Chronic PancreatitisPhase 1NCT01452217
Non-invasive MRI to Quantify the Effect of Secretin on Pancreatic Blood Flow and Perfusion in Healthy Volunteers
A Phase 1 study testing Secretin in people with Chronic Pancreatitis, run by University of Nottingham at 1 site in United Kingdom.
Trial summary
Alterations in pancreatic blood have been implicated in pancreatic inflammation and pain. Several modalities have been used to assess pancreatic blood flow although some of these methods are invasive, use ionising radiation or intravenous contrast media. Read more about this study
- Who is it for?
- Ages 18 to 75 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Chronic Pancreatitis
- What is being tested?
- Secretin
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 12 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- Sep 2010to Oct 2011
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- Men only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Male
- Healthy
- Able to give informed consent
Who cannot join
- Current illness
- Contraindications to magnetic resonance imaging
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
University of Nottingham
Nottingham, Nottinghamshire, NG7 2UH
About this study
Official title: The Use of Non-invasive MRI to Quantify the Effect of Secretin on Pancreatic Blood Flow and Perfusion in Healthy Volunteers
Alterations in pancreatic blood have been implicated in pancreatic inflammation and pain. Several modalities have been used to assess pancreatic blood flow although some of these methods are invasive, use ionising radiation or intravenous contrast media. This is the first study to utilise non-invasive magnetic resonance imaging to quantify flow within arteries supplying the pancreas and pancreatic perfusion is response to secretin stimulation.
Read the detailed description
Background An alteration in pancreatic blood flow may be important in a number of clinical conditions. Reduction of blood flow is seen in patients with acute and chronic pancreatitis and the quantification of perfusion may be useful in the management of pancreatic malignancy and assessment of pancreatic transplants. Unfortunately, the measurement of pancreatic blood flow is technically difficult due to the anatomical location of the organ and complex blood supply.
The pancreas receives its blood supply from a rich plexus of arteries but the foremost arterial supply arises from the splenic and pancreaticoduodenal arteries, both superior and inferior.
Various methods have been used in an attempt to quantify the blood flow but all have potential drawbacks. The use of endoscopic and laparoscopic methods are invasive as is the use of intravenous contrast media. Furthermore, the use of computed tomography exposes patients to ionising radiation.
As the arterial supply to the pancreas is complex, measuring single artery flow does not provide an accurate measure of perfusion. Furthermore, as some of the named branches supplying the arteries are secondary or tertiary branches of more major vessels, narrow arterial diameter precludes accurate radiological measurement. Arterial Spin Labelling (ASL) magnetic resonance imaging (MRI), on the other hand is a validated technique allowing accurate measurement of visceral perfusion.
Transient physiological changes occur in pancreatic blood flow secondary to increased demands such as eating. Changes can also be induced pharmacologically using pancreatic stimulating agents, such as secretin. This naturally occuring peptide is produced within the S cells of the proximal small bowel mucosa. It causes an increase in bicarbonate secretion by the duct cells of the pancreas and biliary tract via an oxygen dependant cyclic AMP mediated pathway. Secretin has been used previously to assess alterations in blood flow and is used clinically in the assessment of sphincter of Oddi dysfunction in conjunction with magnetic resonance cholangiopancreatography.
Aims and Hypothesis This pilot study aims to evaluate the MRI techniques of measuring pancreatic perfusion and blood flow at rest and during secretin stimulation in healthy volunteers, prior to an evaluation in the chronic pancreatitis patient group.
Experimental protocol and methods Volunteers will be recruited from advertisements placed on designated University of Nottingham notice boards. All volunteers will complete a questionnaire of abdominal symptoms, Hospital anxiety and depression scale (HAD) and the patient health questionnaire 15 (PhQ15). Each volunteers will attend the 1.5T Brain and Body Imaging centre on the University of Nottingham Campus for all study evaluations.
Following an overnight fast a baseline MRI scan will be undertaken. Volunteers will then receive 1 IU/kg of secretin (Sanochemia Pharmazeutika AG, Wien, Germany) via the intravenous route over 3 minutes.
