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

项目摘要/摘要 慢性胰腺炎(CP)是一种进行性疾病，通常导致外分泌和内分泌丧失 功能和虚弱腹痛。不知道为什么有些人会进步和 出现并发症，包括胰源性糖尿病(T3cDM)和/或胰腺癌 (PDAC)。在这个联盟中，调查人员提出并发起了几个强有力的 研究风险因素、环境影响和概念验证研究以推动该领域的发展 前瞻性，特别是那些增加T3cDM和PDAC风险的因素。其中许多 研究正在进行中，而新的创新建议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)来满足 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：继续，INSPPIRE 2和NOD，以及这两项研究旨在更好地确定 并对T3cDM进行表征、检测和描绘。在SA#2中，我们建议继续辅助 在第一个供资周期内开始研究，特别是最低限度方案。SA#3：Galectin-3(Gal-3)是一种 碳水化合物结合蛋白，似乎与纤维形成和组织重塑有关 在CP中。一种Gal-3抑制剂是安全的，并显示出减轻非酒精性肝纤维化的潜力 脂肪性肝炎。我们建议检验Gal-3抑制剂安全有效的假说 可逆转或阻止CP中观察到的纤维化。我们将评估变化 胰腺纤维化的MRI评估以及血清和胰液探查 生物标志物。在SA#4中，我们提出了评估不同策略和 干预的重点是减轻CP患者的腹痛。抗癫痫药乳糖胺 药物，似乎能抑制阿片类药物引起的痛敏。在SA#4a中，我们将执行剂量递增 评估在阿片类药物治疗中添加乳糖胺的安全性和耐受性的试验，随后进行了 试点随机试验，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乳糖胺后的生活质量。SA#4b：定量感觉测试(QST) 在不同的皮肤处使用电刺激和压力刺激来缓解疼痛 系统。我们将调查：(I)QST简档与人口统计学和 疑似或确诊CP患者的临床特征；(Ii)QST图谱是否可以 可用于预测内窥镜或外科治疗的临床结果。SA#4c：胰腺 胆管结石可能会使CP复杂化，导致腹痛，并在 ERCP常常能显著缓解疼痛。在这项建议中，我们比较了两种方法的疗效 ERCP辅助手术治疗痛性胰管结石

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.