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.
研究概览
地位
详细说明
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.
研究类型
注册 (估计的)
联系人和位置
学习联系方式
- 姓名：Teresa Mezza, MD, PhD
- 电话号码：+390630156664
- 邮箱：teresa.mezza@policlinicogemelli.it
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
取样方法
研究人群
描述
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.
学习计划
研究是如何设计的？
设计细节
队列和干预
团体/队列 |
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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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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Identification and Characterization of Metabolic Endotypes
大体时间：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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合作者和调查者
调查人员
- 首席研究员：Teresa Mezza、Fondazione Policlinico Universitario Agostino Gemelli IRCCS
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他相关的 MeSH 术语
其他研究编号
- 27477
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