to assess the GLP-1 secretory and glucometabolic effects of endogenously released bile, with and without concomitant single-dose administration of metformin in patients with type 2 diabetes. DESIGN Randomized, placebo-controlled, and double-blinded crossover study. SETTING This study was conducted at Center for Diabetes Research, Gentofte Hospital, Denmark. PATIENTS Fifteen metformin-treated patients with type 2 diabetes; all participants completed the study. INTERVENTIONS Four experimental study days in randomized order with administration of either 1500 mg metformin or placebo in combination with intravenous infusion of cholecystokinin (0.4 pmol × kg-1 × min-1) or saline. MAIN OUTCOME MEASURE Plasma GLP-1 excursions as measured by baseline-subtracted area under the curve. RESULTS Single-dose metformin further enhanced bile acid-mediated induction of GLP-1 secretion (P = 0.02), whereas metformin alone did not increase plasma GLP-1 concentrations compared with placebo (P = 0.17). Metformin, both with (P = 0.02) and without (P = 0.02) concomitant cholecystokinin-induced gallbladder emptying, elicited reduced plasma glucose excursions compared with placebo. No GLP-1-mediated induction of insulin secretion or suppression of glucagon was observed. CONCLUSIONS Metformin elicited an enhancement of the GLP-1 response to cholecystokinin-induced gallbladder emptying in patients with type 2 diabetes, whereas no derived effects on insulin or glucagon secretion were evident in this acute setting.
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Affiliation(s)
- Andreas Brønden
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Anders Albér
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Ulrich Rohde
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Jens F Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 2100 Copenhagen Ø, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Steno Diabetes Center Copenhagen, University of Copenhagen, 2820 Gentofte, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
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Koffert JP, Mikkola K, Virtanen KA, Andersson AMD, Faxius L, Hällsten K, Heglind M, Guiducci L, Pham T, Silvola JMU, Virta J, Eriksson O, Kauhanen SP, Saraste A, Enerbäck S, Iozzo P, Parkkola R, Gomez MF, Nuutila P. Metformin treatment significantly enhances intestinal glucose uptake in patients with type 2 diabetes: Results from a randomized clinical trial. Diabetes Res Clin Pract 2017; 131:208-216. [PMID: 28778047 DOI: 10.1016/j.diabres.2017.07.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/13/2017] [Accepted: 07/07/2017] [Indexed: 12/26/2022]
Abstract
AIMS Metformin therapy is associated with diffuse intestinal 18F-fluoro-deoxyglucose (FDG) accumulation in clinical diagnostics using routine FDG-PET imaging. We aimed to study whether metformin induced glucose uptake in intestine is associated with the improved glycaemic control in patients with type 2 diabetes. Therefore, we compared the effects of metformin and rosiglitazone on intestinal glucose metabolism in patients with type 2 diabetes in a randomized placebo controlled clinical trial, and further, to understand the underlying mechanism, evaluated the effect of metformin in rats. METHODS Forty-one patients with newly diagnosed type 2 diabetes were randomized to metformin (1g, b.i.d), rosiglitazone (4mg, b.i.d), or placebo in a 26-week double-blind trial. Tissue specific intestinal glucose uptake was measured before and after the treatment period using FDG-PET during euglycemic hyperinsulinemia. In addition, rats were treated with metformin or vehicle for 12weeks, and intestinal FDG uptake was measured in vivo and with autoradiography. RESULTS Glucose uptake increased 2-fold in the small intestine and 3-fold in the colon for the metformin group and associated with improved glycemic control. Rosiglitazone increased only slightly intestinal glucose uptake. In rodents, metformin treatment enhanced intestinal FDG retention (P=0.002), which was localized in the mucosal enterocytes of the small intestine. CONCLUSIONS Metformin treatment significantly enhances intestinal glucose uptake from the circulation of patients with type 2 diabetes. This intestine-specific effect is associated with improved glycemic control and localized to mucosal layer. These human findings demonstrate directs effect of metformin on intestinal metabolism and elucidate the actions of metformin. Clinical trial number NCT02526615.
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Affiliation(s)
- Jukka P Koffert
- Turku PET Centre, University of Turku, Turku, Finland; Department of Gastroenterology, Turunmaa Hospital, Southwest Finland Hospital District, Turku, Finland
| | - Kirsi Mikkola
- Turku PET Centre, University of Turku, Turku, Finland
| | | | | | - Linda Faxius
- Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Sweden
| | | | - Mikael Heglind
- Department of Clinical and Medical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE 40530 Gothenburg, Sweden
| | - Letizia Guiducci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Tam Pham
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Jenni Virta
- Turku PET Centre, University of Turku, Turku, Finland
| | - Olof Eriksson
- Turku PET Centre, University of Turku, Turku, Finland; Department of Biosciences, Åbo Akademi University, Turku, Finland; Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Saila P Kauhanen
- Turku PET Centre, University of Turku, Turku, Finland; Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland
| | - Sven Enerbäck
- Department of Clinical and Medical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE 40530 Gothenburg, Sweden
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Riitta Parkkola
- Department of Radiology, Turku University, Finland; Department of Radiology, Turku University Hospital, Finland
| | - Maria F Gomez
- Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Sweden
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland; Department of Endocrinology, Turku University Hospital, Turku, Finland.
