Withaferin A Shows Early Promise to Treat Pancreatitis

A recent study has demonstrated promising results for Withaferin A (“WA”), a plant-based compound traditionally used in Indian herbal medicine, in treating pancreatitis.

Researchers from Virginia Commonwealth University, the University of Virginia and the Baylor Institute induced pancreatitis in mice and then studied the effect of WA on progression of the disease.  They found that WA reduced the severity of pancreatitis, both when administered preventatively and as a treatment.  WA acted to suppress the proinflammatory genes activated by pancreatitis and decrease pancreatic cell death.  The results were apparently confirmed in tests with human tissue.

WA is a steroidal lactone derived from Indian Winter Cherry or ashwagandha, a plant traditionally used in Aruyvedic medicine.  It has been studied for possible treatment of prostate prostate cancer, lymphoma and diabetes, among other conditions, but does not appear to be utilized currently as an FDA-approved treatment.

While preliminary, the study seems to merit additional research.  An abstract of the article, published in July’s Journal of Gastroenterology, can be accessed here.

Potential Treatment for Pancreatic Cancer Converts Cancer Cells Back to Healthy Ones

Statins Hold Promise to Treat Pancreatitis

Pancreatitis is an extremely debilitating condition.  In its acute form, it often requires hospitalization and lengthy recovery; it can also be fatal.  Chronic pancreatitis is progressive, causing severe chronic pain, nausea, fatigue, and a host of other issues, significantly impacting quality of life.  And so far there has been no medication to treat the disease — leaving patients and their doctors with few good options other than risky and invasive surgery.

Recent research has raised hope that a common class of medicines used to treat cholesterol, statins, may be effective to treat pancreatitis.  A study published this month in Gut (a leading gastroenterology journal) suggests that simvastatin, a popular statin sold under the brand name “Zocor,”  was associated with a reduced risk of acute pancreatitis.  The same result held true for atorvastatin, which is sold under the brand “Lipitor”.  (You can find an abstract of the study here.)

statinsAnother study published in 2011 in the journal Laboratory Investigation involving rats (and not humans) found that a different statin, prevastatin, reduces the progression of inflammation, fibrosis and loss of exocrine function in chronic pancreatitis.  The study’s authors conclude that “These results support the clinical use of pravastatin for patients with chronic pancreatitis.” You can find an abstract of the study here and a the full text here.

Together these studies certainly raise the possibility that statins may reduce the risk or severity of pancreatitis, or possibly both.  There has not yet been a clinical trial testing these hypotheses — the Gut study published this month was a “retrospective cohort study,” meaning that it examined past data from a patient population rather than testing a possible intervention prospectively on current patients.  I have heard through the grapevine that at least one top hospital is seeking funding for such a trial; hopefully they will be successful soon.

However, while statins are not approved to treat or prevent pancreatitis, doctors are still able to prescribe them for that purpose.  This is called an “off-label use,” and it is both legal and common (you can read a WebMD article on the practice here).   Moreover, since statins are among the most prescribed drugs in the U.S., they are widely accepted and their side effects fairly well understood…making it a relatively low-risk experiment.   (The most common side effects are muscle pains, though statins can also put strain on your liver — see the Mayo Clinic’s primer on statins here.)

This is a very exciting possibility for those of us suffering from pancreatitis, with few good options on the horizon.  (For information on Sun-101, another drug in development that could be used for chronic pancreatitis, visit this post.)  At this point we have grounds for cautious optimism…well worth a discussion with your doctor.

Favorable Long Term Outcomes with Total Pancreatectomy and Islet Transplantation

One of the top surgical options for those suffering from chronic pancreatitis is removal of the pancreas, with transplantation of the pancreas’s islet cells to the liver.  (The surgery is called total pancreatectomy with islet autotransplantation, commonly abbreviated TP/IAT.)

When successful, this removes the source of pain and toxicity — the exocrine function of the pancreas, or its production of enzymes — while allowing the liver to perform the endocrine function of the liver (the production of insulin).  Patients must take enzymes for food disgestion, but if sufficient healthy islet cells are left and the transplantation succeeds, patients would not become diabetic and require insulin.

Many patients report that the surgery is a lifesaver, greatly reducing their pain and allowing them to live a normal life again. Recently we posted a video that discusses outcomes 6 and 12 months after surgery, finding a significant increase in physical and mental health ratings and improvement in quality of life.

In October, a study will be published in the Annals of Surgery examining patient outcomes five years after TP/IAT surgery for 112 patients.  There were no deaths at the time of surgery and the survival rate after five years was almost 95%.   There were continued improvements in reported quality of life during the period, and at five years 73% were “narcotic independent.”  Only 27% ended up insulin independent at the end of the period.

