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.

Another Promising Test for Early Stage Pancreatic Cancer

Recently, we wrote about a very encouraging test for pancreatic cancer that initially showed 100% accuracy.  It is a blood test , so relatively non-invasive — though the test must be custom designed to detect the “telomeres” that signal emerging cancer.

Now, a new study has been announced that uses a urine test to detect early pancreatic cancer.  This test detects four different varieties of “MicroRNAs,” which are involved in a variety of cell regulation processes and, when they show up in unpredictable forms or amounts, signal the presence of cancer.  The test was conducted at several hospitals in England.

The test showed high sensitivity (accurate detection of positive results) and specificity (accurate detection of negative results) — over 80% for both. While not as high as the blood test announced recently, these tests must go through lengthy, rigorous study, so the more candidates, the better.

Now we should hope that both tests navigate regulatory hurdles quickly and successfully.

Early Test for Pancreatic Cancer Hopefully On the Way

Pancreatic cancer is one of the most deadly forms of cancer, with a five-year survival rate of only six percent.  The low survival rate is because, in 80% of the cases, it has already spread to other organs when first detected.

Early detection means better treatment options and a much better chance of survival.  The problem is that PanCan has been very hard to detect early.  According to the Pancreatic Cancer Action Network, “[t]here is currently no standard diagnostic tool or established early detection method for pancreatic cancer,” but such a test is “urgently needed.”

Pancreatic cancer is a particular concern for people battling chronic pancreatitis since about five percent of CP patients will contract pancreatic cancer — a much higher risk than faced by the general population.

Fortunately, life-saving help may be on the way.  This summer, researchers led by a team at MD Anderson Cancer Center announced that they have developed a blood test that detected pancreatic cancer with “absolute specificity and sensitivity.” Put simply, this means 100% accuracy.  The test detests “exosomes” — tiny particles released by cancer cells — that are present when a patient has pancreatic cancer, but not when the patient has chronic pancreatitis.  The exosomes apparently have value beyond detection, providing doctors with helpful information on the stage and precise mutations of the cancer — opening up the possibility of customized therapies.

By OpenStax College [CC BY 3.0]

Moreover, because detection involved a blood test, it is much less invasive than the usual diagnostic tools used for PanCan, such as CT scans and endoscopic ultrasounds…but with greater accuracy.

The researchers caution that larger studies are required to validate the findings, but note that 100% accuracy is extremely encouraging (and not something often found in such tests).

It is high time that doctors had effective tools to detect and fight this lethal disease.  We should all hope — and demand — that the test be made commercially available as soon as possible.

 

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

The Bionic Pancreas for Diabetes…and Hopefully A Good Step for Chronic Pancreatitis

Big news in the world of diabetes was announced this week:  Researchers at Mass General Hospital and Boston University invented a “bionic pancreas” that can help diabetes patients regulate their blood sugar.  The device includes a sensor implanted under the skin and two pumps, all controlled by an iPhone app.  The sensor measures blood sugar every five minutes.  When it detects that blood sugar is too high, the app signals one pump to deliver fast-acting insulin to the bloodstream; if blood sugar is too low, it signals the other pump to provide glucagon that will raise it.

bionic pancreasCurrently, patients can use insulin pumps that deliver an amount of insulin based on their blood sugar and what they eat, which they program into the pump.  The addition of the sensor takes this to another level…though users still enter some data about what they are eating into the app (such as whether they are eating breakfast, lunch or dinner, and whether they are eating more or less than usual), which then drives an algorithm to determine how much medicine should be needed.

The device showed some promising results in a five-day human trial involving 20 adults and 32 teenagers with type 1 diabetes.   For example, when using the bionic pancreas, all of the adults had mean glucose levels at the therapeutic target compared with 9 out of the 20 when using the insulin pump.  (See a New England Journal of Medicine article discussing methods and results in detail.)

One implication for those suffering with chronic pancreatitis is that it can help deal with diabetes following a pancreatic resection, or removal of the pancreas.  More and more patients opt to undergo this serious procedure when quality of life suffers due to CP.  The state of the art procedure includes transplantation of insulin-producing cells to the liver with the goal of avoiding diabetes, but it is a significant risk.  (You can see a video discussing the results of the TP/IP procedure in this post.)  It is good to know that those patients will likely have additional tools available to them to deal with that risk.