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Ribeiro-Parenti L, Cavin JB, Le Gall M. Intestinal adaptations following bariatric surgery: towards the identification of new pharmacological targets for obesity-related metabolic diseases. Curr Opin Pharmacol 2017; 37:29-34. [PMID: 28822847 DOI: 10.1016/j.coph.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
Although the gastrointestinal tract is the primary target of bariatric surgery, its contributions to the metabolic changes observed after surgery are still underestimated. Changes in the number of incretin-producing cells could result in the modified hormonal response seen after surgery. Additionally, the rate of absorption and consumption of glucose could contribute to the ameliorated glycaemia. Moreover, decreased intestinal permeability could prevent endotoxemia. Recently, numerous studies have focused on intestinal adaptation following bariatric surgeries. These studies bring new insight into the different roles the GI tract plays in the metabolic outcomes of bariatric surgery and open new avenues for therapeutic treatments.
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Affiliation(s)
- Lara Ribeiro-Parenti
- Inserm UMR 1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity APHP, F-75890 Paris, France
| | - Jean-Baptiste Cavin
- Inserm UMR 1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity APHP, F-75890 Paris, France; Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Alberta, T2N4N1 Calgary, Canada
| | - Maude Le Gall
- Inserm UMR 1149, UFR de Médecine Paris Diderot, Université Paris Diderot, Sorbonne Paris Cité, DHU Unity APHP, F-75890 Paris, France.
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Bahler L, Holleman F, Chan MW, Booij J, Hoekstra JB, Verberne HJ. 18F-FDG uptake in the colon is modulated by metformin but not associated with core body temperature and energy expenditure. PLoS One 2017; 12:e0176242. [PMID: 28464031 PMCID: PMC5413044 DOI: 10.1371/journal.pone.0176242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/06/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose Physiological colonic 18F-fluorodeoxyglucose (18F-FDG) uptake is a frequent finding on 18F-FDG positron emission tomography computed tomography (PET-CT). Interestingly, metformin, a glucose lowering drug associated with moderate weight loss, is also associated with an increased colonic 18F-FDG uptake. Consequently, increased colonic glucose use might partly explain the weight losing effect of metformin when this results in an increased energy expenditure and/or core body temperature. Therefore, we aimed to determine whether metformin modifies the metabolic activity of the colon by increasing glucose uptake. Methods In this open label, non-randomized, prospective mechanistic study, we included eight lean and eight overweight males. We measured colonic 18F-FDG uptake on PET-CT, energy expenditure and core body temperature before and after the use of metformin. The maximal colonic 18F-FDG uptake was measured in 5 separate segments (caecum, colon ascendens,—transversum,—descendens and sigmoid). Results The maximal colonic 18F-FDG uptake increased significantly in all separate segments after the use of metformin. There was no significant difference in energy expenditure or core body temperature after the use of metformin. There was no correlation between maximal colonic 18F-FDG uptake and energy expenditure or core body temperature. Conclusion Metformin significantly increases colonic 18F-FDG uptake, but this increased uptake is not associated with an increase in energy expenditure or core body temperature. Although the colon might be an important site of the glucose plasma lowering actions of metformin, this mechanism of action does not explain directly any associated weight loss.
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Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Man-Wai Chan
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost B. Hoekstra
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hein J. Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Wu T, Horowitz M, Rayner CK. New insights into the anti-diabetic actions of metformin: from the liver to the gut. Expert Rev Gastroenterol Hepatol 2017; 11:157-166. [PMID: 27983877 DOI: 10.1080/17474124.2017.1273769] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metformin is established as the first-line therapy for type 2 diabetes (T2DM), but its mode of action remains elusive. Elucidation of the mechanisms underlying the anti-diabetic action of metformin may have the potential to optimise its glucose-lowering efficacy and lead to the development of agents acting on novel targets for the management of type 2 diabetes. Areas covered: This review highlights key pharmacokinetic features of metformin, summarises recent insights into its hepatic and gastrointestinal actions relevant to blood glucose homeostasis, and discusses the common gastrointestinal side effects of metformin. Literature concerning these areas was reviewed on PubMed. Expert commentary: The mechanisms by which metformin improves glycaemic control in type 2 diabetes are complex. Although novel hepatic pathways continue to be reported in preclinical studies, there is a lack of human evidence for most of these. Considering the fundamental role of the gastrointestinal tract in the regulation of blood glucose homeostasis and pleiotropic actions of metformin on several gastrointestinal targets relevant to glycaemic control, the gut is likely to represent at least as important a site of metformin action as the liver in the management of type 2 diabetes.
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Affiliation(s)
- Tongzhi Wu
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
| | - Michael Horowitz
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
| | - Christopher K Rayner
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
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Choi BW, Kim HW, Won KS, Song BI, Cho KB, Bae SU. Diagnostic accuracy of 18F-FDG PET/CT for detecting synchronous advanced colorectal neoplasia in patients with gastric cancer. Medicine (Baltimore) 2016; 95:e4741. [PMID: 27603371 PMCID: PMC5023894 DOI: 10.1097/md.0000000000004741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Preoperative screening for synchronous colorectal neoplasia (CRN) has been recommended in patients with gastric cancer because patients with gastric cancer are at increased risk for synchronous CRN. The aim of this study was to investigate the diagnostic accuracy of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting synchronous advanced CRN in patients with gastric cancer.A total of 256 patients who underwent colonoscopy and F-FDG PET/CT for preoperative staging were enrolled in this study. The diagnosis of focal colonic F-FDG uptake on F-FDG PET/CT image was made based on histopathologic results from the colonoscopic biopsy. The F-FDG PET/CT result was considered as true positive for advanced CRN when focal F-FDG uptake matched colorectal carcinoma or adenoma with high-grade dysplasia in the same location on colonoscopy.Synchronous advanced CRN was detected in 21 of the 256 patients (4.7%). Sensitivity, specificity, and accuracy of F-FDG PET/CT were 76.2%, 96.2%, and 94.5%. The size of CRN with a true positive result was significantly larger than that with a false negative result.F-FDG PET/CT demonstrated high diagnostic accuracy for detecting synchronous advanced CRN in patients with gastric cancer. Colonoscopy is recommended as the next diagnostic step for further evaluation of a positive F-FDG PET/CT result in patients with gastric cancer.
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Affiliation(s)
- Byung Wook Choi
- Department of Nuclear Medicine
- Correspondence: Hae Won Kim, Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: ); Byung Wook Choi, Department of Nuclear Medicine, Keimyung University, School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: )
| | - Hae Won Kim
- Department of Nuclear Medicine
- Correspondence: Hae Won Kim, Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: ); Byung Wook Choi, Department of Nuclear Medicine, Keimyung University, School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: )
| | | | | | | | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Lee KE, Moon CM, Yoon HJ, Kim BS, Chang JY, Son HM, Ryu MS, Kim SE, Shim KN, Jung HK, Jung SA. Background Colonic 18F-Fluoro-2-Deoxy-D-Glucose Uptake on Positron Emission Tomography Is Associated with the Presence of Colorectal Adenoma. PLoS One 2016; 11:e0160886. [PMID: 27509022 PMCID: PMC4979890 DOI: 10.1371/journal.pone.0160886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/26/2016] [Indexed: 12/26/2022] Open
Abstract
18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) scan is used to evaluate various kinds of tumors. While most studies on PET findings of the colon focus on the colonic uptake pattern, studies regarding background colonic uptake on PET scan are rare. The purpose of this study was to identify the association between the background colonic uptake and the presence of colorectal adenoma (CRA), which is a frequent precancerous lesion. We retrospectively reviewed the medical records of 241 patients with gynecologic malignancy who had received PET or PET/computed tomography (CT) scan and colonoscopy at the same period as a baseline evaluation. Background colonic 18F-FDG uptake was visually graded and the maximal standardized uptake values (SUVmax) of 7 different bowel segments were averaged. In univariate analysis, older age at diagnosis (≥ 50 years, p = 0.034), overweight (BMI ≥ 23 kg/m², p = 0.010), hypercholesterolemia (≥ 200 mg/dL, p = 0.027), and high grade background colonic uptake (p = 0.009) were positively associated with the prevalence of CRA. By multiple logistic regression, high grade background colonic uptake was independently predictive of CRA (odds ratio = 2.25, p = 0.021). The proportion of CRA patients significantly increased as background colonic uptake grade increased from 1 to 4 (trend p = 0.015). Out of the 138 patients who underwent PET/CT, the proportion of CRA patients in the group with high SUVmax (> 2.25) was significantly higher than in the low SUVmax group (27.5% vs. 11.6%, p = 0.031). In conclusion, high grade of background colonic 18F-FDG uptake is significantly associated with the prevalence of CRA.
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Affiliation(s)
- Ko Eun Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Mo Moon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
- * E-mail: (CMM); (BSK)
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
- * E-mail: (CMM); (BSK)
| | - Ji Young Chang
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyo Moon Son
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min Sun Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel. Ann Nucl Med 2016; 30:629-636. [PMID: 27392947 DOI: 10.1007/s12149-016-1106-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Metformin-induced [F-18] fluorodeoxyglucose (FDG) bowel uptake can hinder positron emission tomography/computed tomography (PET/CT) evaluation of the bowel. This study aimed to investigate the segmental bowel uptake of FDG according to metformin discontinuation times up to 72 h. METHODS We retrospectively divided 240 diabetic patients into four groups: metformin discontinuation <24 h (group A; n = 86), 24-48 h (group B; n = 40), 48-72 h (group C; n = 12), and no metformin (control group; n = 102). Segmental FDG bowel uptakes were measured visually (four-point scale) and semi-quantitatively (maximum standardized uptake value). RESULTS Compared with the control group, FDG uptake increased significantly from the ileum to the rectosigmoid colon in group A, from the transverse to the rectosigmoid colon in group B, and from the descending colon to the rectosigmoid colon in group C in both visual and semi-quantitative analyses. CONCLUSIONS Metformin discontinuation for <72 h is likely suboptimal for PET/CT image interpretation, especially with respect to the distal segments of the colon.