The volunteers will then be scanned again at 5, 10, 20, 30 and 40 min following the stimulus.
MRI scanning will be carried out on the Philips 1.5T Achieva MRI scanner located in the Brain and Body Imaging Centre University of Nottingham. The volunteers will be placed supine in the scanner with a receiver body coil wrapped around the abdomen. All image analysis will be carried out using commercial and/or in house packages.
Outcome measures at baseline and following secretin stimulation:
- Pancreatic perfusion
- Superior mesenteric artery blood flow
- Gastroduodenal artery blood flow
- Hepatic artery blood flow
- Splenic artery blood flow
- Conditions
- Chronic Pancreatitis
- Being tested
- Secretin
- Keywords
- Pancreas, Chronic pancreatitis, Perfusion, Blood flow, Magnetic resonance imaging
- Medical subject headings
- Pancreatitis, Chronic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
SecretinDrug
Secretin 1 IU/kg over 3 min
| Study group | Role | What they receive |
|---|---|---|
| Secretin | Experimental | Not described Receives: Drug: Secretin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pancreatic perfusion
Overall perfusion of the pancreas
Measured: 0, 5, 10, 20, 30 and 40 min
Secondary outcomes (4)
Superior mesenteric artery blood flow
Blood flow in the superior mesenteric artery
Measured: 0, 5, 10, 20, 30 and 40 min
Gastroduodenal artery blood flow
Blood flow in the gastroduodenal artery
Measured: 0, 5, 10, 20, 30 and 40 min
Hepatic artery blood flow
Blood flow in the hepatic artery
Measured: 0, 5, 10, 20, 30 and 40 min
Splenic artery blood flow
Blood flow in the splenic artery
Measured: 0, 5, 10, 20, 30 and 40 min
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Oct 2011 (estimated)
- Study startSep 2010
- Primary completionSep 2011
- Study completionOct 2011
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (13)Papers the sponsor has linked to this study.
- Other trials for Chronic PancreatitisStudies of the same condition, open and under way.
- More trials run by University of NottinghamThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Diagnosis
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 12 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Nottingham
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- John Simpson, PhD FRCS, Principal investigator, University of Nottingham
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01452217
- Sponsor's protocol ID
- D/07/2010
- Status last verified
- Oct 2011
- First submitted
- 10 Oct 2011
- Last updated
- 14 Oct 2011
- Results posted
- No
- Data monitoring committee
- No
Publications
Delrue L, Blanckaert P, Mertens D, Van Meerbeeck S, Ceelen W, Duyck P. Tissue perfusion in pathologies of the pancreas: assessment using 128-slice computed tomography. Abdom Imaging. 2012 Aug;37(4):595-601. doi: 10.1007/s00261-011-9783-0.
PubMed 21811851Tsushima Y, Kusano S. Age-dependent decline in parenchymal perfusion in the normal human pancreas: measurement by dynamic computed tomography. Pancreas. 1998 Aug;17(2):148-52. doi: 10.1097/00006676-199808000-00006.
PubMed 9700945Ishida H, Makino T, Kobayashi M, Tsuneoka K. Laparoscopic measurement of pancreatic blood flow. Endoscopy. 1983 May;15(3):107-10. doi: 10.1055/s-2007-1021480.
PubMed 6223807Lewis MP, Lo SK, Reber PU, Patel A, Gloor B, Todd KE, Toyama MT, Sherman S, Ashley SW, Reber HA. Endoscopic measurement of pancreatic tissue perfusion in patients with chronic pancreatitis and control patients. Gastrointest Endosc. 2000 Feb;51(2):195-9. doi: 10.1016/s0016-5107(00)70417-2.
PubMed 10650267Bali MA, Metens T, Denolin V, De Maertelaer V, Deviere J, Matos C. Pancreatic perfusion: noninvasive quantitative assessment with dynamic contrast-enhanced MR imaging without and with secretin stimulation in healthy volunteers--initial results. Radiology. 2008 Apr;247(1):115-21. doi: 10.1148/radiol.2471070685. Epub 2008 Feb 21.
PubMed 18292476Hacki WH. Secretin. Clin Gastroenterol. 1980 Sep;9(3):609-32. No abstract available.
PubMed 7000396Bize PE, Platon A, Becker CD, Poletti PA. Perfusion measurement in acute pancreatitis using dynamic perfusion MDCT. AJR Am J Roentgenol. 2006 Jan;186(1):114-8. doi: 10.2214/AJR.04.1416.
PubMed 16357388Hirota M, Tsuda M, Tsuji Y, Kanno A, Kikuta K, Kume K, Hamada S, Unno J, Ito H, Ariga H, Chiba T, Masamune A, Satoh K, Shimosegawa T. Perfusion computed tomography findings of autoimmune pancreatitis. Pancreas. 2011 Nov;40(8):1295-301. doi: 10.1097/MPA.0b013e31821fcc4f.
PubMed 21705954Cuthbertson CM, Christophi C. Disturbances of the microcirculation in acute pancreatitis. Br J Surg. 2006 May;93(5):518-30. doi: 10.1002/bjs.5316.
PubMed 16607683Foitzik T, Eibl G, Hotz HG, Faulhaber J, Kirchengast M, Buhr HJ. Endothelin receptor blockade in severe acute pancreatitis leads to systemic enhancement of microcirculation, stabilization of capillary permeability, and improved survival rates. Surgery. 2000 Sep;128(3):399-407. doi: 10.1067/msy.2000.107104.
PubMed 10965310Drewes AM, Krarup AL, Detlefsen S, Malmstrom ML, Dimcevski G, Funch-Jensen P. Pain in chronic pancreatitis: the role of neuropathic pain mechanisms. Gut. 2008 Nov;57(11):1616-27. doi: 10.1136/gut.2007.146621. Epub 2008 Jun 19.
PubMed 18566105Terrace JD, Paterson HM, Garden OJ, Parks RW, Madhavan KK. Results of decompression surgery for pain in chronic pancreatitis. HPB (Oxford). 2007;9(4):308-11. doi: 10.1080/13651820701481497.
PubMed 18345310Heverhagen JT, Wagner HJ, Ebel H, Levine AL, Klose KJ, Hellinger A. Pancreatic transplants: noninvasive evaluation with secretin-augmented mr pancreatography and MR perfusion measurements--preliminary results. Radiology. 2004 Oct;233(1):273-80. doi: 10.1148/radiol.2331031188.
PubMed 15454624
Study at a glance
From the registry record, last updated by the sponsor on 14 Oct 2011. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Use of Non-invasive MRI to Quantify the Effect of Secretin on Pancreatic Blood Flow and Perfusion in Healthy Volunteers
- ClinicalTrials.gov ID
- NCT01452217
- Acronym / sponsor ID
- D/07/2010
- Conditions
- Chronic Pancreatitis
- Keywords
- Pancreas, Chronic pancreatitis, Perfusion, Blood flow, Magnetic resonance imaging
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 12 participants (actual)
- Lead sponsor
- University of NottinghamUniversity, hospital or other
- Study start
- Sep 2010
- Primary completion
- Sep 2011 (actual)
- Study completion
- Oct 2011 (actual)
- First posted
- 14 Oct 2011 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Alterations in pancreatic blood have been implicated in pancreatic inflammation and pain. Several modalities have been used to assess pancreatic blood flow although some of these methods are invasive, use ionising radiation or intravenous contrast media. This is the first study to utilise non-invasive magnetic resonance imaging to quantify flow within arteries supplying the pancreas and pancreatic perfusion is response to secretin stimulation.
Detailed description
Background An alteration in pancreatic blood flow may be important in a number of clinical conditions. Reduction of blood flow is seen in patients with acute and chronic pancreatitis and the quantification of perfusion may be useful in the management of pancreatic malignancy and assessment of pancreatic transplants. Unfortunately, the measurement of pancreatic blood flow is technically difficult due to the anatomical location of the organ and complex blood supply.
The pancreas receives its blood supply from a rich plexus of arteries but the foremost arterial supply arises from the splenic and pancreaticoduodenal arteries, both superior and inferior.
Various methods have been used in an attempt to quantify the blood flow but all have potential drawbacks. The use of endoscopic and laparoscopic methods are invasive as is the use of intravenous contrast media. Furthermore, the use of computed tomography exposes patients to ionising radiation.
As the arterial supply to the pancreas is complex, measuring single artery flow does not provide an accurate measure of perfusion. Furthermore, as some of the named branches supplying the arteries are secondary or tertiary branches of more major vessels, narrow arterial diameter precludes accurate radiological measurement. Arterial Spin Labelling (ASL) magnetic resonance imaging (MRI), on the other hand is a validated technique allowing accurate measurement of visceral perfusion.
Transient physiological changes occur in pancreatic blood flow secondary to increased demands such as eating. Changes can also be induced pharmacologically using pancreatic stimulating agents, such as secretin. This naturally occuring peptide is produced within the S cells of the proximal small bowel mucosa. It causes an increase in bicarbonate secretion by the duct cells of the pancreas and biliary tract via an oxygen dependant cyclic AMP mediated pathway. Secretin has been used previously to assess alterations in blood flow and is used clinically in the assessment of sphincter of Oddi dysfunction in conjunction with magnetic resonance cholangiopancreatography.
Aims and Hypothesis This pilot study aims to evaluate the MRI techniques of measuring pancreatic perfusion and blood flow at rest and during secretin stimulation in healthy volunteers, prior to an evaluation in the chronic pancreatitis patient group.
Experimental protocol and methods Volunteers will be recruited from advertisements placed on designated University of Nottingham notice boards. All volunteers will complete a questionnaire of abdominal symptoms, Hospital anxiety and depression scale (HAD) and the patient health questionnaire 15 (PhQ15). Each volunteers will attend the 1.5T Brain and Body Imaging centre on the University of Nottingham Campus for all study evaluations.
Following an overnight fast a baseline MRI scan will be undertaken. Volunteers will then receive 1 IU/kg of secretin (Sanochemia Pharmazeutika AG, Wien, Germany) via the intravenous route over 3 minutes.
The volunteers will then be scanned again at 5, 10, 20, 30 and 40 min following the stimulus.
MRI scanning will be carried out on the Philips 1.5T Achieva MRI scanner located in the Brain and Body Imaging Centre University of Nottingham. The volunteers will be placed supine in the scanner with a receiver body coil wrapped around the abdomen. All image analysis will be carried out using commercial and/or in house packages.
Outcome measures at baseline and following secretin stimulation:
- Pancreatic perfusion
- Superior mesenteric artery blood flow
- Gastroduodenal artery blood flow
- Hepatic artery blood flow
- Splenic artery blood flow
Study design
- Primary purpose
- Diagnosis
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Secretin | Experimental | Drug: Secretin |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Male
- Healthy
- Able to give informed consent
Key exclusion criteria (2 listed)
- Current illness
- Contraindications to magnetic resonance imaging
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| SecretinSecretin 1 IU/kg over 3 min | Drug | Secretin |
Primary outcome
Pancreatic perfusion
Time frame: 0, 5, 10, 20, 30 and 40 min
Overall perfusion of the pancreas
4 secondary outcomes
Superior mesenteric artery blood flow
Time frame: 0, 5, 10, 20, 30 and 40 min
Gastroduodenal artery blood flow
Time frame: 0, 5, 10, 20, 30 and 40 min
Hepatic artery blood flow
Time frame: 0, 5, 10, 20, 30 and 40 min
Splenic artery blood flow
Time frame: 0, 5, 10, 20, 30 and 40 min
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Oct 2011.