The greater hope is that it is a step in the direction of a true bionic pancreas — an implantable device that performs the critical functions of the pancreas and can supplement or replace the defective organ that causes so many of us pain and suffering.  That step will likely require stem cells, perhaps in combination with 3D printing of tissue — both of which are the subject of research now.  (See a recent post on growing insulin-producing cells.)  Those developments cannot come soon enough…but are likely -10 years away.  In the meantime, hopefully incremental solutions like this will continue to emerge.

For more information on the bionic pancreas, see the researchers’ website at http://www.artificialpancreas.org/ or see a recent Time Magazine piece on the development 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/.

One Patient’s Story of Recurrent Pancreatitis Due to Sphincter of Oddi Dysfunction

One reader was kind enough to send in his story, which is dramatic but probably not atypical for CP sufferers.  I hope you find it useful.  Please feel free to respond to some of his questions at the end.

From R.:

If you don’t mind, I’d like to share the story of my own pancreas odyssey, in hopes that it might be helpful to you or one of your sites visitors as they navigate their way through life with a pesky pancreas. There is such variance in knowledge of the pancreas in the medical community and such a real potential for misdiagnosis that I would be happy if I could spare one person from an unnecessary procedure or an avoidable delay in the improvement of their condition.

And maybe you, or someone visiting this website, might have some information useful to my situation.

For fifty years, my pancreas and I quietly coexisted in symbiotic harmony. Four years ago, that relationship changed — for reasons that none of the top pancreas specialists in my region can fathom.

None of the etiological tick boxes fit me: not a drinker, no gallstones/gallbladder issues, quit smoking years ago, followed (and follow) an exercise regimen and have always been in very good shape, always ate thoughtfully, no problems with triglycerides, no auto-immune issues, no genetic markers for cystic fibrosis or any other known hereditary cause. No scorpion bites etc…Because of this, Doctor Freeman at the University of Minnesota Pancreas Center calls me his 54 year old poster-boy for idiopathic acute recurrent pancreatitis.

My first attack happened late in the evening of a very stressful day in February 2010. I had the sudden onset of a stabbing pain just beneath my sternum that radiated to my back. I waited a day and a half before going to an urgent care center, where lab tests showed my amylase and lipase levels were sky-high (a hallmark of my attacks) , and I was formally diagnosed with acute pancreatitis. I was transferred to a hospital and spent 5 days getting x-rays, ultra-sounds, blood tests done, while being given IV hydration, analgesics and no food for several days to rest the pancreas. The hospital explained the common etiologies for pancreatitis and said that since they could not find a reason for the attack — that it could very well be a unique experience. (If only that had proved to be true!)

In March 2011, after my second attack, I had a EUS performed and the Dr. found no signs of a chronic condition, no signs of stones or any real sludge, but surmised that some micro-crystals may have played a role.

In May 2011, after my third attack, my GP told me ‘Why don’t you just go and get your gallbladder removed?’
So, in August 2011, I had my gallbladder removed; a lovely, gallbladder that had no signs of stones or disease. A week later, I was back in the hospital with another pancreatitis attack. (Major Bummer).

After this, I followed up with a G.I. specialist who was recommended by this hospital. This specialist thought I had pancreas divisum or auto-immune pancreatitis (even though my IgG4 lab results were fine) and even contemplated taking a biopsy of my pancreas for cancer.

By this time, I was getting frustrated and decided to find the best doctor possible. Due diligence and a ‘gut feeling’ led me to make an appointment with Dr. Martin Freeman at the University of Minnesota’s Pancreatic Biliary Center. Dr. Freeman is a world-renowned pancreas expert and his center is preeminent in treating pancreatic disease. He recommended an MRI with secretin, to get a clear picture of my anatomy. The imaging positively ruled out pancreas divisum and revealed no structural signs of why I was having these attacks.

In November 2011, after my fourth pancreatitis hospitalization of that year, I told Dr. Freeman that I had to do something about this… the pancreatitis attacks were affecting my ability to plan my life.

In January 2012, he performed an ERCP on me and checked the pressure on my biliary and pancreatic ducts and found the pressures were very high… so he performed a dual sphincterotomy to relieve the pressures. I now became well-versed in the literature on Sphincter of Oddi Dysfunction and the role it can play in idiopathic pancreatitis.

After the ERCP, I felt great and began to feel that I could actually resume a ‘normal’ life. Five months later, however, everything went Haywire. In a six-week period I had five consecutive pancreatitis hospitalizations. I had absolutely, no idea what could be contributing to this flurry of attacks: my diet was the same very low-fat regimen that I had been on since my second attack of pancreatitis, I was on no medications, etc… nothing made sense.