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Bahler L, Stroek K, Hoekstra JB, Verberne HJ, Holleman F. Metformin-related colonic glucose uptake; potential role for increasing glucose disposal?--A retrospective analysis of (18)F-FDG uptake in the colon on PET-CT. Diabetes Res Clin Pract 2016; 114:55-63. [PMID: 27103370 DOI: 10.1016/j.diabres.2016.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
Abstract
AIM The use of metformin has been associated with diffusely increased colonic (18)F-fluorodeoxyglucose ((18)F-FDG) uptake. Interestingly, metformin use is associated with moderate weight loss. It could be hypothesized that increased colonic glucose disposal is related to this weight loss. It is unknown whether other factors influence (18)F-FDG uptake in the colon. The aim of this study was to retrospectively assess independent determinants of colonic (18)F-FDG uptake. METHODS We retrospectively analysed 270 (18)F-FDG PET-CTs which were made for diagnostic purposes. Colonic (18)F-FDG uptake was assessed using a 4-point scale using the liver as a reference (1; lower, 2; similar, 3; moderately higher than hepatic activity, 4; intense diffuse increased uptake). Determinants of (18)F-FDG uptake in the colon were assessed using forward logistic regression (i.e., grade 1&2 vs 3&4). RESULTS The patients had a mean age of 60.2±14.8 years, a BMI of 25.8±5.2kg/m(2) and 52% were female. Most patients had a grade 2 (44%) or grade 3 (39%) (18)F-FDG uptake in the colon. Diabetes mellitus type 2 was observed in 14% of the patients. In total, 5% of the patients used insulin, 12% used metformin and 5% used sulfonylurea derivatives (SU). While there seemed to be an effect of SU on (18)F-FDG uptake in the ileum [OR 3.6 (95% CI: 1.3-33.1), p=0.03], metformin was the only drug associated with (18)F-FDG uptake for both the whole colon [OR 10.0 (95% CI: 2.9-34.7), p<0.001] and all individual segments. CONCLUSION Metformin use is an independent determinant of increased colonic (18)F-FDG uptake, suggesting a potential role for increasing colonic glucose disposal.
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Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands.
| | - Kevin Stroek
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
| | - Joost B Hoekstra
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
| | - Hein J Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
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Higurashi T, Hosono K, Takahashi H, Komiya Y, Umezawa S, Sakai E, Uchiyama T, Taniguchi L, Hata Y, Uchiyama S, Hattori A, Nagase H, Kessoku T, Arimoto J, Matsuhashi N, Inayama Y, Yamanaka S, Taguri M, Nakajima A. Metformin for chemoprevention of metachronous colorectal adenoma or polyps in post-polypectomy patients without diabetes: a multicentre double-blind, placebo-controlled, randomised phase 3 trial. Lancet Oncol 2016; 17:475-483. [PMID: 26947328 DOI: 10.1016/s1470-2045(15)00565-3] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/24/2015] [Accepted: 12/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of, and mortality from, colorectal cancer is increasing worldwide, and new strategies for prevention are needed to reduce the burden of this disease. The oral diabetes medicine metformin might have chemopreventive effects against cancer, including colorectal cancer. However, no clinical trial data exist for the use of metformin for colorectal cancer chemoprevention. Therefore, we devised a 1-year clinical trial to assess the safety and chemopreventive effects of metformin on sporadic colorectal cancer (assessed by adenoma and polyp recurrence) in patients with a high risk of adenoma recurrence. METHODS This trial was a multicentre, double-blind, placebo-controlled, randomised phase 3 trial. Non-diabetic adult patients who had previously had single or multiple colorectal adenomas or polyps resected by endoscopy were enrolled into the study from five hospitals in Japan. Eligible patients were randomly assigned (1:1) to receive oral metformin (250 mg daily) or identical placebo tablets by a stratified computer-based randomisation method, with stratification by institute, age, sex, and body-mass index. All patients, endoscopists, doctors, and investigators were masked to drug allocation until the end of the trial. After 1 year of administration of metformin or placebo, colonoscopies were done to assess the co-primary endpoints: the number and prevalence of adenomas or polyps. Our analysis included all participants who underwent random allocation, according to the intention-to-treat principle. This trial is registered with University Hospital Medical Information Network (UMIN), number UMIN000006254. FINDINGS Between Sept 1, 2011, and Dec 30, 2014, 498 patients who had had single or multiple colorectal adenomas resected by endoscopy were enrolled into the study. After exclusions for ineligibility, 151 patients underwent randomisation: 79 were assigned to the metformin group and 72 to the placebo group. 71 patients in the metformin group and 62 in the placebo group underwent 1-year follow-up colonoscopy. The prevalence of total polyps (hyperplastic polyps plus adenomas) and of adenomas in the metformin group was significantly lower than that in the placebo group (total polyps: metformin group 27 [38·0%; 95% CI 26·7-49·3] of 71 patients, placebo group 35 [56·5%; 95% CI 44·1-68·8] of 62; p=0·034, risk ratio [RR] 0·67 [95% CI 0·47-0·97]; adenomas: metformin group 22 [30·6%; 95% CI 19·9-41·2] of 71 patients, placebo group 32 [51·6%; 95% CI 39·2-64·1] of 62; p=0·016, RR 0·60 [95% CI 0·39-0·92]). The median number of polyps was zero (IQR 0-1) in the metformin group and one (0-1) in the placebo group (p=0·041). The median number of adenomas was zero (0-1) in the metformin group and zero (0-1) in the placebo group (p=0·037). 15 (11%) of patients had adverse events, all of which were grade 1. We recorded no serious adverse events during the 1-year trial. INTERPRETATION The administration of low-dose metformin for 1 year to patients without diabetes was safe. Low-dose metformin reduced the prevalence and number of metachronous adenomas or polyps after polypectomy. Metformin has a potential role in the chemoprevention of colorectal cancer. However, further large, long-term trials are needed to provide definitive conclusions. FUNDING Ministry of Health, Labour and Welfare, Japan.
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Affiliation(s)
- Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hirokazu Takahashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yasuhiko Komiya
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shotaro Umezawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Eiji Sakai
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Uchiyama
- Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Leo Taniguchi
- Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Yasuo Hata
- Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Shiori Uchiyama
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Akiko Hattori
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Hajime Nagase
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Jun Arimoto
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Nobuyuki Matsuhashi
- Department of Gastroenterology, Kanto Medical Center, NTT East, Shinagawa, Japan
| | - Yoshiaki Inayama
- Department of Pathology, Yokohama City University, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University, Yokohama, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
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Abstract
Metformin is an effective agent with a good safety profile that is widely used as a first-line treatment for type 2 diabetes, yet its mechanisms of action and variability in terms of efficacy and side effects remain poorly understood. Although the liver is recognised as a major site of metformin pharmacodynamics, recent evidence also implicates the gut as an important site of action. Metformin has a number of actions within the gut. It increases intestinal glucose uptake and lactate production, increases GLP-1 concentrations and the bile acid pool within the intestine, and alters the microbiome. A novel delayed-release preparation of metformin has recently been shown to improve glycaemic control to a similar extent to immediate-release metformin, but with less systemic exposure. We believe that metformin response and tolerance is intrinsically linked with the gut. This review examines the passage of metformin through the gut, and how this can affect the efficacy of metformin treatment in the individual, and contribute to the side effects associated with metformin intolerance.
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Affiliation(s)
- Laura J McCreight
- Pearson Group, Division of Cardiovascular and Diabetes Medicine, School of Medicine, University of Dundee, Ninewells Hospital, Mailbox 12, Level 5, Dundee, DD1 9SY, UK
| | - Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Ewan R Pearson
- Pearson Group, Division of Cardiovascular and Diabetes Medicine, School of Medicine, University of Dundee, Ninewells Hospital, Mailbox 12, Level 5, Dundee, DD1 9SY, UK.
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Bardhan KD, Cullis J, Williams NR, Arasaradnam RP, Wilson AJ. Quantification of 18FDG in the Normal Colon-A First Step in Investigating Whether Its Presence Is a Marker of a Physiological Process. PLoS One 2016; 11:e0147838. [PMID: 26821281 PMCID: PMC4731074 DOI: 10.1371/journal.pone.0147838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
The visibility of the colon in positron emission tomography (PET) scans of patients without gastrointestinal disease indicating the presence of 18F Fluorodeoxyglucose (18FDG) is well recognised, but unquantified and unexplained. In this paper a qualitative scoring system was applied to PET scans from 30 randomly selected patients without gastrointestinal disease to detect the presence of 18FDG in 4 different sections of the colon and then both the total pixel value and the pixel value per unit length of each section of the colon were determined to quantify the amount of 18FDG from a randomly selected subset of 10 of these patients. Analysis of the qualitative scores using a non-parametric ANOVA showed that all sections of the colon contained 18FDG but there were differences in the amount of 18FDG present between sections (p<0.05). Wilcoxon matched-pair signed-rank tests between pairs of segments showed statistically significant differences between all pairs (p<0.05) with the exception of the caecum and ascending colon and the descending colon. The same non-parametric statistical analysis of the quantitative measures showed no difference in the total amount of 18FDG between sections (p>0.05), but a difference in the amount/unit length between sections (p<0.01) with only the caecum and ascending colon and the descending colon having a statistically significant difference (p<0.05). These results are consistent since the eye is drawn to focal localisation of the 18FDG when qualitatively scoring the scans. The presence of 18FDG in the colon is counterintuitive since it must be passing from the blood to the lumen through the colonic wall. There is no active mechanism to achieve this and therefore we hypothesise that the transport is a passive process driven by the concentration gradient of 18FDG across the colonic wall. This hypothesis is consistent with the results obtained from the qualitative and quantitative measures analysed.
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Affiliation(s)
- Karna D. Bardhan
- Department of Gastroenterology, Rotherham General Hospital, Rotherham S60 2UD, United Kingdom
- School of Medicine, University of Sheffield, Sheffield S10 2TN, United Kingdom
- * E-mail:
| | - James Cullis
- Nuclear Medicine, Department of Clinical Physics and Bioengineering, University Hospital, Coventry CV2 2DX, United Kingdom
| | - Nigel R. Williams
- Nuclear Medicine, Department of Clinical Physics and Bioengineering, University Hospital, Coventry CV2 2DX, United Kingdom
| | - Ramesh P. Arasaradnam
- Department of Gastroenterology, University Hospital, Coventry CV2 2DX, United Kingdom
- Clinical Sciences Research Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Adrian J. Wilson
- Department of Research, Development and Innovation, University Hospital, Coventry CV2 2DX, United Kingdom
- Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom
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80
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Background Intestinal 18F-FDG Uptake Is Related to Serum Lipid Profile and Obesity in Breast Cancer Patients. PLoS One 2015; 10:e0141473. [PMID: 26523374 PMCID: PMC4629908 DOI: 10.1371/journal.pone.0141473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/07/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study investigated the relationships between background intestinal uptake on 18F-FDG PET and cardio-metabolic risk (CMR) factors. METHODS A total of 326 female patients that underwent 18F-FDG PET to determine the initial stage of breast cancer were enrolled. None of the patients had history of diabetes or hypertension. The background intestinal uptake on PET was visually graded (low vs. high uptake group) and quantitatively measured using the maximal standardized uptake value (SUVmax). SUVmax of 7 bowel segments (duodenum, jejunum, ileum, cecum, hepatic flexure, splenic flexure, and descending colon-sigmoid junction) were averaged for the total bowel (TB SUVmax). Age, body mass index (BMI), fasting blood glucose level (BST), triglyceride (TG), cholesterol, high density lipoprotein (HDL), and low density lipoprotein (LDL) were the considered CMR factors. The relationships between background intestinal 18F-FDG uptake on PET and diverse CMR factors were analyzed. RESULTS The visual grades based on background intestinal 18F-FDG uptake classified 100 (30.7%) patients into the low uptake group, while 226 (69.3%) were classified into the high uptake group. Among CMR factors, age (p = 0.004), BMI (p<0.001), and TG (p<0.001) were significantly different according to visual grade of background intestinal 18F-FDG uptake. Quantitative TB SUVmax showed significant positive correlation with age (r = 0.203, p<0.001), BMI (r = 0.373, p<0.001), TG (r = 0.338, p<0.001), cholesterol (r = 0.148, p = 0.008), and LDL (r = 0.143, p = 0.024) and significant negative correlation with HDL (r = -0.147, p = 0.022). Multivariate analysis indicated that BMI and TG were independent factors in both visually graded background intestinal 18F-FDG uptake (p = 0.027 and p = 0.023, respectively) and quantitatively measured TB SUVmax (p = 0.006 and p = 0.004, respectively). CONCLUSION Increased background intestinal 18F-FDG uptake on PET may suggest alteration of lipid metabolism and risk of cardio-metabolic disease in non-diabetic and non-hypertensive breast cancer patients.
