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Hagn-Meincke R, Yadav D, Andersen DK, Vege SS, Fogel EL, Serrano J, Bellin MD, Topazian MD, Conwell DL, Li L, Van Den Eeden SK, Drewes AM, Pandol SJ, Forsmark CE, Fisher WE, Hart PA, Olesen SS, Park WG. Circulating immune signatures in chronic pancreatitis with and without preceding acute pancreatitis: A pilot study. Pancreatology 2024; 24:384-393. [PMID: 38461145 PMCID: PMC11023786 DOI: 10.1016/j.pan.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To investigate profiles of circulating immune signatures in healthy controls and chronic pancreatitis patients (CP) with and without a preceding history of acute pancreatitis (AP). METHODS We performed a phase 1, cross-sectional analysis of prospectively collected serum samples from the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translation StuDies (PROCEED) study. All samples were collected during a clinically quiescent phase. CP subjects were categorized into two subgroups based on preceding episode(s) of AP. Healthy controls were included for comparison. Blinded samples were analyzed using an 80-plex Luminex assay of cytokines, chemokines, and adhesion molecules. Group and pairwise comparisons of analytes were performed between the subgroups. RESULTS In total, 133 patients with CP (111 with AP and 22 without AP) and 50 healthy controls were included. Among the 80 analytes studied, CP patients with a history of AP had significantly higher serum levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-8, IL-1 receptor antagonist, IL-15) and chemokines (Cutaneous T-Cell Attracting Chemokine (CTACK), Monokine induced Gamma Interferon (MIG), Macrophage-derived Chemokine (MDC), Monocyte Chemoattractant Protein-1 (MCP-1)) compared to CP without preceding AP and controls. In contrast, CP patients without AP had immune profiles characterized by low systemic inflammation and downregulation of anti-inflammatory mediators, including IL-10. CONCLUSION CP patients with a preceding history of AP have signs of systemic inflammatory activity even during a clinically quiescent phase. In contrast, CP patients without a history of AP have low systemic inflammatory activity. These findings suggest the presence of two immunologically diverse subtypes of CP.
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Affiliation(s)
- Rasmus Hagn-Meincke
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Melena D Bellin
- Division of Pediatric Endocrinology, University of Minnesota, Minnesota, MN, USA
| | - Mark D Topazian
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Darwin L Conwell
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Asbjørn M Drewes
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition. University of Florida, Gainesville, FL, USA
| | - William E Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Søren S Olesen
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Han S, Conwell DL, Easler JJ, Yang Y, Andersen DK, Fisher WE, Fogel EL, Forsmark C, Hart PA, Hughes SJ, Li L, Pandol SJ, Park WG, Serrano J, Van Den Eeden SK, Vege SS, Yadav D. Utilization of Pancreatic Endotherapy in Patients with Chronic Pancreatitis: Results From a Multicenter Cohort Study in the United States. Gastrointest Endosc 2024:S0016-5107(24)00215-3. [PMID: 38583544 DOI: 10.1016/j.gie.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS Although commonly used for treating complications of chronic pancreatitis (CP), data on the frequency and factors associated with the use of pancreatic endotherapy (PET) are limited. Our aim was to define the utilization and factors predictive for receiving PET in a well-characterized CP cohort. METHODS This is a cross-sectional analysis of data from PROCEED, a multicenter US cohort study of CP. PET modalities primarily consisted of ERCP. A treatment course was defined as the number of sessions performed for a specific indication. A repeat course was defined as PET >1 year after completion of the last course. Multivariable logistic regression identified predictive factors for receiving PET, and proportional rates model assessed risk factors for repeat PET. RESULTS Of a total of 681 subjects, 238 (34.9%) received PET. Factors associated with receiving PET included female sex (OR: 1.26, 95% CI: 1.03-1.53), lower education (OR: 1.30, 95% CI: 1.04-1.62), income ≤ $50,000 per year (OR: 1.35, 95% CI: 1.07-1.71) and prior acute pancreatitis (AP) (OR: 1.74, 95% CI: 1.31, 2.32). 103/238 subjects (43.3%) underwent repeat PET at a median duration of 2 years with 23.1% receiving 2 courses, 9.7% receiving 3 courses, and 10.4% receiving 4+ courses. CONCLUSIONS Nearly half of patients with CP who undergo PET received one or more repeat courses within 2-3 years. In addition to a prior history of AP, demographic and socioeconomic factors were associated with receiving PET.
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Affiliation(s)
- Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Yunlong Yang
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - William E Fisher
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Chris Forsmark
- Division of Gastroenterology, University of Florida, Gainesville, Florida
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Steven J Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Stephen J Pandol
- Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Walter G Park
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, California
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Gumpper-Fedus K, Chasser K, Pita-Grisanti V, Torok M, Pfau T, Mace TA, Cole RM, Belury MA, Culp S, Hart PA, Krishna SG, Lara LF, Ramsey ML, Fisher W, Fogel EL, Forsmark CE, Li L, Pandol S, Park WG, Serrano J, Van Den Eeden SK, Vege SS, Yadav D, Conwell DL, Cruz-Monserrate Z. Systemic Neutrophil Gelatinase-Associated Lipocalin Alterations in Chronic Pancreatitis: A Multicenter, Cross-Sectional Study. Clin Transl Gastroenterol 2024; 15:e00686. [PMID: 38284831 PMCID: PMC11042777 DOI: 10.14309/ctg.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Chronic pancreatitis (CP) is a progressive fibroinflammatory disorder lacking therapies and biomarkers. Neutrophil gelatinase-associated lipocalin (NGAL) is a proinflammatory cytokine elevated during inflammation that binds fatty acids (FAs) such as linoleic acid. We hypothesized that systemic NGAL could serve as a biomarker for CP and, with FAs, provide insights into inflammatory and metabolic alterations. METHODS NGAL was measured by immunoassay, and FA composition was measured by gas chromatography in plasma (n = 171) from a multicenter study, including controls (n = 50), acute and recurrent acute pancreatitis (AP/RAP) (n = 71), and CP (n = 50). Peripheral blood mononuclear cells (PBMCs) from controls (n = 16), AP/RAP (n = 17), and CP (n = 15) were measured by cytometry by time-of-flight. RESULTS Plasma NGAL was elevated in subjects with CP compared with controls (area under the curve [AUC] = 0.777) or AP/RAP (AUC = 0.754) in univariate and multivariate analyses with sex, age, body mass index, and smoking (control AUC = 0.874; AP/RAP AUC = 0.819). NGAL was elevated in CP and diabetes compared with CP without diabetes ( P < 0.001). NGAL + PBMC populations distinguished CP from controls (AUC = 0.950) or AP/RAP (AUC = 0.941). Linoleic acid was lower, whereas dihomo-γ-linolenic and adrenic acids were elevated in CP ( P < 0.05). Linoleic acid was elevated in CP with diabetes compared with CP subjects without diabetes ( P = 0.0471). DISCUSSION Elevated plasma NGAL and differences in NGAL + PBMCs indicate an immune response shift that may serve as biomarkers of CP. The potential interaction of FAs and NGAL levels provide insights into the metabolic pathophysiology and improve diagnostic classification of CP.
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Affiliation(s)
- Kristyn Gumpper-Fedus
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kaylin Chasser
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Valentina Pita-Grisanti
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University Interdisciplinary Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Molly Torok
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy Pfau
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas A. Mace
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rachel M. Cole
- Department of Food Science and Technology, College of Food, Agriculture, and Environmental Sciences, The Ohio State University Columbus, Ohio, USA
| | - Martha A. Belury
- Department of Food Science and Technology, College of Food, Agriculture, and Environmental Sciences, The Ohio State University Columbus, Ohio, USA
| | - Stacey Culp
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luis F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mitchell L. Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Evan L. Fogel
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Chris E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Walter G. Park
- Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | | | - Santhi Swaroop Vege
- Department of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, Minnesota, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Darwin L. Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Gardner TB, Park WG, Allen PJ. Diagnosis and Management of Pancreatic Cysts. Gastroenterology 2024:S0016-5085(24)00248-8. [PMID: 38442782 DOI: 10.1053/j.gastro.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/01/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Timothy B Gardner
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Walter G Park
- Section of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Peter J Allen
- Division of Surgical Oncology, Duke University Medical Center, Durham, North Carolina
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5
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Hagn-Meincke R, Hart PA, Andersen DK, Vege SS, Fogel EL, Serrano J, Bellin MD, Topazian MD, Conwell DL, Li L, Van Den Eeden SK, Drewes AM, Pandol SJ, Forsmark CE, Fisher WE, Yadav D, Olesen SS, Park WG. Circulating immune signatures across clinical stages of chronic pancreatitis: a pilot study. Eur J Gastroenterol Hepatol 2024; 36:177-183. [PMID: 38047728 PMCID: PMC10842751 DOI: 10.1097/meg.0000000000002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This pilot study seeks to identify serum immune signatures across clinical stages of patients with chronic pancreatitis (CP). METHODS We performed a cross-sectional analysis of prospectively collected serum samples from the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translation StuDies-study. CP subjects were categorised into three clinical stages based on the presence/absence of metabolic complications: (1) CP with no diabetes and exocrine pancreatic dysfunction (EPD), (2) CP with either diabetes or EPD, and (3) CP with diabetes and EPD. Blinded samples were analysed using an 80-plex Luminex assay of cytokines/chemokines/adhesion molecules. Group and pairwise comparisons were performed to characterise immune signatures across CP subgroups. RESULTS A total of 135 CP subjects (evenly distributed between clinical stages) and 50 controls were studied. Interleukin-6 (IL-6), interleukin-8 (IL-8), and soluble intercellular adhesion molecule 1 (sICAM-1) were significantly elevated in CP subjects compared to controls. The levels of IL-6 and IL-8 increased with advancing disease stages, with the highest levels observed in CP with diabetes and EPD (clinical stage 3). Furthermore, hepatocyte growth factor and macrophage-derived chemokine were significantly increased in clinical stage 3 compared to controls. CONCLUSION Our study reveals a progressive elevation in pro-inflammatory cytokines and chemokines with advancing clinical stages of CP. These findings indicate potential targets for the development of disease-modifying interventions.
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Affiliation(s)
- Rasmus Hagn-Meincke
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Santhi S Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Melena D Bellin
- Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, Minnesota
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Darwin L Conwell
- Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | | | - Asbjørn M Drewes
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition. University of Florida, Gainesville, Florida
| | - William E Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, Texas
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Søren S Olesen
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Wang J, Seo JW, Kare AJ, Schneider M, Tumbale SK, Wu B, Raie MN, Pandrala M, Iagaru A, Brunsing RL, Charville GW, Park WG, Ferrara KW. Spatial transcriptomic analysis drives PET imaging of tight junction protein expression in pancreatic cancer theranostics. bioRxiv 2024:2024.01.07.574209. [PMID: 38249519 PMCID: PMC10798647 DOI: 10.1101/2024.01.07.574209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
We apply spatial transcriptomics and proteomics to select pancreatic cancer surface receptor targets for molecular imaging and theranostics using an approach that can be applied to many cancers. Selected cancer surfaceome epithelial markers were spatially correlated and provided specific cancer localization, whereas the spatial correlation between cancer markers and immune- cell or fibroblast markers was low. While molecular imaging of cancer-associated fibroblasts and integrins has been proposed for pancreatic cancer, our data point to the tight junction protein claudin-4 as a theranostic target. Claudin-4 expression increased ∼16 fold in cancer as compared with normal pancreas, and the tight junction localization conferred low background for imaging in normal tissue. We developed a peptide-based molecular imaging agent targeted to claudin-4 with accumulation to ∼25% injected activity per cc (IA/cc) in metastases and ∼18% IA/cc in tumors. Our work motivates a new approach for data-driven selection of molecular targets.
