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      Precision medicine for acute pancreatitis: current status and future opportunities

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          Abstract

          Acute pancreatitis is a common inflammatory condition affecting the pancreas, predominantly caused by gallstones, alcohol excess, and hypertriglyceridaemia, with severe disease carrying up to 50% mortality. Despite significant research and preclinical promise, no targeted drug treatments exist for the disease and precision medicine approaches are lacking significantly, when compared to other health conditions. Advances in omics applications will facilitate improved preclinical models and target identification as well as biomarker discovery for refined trial design, focusing on risk stratification, subject selection, and outcome determination. Randomised treatment of Acute Pancreatitis with Infliximab: Double-blind, placebo-controlled, multi-centre trial (RAPID-I) is a pioneering trial, currently under way in acute pancreatitis, which may serve as an innovative model for the implementation of precision medicine strategies for acute pancreatitis in the future.

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          Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus.

          Peter A Banks, Thomas Bollen, CHRISTOS DERVENIS … (2012)
          The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.
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            Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018.

            Anne Peery, Seth Crockett, Caitlin C Murphy … (2019)
            Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States.
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              The epidemiology of pancreatitis and pancreatic cancer.

              Dhiraj Yadav, Albert B Lowenfels (2013)
              Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admission in the United States. Chronic pancreatitis, although lower in incidence, significantly reduces patients' quality of life. Pancreatic cancer is associated with a high mortality rate and is one of the top 5 causes of death from cancer. The burden of pancreatic disorders is expected to increase over time. The risk and etiology of pancreatitis differ with age and sex, and all pancreatic disorders affect the black population more than any other race. Gallstones are the most common cause of acute pancreatitis, and early cholecystectomy eliminates the risk of future attacks. Alcohol continues to be the single most important risk factor for chronic pancreatitis. Smoking is an independent risk factor for acute and chronic pancreatitis, and its effects could synergize with those of alcohol. Significant risk factors for pancreatic cancer include smoking and non-O blood groups. Alcohol abstinence and smoking cessation can alter the progression of pancreatitis and reduce recurrence; smoking cessation is the most effective strategy to reduce the risk of pancreatic cancer. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Precis Clin Med
                Journal ID (iso-abbrev): Precis Clin Med
                Journal ID (publisher-id): pcm
                Title: Precision Clinical Medicine
                Publisher: Oxford University Press
                ISSN (Print): 2096-5303
                ISSN (Electronic): 2516-1571
                Publication date (Print): June 2019
                Publication date (Electronic): 21 June 2019
                Publication date PMC-release: 21 June 2019
                Volume: 2
                Issue: 2
                Pages: 81-86
                Affiliations
                Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
                Author notes
                Correspondence: Robert Sutton, r.sutton@ 123456liverpool.ac.uk
                Article
                Publisher ID: pbz010
                DOI: 10.1093/pcmedi/pbz010
                PMC ID: 8985768
                PubMed ID: 35692449
                SO-VID: 18dff793-10b5-4984-8657-fb5f6259fe74
                Copyright © © The Author(s) 2019. Published by Oxford University Press on behalf of International Communication Association.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                Date received : 04 May 2019
                Date revision received : 14 May 2019
                Date accepted : 14 June 2019
                Page count
                Pages: 6
                Categories
                Subject: Perspective

                Keywords: precision medicine,acute pancreatitis,animal models,clinical trials
                Data availability:
                Keywords: precision medicine, acute pancreatitis, animal models, clinical trials

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