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81
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Glaudemans AW, Israel O, Slart RH. Pitfalls and Limitations of Radionuclide and Hybrid Imaging in Infection and Inflammation. Semin Nucl Med 2015; 45:500-12. [DOI: 10.1053/j.semnuclmed.2015.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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82
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Abstract
Accurate reporting of combined PET/CT imaging requires a thorough understanding of the normal and variant physiological distribution of tracers as well as common incidental findings and technical artifacts. We describe these pitfalls and artifacts, what action may help to mitigate them in clinical practice, and what further action may be appropriate. This review presents these in a region-based approach, in order to closely mimic clinical practice, and focuses on technical artifacts followed by a description of two commonly used oncologic tracers: FDG and choline.
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Affiliation(s)
| | - Paul John Schleyer
- St Thomas' PET Imaging Centre, Guys and St Thomas NHS Trust and Kings College London, London, UK
| | - Gary John Cook
- St Thomas' PET Imaging Centre, Guys and St Thomas NHS Trust and Kings College London, London, UK
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83
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Qiu L, Tang Y, Chen Y, Huang Z, Zhu Y, Zhang L, Cai L, Wan Q, Feng Y. The effect of MRI contrast agents on hepatic and splenic uptake in the rabbit during (99m) Tc-MDP bone scintigraphy. CONTRAST MEDIA & MOLECULAR IMAGING 2015; 10:438-45. [PMID: 26036779 DOI: 10.1002/cmmi.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/26/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Abstract
The objective of this study was to investigate the effects of Omniscan® and Magnevist® on (99m) Tc-MDP uptake in rabbits during (99m) Tc-MDP bone scintigraphy. In Experiment Group 1, 30 healthy adult rabbits were randomized into six subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min, 360 min, 24 h). All six subgroups were injected first with Omniscan®, then with (99m) Tc-MDP. After 7 days, the same six subgroups were injected with normal saline followed by (99m) Tc-MDP at the same time intervals. In Experiment Group 2, 20 healthy adult rabbits were allocated randomly to four subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min). All four subgroups were injected first with Magnevist®, then with (99m) Tc-MDP. After 7 days, the same four subgroups were injected with normal saline followed by (99m) Tc-MDP. In all experiments, whole-body skeletal imaging was performed. Liver, spleen, and background were delineated to determine the target-to-background (T/B) ratio. Diffusely increased intake of the imaging agent was seen in the liver and spleen when the injection-time interval between Omniscan® and (99m) Tc-MDP varied from 30 min to 240 min and when the time interval between Magnevist® and (99m) Tc-MDP was 30 min-60 min. The imaging findings are consistent with the results of L/B and S/B ratios in each experiment group. Both Omniscan® and Magnevist® have an effect on (99m) Tc-MDP uptake during bone scanning; the main effect is diffusely increased hepatic and splenic activity.
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Affiliation(s)
- Lin Qiu
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yuhui Tang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yue Chen
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Zhanwen Huang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yan Zhu
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Li Zhang
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Liang Cai
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Qiang Wan
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
| | - Yue Feng
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, 646000, China
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Abstract
BACKGROUND PET with computed tomography (PET-CT) is an important imaging modality in the assessment of patients with cancer. The glucose analogue fluorine-18 2'-fluorodeoxyglucose (F-FDG) is a commonly used tracer in PET-CT. As we serve a diverse population with a high prevalence of diabetes mellitus (DM) and malignant disease, we wished to ensure that patients had access to the PET-CT imaging service as efficiently as possible. PATIENTS AND METHODS We reviewed the simple instructions followed by patients and technical staff in preparation for F-FDG PET-CT scanning at our institution to ensure that there was minimum disruption to the diagnostic pathway. RESULTS Only a small percentage (1.5%, 3/200) of patients referred for PET-CT could not proceed with scanning because of unacceptably high serum glucose (SG) levels at the first attendance (SG≥11.1 mmol/l), all of whom were successfully scanned within a week. This cutoff level of SG is based on the European Association of Nuclear Medicine (EANM) guidelines. There was no case in which the patient's diagnostic pathway was delayed purely by the time taken to control glycaemic levels. A significant number of patients were in fact diagnosed with DM, impaired glucose tolerance or impaired fasting glucose as a result of being referred for the PET-CT scan. These patients were actually those for whom a diagnosis of DM was thought to be absent at the time of referral, as opposed to those for whom the diagnosis was not known one way or the other. CONCLUSIONS We conclude that scheduling for F-FDG PET-CT can be performed efficiently using simple preparation instructions, even in the context of high prevalence of DM and with a high rate of incidental diagnosis of DM at the time of scanning.
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85
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Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
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Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
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Capitanio S, Marini C, Sambuceti G, Morbelli S. Metformin and cancer: Technical and clinical implications for FDG-PET imaging. World J Radiol 2015; 7:57-60. [PMID: 25825634 PMCID: PMC4374089 DOI: 10.4329/wjr.v7.i3.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Metformin is the most widely used hypoglycemic agent. Besides its conventional indications, increasing evidence demonstrate a potential efficacy of this biguanide as an anticancer drug. Possible mechanisms of actions seem to be independent from its hypoglycemic effect and seem to involve the interference with key pathways in cellular proliferation and glycolysis. To date, many clinical trials implying the use of metformin in cancer treatment are on-going. The increasing use of 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in cancer evaluation raises a number of questions about the possible interference of the biguanide on FDG distribution. In particular, the interferences exerted by metformin on AMP-activated protein kinase pathway (the cellular energy sensor), on insulin levels and on Hexokinase could potentially have repercussion on glucose handling and thus on FDG distribution. A better comprehension of the impact of metformin on FDG uptake is needed in order to optimize the use of PET in this setting. This evaluation would be useful to ameliorate scans interpretation in diabetic patients under chronic metformin treatment and to critically interpret images in the context of clinical trials. Furthermore, collecting prospective data in this setting would help to verify whether FDG-PET could be a valid tool to appreciate the anticancer effect of this new therapeutic approach.
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87
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Abstract
Metformin is currently the first-line drug treatment for type 2 diabetes. Besides its glucose-lowering effect, there is interest in actions of the drug of potential relevance to cardiovascular diseases and cancer. However, the underlying mechanisms of action remain elusive. Convincing data place energy metabolism at the center of metformin's mechanism of action in diabetes and may also be of importance in cardiovascular diseases and cancer. Metformin-induced activation of the energy-sensor AMPK is well documented, but may not account for all actions of the drug. Here, we summarize current knowledge about the different AMPK-dependent and AMPK-independent mechanisms underlying metformin action.
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Affiliation(s)
- Marc Foretz
- INSERM, U1016, Institut Cochin, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France
| | - Bruno Guigas
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc Bertrand
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle de Recherche Cardiovasculaire, Brussels, Belgium
| | - Michael Pollak
- Department of Oncology, McGill University and Segal Cancer Centre of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Benoit Viollet
- INSERM, U1016, Institut Cochin, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France.
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88
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Abstract
A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.
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Affiliation(s)
- Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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89
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Overcoming Drug Development Bottlenecks With Repurposing: Repurposing biguanides to target energy metabolism for cancer treatment. Nat Med 2014; 20:591-3. [PMID: 24901568 DOI: 10.1038/nm.3596] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Oh DY, Kim JW, Koh SJ, Kim M, Park JH, Cho SY, Kim BG, Lee KL, Im JP. Does diabetes mellitus influence standardized uptake values of fluorodeoxyglucose positron emission tomography in colorectal cancer? Intest Res 2014; 12:146-52. [PMID: 25349582 PMCID: PMC4204697 DOI: 10.5217/ir.2014.12.2.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 01/24/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022] Open
Abstract
Background/Aims Hyperglycemia is associated with decreased 2-18[F]fluoro-2-deoxy-D-glucose (FDG) uptake by tumors assessed by positron emission tomography (PET). In this retrospective study we investigated a comparison of standardized uptake values (SUVs) in patients with primary colorectal cancers who either had diabetes mellitus (DM) or were otherwise healthy. Methods The medical records of 397 patients who were diagnosed with colorectal cancer and underwent PET-CT between January 2006 and December 2012 were analyzed. Eighty patients with DM and 317 patients without DM were included. Clinical characteristics were reviewed and maximal standardized uptake values (SUVmax) were calculated in the primary colorectal lesions. Results There was no significant difference between tumor SUVmax in DM patients (10.60±5.78) and those without DM (10.92±5.44). In addition, no significant difference was detected between tumor SUVmax in DM patients with glycated hemoglobin (HbA1c) levels <8% (10.34±5.17) and those with HbA1c levels ≥8% (10.61±7.27). The maximum size of the primary colorectal tumor was associated with SUVmax in a linear regression analysis. Conclusion The results of this study showed that DM did not influence FDG uptake values in colorectal cancer patients regardless of glucose levels.
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Affiliation(s)
- Da Yeon Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Seong-Joon Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Mingoo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Ji Hoon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Su Yeon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Kook Lae Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Bevilacqua T, Greene GS. Diffuse bowel uptake of 18F-FDG on PET/CT examination of a patient with diabetes treated with metformin. BMJ Case Rep 2014; 2014:bcr-2013-202058. [PMID: 24700035 DOI: 10.1136/bcr-2013-202058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Thomas Bevilacqua
- Department of Radiology, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
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94
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Ozguven MA, Karacalioglu AO, Ince S, Emer MO. Altered biodistribution of FDG in patients with type-2 diabetes mellitus. Ann Nucl Med 2014; 28:505-11. [DOI: 10.1007/s12149-014-0840-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/10/2014] [Indexed: 12/12/2022]
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Abstract
With the widespread use of whole-body fluorodeoxyglucose (FDG)-PET/computed tomography as a diagnostic tool in patients with cancer, incidental findings are of increasing importance. This is particularly true within the pelvis, where several benign findings might present with increased FDG uptake. In addition, physiologic excretion of radiotracer by way of the urinary tract can complicate image analysis. This article reviews potential incidental benign findings in the pelvis that one should be aware of when interpreting FDG-PET/computed tomography scans.