Bear in mind that the procedure is relatively new, and is constantly evolving.  For example, the surgery has just started being performed laparoscopically, which should be expected to improve outcomes. It is fair to assume that the more recent procedures are even more favorable statistically than ones performed ten years ago.  On the other hand, there is no truly longitudinal data that indicate how patients fare without a pancreas decades after the procedure, something patients are very keen to understand.

You can find an abstract of the article here.

New Drug Reduces Risk from TP (Pancreatic Resection) By Half

A new drug from Novartis, Signifor, has shown to reduce the risk of complications from pancreatic resection by half.

Resection is one of the surgical options available to pancreatitis patients, as well as people battling pancreatic cancer.  The procedure is relatively risky, however — according to one of the researchers, it remains “one of the few operations where major complications, major operative morbidity, is a common event.”  One major group of complications from pancreatic resection involves pancreatic fistula, leaks, or abscess.  The risk is significant, affecting 30 to 50% of patients.

The study, which involved over 300 patients, found that the drug reduced the risk of a relatively severe complication from approximately one in five to one in ten.

The study was originally published in the New England Journal of Medicine.  You can find an article on the study in MedPage Today.

A Helpful Patient Blog on Chronic Pancreatitis, with CP-Friendly Recipes

Happy Panky BlogA reader recently directed me to the blog of another pancreatitis sufferer, Sherry.  It tells her story of CP, which began after eating too much junk (on top of underlying susceptibility due to cystic fibrosis) and landed her in the hospital for a week.  The blog also gives her very thoughtful coping tools for living with CP, which she calls “10 Ways to a Happy Panky.”    They are spot on and well worth a read.

Sherry also includes recipes for dishes that are low fat, but inventive and appealing.  One nice surprise was chili dogs and fries with carefully picked ingredients.

Kudos to Sherry for creating this helpful and inspiring site!  Check it out at http://happypanky.wordpress.com/.

Video: Life after Pancreatic Surgery (TP/IAT) for Patients with Chronic Pancreatitis

Earlier this year in South Carolina, some of the world’s top physicians and researchers gathered for the International Symposium on the Surgical and Medical Treatment of Chronic Pancreatitis. Organized by the Medical University of South Carolina, the goal of the Symposium was “to bring together leading scientists, physicians and surgeons interested in improving patient care in chronic pancreatitis.”

One presentation from Dr. Katherine Morgan examined outcomes from TP/IAT surgery, which involves removal of the pancreas and simultaneous transplant of pancreatic islet cells (responsible for production of insulin) to the liver.  This surgery seems to be the last, best hope of those suffering from chronic pancreatitis, so this topic is one of keen interest.

Dr. Morgan first recounts several cases with very positive outcomes and several with less successful outcomes, and then goes into some depth on the history of the surgical procedure and how outcomes have been measured.  Starting at about the 12 minute mark, Dr. Morgan discusses how patients fare before and after TP/IAT surgery.  She notes that chronic pancreatitis patients before surgery are a “pretty miserable group” in terms of physical and mental health– something patients will definitely relate to.  After the surgery, there was a significant increase in both physical and mental health ratings, getting closer (but not equal) to the benchmark for healthy patients.  Notably, most patients were not able to stop narcotics (75% were still on them post surgery), but quality of life did improve nonetheless.  Improvements applied both to patients who were undergoing their first surgery and those so-called “salvage” patients who had been through pancreatic surgery before without relief.

Interestingly, even those who experienced significant surgical complications still saw significant improvements in quality of life.

Dr. Morgan wraps up by discussing the data that her group collects on patients with CP, called the “Element System.”  It includes assessment of quality of life, depression, a pain inventory, a narcotic misuse measure, and then a detailed symptom and behavioral questionnaire.  This seems to be more systematic and thorough than most centers for pancreatic disease.

There are other videos from the Symposium, many of which can be found here.     This one is worth watching for anyone considering TP/IAT surgery.

 

 

Growing Insulin-Producing Cells in the Liver to Cure Diabetes…and Treat Pancreatitis

A venture called Orgenesis is working on a novel treatment for diabetes that converts a patient’s liver cells into insulin-producing cells.  Their goal is bold:  “The end of diabetes as we know it.”

The treatment is meant as an alternative to islet transplantation, which bears risk of transplant rejection, among other problems.  In other words, instead of removing beta cells from the pancreas and introducing them into the liver, Orgenesis aims to prompt mature liver cells to reprogram themselves into insulin-producing beta cells. This is part of a new wave of development called “autologous cell replacement” that converts existing tissue into an alternate organ, or “stem-like cells.”

Islet transplantation is the current best practice when pancreatitis patients have their pancreas removed in order to allow the liver to produce insulin.  A safer, more effective means of doing so would be a welcome development.  The firm recently secured a $3 million funding round, which will hopefully enable it to continue or even accelerate its work.

Here is their introductory video: