Exocrine-Endocrine Pancreatic Crosstalk: Precision Pathways to Reframe Diabetes Pathophysiology (EXPAND)
The EXPAND study is a prospective observational study designed to investigate the biological mechanisms underlying the heterogeneity of type 2 diabetes and related metabolic disorders.
The study will enroll adults with and without pancreatic disease, including patients undergoing pancreatic surgery, individuals with chronic pancreatitis, subjects at high risk of type 2 diabetes, and patients with newly diagnosed type 2 diabetes. Clinical, metabolic, imaging, genetic, microbiome, and molecular data will be integrated to identify distinct metabolic endotypes and to investigate the interactions between the exocrine pancreas, endocrine pancreas, and adipose tissue. The ultimate goal is to improve the understanding of diabetes pathophysiology and support the development of precision medicine approaches.
Tutkimuksen yleiskatsaus
Tila
Yksityiskohtainen kuvaus
Type 2 diabetes mellitus is a heterogeneous disease characterized by substantial variability in pathophysiological mechanisms, disease progression, and clinical outcomes. Current clinical classifications do not fully capture the biological complexity underlying metabolic dysfunction.
The EXPAND (Exocrine-Endocrine Pancreatic Axis in Diabetes) study is a prospective observational study aimed at identifying and characterizing metabolic endotypes through the integration of clinical, metabolic, imaging, genetic, microbiome, and multi-omic data. The study is based on the hypothesis that interactions among the exocrine pancreas, endocrine pancreas, and adipose tissue contribute to beta-cell dysfunction and metabolic heterogeneity.
Approximately 440 participants will be enrolled across five predefined cohorts: patients undergoing pancreatic resection for pancreatic diseases, patients with chronic or previous pancreatitis, individuals at increased risk of type 2 diabetes, and subjects with newly diagnosed type 2 diabetes.
Participants will undergo detailed metabolic phenotyping including oral glucose tolerance tests, hyperglycemic/euglycemic clamp studies, laboratory assessments, magnetic resonance imaging-based body fat quantification, dietary assessment, genetic analyses, microbiome profiling, and biomarker measurements. For surgical cohorts, pancreatic and adipose tissue samples obtained during clinically indicated surgery will also be analyzed.
Unsupervised clustering and archetype analysis approaches will be used to identify metabolic endotypes. Associations between endotypes and clinical, metabolic, imaging, histopathological, genetic, and molecular characteristics will be explored. Longitudinal analyses in surgical cohorts will evaluate metabolic changes following pancreatic resection.
The results are expected to improve the understanding of diabetes pathophysiology and facilitate the development of biomarker-driven precision medicine strategies.
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Teresa Mezza, MD, PhD
- Puhelinnumero: +390630156664
- Sähköposti: teresa.mezza@policlinicogemelli.it
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Näytteenottomenetelmä
Tutkimusväestö
Kuvaus
Inclusion Criteria:
- Adults aged 20 to 78 years.
- Ability and willingness to provide written informed consent.
- Eligibility for one of the study cohorts:
- Individuals undergoing pancreatectomy for non-endocrine pancreatic disease.
- Individuals with pancreatic ductal adenocarcinoma undergoing pancreatectomy.
- Individuals with chronic pancreatitis or a previous episode of acute pancreatitis.
- Individuals at increased risk of type 2 diabetes mellitus, including impaired fasting glucose and/or impaired glucose tolerance.
- Individuals with newly diagnosed type 2 diabetes mellitus.
- Ability to undergo study-related metabolic assessments and sample collection procedures.
Exclusion Criteria:
- Age <20 years or >78 years.
- Inability or unwillingness to provide informed consent.
- Pregnancy or breastfeeding.
- Diagnosis of type 1 diabetes mellitus.
- Participation in another interventional clinical trial involving an investigational medicinal product within 30 days before enrollment.
- Clinical conditions that preclude completion of the planned metabolic assessments.
- Inability to comply with study procedures.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
Kohortit ja interventiot
Ryhmä/Kohortti |
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Pancreatic Surgery for Non-Endocrine Pancreatic Disease
Adults undergoing partial or total pancreatectomy for non-endocrine pancreatic disease.
Participants will undergo clinical evaluation, metabolic phenotyping, imaging assessments, biomarker measurements, gut microbiome profiling from stool samples, and Genetic Risk Score determination.
Pancreatic and adipose tissue specimens obtained during clinically indicated surgery may be analyzed for histopathological, molecular, and multi-omic studies.
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Pancreatic Ductal Adenocarcinoma Undergoing Pancreatectomy
Adults with pancreatic ductal adenocarcinoma undergoing partial or total pancreatectomy.
Participants will undergo clinical evaluation, metabolic phenotyping, imaging assessments, biomarker measurements, gut microbiome profiling from stool samples, and Genetic Risk Score determination.
Pancreatic and adipose tissue specimens obtained during clinically indicated surgery may be analyzed for histopathological, molecular, and multi-omic studies.
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Chronic or Previous Pancreatitis
Adults with chronic pancreatitis or a previous episode of acute pancreatitis.
Participants will undergo clinical evaluation, metabolic phenotyping, imaging assessments, biomarker measurements, gut microbiome profiling from stool samples, and Genetic Risk Score determination.
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Individuals at Risk for Type 2 Diabetes
Adults at increased risk of type 2 diabetes, including individuals with impaired fasting glucose and/or impaired glucose tolerance, without exocrine pancreatic disease.
Participants will undergo clinical evaluation, metabolic phenotyping, imaging assessments, biomarker measurements, gut microbiome profiling from stool samples, and Genetic Risk Score determination.
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Newly Diagnosed Type 2 Diabetes
Adults with newly diagnosed type 2 diabetes mellitus.
Participants will undergo clinical evaluation, metabolic phenotyping, imaging assessments, biomarker measurements, gut microbiome profiling from stool samples, and Genetic Risk Score determination.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Identification and Characterization of Metabolic Endotypes
Aikaikkuna: At baseline and during study assessments up to 60 months
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Identification and characterization of physiological endotypes of glucose metabolism using unsupervised clustering and archetype analysis integrating metabolic phenotyping, imaging, and biological/multi-omic variables.
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At baseline and during study assessments up to 60 months
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Yhteistyökumppanit ja tutkijat
Tutkijat
- Päätutkija: Teresa Mezza, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
- Endokriinisen järjestelmän sairaudet
- Patologiset prosessit
- Neoplasmat sivustoittain
- Neoplasmat
- Krooninen sairaus
- Sairauden ominaisuudet
- Metaboliset sairaudet
- Ruoansulatuskanavan kasvaimet
- Ruoansulatuskanavan sairaudet
- Glukoosiaineenvaihduntahäiriöt
- Diabetes mellitus
- Endokriinisten rauhasten kasvaimet
- Haiman sairaudet
- Hyperinsulinismi
- Tautialttius
- Geneettinen alttius sairauksille
- Patologiset tilat, merkit ja oireet
- Ravitsemukselliset ja aineenvaihduntataudit
- Haimatulehdus
- Geneettinen riskipiste
- Diabetes mellitus, tyyppi 2
- Haiman kasvaimet
- Haimatulehdus, krooninen
- Insuliiniresistenssi
- Prediabeettinen tila
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