- Background: PubMed 21811851Delrue L, Blanckaert P, Mertens D, Van Meerbeeck S, Ceelen W, Duyck P. Tissue perfusion in pathologies of the pancreas: assessment using 128-slice computed tomography. Abdom Imaging. 2012 Aug;37(4):595-601. doi: 10.1007/s00261-011-9783-0.
- Background: PubMed 9700945Tsushima Y, Kusano S. Age-dependent decline in parenchymal perfusion in the normal human pancreas: measurement by dynamic computed tomography. Pancreas. 1998 Aug;17(2):148-52. doi: 10.1097/00006676-199808000-00006.
- Background: PubMed 6223807Ishida H, Makino T, Kobayashi M, Tsuneoka K. Laparoscopic measurement of pancreatic blood flow. Endoscopy. 1983 May;15(3):107-10. doi: 10.1055/s-2007-1021480.
- Background: PubMed 10650267Lewis MP, Lo SK, Reber PU, Patel A, Gloor B, Todd KE, Toyama MT, Sherman S, Ashley SW, Reber HA. Endoscopic measurement of pancreatic tissue perfusion in patients with chronic pancreatitis and control patients. Gastrointest Endosc. 2000 Feb;51(2):195-9. doi: 10.1016/s0016-5107(00)70417-2.
- Background: PubMed 18292476Bali MA, Metens T, Denolin V, De Maertelaer V, Deviere J, Matos C. Pancreatic perfusion: noninvasive quantitative assessment with dynamic contrast-enhanced MR imaging without and with secretin stimulation in healthy volunteers--initial results. Radiology. 2008 Apr;247(1):115-21. doi: 10.1148/radiol.2471070685. Epub 2008 Feb 21.
- Background: PubMed 7000396Hacki WH. Secretin. Clin Gastroenterol. 1980 Sep;9(3):609-32. No abstract available.
- Background: PubMed 16357388Bize PE, Platon A, Becker CD, Poletti PA. Perfusion measurement in acute pancreatitis using dynamic perfusion MDCT. AJR Am J Roentgenol. 2006 Jan;186(1):114-8. doi: 10.2214/AJR.04.1416.
- Background: PubMed 21705954Hirota M, Tsuda M, Tsuji Y, Kanno A, Kikuta K, Kume K, Hamada S, Unno J, Ito H, Ariga H, Chiba T, Masamune A, Satoh K, Shimosegawa T. Perfusion computed tomography findings of autoimmune pancreatitis. Pancreas. 2011 Nov;40(8):1295-301. doi: 10.1097/MPA.0b013e31821fcc4f.
- Background: PubMed 16607683Cuthbertson CM, Christophi C. Disturbances of the microcirculation in acute pancreatitis. Br J Surg. 2006 May;93(5):518-30. doi: 10.1002/bjs.5316.
- Background: PubMed 10965310Foitzik T, Eibl G, Hotz HG, Faulhaber J, Kirchengast M, Buhr HJ. Endothelin receptor blockade in severe acute pancreatitis leads to systemic enhancement of microcirculation, stabilization of capillary permeability, and improved survival rates. Surgery. 2000 Sep;128(3):399-407. doi: 10.1067/msy.2000.107104.
- Background: PubMed 18566105Drewes AM, Krarup AL, Detlefsen S, Malmstrom ML, Dimcevski G, Funch-Jensen P. Pain in chronic pancreatitis: the role of neuropathic pain mechanisms. Gut. 2008 Nov;57(11):1616-27. doi: 10.1136/gut.2007.146621. Epub 2008 Jun 19.
- Background: PubMed 18345310Terrace JD, Paterson HM, Garden OJ, Parks RW, Madhavan KK. Results of decompression surgery for pain in chronic pancreatitis. HPB (Oxford). 2007;9(4):308-11. doi: 10.1080/13651820701481497.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
John Simpson, PhD FRCS principal investigator
University of Nottingham
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Secretin in people with Chronic Pancreatitis, run by University of Nottingham at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 14 Oct 2011. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pancreatic perfusion (time frame: 0, 5, 10, 20, 30 and 40 min). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01452217, which also lists 13 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Oct 2011.