Control mechanisms of mammalian pepsinogen secretion

The objective of this thesis was to delineate aspects of the control mechanisms of mammalian pepsinogen secretion. In order to accomplish this goal, a comprehensive study was undertaken which would establish an historical perspective of the subject, validate appropriate methodology and then seek to answer specific questions regarding the physiology and pathophysiology of pepsinogen secretion. More specifically, the objectives of this thesis were: 1. To review the historical background of the subject of pepsinogen in the context of the physiology of digestion with specific emphasis on the work and lives of the two major initial proponents of pepsinogen research (Schwann and Langley). 2. To provide a contemporary overview and evaluation of the current status of pepsinogen pathophysiology. 3. To modify and adapt experimental models necessary for the study of pepsinogen and acid secretion in mammalian gastric mucosa and cells. 4. To establish and validate a pepsinogen assay sensitive and reproducible enough for use in mammalian mucosa! and cellular secretory systems. 5. To delineate the fundamental (second messenger) control mechanisms (cyclic AMP and calcium calmodulin) of pepsinogen secretion in the isolated gastric gland model. 6. To define whether the process of pepsinogen secretion is independent of acid secretion in intact mucosa! preparations. 7. To identify different classes of pharmacological agents which would inhibit pepsinogen secretion and/or release. 8. To identify whether conditions present in critically ill patients liable to mucosal "stress ulceration" might influence the release of pepsinogen

Peptide Receptor Radionuclide Therapy for Advanced Neuroendocrine Tumors

No abstract availabl

Circulating Transcript Analysis (NETest) in GEP-NETs Treated With Somatostatin Analogs Defines Therapy

Context: Early and precise delineation of therapeutic responses are key issues in neuroendocrine neoplasm/tumor management. Imaging is currently used but exhibits limitations in sensitivity and specificity. The utility of biomarkers is unclear. Objective, Setting, and Design: This prospective cohort study (11 mo) sought to determine whether measurements of circulating neuroendocrine tumor transcripts (NETest) predict responses to somatostatin analogs (SSAs). Patients: The test set consisted of 35 SSA-treated gastroenteropancreatic-NETs (RECISTevaluated). The prospective set consisted of 28 SSA-treated Grade 1–Grade 2 GEP-NETs. Intervention(s): Whole blood for transcript analysis (NETest) and plasma for Chromogranin A (CgA) (baseline), were collected every 4 weeks (prior to SSA injection). Morphologic (multidetector computed tomography/MRI) and functional imaging (99mTc-[HYNIC, Tyr3]-Octreotide) was undertaken at entry and 6-month intervals until progression (RECIST 1.0). Main Outcome Measure(s): Treatment response. Results: Test set: NETest (≥80%; scale, 0–100%) differentiated stable (SD) and progressive (PD) disease (P < .0001). Prospective set: 28 patients (26/28 SD) undergoing standard SSA. Grading: 12 G1, 16 G2. SSA Response: progression-free survival: 315 days: 14 (50%) SD, 14 (50%) PD. NETest: Twenty had elevated (≥80%) values; 14 developed PD; six, SD. CgA: Twelve of 28 exhibited elevated baseline values and/or subsequent >25% increase; eight developed PD; four, SD. NETest (P = .002) and grade (P = .054) were the only factors associated with treatment response. Multiple regression analysis established that the NETest could predict disease progression (P = .0002). NETest changes occurred significantly earlier (146 d prior to progression vs 56 d CgA; P < .0001; χ2 = 19) and in more patients (100 vs 57%; P < .02). Conclusions: NETest values (80–100%) were more accurate and occurred at a significantly earlier time point than CgA and predicted SSA treatment response