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Saloman JL, Li Y, Stello K, Li W, Li S, Phillips AE, Hall K, Fogel EL, Vege SS, Li L, Andersen DK, Fisher WE, Forsmark CE, Hart PA, Pandol SJ, Park WG, Topazian MD, Van Den Eeden SK, Serrano J, Conwell DL, Yadav D. Serum Biomarkers of Nociceptive and Neuropathic Pain in Chronic Pancreatitis. J Pain 2023; 24:2199-2210. [PMID: 37451493 PMCID: PMC10787046 DOI: 10.1016/j.jpain.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Debilitating abdominal pain is a common symptom affecting most patients with chronic pancreatitis (CP). There are multiple underlying mechanisms that contribute to CP-related pain, which makes successful treatment difficult. The identification of biomarkers for subtypes of pain could provide viable targets for nonopioid interventions and the development of mechanistic approaches to pain management in CP. Nineteen inflammation- and nociception-associated proteins were measured in serum collected from 358 subjects with definite CP enrolled in PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies, a prospective observational study of pancreatitis in US adult subjects. First, serum levels of putative biomarkers were compared between CP subjects with and without pain. Only platelet-derived growth factor B (PDGF-B) stood out, with levels significantly higher in the CP pain group as compared to subjects with no pain. Subjects with pain were then stratified into 4 pain subtypes (Neuropathic, Nociceptive, Mixed, and Unclassified). A comparison of putative biomarker concentration among 5 groups (no pain and 4 pain subtypes) identified unique proteins that were correlated with pain subtypes. Serum transforming growth factor beta 1 (TGFβ1) level was significantly higher in the Nociceptive pain group compared to the No pain group, suggesting that TGFβ1 may be a biomarker for nociceptive pain. The Neuropathic pain only group was too small to detect statistical differences. However, glycoprotein 130 (GP130), a coreceptor for interleukin 6, was significantly higher in the Mixed pain group compared to the groups lacking a neuropathic pain component. These data suggest that GP130 may be a biomarker for neuropathic pain in CP. PERSPECTIVE: Serum TGFβ1 and GP130 may be biomarkers for nociceptive and neuropathic CP pain, respectively. Preclinical data suggest inhibiting TGFβ1 or GP130 reduces CP pain in rodent models, indicating that additional translational and clinical studies may be warranted to develop a precision medicine approach to the management of pain in CP.
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Affiliation(s)
- Jami L. Saloman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
- Pittsburgh Center for Pain Research, School of Medicine, University of Pittsburgh, PA, USA
- Department of Neurobiology, School of Medicine, University of Pittsburgh, PA, USA
| | - Yan Li
- Department of Biostatistics, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kimberly Stello
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
| | - Wenhao Li
- Department of Biostatistics, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shuang Li
- Department of Biostatistics, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Anna Evans Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
| | - Kristen Hall
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
| | - Evan L. Fogel
- Digestive and Liver Disorders, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Liang Li
- Department of Biostatistics, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - William E. Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, TX
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition. University of Florida, Gainesville, FL
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen J. Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Walter G. Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mark D. Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Darwin L. Conwell
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, PA, USA
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Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Persohn SA, Dasyam AK, Shah ZK, Venkatesh SK, Takahashi N, Wachsman A, Li L, Li Y, Pandol SJ, Park WG, Vege SS, Hart PA, Topazian M, Andersen DK, Fogel EL. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol (NY) 2023; 48:3162-3173. [PMID: 37436452 PMCID: PMC10650972 DOI: 10.1007/s00261-023-04000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls. METHODS This prospective study performed abdominal MRI scans at seven institutions, using 1.5 T Siemens and GE scanners, in 50 control and 51 definite CP participants, from February 2019 to May 2021. MRI parameters included the T1-weighted signal intensity ratio of the pancreas (T1 score), arterial-to-venous enhancement ratio (AVR) during venous and delayed phases, pancreas volume, and diameter. We evaluated the diagnostic performance of these parameters individually and two semi-quantitative MRI scores derived using logistic regression: SQ-MRI Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume). RESULTS When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively. CONCLUSION Semi-quantitative parameters of the pancreatic parenchyma, including T1 score, enhancement ratio, pancreas volume, diameter and multi-parametric models combining these parameters are helpful in diagnosis of CP. Longitudinal analyses including more extensive population are warranted to develop new diagnostic criteria for CP.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Paul R Territo
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Scott A Persohn
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Ashley Wachsman
- Department of Imaging, University of California in Los Angeles, Los Angeles, CA, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
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9
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Nikiforova MN, Wald AI, Spagnolo DM, Melan MA, Grupillo M, Lai YT, Brand RE, O’Broin-Lennon AM, McGrath K, Park WG, Pfau PR, Polanco PM, Kubiliun N, DeWitt J, Easler JJ, Dam A, Mok SR, Wallace MB, Kumbhari V, Boone BA, Marsh W, Thakkar S, Fairley KJ, Afghani E, Bhat Y, Ramrakhiani S, Nasr J, Skef W, Thiruvengadam NR, Khalid A, Fasanella K, Chennat J, Das R, Singh H, Sarkaria S, Slivka A, Gabbert C, Sawas T, Tielleman T, Vanderveldt HD, Tavakkoli A, Smith LM, Smith K, Bell PD, Hruban RH, Paniccia A, Zureikat A, Lee KK, Ongchin M, Zeh H, Minter R, He J, Nikiforov YE, Singhi AD. A Combined DNA/RNA-based Next-Generation Sequencing Platform to Improve the Classification of Pancreatic Cysts and Early Detection of Pancreatic Cancer Arising From Pancreatic Cysts. Ann Surg 2023; 278:e789-e797. [PMID: 37212422 PMCID: PMC10481930 DOI: 10.1097/sla.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We report the development and validation of a combined DNA/RNA next-generation sequencing (NGS) platform to improve the evaluation of pancreatic cysts. BACKGROUND AND AIMS Despite a multidisciplinary approach, pancreatic cyst classification, such as a cystic precursor neoplasm, and the detection of high-grade dysplasia and early adenocarcinoma (advanced neoplasia) can be challenging. NGS of preoperative pancreatic cyst fluid improves the clinical evaluation of pancreatic cysts, but the recent identification of novel genomic alterations necessitates the creation of a comprehensive panel and the development of a genomic classifier to integrate the complex molecular results. METHODS An updated and unique 74-gene DNA/RNA-targeted NGS panel (PancreaSeq Genomic Classifier) was created to evaluate 5 classes of genomic alterations to include gene mutations (e.g., KRAS, GNAS, etc.), gene fusions and gene expression. Further, CEA mRNA ( CEACAM5 ) was integrated into the assay using RT-qPCR. Separate multi-institutional cohorts for training (n=108) and validation (n=77) were tested, and diagnostic performance was compared to clinical, imaging, cytopathologic, and guideline data. RESULTS Upon creation of a genomic classifier system, PancreaSeq GC yielded a 95% sensitivity and 100% specificity for a cystic precursor neoplasm, and the sensitivity and specificity for advanced neoplasia were 82% and 100%, respectively. Associated symptoms, cyst size, duct dilatation, a mural nodule, increasing cyst size, and malignant cytopathology had lower sensitivities (41-59%) and lower specificities (56-96%) for advanced neoplasia. This test also increased the sensitivity of current pancreatic cyst guidelines (IAP/Fukuoka and AGA) by >10% and maintained their inherent specificity. CONCLUSIONS PancreaSeq GC was not only accurate in predicting pancreatic cyst type and advanced neoplasia but also improved the sensitivity of current pancreatic cyst guidelines.
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Affiliation(s)
- Marina N. Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Abigail I. Wald
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel M. Spagnolo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melissa A. Melan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maria Grupillo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yi-Tak Lai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Randall E. Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anne Marie O’Broin-Lennon
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Walter G. Park
- Department of Medicine, Stanford University, Stanford, CA
| | - Patrick R. Pfau
- Department of Medicine, University of Wisconsin, Madison, WI
| | - Patricio M. Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nisa Kubiliun
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN
| | - Jeffrey J. Easler
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN
| | - Aamir Dam
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Shaffer R. Mok
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Michael B. Wallace
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Brian A. Boone
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV
| | - Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, WV
| | - Kimberly J. Fairley
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, WV
| | - Elham Afghani
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Yasser Bhat
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, CA
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, CA
| | - John Nasr
- Department of Medicine, Wheeling Hospital, West Virginia University Health Sciences Center, Morgantown, WV
| | - Wasseem Skef
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA
| | - Nikhil R. Thiruvengadam
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kenneth Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Charles Gabbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tarek Sawas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Tielleman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Anna Tavakkoli
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lynette M. Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Katelyn Smith
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Phoenix D. Bell
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ralph H. Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kenneth K. Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, TX
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Jin He
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Aatur D. Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
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10
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Siddappa PK, Park WG. Pancreatic Cyst Fluid Analysis. Gastrointest Endosc Clin N Am 2023; 33:599-612. [PMID: 37245938 DOI: 10.1016/j.giec.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pancreatic cyst fluid analysis can help diagnose pancreatic cyst type and the risk of high-grade dysplasia and cancer. Recent evidence from molecular analysis of cyst fluid has revolutionized the field with multiple markers showing promise in accurate diagnosis and prognostication of pancreatic cysts. The availability of multi-analyte panels has great potential for more accurate prediction of cancer.
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Affiliation(s)
- Pradeep K Siddappa
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, CA, USA
| | - Walter G Park
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, CA, USA.
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11
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Yadav D, Askew RL, Palermo T, Li L, Andersen DK, Chen M, Fisher WE, Fogel EL, Forsmark CE, Hart PA, Othman MO, Pandol SJ, Park WG, Topazian MD, Van Den Eeden SK, Vege SS, Yang Y, Serrano J, Conwell DL. Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health. Clin Gastroenterol Hepatol 2023; 21:1781-1791.e4. [PMID: 36191836 PMCID: PMC10065964 DOI: 10.1016/j.cgh.2022.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Pain is a cardinal symptom of chronic pancreatitis (CP). Using Patient-Reported Outcomes Measurement Information System (PROMIS) measures, we characterized physical and mental health and symptom profiles of a well-defined cohort of individuals with CP and compared them with control subjects. Among patients with CP, we also examined associations between pain (intensity, temporal nature) and PROMIS symptom profiles and the prevalence of clinically significant psychological comorbidities. METHODS We analyzed baseline data in 488 CP patients and 254 control subjects enrolled in PROCEED (Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies), an ongoing longitudinal cohort study. Participants completed the PROMIS-Global Health, which captures global physical and mental health, and the PROMIS-29 profile, which captures 7 symptom domains. Self-reported pain was categorized by severity (none, mild-moderate, severe) and temporal nature (none, intermittent, constant). Demographic and clinical data were obtained from the PROCEED database. RESULTS Pain was significantly associated with impairments in physical and mental health. Compared with participants with no pain, CP participants with severe pain (but not mild-moderate pain) had more decrements in each PROMIS domain in multivariable models (effect sizes, 2.54-7.03) and had a higher prevalence of clinically significant depression, anxiety, sleep disturbance, and physical disability (odds ratios, 2.11-4.74). Similar results were noted for constant pain (but not intermittent pain) for PROMIS domains (effect sizes, 4.08-10.37) and clinically significant depression, anxiety, sleep disturbance and physical disability (odds ratios, 2.80-5.38). CONCLUSIONS Severe and constant pain are major drivers for poor psychological and physical health in CP. Systematic evaluation and management of psychiatric comorbidities and sleep disturbance should be incorporated into routine management of patients with CP. (ClinicalTrials.gov, Number: NCT03099850).
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Affiliation(s)
- Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Robert L Askew
- Department of Psychology, Stetson University, DeLand, Florida
| | - Tonya Palermo
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Minxing Chen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William E Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, Texas
| | - Evan L Fogel
- Digestive and Liver Disorders, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Yunlong Yang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose Serrano
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
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12
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Hart PA, Kudva YC, Yadav D, Andersen DK, Li Y, Toledo FGS, Wang F, Bellin MD, Bradley D, Brand RE, Cusi K, Fisher W, Mather K, Park WG, Saeed Z, Considine RV, Graham SC, Rinaudo JA, Serrano J, Goodarzi MO. A Reduced Pancreatic Polypeptide Response is Associated With New-onset Pancreatogenic Diabetes Versus Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:e120-e128. [PMID: 36404274 PMCID: PMC10306084 DOI: 10.1210/clinem/dgac670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Pancreatogenic diabetes refers to diabetes mellitus (DM) that develops in the setting of a disease of the exocrine pancreas, including pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP). We sought to evaluate whether a blunted nutrient response of pancreatic polypeptide (PP) can differentiate these DM subtypes from type 2 DM (T2DM). METHODS Subjects with new-onset DM (<3 years' duration) in the setting of PDAC (PDAC-DM, n = 28), CP (CP-DM, n = 38), or T2DM (n = 99) completed a standardized mixed meal tolerance test, then serum PP concentrations were subsequently measured at a central laboratory. Two-way comparisons of PP concentrations between groups were performed using Wilcoxon rank-sum test and analysis of covariance while adjusting for age, sex, and body mass index. RESULTS The fasting PP concentration was lower in both the PDAC-DM and CP-DM groups than in the T2DM group (P = 0.03 and <0.01, respectively). The fold change in PP at 15 minutes following meal stimulation was significantly lower in the PDAC-DM (median, 1.869) and CP-DM (1.813) groups compared with T2DM (3.283; P < 0.01 for both comparisons). The area under the curve of PP concentration was significantly lower in both the PDAC-DM and CP-DM groups than in T2DM regardless of the interval used for calculation and remained significant after adjustments. CONCLUSIONS Fasting PP concentrations and the response to meal stimulation are reduced in new-onset DM associated with PDAC or CP compared with T2DM. These findings support further investigations into the use of PP concentrations to characterize pancreatogenic DM and to understand the pathophysiological role in exocrine pancreatic diseases (NCT03460769).
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Affiliation(s)
- Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Yogish C Kudva
- Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20814, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frederico G S Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Fuchenchu Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Melena D Bellin
- Departments of Pediatrics and Surgery, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Kenneth Cusi
- Division of Endocrinology & Metabolism, University of Florida, Gainesville, FL 32611, USA
| | - William Fisher
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kieren Mather
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Walter G Park
- Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Zeb Saeed
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Robert V Considine
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sarah C Graham
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jo Ann Rinaudo
- Cancer Biomarker Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20814, USA
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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13
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Lee B, Jones EK, Manohar M, Li L, Yadav D, Conwell DL, Hart PA, Vege SS, Fogel EL, Serrano J, Andersen D, Bellin MD, Topazian M, Van Den Eeden SK, Pandol SJ, Forsmark C, Fisher WE, Park WG, Husain SZ, Habtezion A. Distinct serum immune profiles define the spectrum of acute and chronic pancreatitis from the multi-center PROCEED study. Gastroenterology 2023:S0016-5085(23)00594-2. [PMID: 37061168 DOI: 10.1053/j.gastro.2023.03.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND AIMS Pancreatitis is a disease continuum, starting with acute pancreatitis (AP) and, in some cases, progressing to recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). Currently, there are no approved therapies or early diagnostic or prognostic biomarkers for pancreatitis. The current study aimed to examine whether patient serum immune profiling could identify non-invasive biomarkers and provide mechanistic insight into the disease continuum of pancreatitis. METHODS Using Olink immunoassay, we assessed the protein levels of 92 immune markers in serum samples from participants enrolled in the PROCEED study of the CPDPC consortium. Samples (n=231) were obtained from subjects without the pancreatic disease (n=56) and those with chronic abdominal pain (CAP) (n=24), AP (n=38), RAP (n=56), and CP (n=57). RESULTS Thirty-three immune markers differentiated the combined pancreatitis groups from controls. Immune markers related to IL-17 signaling distinguished CP from AP and RAP. Similarly, the serum level of IL-17A and CCL20 differentiated CP from CAP, suggesting the involvement of Th17 cells in CP pathogenesis. The receiver operator characteristic (ROC) curve with two immune markers (IL-17A and ST1A1) could differentiate CP from CAP (optimistic AUC=0.78). Macrophage classical activation pathway elevated along the continuum of pancreatitis, suggesting an accumulation of proinflammatory signals over disease progression. Several immune markers were associated with smoking, alcohol, and diabetes status. CONCLUSION Immune profiling of serum samples from a large pancreatitis cohort led to identifying distinct immune markers that could serve as potential biomarkers to differentiate the varying pancreatitis disease states. In addition, the finding of IL-17 signaling in CP could provide insight into the immune mechanisms underlying disease progression.
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Affiliation(s)
- Bomi Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine, Stanford University, CA.
| | - Elaina K Jones
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine, Stanford University, CA
| | - Murli Manohar
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine, Stanford University, CA
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Dana Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Melena D Bellin
- Division of Pediatric Endocrinology, University of Minnesota, Minnesota, MN
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Chris Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition. University of Florida, Gainesville, FL
| | - William E Fisher
- Division of General Surgery, Baylor College of Medicine, Houston, TX
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sohail Z Husain
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine, Stanford University, CA
| | - Aida Habtezion
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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14
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Abstract
Smart toilets are a key tool for enabling precision health monitoring in the home, but such passive monitoring has ethical considerations.
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Affiliation(s)
- T Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Kevin Mintz
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Seung-Min Park
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.,Molecular Imaging Program at Stanford, Stanford University School of Medicine, CA 94305 USA
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15
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Jeon C, Hart PA, Li L, Yang Y, Chang E, Bellin MD, Fisher WE, Fogel EL, Forsmark CE, Park WG, Van Den Eeden SK, Vege SS, Serrano J, Whitcomb DC, Andersen DK, Conwell DL, Yadav D, Goodarzi MO. Development of a Clinical Prediction Model for Diabetes in Chronic Pancreatitis: The PREDICT3c Study. Diabetes Care 2023; 46:46-55. [PMID: 36382801 PMCID: PMC9797648 DOI: 10.2337/dc22-1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Diabetes that arises from chronic pancreatitis (CP) is associated with increased morbidity and mortality. Methods to predict which patients with CP are at greatest risk for diabetes are urgently needed. We aimed to examine independent risk factors for diabetes in a large cohort of patients with CP. RESEARCH DESIGN AND METHODS This cross-sectional study comprised 645 individuals with CP enrolled in the PROCEED study, of whom 276 had diabetes. We conducted univariable and multivariable regression analyses of potential risk factors for diabetes. Model performance was assessed by area under the receiver operating characteristic curve (AUROC) analysis, and accuracy was evaluated by cross validation. Exploratory analyses were stratified according to the timing of development of diabetes relative to the diagnosis of pancreatitis. RESULTS Independent correlates of diabetes in CP included risk factors for type 2 diabetes (older age, overweight/obese status, male sex, non-White race, tobacco use) as well as pancreatic disease-related factors (history of acute pancreatitis complications, nonalcoholic etiology of CP, exocrine pancreatic dysfunction, pancreatic calcification, pancreatic atrophy) (AUROC 0.745). Type 2 diabetes risk factors were predominant for diabetes occurring before pancreatitis, and pancreatic disease-related factors were predominant for diabetes occurring after pancreatitis. CONCLUSIONS Multiple factors are associated with diabetes in CP, including canonical risk factors for type 2 diabetes and features associated with pancreatitis severity. This study lays the groundwork for the future development of models integrating clinical and nonclinical data to identify patients with CP at risk for diabetes and identifies modifiable risk factors (obesity, smoking) on which to focus for diabetes prevention.
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Affiliation(s)
- Christie Jeon
- Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Yunlong Yang
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Eleanor Chang
- Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melena D. Bellin
- Division of Endocrinology and Metabolism, Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN
| | | | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL
| | - Walter G. Park
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - David C. Whitcomb
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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16
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Paniccia A, Polanco PM, Boone BA, Wald AI, McGrath K, Brand RE, Khalid A, Kubiliun N, O'Broin-Lennon AM, Park WG, Klapman J, Tharian B, Inamdar S, Fasanella K, Nasr J, Chennat J, Das R, DeWitt J, Easler JJ, Bick B, Singh H, Fairley KJ, Sarkaria S, Sawas T, Skef W, Slivka A, Tavakkoli A, Thakkar S, Kim V, Vanderveldt HD, Richardson A, Wallace MB, Brahmbhatt B, Engels M, Gabbert C, Dugum M, El-Dika S, Bhat Y, Ramrakhiani S, Bakis G, Rolshud D, Millspaugh G, Tielleman T, Schmidt C, Mansour J, Marsh W, Ongchin M, Centeno B, Monaco SE, Ohori NP, Lajara S, Thompson ED, Hruban RH, Bell PD, Smith K, Permuth JB, Vandenbussche C, Ernst W, Grupillo M, Kaya C, Hogg M, He J, Wolfgang CL, Lee KK, Zeh H, Zureikat A, Nikiforova MN, Singhi AD. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology 2023; 164:117-133.e7. [PMID: 36209796 PMCID: PMC9844531 DOI: 10.1053/j.gastro.2022.09.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Next-generation sequencing (NGS) of pancreatic cyst fluid is a useful adjunct in the assessment of patients with pancreatic cyst. However, previous studies have been retrospective or single institutional experiences. The aim of this study was to prospectively evaluate NGS on a multi-institutional cohort of patients with pancreatic cyst in real time. METHODS The performance of a 22-gene NGS panel (PancreaSeq) was first retrospectively confirmed and then within a 2-year timeframe, PancreaSeq testing was prospectively used to evaluate endoscopic ultrasound-guided fine-needle aspiration pancreatic cyst fluid from 31 institutions. PancreaSeq results were correlated with endoscopic ultrasound findings, ancillary studies, current pancreatic cyst guidelines, follow-up, and expanded testing (Oncomine) of postoperative specimens. RESULTS Among 1933 PCs prospectively tested, 1887 (98%) specimens from 1832 patients were satisfactory for PancreaSeq testing. Follow-up was available for 1216 (66%) patients (median, 23 months). Based on 251 (21%) patients with surgical pathology, mitogen-activated protein kinase/GNAS mutations had 90% sensitivity and 100% specificity for a mucinous cyst (positive predictive value [PPV], 100%; negative predictive value [NPV], 77%). On exclusion of low-level variants, the combination of mitogen-activated protein kinase/GNAS and TP53/SMAD4/CTNNB1/mammalian target of rapamycin alterations had 88% sensitivity and 98% specificity for advanced neoplasia (PPV, 97%; NPV, 93%). Inclusion of cytopathologic evaluation to PancreaSeq testing improved the sensitivity to 93% and maintained a high specificity of 95% (PPV, 92%; NPV, 95%). In comparison, other modalities and current pancreatic cyst guidelines, such as the American Gastroenterology Association and International Association of Pancreatology/Fukuoka guidelines, show inferior diagnostic performance. The sensitivities and specificities of VHL and MEN1/loss of heterozygosity alterations were 71% and 100% for serous cystadenomas (PPV, 100%; NPV, 98%), and 68% and 98% for pancreatic neuroendocrine tumors (PPV, 85%; NPV, 95%), respectively. On follow-up, serous cystadenomas with TP53/TERT mutations exhibited interval growth, whereas pancreatic neuroendocrine tumors with loss of heterozygosity of ≥3 genes tended to have distant metastasis. None of the 965 patients who did not undergo surgery developed malignancy. Postoperative Oncomine testing identified mucinous cysts with BRAF fusions and ERBB2 amplification, and advanced neoplasia with CDKN2A alterations. CONCLUSIONS PancreaSeq was not only sensitive and specific for various pancreatic cyst types and advanced neoplasia arising from mucinous cysts, but also reveals the diversity of genomic alterations seen in pancreatic cysts and their clinical significance.
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Affiliation(s)
- Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Patricio M Polanco
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Brian A Boone
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Abigail I Wald
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Randall E Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Nisa Kubiliun
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Marie O'Broin-Lennon
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Walter G Park
- Department of Medicine, Stanford University, Stanford, California
| | - Jason Klapman
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Benjamin Tharian
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sumant Inamdar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kenneth Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Nasr
- Department of Medicine, Wheeling Hospital, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Jeffrey J Easler
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Benjamin Bick
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kimberly J Fairley
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tarek Sawas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wasseem Skef
- Department of Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anna Tavakkoli
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Victoria Kim
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Michael B Wallace
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida; Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Bhaumik Brahmbhatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Megan Engels
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Charles Gabbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mohannad Dugum
- Digestive Health Center, Essentia Health-Duluth Clinic, Duluth, Minnesota
| | - Samer El-Dika
- Department of Medicine, Stanford University, Stanford, California
| | - Yasser Bhat
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | | | | | | | - Thomas Tielleman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carl Schmidt
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - John Mansour
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barbara Centeno
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Sara E Monaco
- Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth D Thompson
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Phoenix D Bell
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katelyn Smith
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer B Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christopher Vandenbussche
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wayne Ernst
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria Grupillo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Cihan Kaya
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Hogg
- Department of Surgery, NorthShore University Health System, Chicago, Illinois
| | - Jin He
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher L Wolfgang
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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17
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Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Persohn SA, Dasyam AK, Shah ZK, Venkatesh SK, Takahashi N, Wachsman A, Li L, Li Y, Pandol SJ, Park WG, Vege SS, Hart PA, Topazian M, Andersen DK, Fogel EL. Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP). Abdom Radiol (NY) 2022; 47:3792-3805. [PMID: 36038644 PMCID: PMC9423890 DOI: 10.1007/s00261-022-03654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine if quantitative MRI techniques can be helpful to evaluate chronic pancreatitis (CP) in a setting of multi-institutional study. METHODS This study included a subgroup of participants (n = 101) enrolled in the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study (NCT03099850) from February 2019 to May 2021. MRI was performed on 1.5 T using Siemens and GE scanners at seven clinical centers across the USA. Quantitative MRI parameters of the pancreas included T1 relaxation time, extracellular volume (ECV) fraction, apparent diffusion coefficient (ADC), and fat signal fraction. We report the diagnostic performance and mean values within the control (n = 50) and CP (n = 51) groups. The T1, ECV and fat signal fraction were combined to generate the quantitative MRI score (Q-MRI). RESULTS There was significantly higher T1 relaxation time; mean 669 ms (± 171) vs. 593 ms (± 82) (p = 0.006), ECV fraction; 40.2% (± 14.7) vs. 30.3% (± 11.9) (p < 0.001), and pancreatic fat signal fraction; 12.2% (± 5.5) vs. 8.2% (± 4.4) (p < 0.001) in the CP group compared to controls. The ADC was similar between groups (p = 0.45). The AUCs for the T1, ECV, and pancreatic fat signal fraction were 0.62, 0.72, and 0.73, respectively. The composite Q-MRI score improved the diagnostic performance (cross-validated AUC: 0.76). CONCLUSION Quantitative MR parameters evaluating the pancreatic parenchyma (T1, ECV fraction, and fat signal fraction) are helpful in the diagnosis of CP. A Q-MRI score that combines these three MR parameters improves diagnostic performance. Further studies are warranted with larger study populations including patients with acute and recurrent acute pancreatitis and longitudinal follow-ups.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine Indianapolis, 550 N. University Blvd. Suite 0663, Indianapolis, IN 46202 USA
| | - Dhiraj Yadav
- Department of Medicine Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Darwin L. Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY USA
| | - Paul R. Territo
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Scott A. Persohn
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Anil K. Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Zarine K. Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | | | - Ashley Wachsman
- Department of Radiology Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA USA
| | - Liang Li
- Department of Biostatistics Director, Quantitative Science Program, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Yan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Stephen J. Pandol
- Division of Digestive and Liver Diseases Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Walter G. Park
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA USA
| | - Santhi S. Vege
- Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology & Nutrition The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD USA
| | - Evan L. Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN USA
| | - On behalf of the Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer (CPDPC)
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine Indianapolis, 550 N. University Blvd. Suite 0663, Indianapolis, IN 46202 USA
- Department of Medicine Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY USA
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH USA
- Department of Radiology, Mayo Clinic, Rochester, MN USA
- Department of Radiology Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA USA
- Department of Biostatistics Director, Quantitative Science Program, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Division of Digestive and Liver Diseases Cedars-Sinai Medical Center, Los Angeles, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
- Division of Gastroenterology, Hepatology & Nutrition The Ohio State University Wexner Medical Center, Columbus, OH USA
- Mayo Clinic, Rochester, MN USA
- Division of Digestive Diseases and Nutrition National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD USA
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN USA
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18
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Tirkes T, Dasyam AK, Shah ZK, Fogel EL, Vege SS, Li L, Li S, Chang ST, Farinas CA, Grajo JR, Mawad K, Takahashi N, Venkatesh SK, Wachsman A, Fisher WE, Forsmark CE, Hart PA, Pandol SJ, Park WG, Van Den Eeden SK, Yang Y, Topazian M, Andersen DK, Serrano J, Conwell DL, Yadav D. T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis. Abdom Radiol (NY) 2022; 47:3507-3519. [PMID: 35857066 PMCID: PMC10020893 DOI: 10.1007/s00261-022-03611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study. METHODS The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institution used a standardized method to measure the T1 signal intensity of the pancreas and the reference organs (spleen, paraspinal muscle, liver), which was used to derive respective T1 scores. Participants were stratified according to the seven mechanistic stages of chronic pancreatitis (MSCP 0-6) based on their clinical history, MRCP, and CT findings. RESULTS The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p < 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals. CONCLUSION The T1 score calculated by SIR of the pancreas-to-spleen shows a negative linear correlation with the progression of chronic pancreatitis. It holds promise as a practical imaging biomarker in evaluating disease severity in clinical research and practice.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shuang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephanie T Chang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos A Farinas
- Baylor College of Medicine, Radiology Department, TX, Houston, USA
| | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Kareem Mawad
- The Permanente Medical Group, South San Francisco Medical Center, South San Francisco, CA, 94080, USA
| | | | | | - Ashley Wachsman
- Department of Radiology, Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA, USA
| | - William E Fisher
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, 32610, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | | | - Yunlong Yang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Dhiraj Yadav
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Hart PA, Yadav D, Li L, Appana S, Fisher W, Fogel E, Forsmark CE, Park WG, Pandol S, Topazian MD, Van Den Eden SK, Vege SS, Bradley D, Serrano J, Conwell DL. High Prevalence of Osteopathy in Chronic Pancreatitis: A Cross-sectional Analysis From the PROCEED Study. Clin Gastroenterol Hepatol 2022; 20:2005-2013. [PMID: 34571258 PMCID: PMC8942866 DOI: 10.1016/j.cgh.2021.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP. METHODS We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression model with forward selection to identify risk factors for osteopathy. RESULTS The majority of subjects had osteopathy on DXA scan (56.0%; 17.0% osteoporosis; 39.0% osteopenia). Subjects with osteopathy had a higher prevalence of traumatic (40.0% vs 26.4%; P = .02) and spontaneous fractures (3.9% vs 0; P = .04). On multivariate analysis, older age (odds ratio [OR], 1.29 per 5 years; 95% confidence interval [CI], 1.15-1.45), female sex (OR, 3.08; 95% CI, 1.75-5.43), white race (OR, 2.68; 95% CI, 1.20-6.01), and underweight body mass index category (OR, 7.40; 95% CI, 1.56-34.99) were associated with higher probability of osteopathy. There were no significant associations between osteopathy and other patient and disease-related features of CP. CONCLUSION In the largest study of patients with CP who underwent DXA screening, the majority had osteopathy. There are overlapping risk factors with osteopathy in the general population, but the high prevalence in men and younger women supports the need for future investigations into the mechanisms of bone loss in CP. CLINICALTRIALS gov number, NCT03099850.
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Affiliation(s)
- Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Savi Appana
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - William Fisher
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Evan Fogel
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Chris E Forsmark
- Division of Gastroenterology, University of Florida, Gainesville, Florida
| | - Walter G Park
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, California
| | - Stephen Pandol
- Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - David Bradley
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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20
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Kamaya A, Fung C, Szpakowski JL, Fetzer DT, Walsh AJ, Alimi Y, Bingham DB, Corwin MT, Dahiya N, Gabriel H, Park WG, Porembka MR, Rodgers SK, Tublin ME, Yuan X, Zhang Y, Middleton WD. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305:277-289. [PMID: 35787200 DOI: 10.1148/radiol.213079] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.
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Affiliation(s)
- Aya Kamaya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Christopher Fung
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Jean-Luc Szpakowski
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David T Fetzer
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Andrew J Walsh
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yewande Alimi
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David B Bingham
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Michael T Corwin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Helena Gabriel
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Walter G Park
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Matthew R Porembka
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Shuchi K Rodgers
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Mitchell E Tublin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Xin Yuan
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yang Zhang
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - William D Middleton
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
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21
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Tirkes T, Chinchilli VM, Bagci U, Parker JG, Zhao X, Dasyam AK, Feranec N, Grajo JR, Shah ZK, Poullos PD, Spilseth B, Zaheer A, Xie KL, Wachsman AM, Campbell-Thompson M, Conwell DL, Fogel EL, Forsmark CE, Hart PA, Pandol SJ, Park WG, Pratley RE, Yazici C, Laughlin MR, Andersen DK, Serrano J, Bellin MD, Yadav D. Design and Rationale for the Use of Magnetic Resonance Imaging Biomarkers to Predict Diabetes After Acute Pancreatitis in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: From the Type 1 Diabetes in Acute Pancreatitis Consortium. Pancreas 2022; 51:586-592. [PMID: 36206463 PMCID: PMC9756870 DOI: 10.1097/mpa.0000000000002080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT This core component of the Diabetes RElated to Acute pancreatitis and its Mechanisms (DREAM) study will examine the hypothesis that advanced magnetic resonance imaging (MRI) techniques can reflect underlying pathophysiologic changes and provide imaging biomarkers that predict diabetes mellitus (DM) after acute pancreatitis (AP). A subset of participants in the DREAM study will enroll and undergo serial MRI examinations using a specific research protocol. The aim of the study is to differentiate at-risk individuals from those who remain euglycemic by identifying parenchymal features after AP. Performing longitudinal MRI will enable us to observe and understand the natural history of post-AP DM. We will compare MRI parameters obtained by interrogating tissue properties in euglycemic, prediabetic, and incident diabetes subjects and correlate them with metabolic, genetic, and immunological phenotypes. Differentiating imaging parameters will be combined to develop a quantitative composite risk score. This composite risk score will potentially have the ability to monitor the risk of DM in clinical practice or trials. We will use artificial intelligence, specifically deep learning, algorithms to optimize the predictive ability of MRI. In addition to the research MRI, the DREAM study will also correlate clinical computed tomography and MRI scans with DM development.
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Affiliation(s)
- Temel Tirkes
- From the Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | | | - Jason G Parker
- From the Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Xuandong Zhao
- From the Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Joseph R Grajo
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL
| | - Zarine K Shah
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Benjamin Spilseth
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins Medicine, Baltimore, MD
| | - Karen L Xie
- Department of Radiology, University of Illinois at Chicago, Chicago, IL
| | - Ashley M Wachsman
- Department of Radiology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Martha Campbell-Thompson
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN
| | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA
| | | | - Cemal Yazici
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | | | - Dana K Andersen
- Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Jose Serrano
- Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Wasserfall C, Dyer AM, Speake C, Andersen DK, Baab KT, Bellin MD, Broach JR, Campbell-Thompson M, Chinchilli VM, Lee PJ, Park WG, Pratley RE, Saloman JL, Sims EK, Tang G, Yadav D, Yazici C, Conwell DL. Standard Operating Procedures for Biospecimen Collection, Processing, and Storage: From the Type 1 Diabetes in Acute Pancreatitis Consortium. Pancreas 2022; 51:593-597. [PMID: 36206464 PMCID: PMC9555853 DOI: 10.1097/mpa.0000000000002077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Differences in methods for biospecimen collection, processing, and storage can yield considerable variability and error. Therefore, best practices for standard operating procedures are critical for successful discovery, development, and validation of disease biomarkers. Here, we describe standard operating procedures developed for biospecimen collection during the DREAM (Diabetes RElated to Acute pancreatitis and its Mechanisms) Study within the Type 1 Diabetes in Acute Pancreatitis Consortium. Notably, these protocols were developed using an integrative process based on prior consortium experience and with input from working groups with expertise in immunology, pancreatitis, and diabetes. Publication and adoption consistent biospecimen protocols will inform future studies and allow for better comparisons across different metabolic research efforts.
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Affiliation(s)
- Clive Wasserfall
- From the Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Anne-Marie Dyer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Cate Speake
- Diabetes Clinical Research Program, Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Dana K Andersen
- Division of Digestive Disease and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kendall Thomas Baab
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | | | - James R Broach
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, PA
| | - Martha Campbell-Thompson
- From the Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Walter G Park
- Division of Gastroenterology, Stanford University School of Medicine, Palo Alto, CA
| | | | - Jami L Saloman
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Emily K Sims
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Gong Tang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Cemal Yazici
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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23
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Hart PA, Papachristou GI, Park WG, Dyer AM, Chinchilli VM, Afghani E, Akshintala VS, Andersen DK, Buxbaum JL, Conwell DL, Dungan KM, Easler JJ, Fogel EL, Greenbaum CJ, Kalyani RR, Korc M, Kozarek R, Laughlin MR, Lee PJ, Maranki JL, Pandol SJ, Phillips AE, Serrano J, Singh VK, Speake C, Tirkes T, Toledo FG, Trikudanathan G, Vege SS, Wang M, Yazici C, Zaheer A, Forsmark CE, Bellin MD, Yadav D. Rationale and Design for the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study: A Prospective Cohort Study From the Type 1 Diabetes in Acute Pancreatitis Consortium. Pancreas 2022; 51:568-574. [PMID: 36206460 PMCID: PMC9555871 DOI: 10.1097/mpa.0000000000002079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Acute pancreatitis (AP) is a disease characterized by an acute inflammatory phase followed by a convalescent phase. Diabetes mellitus (DM) was historically felt to be a transient phenomenon related to acute inflammation; however, it is increasingly recognized as an important late and chronic complication. There are several challenges that have prevented precisely determining the incidence rate of DM after AP and understanding the underlying mechanisms. The DREAM (Diabetes RElated to Acute Pancreatitis and its Mechanisms) Study is a prospective cohort study designed to address these and other knowledge gaps to provide the evidence needed to screen for, prevent, and treat DM after AP. In the following article, we summarize literature regarding the epidemiology of DM after AP and provide the rationale and an overview of the DREAM study.
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Affiliation(s)
- Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Walter G. Park
- Division of Gastroenterology, Stanford University School of Medicine, Palo Alto, CA
| | - Anne-Marie Dyer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Elham Afghani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Venkata S. Akshintala
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - James L. Buxbaum
- Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeffrey J. Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Carla J. Greenbaum
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Murray Korc
- Division of Endocrinology, University of California Irvine, Irvine, CA
| | - Richard Kozarek
- Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA
- Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA
| | - Maren R. Laughlin
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Peter J. Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jennifer L. Maranki
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Milton Hershey Medical Center, Hershey, PA
| | - Stephen J. Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Anna Evans Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Vikesh K. Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA
| | - Temel Tirkes
- Department of Radiology and Imaging Services, Indiana University, Indianapolis, IN
| | - Frederico G.S. Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Cemal Yazici
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Atif Zaheer
- Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Christopher E. Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL
| | - Melena D. Bellin
- Departments of Pediatrics and Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Manohar M, Jones EK, Rubin SJS, Subrahmanyam PB, Swaminathan G, Mikhail D, Bai L, Singh G, Wei Y, Sharma V, Siebert JC, Maecker HT, Husain SZ, Park WG, Pandol SJ, Habtezion A. Novel Circulating and Tissue Monocytes as Well as Macrophages in Pancreatitis and Recovery. Gastroenterology 2021; 161:2014-2029.e14. [PMID: 34450180 PMCID: PMC8796698 DOI: 10.1053/j.gastro.2021.08.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Acute pancreatitis (AP) is an inflammatory disease with mild to severe course that is associated with local and systemic complications and significant mortality. Uncovering inflammatory pathways that lead to progression and recovery will inform ways to monitor and/or develop effective therapies. METHODS We performed single-cell mass Cytometry by Time Of Flight (CyTOF) analysis to identify pancreatic and systemic inflammatory signals during mild AP (referred to as AP), severe AP (SAP), and recovery using 2 independent experimental models and blood from patients with AP and recurrent AP. Flow cytometric validation of monocytes subsets identified using CyTOF analysis was performed independently. RESULTS Ly6C+ inflammatory monocytes were the most altered cells in the pancreas during experimental AP, recovery, and SAP. Deep profiling uncovered heterogeneity among pancreatic and blood monocytes and identified 7 novel subsets during AP and recovery, and 6 monocyte subsets during SAP. Notably, a dynamic shift in pancreatic CD206+ macrophage population was observed during AP and recovery. Deeper profiling of the CD206+ macrophage identified 7 novel subsets during AP, recovery, and SAP. Differential expression analysis of these novel monocyte and CD206+ macrophage subsets revealed significantly altered surface (CD44, CD54, CD115, CD140a, CD196, podoplanin) and functional markers (interferon-γ, interleukin 4, interleukin 22, latency associated peptide-transforming growth factor-β, tumor necrosis factor-α, T-bet, RoRγt) that were associated with recovery and SAP. Moreover, a targeted functional analysis further revealed distinct expression of pro- and anti-inflammatory cytokines by pancreatic CD206+ macrophage subsets as the disease either progressed or resolved. Similarly, we identified heterogeneity among circulating classical inflammatory monocytes (CD14+CD16-) and novel subsets in patients with AP and recurrent AP. CONCLUSIONS We identified several novel monocyte/macrophage subsets with unique phenotype and functional characteristics that are associated with AP, recovery, and SAP. Our findings highlight differential innate immune responses during AP progression and recovery that can be leveraged for future disease monitoring and targeting.
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Affiliation(s)
- Murli Manohar
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - Elaina K Jones
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Samuel J S Rubin
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Priyanka B Subrahmanyam
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California
| | - Gayathri Swaminathan
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - David Mikhail
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lawrence Bai
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Gulshan Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yi Wei
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Vishal Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Holden T Maecker
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California
| | - Sohail Z Husain
- Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aida Habtezion
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California.
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25
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Park WG, Sandhu A, MaCurdy T. Development of a Cost Measure for Screening/Surveillance Colonoscopy for the Merit-Based Incentive Payment System. Gastroenterology 2021; 161:4-7.e4. [PMID: 33798526 DOI: 10.1053/j.gastro.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Alex Sandhu
- Acumen, Burlingame, California; Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Abstract
Diabetes following acute pancreatitis (AP) is becoming increasingly recognized. It is unclear what subtype of diabetes mellitus (DM) occurs; however, type 3c diabetes mellitus (T3cDM) is gaining increasing recognition. T3cDM has differing pathophysiology than other subtypes of DM and therefore differing disease course and treatment. Current studies have examined the incidence and prevalence of DM following AP, and meta-analyses have shown around 15% develop DM at 1 year with an increasing proportion developing DM at 5 years. It has been observed that some patients have transient hyperglycemia following AP episode with a subset developing persistent impaired glucose metabolism; however, the exact timeline is not well defined. The data on risk factors for developing DM after AP is limited and mixed; however, it is likely that severity of AP may impact the propensity to develop DM. Screening guidelines have not been established following AP; however, screening 1-year post-event will likely capture a sizable proportion of newly developed DM. The endocrine and exocrine pancreas are closely linked, and studies have found significant overlap in dysfunction of both after AP. Finally, there are some data to suggest that diabetes predisposes patients to structural changes in the pancreas and increased risk of developing AP.
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Affiliation(s)
- Allyson Richardson
- Department of Internal Medicine, Stanford University Medical Center, Stanford, CA,
USA
| | - Walter G. Park
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA,
USA
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27
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Zaid M, Elganainy D, Dogra P, Dai A, Widmann L, Fernandes P, Wang Z, Pelaez MJ, Ramirez JR, Singhi AD, Dasyam AK, Brand RE, Park WG, Rahmanuddin S, Rosenthal MH, Wolpin BM, Khalaf N, Goel A, Von Hoff DD, Tamm EP, Maitra A, Cristini V, Koay EJ. Imaging-Based Subtypes of Pancreatic Ductal Adenocarcinoma Exhibit Differential Growth and Metabolic Patterns in the Pre-Diagnostic Period: Implications for Early Detection. Front Oncol 2020; 10:596931. [PMID: 33344245 PMCID: PMC7738633 DOI: 10.3389/fonc.2020.596931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previously, we characterized subtypes of pancreatic ductal adenocarcinoma (PDAC) on computed-tomography (CT) scans, whereby conspicuous (high delta) PDAC tumors are more likely to have aggressive biology and poorer clinical outcomes compared to inconspicuous (low delta) tumors. Here, we hypothesized that these imaging-based subtypes would exhibit different growth-rates and distinctive metabolic effects in the period prior to PDAC diagnosis. MATERIALS AND METHODS Retrospectively, we evaluated 55 patients who developed PDAC as a second primary cancer and underwent serial pre-diagnostic (T0) and diagnostic (T1) CT-scans. We scored the PDAC tumors into high and low delta on T1 and, serially, obtained the biaxial measurements of the pancreatic lesions (T0-T1). We used the Gompertz-function to model the growth-kinetics and estimate the tumor growth-rate constant (α) which was used for tumor binary classification, followed by cross-validation of the classifier accuracy. We used maximum-likelihood estimation to estimate initiation-time from a single cell (10-6 mm3) to a 10 mm3 tumor mass. Finally, we serially quantified the subcutaneous-abdominal-fat (SAF), visceral-abdominal-fat (VAF), and muscles volumes (cm3) on CT-scans, and recorded the change in blood glucose (BG) levels. T-test, likelihood-ratio, Cox proportional-hazards, and Kaplan-Meier were used for statistical analysis and p-value <0.05 was considered significant. RESULTS Compared to high delta tumors, low delta tumors had significantly slower average growth-rate constants (0.024 month-1 vs. 0.088 month-1, p<0.0001) and longer average initiation-times (14 years vs. 5 years, p<0.0001). α demonstrated high accuracy (area under the curve (AUC)=0.85) in classifying the tumors into high and low delta, with an optimal cut-off of 0.034 month-1. Leave-one-out-cross-validation showed 80% accuracy in predicting the delta-class (AUC=0.84). High delta tumors exhibited accelerated SAF, VAF, and muscle wasting (p <0.001), and BG disturbance (p<0.01) compared to low delta tumors. Patients with low delta tumors had better PDAC-specific progression-free survival (log-rank, p<0.0001), earlier stage tumors (p=0.005), and higher likelihood to receive resection after PDAC diagnosis (p=0.008), compared to those with high delta tumors. CONCLUSION Imaging-based subtypes of PDAC exhibit distinct growth, metabolic, and clinical profiles during the pre-diagnostic period. Our results suggest that heterogeneous disease biology may be an important consideration in early detection strategies for PDAC.
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Affiliation(s)
- Mohamed Zaid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dalia Elganainy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, United States
| | - Annie Dai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lauren Widmann
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pearl Fernandes
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, United States
| | - Maria J. Pelaez
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, United States
| | - Javier R. Ramirez
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, United States
| | - Aatur D. Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anil K. Dasyam
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Randall E. Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Walter G. Park
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Syed Rahmanuddin
- Department of Radiology, City of Hope, Duarte, CA, United States
| | - Michael H. Rosenthal
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Brian M. Wolpin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Natalia Khalaf
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ajay Goel
- Department of Molecular Diagnostics and Experimental Therapeutics, City of Hope, Duarte, CA, United States
| | - Daniel D. Von Hoff
- Molecular Medicine, Translational Genomics Research Institute, Phoenix, AZ, United States
| | - Eric P. Tamm
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anirban Maitra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, United States
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Eugene J. Koay,
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28
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Park WG, Li L, Appana S, Wei W, Stello K, Andersen DK, Hughes SJ, Whitcomb DC, Brand RE, Yadav D, Habtezion A. Unique circulating immune signatures for recurrent acute pancreatitis, chronic pancreatitis and pancreatic cancer: A pilot study of these conditions with and without diabetes. Pancreatology 2020; 20:51-59. [PMID: 31791885 PMCID: PMC6983346 DOI: 10.1016/j.pan.2019.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This exploratory study seeks to identify distinct circulating immune signatures among patients having recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), and pancreatic adenocarcinoma (PDAC). METHODS A retrospective analysis of human serum samples from collaborating institutions of the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was performed. Samples came from the North American Pancreatitis Studies 2 (NAPS2) cohort and the Pancreatic Adenocarcinoma Gene Environment Risk Study (PAGER) and were analyzed using a 62-plex Luminex assay in a blinded fashion. Group and pairwise comparisons were performed to identify unique immune signature panels and to calculate diagnostic utility using area under the curve analysis. RESULTS A total of 179 patients' samples were included: 41 controls, 40 CP, 78 PDAC and 20 RAP patients, of which 20 controls, 20 CP, and 58 PDAC patients had diabetes mellitus (DM). A unique immune signature panel could discriminate RAP, CP, and PDAC from controls with an AUC range from 0.77 to 0.86 (95% CI range: 0.64-0.94), RAP from CP, and CP from PDAC with an AUC of 0.77 (95% CI 0.64-0.90) and 0.76 (95% CI 0.67-0.86), respectively. Furthermore, an immune signature panel could also discriminate PDAC-DM from DM controls with an AUC of 0.96 (95% CI: 0.93-1.00) CONCLUSION: This study identifies unique immune analytes that may serve as novel diagnostic and predictive non-invasive biomarkers of RAP, CP, and PDAC. Further validation is warranted in prospective cohorts as developed by the CPDPC.
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Affiliation(s)
- Walter G Park
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Liang Li
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Savitri Appana
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kimberly Stello
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Steven J Hughes
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aida Habtezion
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
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29
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Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Venkatesh SK, Kolipaka A, Li L, Pisegna JR, Pandol SJ, Park WG, Topazian M, Serrano J, Fogel EL. Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Abdom Radiol (NY) 2019; 44:2809-2821. [PMID: 31089778 DOI: 10.1007/s00261-019-02049-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Characteristic features of chronic pancreatitis (CP) may be absent on standard imaging studies. Quantitative Magnetic Resonance Imaging (MRI) techniques such as T1 mapping, extracellular volume (ECV) fraction, diffusion-weighted imaging (DWI) with apparent diffusion coefficient map (ADC), MR elastography (MRE), and T1-weighted signal intensity ratio (SIR) have shown promise for the diagnosis and grading severity of CP. However, radiologists still use the Cambridge classification which is based on traditional ductal imaging alone. There is an urgent need to develop new diagnostic criteria that incorporate both parenchymal and ductal features of CP seen by MRI/MRCP. Designed to fulfill this clinical need, we present the MINIMAP study, which was funded in September 2018 by the National Institutes of Health. This is a comprehensive quantitative MR imaging study which will be performed at multiple institutions in well-phenotyped CP patient cohorts. We hypothesize that quantitative MRI/MRCP features can serve as valuable non-invasive imaging biomarkers to detect and grade CP. We will evaluate the role of T1 relaxometry, ECV, T1-weighted gradient echo SIR, MRE, arteriovenous enhancement ratio, ADC, pancreas volume/atrophy, pancreatic fat fraction, ductal features, and pancreatic exocrine output following secretin stimulation in the assessment of CP. We will attempt to generate a multi-parametric pancreatic tissue fibrosis (PTF) scoring system. We anticipate that a quantitative scoring system may serve as a biomarker of pancreatic fibrosis; hence this imaging technique can be used in clinical practice as well as clinical trials to evaluate the efficacy of agents which may slow the progression or reverse measures of CP.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Darwin L Conwell
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul R Territo
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 W. Walnut Street, R2 E124G, Indianapolis, IN, 46202, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 W. Walnut Street, R2 E124G, Indianapolis, IN, 46202, USA
| | | | - Arunark Kolipaka
- The Ohio State University Wexner Medical Center, 395 West 12th AVE, 4th Floor, Columbus, OH, 43210, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph R Pisegna
- Division of Gastroenterology and Hepatology, Departments of Medicine and Human Genetics, VA Greater Los Angeles HCS, Los Angeles, CA, USA
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Campus, Rochester, MN, USA
| | - Jose Serrano
- CAPT, Medical Corps US Public Health Service, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, 2 Democracy Plaza, Room 6007, MSC 5450, Bethesda, MD, 20892, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
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Thiruvengadam SS, Chuang J, Huang R, Girotra M, Park WG. Chronic pancreatitis changes in high-risk individuals for pancreatic ductal adenocarcinoma. Gastrointest Endosc 2019; 89:842-851.e1. [PMID: 30145314 PMCID: PMC6589432 DOI: 10.1016/j.gie.2018.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Pancreatic intraepithelial neoplasia is associated with chronic pancreatitis (CP) changes on EUS. The objective of this study was to determine whether CP changes were more common in high-risk individuals (HRIs) than in control subjects and whether these changes differed among higher-risk subsets of HRIs. METHODS HRIs and control subjects were identified from an endoscopy database. HRIs were defined as having predisposing mutations or a family history (FH) of pancreatic ductal adenocarcinoma. HRIs were classified as vHRIs who met Cancer of the Pancreas Screening (CAPS) criteria for high risk and mHRIs who did not. Multivariable logistic regression was used to adjust for confounders and CP risk factors. RESULTS Sixty-five HRIs (44 vHRIs, 21 mHRIs) and 118 control subjects were included. HRIs were included for FH (25), Lynch syndrome (5), Peutz-Jeghers syndrome (2), and mutations in BRCA1/2 (26), PALB2 (3), ATM (3), and CDKN2A (1). After adjustment for relevant variables, HRIs were 16 times more likely to exhibit 3 or more CP changes than control subjects (95% confidence interval, 2.6-97.0; P = .003). HRIs were also more likely to have hypoechoic foci (odds ratio, 8.0; 95% confidence interval, 1.9-32.9; P = .004). vHRIs and mHRIs did not differ in frequency of 3 or more CP changes on EUS. CONCLUSIONS HRIs were more likely to exhibit CP changes and hypoechoic foci on EUS compared with control subjects. HRIs with these findings may require closer surveillance. HRIs who did or did not meet CAPS criteria did not differ with regard to CP findings, supporting a more inclusive approach to screening.
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Affiliation(s)
| | - Judith Chuang
- Department of Gastroenterology and Hepatology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Robert Huang
- Department of Gastroenterology and Hepatology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Mohit Girotra
- Department of Gastroenterology and Hepatology, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Walter G. Park
- Department of Gastroenterology and Hepatology, Stanford Hospital and Clinics, Stanford, California, USA
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Lee LS, Andersen DK, Ashida R, Brugge WR, Canto MI, Chang KJ, Chari ST, DeWitt J, Hwang JH, Khashab MA, Kim K, Levy MJ, McGrath K, Park WG, Singhi A, Stevens T, Thompson CC, Topazian MD, Wallace MB, Wani S, Waxman I, Yadav D, Singh VK. EUS and related technologies for the diagnosis and treatment of pancreatic disease: research gaps and opportunities-Summary of a National Institute of Diabetes and Digestive and Kidney Diseases workshop. Gastrointest Endosc 2017; 86:768-778. [PMID: 28941651 PMCID: PMC6698378 DOI: 10.1016/j.gie.2017.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic EUS. The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.
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Affiliation(s)
- Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Reiko Ashida
- Departments of Cancer Survey and Gastrointestinal Oncology, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan
| | - William R Brugge
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mimi I Canto
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenneth J Chang
- Comprehensive Digestive Disease Center, Department of Gastroenterology and Hepatology, University of California at Irvine Health, Orange, California, USA
| | - Suresh T Chari
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John DeWitt
- Division of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Joo Ha Hwang
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kang Kim
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J Levy
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin McGrath
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Walter G Park
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Aatur Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Sewickley, Pennsylvania, USA
| | - Tyler Stevens
- Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark D Topazian
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Irving Waxman
- Department of Medicine, The University of Chicago Comprehensive Cancer Center, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Dhiraj Yadav
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dua MM, Worhunsky DJ, Malhotra L, Park WG, Poultsides GA, Norton JA, Visser BC. Transgastric pancreatic necrosectomy-expedited return to prepancreatitis health. J Surg Res 2017; 219:11-17. [PMID: 29078869 DOI: 10.1016/j.jss.2017.05.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/23/2017] [Accepted: 05/24/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The best operative strategy for necrotizing pancreatitis remains controversial. Traditional surgical necrosectomy is associated with significant morbidity; endoscopic and percutaneous strategies require repeated interventions with prolonged hospitalizations. We have developed a transgastric approach to pancreatic necrosectomy to overcome the shortcomings of the other techniques described. MATERIALS AND METHODS Patients with necrotizing pancreatitis treated from 2009 to 2016 at an academic center were retrospectively reviewed. Open or laparoscopic transgastric necrosectomy was performed if the area of necrosis was walled-off and in a retrogastric position on cross-sectional imaging. Study endpoints included postoperative complications and mortality. RESULTS Forty-six patients underwent transgastric necrosectomy (nine open and 37 laparoscopic). Median (interquartile range) preoperative Acute Physiologic and Chronic Health Evaluation II score was 6 (3-12). Seventy percent of patients had >30% necrosis on preoperative imaging; infected necrosis was present in 35%. Median total length of stay (LOS) was 6 (3-12) d. No patient required a second operative debridement; four patients (9%) had short-term postoperative percutaneous drainage for residual fluid collections. Median follow-up was 1 y; there were no fistula or wound complications. Six patients (13%) had postoperative bleeding; five patients received treatment by image-guided embolization. There was one death in the cohort. CONCLUSIONS Transgastric pancreatic necrosectomy allows for effective debridement with a single definitive operation. When anatomically suitable, this operative strategy offers expedited recovery and avoids long-term morbidity associated with fistulas and prolonged drainage.
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Affiliation(s)
- Monica M Dua
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - David J Worhunsky
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Lavina Malhotra
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Walter G Park
- Division of Gastroenterology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - George A Poultsides
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Jeffrey A Norton
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brendan C Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California
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Ivry SL, Sharib JM, Dominguez DA, Roy N, Hatcher SE, Yip-Schneider MT, Schmidt CM, Brand RE, Park WG, Hebrok M, Kim GE, O'Donoghue AJ, Kirkwood KS, Craik CS. Global Protease Activity Profiling Provides Differential Diagnosis of Pancreatic Cysts. Clin Cancer Res 2017; 23:4865-4874. [PMID: 28424202 DOI: 10.1158/1078-0432.ccr-16-2987] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/23/2017] [Accepted: 04/14/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Sam L Ivry
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California.,Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California, San Francisco, San Francisco, California
| | - Jeremy M Sharib
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Dana A Dominguez
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Nilotpal Roy
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Stacy E Hatcher
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Randall E Brand
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Walter G Park
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthias Hebrok
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Grace E Kim
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Anthony J O'Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Chemistry, University of California, San Diego, La Jolla, California
| | - Kimberly S Kirkwood
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Charles S Craik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California.
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Sighinolfi M, Quan SY, Lee Y, Ibaseta A, Pham K, Dua MM, Poultsides GA, Visser BC, Norton JA, Park WG. Fukuoka and AGA Criteria Have Superior Diagnostic Accuracy for Advanced Cystic Neoplasms than Sendai Criteria. Dig Dis Sci 2017; 62:626-632. [PMID: 28116593 DOI: 10.1007/s10620-017-4460-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/12/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of this study was to compare the American Gastroenterological Association guidelines (AGA criteria), the 2012 (Fukuoka criteria), and 2006 (Sendai criteria) International Consensus Guidelines for the diagnosis of advanced pancreatic cystic neoplasms. METHODS All patients who underwent surgical resection of a pancreatic cyst from August 2007 through January 2016 were retrospectively analyzed at a single tertiary academic center. Relevant clinical and imaging variables along with pathology results were collected to determine appropriate classification for each guideline. Advanced pancreatic cystic neoplasms were defined by the presence of either high-grade dysplasia or cystic adenocarcinoma. Diagnostic accuracy was measured by ROC analysis. RESULTS A total of 209 patients were included. Both the AGA and Fukuoka criteria had a higher diagnostic accuracy for advanced neoplastic cysts than the Sendai criteria: AGA ROC 0.76 (95% CI 0.69-0.81), Fukuoka ROC 0.78 (95% CI 0.74-0.82), and Sendai ROC 0.65 (95% CI 0.61-0.69) (p < 0.0001). There was no difference between the Fukuoka and the AGA criteria. While the sensitivity was higher in the Fukuoka criteria compared to the AGA criteria (97.7 vs. 88.6%), the specificity was higher in the AGA criteria compared to the Fukuoka criteria (62.4 vs. 58.2%). CONCLUSIONS In a surgical series of patients with pancreatic cysts, the AGA and Fukuoka criteria had superior diagnostic accuracy for advanced neoplastic cysts compared to the original Sendai criteria.
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Affiliation(s)
- Michael Sighinolfi
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Susan Y Quan
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Yvonne Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alvaro Ibaseta
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kimberly Pham
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - George A Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brendan C Visser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffery A Norton
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. .,Pancreas Clinic, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5187, Stanford, CA, 94305, USA.
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Papachristou GI, Machicado JD, Stevens T, Goenka MK, Ferreira M, Gutierrez SC, Singh VK, Kamal A, Gonzalez-Gonzalez JA, Pelaez-Luna M, Gulla A, Zarnescu NO, Triantafyllou K, Barbu ST, Easler J, Ocampo C, Capurso G, Archibugi L, Cote GA, Lambiase L, Kochhar R, Chua T, Tiwari SC, Nawaz H, Park WG, de-Madaria E, Lee PJ, Wu BU, Greer PJ, Dugum M, Koutroumpakis E, Akshintala V, Gougol A. Acute pancreatitis patient registry to examine novel therapies in clinical experience (APPRENTICE): an international, multicenter consortium for the study of acute pancreatitis. Ann Gastroenterol 2016; 30:106-113. [PMID: 28042246 PMCID: PMC5198234 DOI: 10.20524/aog.2016.0109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Background We have established a multicenter international consortium to better understand the natural history of acute pancreatitis (AP) worldwide and to develop a platform for future randomized clinical trials. Methods The AP patient registry to examine novel therapies in clinical experience (APPRENTICE) was formed in July 2014. Detailed web-based questionnaires were then developed to prospectively capture information on demographics, etiology, pancreatitis history, comorbidities, risk factors, severity biomarkers, severity indices, health-care utilization, management strategies, and outcomes of AP patients. Results Between November 2015 and September 2016, a total of 20 sites (8 in the United States, 5 in Europe, 3 in South America, 2 in Mexico and 2 in India) prospectively enrolled 509 AP patients. All data were entered into the REDCap (Research Electronic Data Capture) database by participating centers and systematically reviewed by the coordinating site (University of Pittsburgh). The approaches and methodology are described in detail, along with an interim report on the demographic results. Conclusion APPRENTICE, an international collaboration of tertiary AP centers throughout the world, has demonstrated the feasibility of building a large, prospective, multicenter patient registry to study AP. Analysis of the collected data may provide a greater understanding of AP and APPRENTICE will serve as a future platform for randomized clinical trials.
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Affiliation(s)
- Georgios I Papachristou
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
| | - Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
| | - Tyler Stevens
- Cleveland Clinic Foundation, Cleveland, Ohio, USA (Tyler Stevens, Tiffany Chua)
| | - Mahesh Kumar Goenka
- Apollo Gleneagles Hospitals Kolkata, Kolkata, India (Mahesh Kumar Goenka, Subhash Ch. Tewari)
| | - Miguel Ferreira
- Hospital Nacional de Itauguá, Itaugua, Paraguay (Miguel Ferreira)
| | - Silvia C Gutierrez
- Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina (Silvia C. Gutierrez)
| | - Vikesh K Singh
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA (Vikesh K. Singh Ayesha Kamal, Venkata Akshintalaf)
| | - Ayesha Kamal
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA (Vikesh K. Singh Ayesha Kamal, Venkata Akshintalaf)
| | | | - Mario Pelaez-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico (Mario Pelaez-Luna)
| | - Aiste Gulla
- Georgetown University Hospital, Washington, DC, USA (Aiste Gulla); Lithuanian University of Health Sciences, Kaunas, Lithuania (Aiste Gulla)
| | - Narcis O Zarnescu
- Second Department of Surgery, University Emergency Hospital Bucharest, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania (Narcis O. Zarnescu)
| | | | - Sorin T Barbu
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania (Sorin T. Barbu)
| | - Jeffrey Easler
- Indiana University School of Medicine, Indianapolis, Indiana, USA (Jeffrey Easler)
| | - Carlos Ocampo
- Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina (Carlos Ocampo)
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (Gabriele Capurso, Livia Archibugi)
| | - Livia Archibugi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (Gabriele Capurso, Livia Archibugi)
| | - Gregory A Cote
- Medical University of South Carolina, Charleston, South Carolina, USA (Gregory A. Cote)
| | - Louis Lambiase
- University of Tennessee College of Medicine, Chattanooga, Tennessee, USA (Louis Lambiase)
| | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India (Rakesh Kochhar)
| | - Tiffany Chua
- Cleveland Clinic Foundation, Cleveland, Ohio, USA (Tyler Stevens, Tiffany Chua)
| | - Subhash Ch Tiwari
- Apollo Gleneagles Hospitals Kolkata, Kolkata, India (Mahesh Kumar Goenka, Subhash Ch. Tewari)
| | - Haq Nawaz
- Eastern Maine Medical Center, Maine, Bangor, USA (Haq Nawaz)
| | - Walter G Park
- Stanford University, Stanford, California, USA (Walter G. Park)
| | - Enrique de-Madaria
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain (Enrique de-Madaria)
| | - Peter J Lee
- University Hospitals Cleveland Medical Center, Ohio, USA (Peter J. Lee)
| | - Bechien U Wu
- Kaiser Permanente, Pasadena, California, USA (Bechien U. Wu)
| | - Phil J Greer
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
| | - Mohannad Dugum
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
| | - Efstratios Koutroumpakis
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
| | - Venkata Akshintala
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA (Vikesh K. Singh Ayesha Kamal, Venkata Akshintalaf)
| | - Amir Gougol
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (Georgios I. Papachristou, Jorge D. Machicado, Phil J. Greer, Mohannad Dugum, Efstratios Koutroumpakis Amir Gougol)
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Hilmer AJ, Jeffrey RB, Park WG, Khosla C. Cholestyramine as a promising, strong anion exchange resin for direct capture of genetic biomarkers from raw pancreatic fluids. Biotechnol Bioeng 2016; 114:934-938. [PMID: 27800600 DOI: 10.1002/bit.26207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/09/2016] [Accepted: 10/28/2016] [Indexed: 12/27/2022]
Abstract
The ability to capture cell-free DNA from the gastrointestinal tract, in a minimally invasive manner, could enhance our ability to diagnose gastrointestinal disease, or gain a better understanding of the spatial mapping of the intestinal microbiota. We, therefore, sought to identify a class of capture agents that could directly and efficiently sequester genetic material from intestinal fluids. As a particular case study, we examined the ability to capture DNA from pancreatic secretions, for potential application in enabling the sequestration of early, genetic biomarkers of pancreatic disease. We hypothesized that the cholestyramine series of strong cation exchange resins, which are FDA approved for the treatment of high cholesterol, may be capable of capturing DNA from pancreatic secretions. We identified a particular cholestyramine resin, DOWEX 1 × 2 100-200 mesh, which is able to efficiently capture and purify DNA from pancreatic fluid. Using only 200 μL of pancreatic secretions, we are able to recover 247 ± 182 ng of amplifiable human DNA, giving an estimated pancreatic fluid DNA content of 1.23 ± 0.91 ng/μL. To our knowledge, this is the first demonstration of a material that can effectively capture and purify DNA directly from untreated pancreatic fluids. Thus, our approach could hold high utility for the in vivo capture of DNA and disease biomarkers if incorporated into an appropriate sampling device. Biotechnol. Bioeng. 2017;114: 934-938. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew J Hilmer
- Departments of Chemistry, Chemical Engineering, and Biochemistry, Stanford University, Stanford 94305, California
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Chaitan Khosla
- Departments of Chemistry, Chemical Engineering, and Biochemistry, Stanford University, Stanford 94305, California.,Stanford ChEM-H, Stanford, California
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Cloyd JM, Kopecky KE, Norton JA, Kunz PL, Fisher GA, Visser BC, Dua MM, Park WG, Poultsides GA. Neuroendocrine tumors of the pancreas: Degree of cystic component predicts prognosis. Surgery 2016; 160:708-13. [PMID: 27216830 DOI: 10.1016/j.surg.2016.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/18/2016] [Accepted: 04/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although most pancreatic neuroendocrine tumors are solid, approximately 10% are cystic. Some studies have suggested that cystic pancreatic neuroendocrine tumors are associated with a more favorable prognosis. METHODS A retrospective review of all patients with pancreatic neuroendocrine tumors who underwent operative resection between 1999 and 2014 at a single academic medical center was performed. Based on cross-sectional imaging performed before operation, pancreatic neuroendocrine tumors were classified according to the size of the cystic component relative to the total tumor size: purely cystic (100%), mostly cystic (≥50%), mostly solid (<50%), and purely solid (0%). Clinicopathologic characteristics and recurrence-free survival were assessed between groups. RESULTS In the study, 214 patients met inclusion criteria: 8 with purely cystic tumors, 7 with mostly cystic tumors, 15 with mostly solid tumors, and 184 with purely solid tumors. The groups differed in terms of tumor size (1.5 ± 0.5, 3.0 ± 1.7, 3.7 ± 2.6, and 4.0 ± 3.5 cm), lymph node positivity (0%, 0%, 26.7%, and 34.2%), intermediate or high grade (0%, 16.7%, 20.0%, and 31.0%), synchronous liver metastases (0%, 14.3%, 20.0%, and 26.6%) and need for pancreaticoduodenectomy (0%, 0%, 6.7%, and 25.0%), respectively. No cases of purely cystic pancreatic neuroendocrine tumors were associated with synchronous liver or lymph node metastasis, intermediate/high grade, recurrence, or death due to disease. Among patients presenting without metastatic disease, 10-year recurrence-free survival was 100% in patients with purely and mostly cystic tumors versus 53.0% in patients with purely and mostly solid tumors; however, this difference did not reach statistical significance. CONCLUSION Pancreatic neuroendocrine tumors demonstrate a spectrum of biologic behavior with an increasing cystic component being associated with more favorable clinicopathologic features and prognosis. Purely cystic pancreatic neuroendocrine tumors may represent 1 subset that can be safely observed without immediate resection.
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Affiliation(s)
| | | | | | | | | | | | | | - Walter G Park
- Department of Medicine and Gastroenterology, Stanford University, CA
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Dua MM, Worhunsky DJ, Tran TB, Rumma RT, Poultsides GA, Norton JA, Park WG, Visser BC. Severe acute pancreatitis in the community: confusion reigns. J Surg Res 2015; 199:44-50. [DOI: 10.1016/j.jss.2015.04.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 04/03/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
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Dua MM, Qadan M, Lutchman GA, Park WG, Triadafilopoulos G, Visser BC. Non-MalIg(G4)nant Biliary Obstruction: When the Pill Is Mightier than the Knife. Dig Dis Sci 2015; 60:1178-82. [PMID: 25138904 DOI: 10.1007/s10620-014-3329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 12/09/2022]
Affiliation(s)
- Monica M Dua
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
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Adler DG, Lieb JG, Cohen J, Pike IM, Park WG, Rizk MK, Sawhney MS, Scheiman JM, Shaheen NJ, Sherman S, Wani S. Corrigendum: quality indicators for ERCP. Am J Gastroenterol 2015; 110:608. [PMID: 25853209 DOI: 10.1038/ajg.2015.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McGill SK, Kothari S, Friedland S, Chen A, Park WG, Banerjee S. Short turn radius colonoscope in an anatomical model: Retroflexed withdrawal and detection of hidden polyps. World J Gastroenterol 2015; 21:593-599. [PMID: 25593483 PMCID: PMC4294171 DOI: 10.3748/wjg.v21.i2.593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/21/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the new RetroView™ colonoscope and compare its ability to detect simulated polyps “hidden” behind colonic folds with that of a conventional colonoscope, utilizing anatomic colon models.
METHODS: Three anatomic colon models were prepared, with twelve simulated polyps “hidden” behind haustral folds and five placed in easily viewed locations in each model. Five blinded endoscopists examined two colon models in random order with the conventional or RetroView™ colonoscope, utilizing standard withdrawal technique. The third colon model was then examined with the RetroView™ colonoscope withdrawn initially in retroflexion and then in standard withdrawal. Polyp detection rates during standard and retroflexed withdrawal of the conventional and RetroView™ colonoscopes were determined. Polyp detection rates for combined standard and retroflexed withdrawal (combination withdrawal) with the RetroView™ colonoscope were also determined.
RESULTS: For hidden polyps, retroflexed withdrawal using the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (85% vs 12%, P = 0.0001). For hidden polyps, combination withdrawal with the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (93% vs 12%, P≤ 0.0001). The RetroView™ colonoscope in “combination withdrawal” was superior to other methods in detecting all (hidden + easily visible) polyps, with successful detection of 80 of 85 polyps (94%) compared to 28 (32%) polyps detected by the conventional colonoscope in standard withdrawal (P < 0.0001) and 67 (79%) polyps detected by the RetroView™ colonoscope in retroflexed withdrawal alone (P < 0.01). Continuous withdrawal of the colonoscope through the colon model while retroflexed was achieved by all endoscopists. In a post-test survey, four out of five colonoscopists reported that manipulation of the colonoscope was easy or very easy.
CONCLUSION: In simulated testing, the RetroView™ colonoscope increased detection of hidden polyps. Combining standard withdrawal with retroflexed withdrawal may become the new paradigm for “complete screening colonoscopy”.
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Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz JA, Lieb JG, Lieberman DA, Park WG, Shaheen NJ, Wani S. Quality indicators common to all GI endoscopic procedures. Am J Gastroenterol 2015; 110:48-59. [PMID: 25448874 DOI: 10.1038/ajg.2014.383] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Am J Gastroenterol 2015; 110:102-13. [PMID: 25448871 DOI: 10.1038/ajg.2014.387] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Park WG, Shaheen NJ, Cohen J, Pike IM, Adler DG, Inadomi JM, Laine LA, Lieb JG, Rizk MK, Sawhney MS, Wani S. Quality indicators for EGD. Gastrointest Endosc 2015; 81:17-30. [PMID: 25480101 DOI: 10.1016/j.gie.2014.07.057] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
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Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81:31-53. [PMID: 25480100 DOI: 10.1016/j.gie.2014.07.058] [Citation(s) in RCA: 734] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Gastrointest Endosc 2015; 81:67-80. [PMID: 25480097 DOI: 10.1016/j.gie.2014.07.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 02/08/2023]
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DiMaio MA, Park WG, Longacre TA. Gastric Sarcina organisms in a patient with cystic fibrosis. Human Pathology: Case Reports 2014. [DOI: 10.1016/j.ehpc.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Worhunsky DJ, Qadan M, Dua MM, Park WG, Poultsides GA, Norton JA, Visser BC. Laparoscopic transgastric necrosectomy for the management of pancreatic necrosis. J Am Coll Surg 2014; 219:735-43. [PMID: 25158913 DOI: 10.1016/j.jamcollsurg.2014.04.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Traditional open necrosectomy for pancreatic necrosis is associated with significant morbidity and mortality. Although minimally invasive techniques have been described and offer some promise, each has considerable limitations. This study assesses the safety and effectiveness of laparoscopic transgastric necrosectomy (LTN), a novel technique for the management of necrotizing pancreatitis. STUDY DESIGN Between 2009 and 2013, patients with retrogastric pancreatic necrosis requiring debridement were evaluated for LTN. Debridement was performed via a laparoscopic transgastric approach using 2 to 3 ports and the wide cystgastrostomy left open. Patient demographics, disease severity, operative characteristics, and outcomes were collected and analyzed. RESULTS Twenty-one patients (13 men, median age 54 years; interquartile range [IQR] 46 to 62 years) underwent LTN during the study period. The duration between pancreatitis onset and debridement was 65 days (IQR 53 to 124 years). Indications for operation included infection (7 patients) and persistent unwellness (14 patients). Median duration of LTN was 170 minutes (IQR 136 to 199 minutes); there were no conversions. Control of the necrosis was achieved via the single procedure in 19 of 21 patients. Median postoperative hospital stay was 5 days (IQR 3 to 14 days) and the majority (71%) of patients experienced no (n = 9) or only minor postoperative complications (n = 6) by Clavien-Dindo grade. Complications of Clavien-Dindo grade 3 or higher developed in 6 patients, including 1 death (5%). With a median follow-up of 11 months (IQR 7 to 22 months), none of the patients required additional operative debridement or had pancreatic/enteric fistulae or wound complications develop. CONCLUSIONS Laparoscopic transgastric necrosectomy is a novel, minimally invasive technique for the management of pancreatic necrosis that allows for debridement in a single operation. When feasible, LTN can reduce the morbidity associated with traditional open necrosectomy and avoid the limitations of other minimally invasive approaches.
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Affiliation(s)
- David J Worhunsky
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Motaz Qadan
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Monica M Dua
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Walter G Park
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA
| | | | - Jeffrey A Norton
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Brendan C Visser
- Department of Surgery, Stanford University Medical Center, Stanford, CA.
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Park WG, Wu M, Bowen R, Zheng M, Fitch WL, Pai RK, Wodziak D, Visser BC, Poultsides GA, Norton JA, Banerjee S, Chen AM, Friedland S, Scott BA, Pasricha PJ, Lowe AW, Peltz G. Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: glucose and kynurenine. Gastrointest Endosc 2013; 78:295-302.e2. [PMID: 23566642 PMCID: PMC3780566 DOI: 10.1016/j.gie.2013.02.037] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/20/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Better pancreatic cyst fluid biomarkers are needed. OBJECTIVE To determine whether metabolomic profiling of pancreatic cyst fluid would yield clinically useful cyst fluid biomarkers. DESIGN Retrospective study. SETTING Tertiary-care referral center. PATIENTS Two independent cohorts of patients (n = 26 and n = 19) with histologically defined pancreatic cysts. INTERVENTION Exploratory analysis for differentially expressed metabolites between (1) nonmucinous and mucinous cysts and (2) malignant and premalignant cysts was performed in the first cohort. With the second cohort, a validation analysis of promising identified metabolites was performed. MAIN OUTCOME MEASUREMENTS Identification of differentially expressed metabolites between clinically relevant cyst categories and their diagnostic performance (receiver operating characteristic [ROC] curve). RESULTS Two metabolites had diagnostic significance-glucose and kynurenine. Metabolomic abundances for both were significantly lower in mucinous cysts compared with nonmucinous cysts in both cohorts (glucose first cohort P = .002, validation P = .006; and kynurenine first cohort P = .002, validation P = .002). The ROC curve for glucose was 0.92 (95% confidence interval [CI], 0.81-1.00) and 0.88 (95% CI, 0.72-1.00) in the first and validation cohorts, respectively. The ROC for kynurenine was 0.94 (95% CI, 0.81-1.00) and 0.92 (95% CI, 0.76-1.00) in the first and validation cohorts, respectively. Neither could differentiate premalignant from malignant cysts. Glucose and kynurenine levels were significantly elevated for serous cystadenomas in both cohorts. LIMITATIONS Small sample sizes. CONCLUSION Metabolomic profiling identified glucose and kynurenine to have potential clinical utility for differentiating mucinous from nonmucinous pancreatic cysts. These markers also may diagnose serous cystadenomas.
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Affiliation(s)
- Walter G. Park
- Department of Medicine, Stanford University, Stanford, California
| | - Manhong Wu
- Department of Anesthesiology, Stanford University, Stanford, California
| | - Raffick Bowen
- Department of Pathology, Stanford University, Stanford, California
| | - Ming Zheng
- Department of Anesthesiology, Stanford University, Stanford, California
| | - William L. Fitch
- Department of Anesthesiology, Stanford University, Stanford, California
| | - Reetesh K. Pai
- Department of Pathology, Stanford University, Stanford, California
| | - Dariusz Wodziak
- Department of Medicine, Stanford University, Stanford, California
| | - Brendan C. Visser
- Department of General Surgery, Stanford University, Stanford, California
| | | | - Jeff A. Norton
- Department of General Surgery, Stanford University, Stanford, California
| | - Subhas Banerjee
- Department of Medicine, Stanford University, Stanford, California
| | - Ann M. Chen
- Department of Medicine, Stanford University, Stanford, California
| | - Shai Friedland
- Department of Medicine, Stanford University, Stanford, California
| | - Brennan A. Scott
- Department of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, California, USA
| | | | - Anson W. Lowe
- Department of Medicine, Stanford University, Stanford, California
| | - Gary Peltz
- Department of Anesthesiology, Stanford University, Stanford, California
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Ladabaum U, Brill JV, Sonnenberg A, Shaheen NJ, Inadomi J, Wilcox CM, Park WG, Hur C, Pasricha PJ. How to value technological innovation: a proposal for determining relative clinical value. Gastroenterology 2013; 144:5-8. [PMID: 23153872 DOI: 10.1053/j.gastro.2012.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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