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97
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18F-FDG PET/CT for the assessment of gastrointestinal GVHD: results of a pilot study. Bone Marrow Transplant 2013; 49:131-7. [PMID: 24076550 DOI: 10.1038/bmt.2013.144] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 01/25/2023]
Abstract
This prospective pilot study aimed to evaluate the predictive value of (18)F-FDG PET/CT for early diagnosis of acute gastrointestinal GVHD (GI-GVHD). In all, 42 consecutive patients who received allo-SCT were included. (18)F-FDG PET/CT was systematically performed at a median of 28 (range, 24-38) days after allo-SCT. (18)F-FDG PET/CT data review was positive in 15 cases (36%) (9 true positive (TP) cases and 6 false positive (FP) cases) and negative in 27 cases (64%; 26 true negative (TN) cases and 1 false negative (FN) case) at visual analysis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of (18)F-FDG PET/CT for the diagnosis of acute GI-GVHD were, respectively, 81%, 90%, 60%, 96% and 83%. There were no significant differences of SUVmax values between grade 1-2 GI-GVHD and severe grade 3-4 GI-GVHD. Overall, these preliminary findings suggested that the inflammatory activity of the gastrointestinal tract associated with acute GI-GVHD could be assessed by (18)F-FDG PET/CT suggesting that noninvasive (18)F-FDG PET/CT could become a valuable examination to be performed shortly before endoscopy to map acute GI-GVHD lesions, guide the biopsy sites and choose the appropriate endoscopic procedure, especially in those asymptomatic patients with a positive (18)F-FDG PET/CT.
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Abstract
Metformin is widely prescribed for the treatment of type II diabetes. Recently, it has been proposed that this compound or related biguanides may have antineoplastic activity. Biguanides may exploit specific metabolic vulnerabilities of transformed cells by acting on them directly, or may act by indirect mechanisms that involve alterations of the host environment. Preclinical data suggest that drug exposure levels are a key determinant of proposed direct actions. With respect to indirect mechanisms, it will be important to determine whether recently demonstrated metformin-induced changes in levels of candidate systemic mediators such as insulin or inflammatory cytokines are of sufficient magnitude to achieve therapeutic benefit. Results of the first generation of clinical trials now in progress are eagerly anticipated. Ongoing investigations may justify a second generation of trials that explore pharmacokinetic optimization, rational drug combinations, synthetic lethality strategies, novel biguanides, and the use of predictive biomarkers.
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Affiliation(s)
- Michael Pollak
- Department of Oncology, McGill University, Montreal, Quebec, Canada.
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Sharma A. Positron Emission Tomography/Computed Tomography for Diagnosis of Prosthetic Valve Endocarditis. J Am Coll Cardiol 2013; 62:861. [DOI: 10.1016/j.jacc.2013.04.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 11/16/2022]
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Skinner HD, McCurdy MR, Echeverria AE, Lin SH, Welsh JW, O'Reilly MS, Hofstetter WL, Ajani JA, Komaki R, Cox JD, Sandulache VC, Myers JN, Guerrero TM. Metformin use and improved response to therapy in esophageal adenocarcinoma. Acta Oncol 2013; 52:1002-9. [PMID: 22950385 DOI: 10.3109/0284186x.2012.718096] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We investigated the radiographic and pathologic response rate of esophageal adenocarcinoma treated with neoadjuvant chemoradiation in patients taking metformin. MATERIAL AND METHODS Two hundred eighty-five patients with esophageal adenocarcinoma treated with concurrent chemoradiation (CRT) followed by esophagectomy from 1997 to 2012 were included in the study, including 29 diabetics taking metformin, 21 diabetics not taking metformin and 235 non-diabetics. Pre- and post-treatment positron emission tomography (PET) scans were available for 204 patients. Pathologic response was graded at the time of surgery. Response rates were compared using both the χ(2) statistic as well as ANOVA with post-hoc LSD analysis. Multivariate logistic regression analysis was performed to control for predictors of pathologic complete response (CR) after CRT. RESULTS The overall rate of pathologic CR for the study population was 20%. The pathologic CR rate was higher in patients taking metformin (34.5%), compared to diabetic patients not taking metformin (4.8%, p = 0.01) and non-diabetic patients (19.6%, p = 0.05). Pathologic CR was related to metformin dose, with ≥ 1500 mg/d associated with a higher CR rate. No significant difference seen in pre-CRT maximum tumor SUV (p = 0.93), however post-CRT maximum SUV was significantly decreased in patients taking metformin (p = 0.05). On multivariate logistic regression, metformin use was independently associated with pathologic CR (p = 0.04). Metformin use was also associated with decreased in field loco-regional failure following radiation (p = 0.05). CONCLUSION Metformin use is associated with a dose-dependent increased response to CRT in esophageal cancer and may be a sensitizer to this therapy.
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Affiliation(s)
- Heath D Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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