In those five weeks, I lost twenty pounds and experienced the physical and psychological trauma that comes to those of us who have encountered real uncertainty about our health.

I also received a gift that I am truly grateful for. During my last hospitalization at the University of Minnesota hospital, Dr. Steven Miles visited me with a team of young doctors who had taken an interest in my case. Dr. Miles proceeded to give me an elaborately researched presentation on his laptop. He explained every test that the doctors had run on me during this flurry of hospitalizations and concluded that since my pancreatitis attacks always heal consistently — my disease is ‘simple’ and therefore, in the future, I could treat myself at home during an attack with a prescription for a pain reliever.

As a fellow pancreatitis-experiencer, I don’t have to tell you what a godsend it was to be told that I did not automatically have to be hospitalized if I had a pancreatitis event!

After I had recovered from my flurry of hospitalizations, I saw Dr. Freeman in September 2012, for a follow-up ERCP to try and ascertain why I had these attacks. Dr Freeman scoped me and said the ducts looked fine and saw no reason to intervene surgically.

In March 2013, I went for a second opinion at the Mayo Clinic in Rochester, Minnesota. They performed a battery of blood tests and reviewed my medical charts and confirmed that I was one of that rare subset of people who are experiencing true idiopathic recurrent acute pancreatitis. The two doctors who met with me, presented something of a good cop/bad cop dialogue. The ‘good cop’ said that my illness may well be an anomaly that vanishes from my life as mysteriously as it arrived. The ‘bad cop’ was more prudent… escorting me out the door with assurances that future pancreatic research may someday offer me relief.

I am delighted to say that I have not been in the hospital since August of 2012. Since that time, I have continued to have attacks – but they are now getting further apart. (Six months between the last two attacks.) Between acute attacks, I am fortunately, pain free.

There are many things I’ve learned on my journey with pancreatitis. Being diagnosed as idiopathic, has encouraged me to be very proactive in researching and understanding the probable and possible causes for my condition. This knowledge has helped me to better understand and communicate with my personal medical team and to maximize the value of the limited time these professionals can offer. My experience and research has also illuminated the great discrepancy that exists amongst medical professionals in terms of real knowledge of the pancreas and the Sphincter of Oddi. I highly recommend that anyone who has — or thinks they may have — a recurring or chronic issue with their pancreas to seek out the services of a Pancreas specialty center in a research hospital. Before, I found myself in the good hands of Dr. Freeman at the University of Minnesota, I had been erroneously diagnosed with pancreas divisum and recommended for a gall bladder surgery that I very likely did not need. A pancreas specialty center will have the best diagnostic tools available and the most experienced researchers and surgeons.

The more I learn about pancreatitis and Sphincter of Oddi Dysfunction… the more questions I have:

I wonder about the role of stress in pancreatitis and Sphincter of Oddi dysfunction. My first pancreatitis attack, came on a day of great immediate stress, superimposed on a a host of more chronic stressors. Several other attacks have occurred during stressful periods. I am curious if any other pancreatitis-experiencers have attributed their attacks to a stress overload and felt some kind of attendant muscle or sphincter tensioning might play a role in these. Has anyone had better control of their flare-ups with anti-anxiety medication?

I also wonder about the role of medication in the origin of my pancreatitis. I had been on a generic fluoxetine prozac prescription for a few years prior to my pancreatitis attack. After my second attack, I discontinued this medication — but continued to have attacks.

Also, I wonder about the true role of diet in this condition. I maintain a very consistent, very low-fat diet… and still have pancreatitis attacks. (Though, I have had less frequency since switching to a gluten-free diet). I am curious as to what other people who have a similar profile to mine are able to eat. Am I needlessly, depriving myself of some healthy fats out of an unnecessary fear?

Finally, the onset of pancreatitis turned my employment situation topsy-turvy. Now that things have appeared to stabilize, I’m in the process of rebuilding my life and trying to reintegrate myself into the work-world. I’m curious to know how other pancreatitis experiencers manage their work-life while navigating this condition. How do they deal with absences from work? If they are looking for work, how do they explain a gap in their resume caused by illness? Are many pancreatitis experiencers able to create self-employment scenarios that allow them to work around flare-ups?

I know I’ve written a book here, but if I can help anyone out, or if someone who reads this can identify with or assist me in my own healing… these words will be meaningful. I wish you and all others who negotiate this condition; great wisdom, love and healing.

Sincerely,

R.

Becoming Better Everyday

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: