Indiana University (IU) Clinical Center for Chronic Pancreatitis Clinical Research Network

项目总结/摘要 慢性胰腺炎（CP）是一种进行性疾病，常导致外分泌和内分泌功能丧失， 功能和衰弱性腹痛。不知道为什么有些人进步了， 发生并发症，包括胰源性糖尿病（T3 cDM）和/或胰腺癌 （PDAC）。在这个联盟中，研究人员提出并启动了几个有力的 风险因素研究、环境影响和概念验证研究，以推动该领域的发展 尤其是那些增加T3 cDM和PDAC风险的因素。许多这些 研究正在进行中，而新的创新提案将涉及其他研究目标 由参与的NIH研究所确定。我们提出了几个具体目标（SA），以满足 RFA-DK-19-009的目标。在SA #1中，我们建议继续CPDPC的三个主要纵向 研究：PROCEED、INSPPIRE 2和NOD，以及这两项旨在更好地定义 并表征T3 cDM、DETECT和DEPICT。在SA #2中，我们建议继续辅助 在第一个供资周期开始的研究，特别是MINIMAP。SA#3：半乳糖凝集素-3（Gal-3）是一种 一种碳水化合物结合蛋白，似乎与纤维化和组织重塑有关 在CP中。Gal-3抑制剂是安全的，并显示出减少非酒精性肝纤维化的潜力。 脂肪性肝炎我们建议测试Gal-3抑制剂在治疗中安全有效的假设。 CP患者，并可能逆转或停止在CP中观察到的纤维化。我们将评估变化 通过MRI以及血清和胰液探索性评估胰腺纤维化 生物标志物。在SA #4中，我们提出了评估不同策略的创新研究， 干预措施的重点是缓解CP患者的腹痛。拉考沙胺，一种抗癫痫药 药物，似乎抑制阿片类药物诱导的痛觉过敏。在SA #4a中，我们将进行剂量递增 一项评估在阿片类药物治疗中加入拉考沙胺的安全性和耐受性的试验， 初步随机试验，以获得有关疼痛控制、阿片类药物使用和 在阿片类药物中加入拉考沙胺后的生活质量。SA #4b：定量感官测试（QST） 在不同的皮区使用电刺激和压力刺激， 系统我们将调查：（i）QST配置文件和人口统计学之间的关联， 疑似或确诊CP患者的临床特征;（ii）QST曲线是否可以 用于预测内镜或手术治疗的临床结果。SA #4c：胰腺 胆管结石可能使CP复杂化，导致腹痛，在一定程度上切除这些结石。 ERCP经常导致显着的疼痛缓解。在这个建议中，我们比较了两种 经内镜逆行胰胆管造影术治疗慢性胰腺炎疼痛性胰管结石

PROJECT SUMMARY / ABSTRACT Chronic pancreatitis (CP) is a progressive disease, often leading to loss of exocrine and endocrine function and debilitating abdominal pain. It is unknown why some individuals progress and develop complications, including pancreatogenic diabetes (T3cDM) and/or pancreas cancer (PDAC). In this Consortium, investigators have proposed and initiated several well-powered studies of risk factors, environmental influences, and proof-of-concept studies to move the field forward, particularly those factors that increase the risk of T3cDM and PDAC. Many of these studies are ongoing, while new innovative proposals will address other research objectives identified by the participating NIH institutes. We propose several specific aims (SA) to meet the goals of RFA-DK-19-009. In SA #1, we propose to continue the CPDPC's three main longitudinal studies: PROCEED, INSPPIRE 2 and NOD, as well as those two studies designed to better define and characterize T3cDM, DETECT and DEPICT. In SA #2, we propose to continue the ancillary study begun during the first funding cycle, specifically MINIMAP. SA #3: Galectin-3 (Gal-3) is a carbohydrate-binding protein which appears to be involved in fibrogenesis and tissue remodeling in CP. A Gal-3 inhibitor is safe and shows potential for reducing hepatic fibrosis in non-alcoholic steatohepatitis. We propose to test the hypothesis that a Gal-3 inhibitor is safe and efficacious in patients with CP, and may reverse or halt the fibrosis observed in CP. We will evaluate changes in pancreatic fibrosis as assessed by MRI, as well as serum and pancreatic fluid exploratory biomarkers. In SA #4, we propose innovative studies evaluating different strategies and interventions focused on alleviating abdominal pain in CP patients. Lacosamide, an anti-epileptic drug, appears to inhibit opioid-induced hyperalgesia. In SA #4a, we will perform a dose-escalation trial to evaluate the safety and tolerability of adding lacosamide to opioid therapy, followed by a pilot randomized trial to obtain preliminary data regarding change in pain control, opioid use and quality of life after adding lacosamide to an opioid. SA #4b: Quantitative sensory testing (QST) uses electrical and pressure stimulation at different dermatomes in order to unravel the pain system. We will investigate: (i) the association between QST profiles and demographic and clinical characteristics in patients with suspected or definite CP; (ii) whether the QST profile can be used to predict the clinical outcome of endoscopic or surgical treatment. SA #4c: Pancreatic duct stones may complicate CP, contributing to abdominal pain, and removal of these stones at ERCP frequently leads to significant pain relief. In this proposal, we compare the efficacy of two adjunctive procedures to ERCP for the treatment of main pancreatic duct stones in painful CP.