Effect of Octreotide, a Long-Acting Somatostatin Analogue, on Plasma Amino Acid Uptake by the Pancreas

Gullo, Lucio; Pezzilli, R; Ancona, D.; Am, Labate; Barbara, L

doi:10.1097/00006676-199111000-00008

Cited by 11 publications

(5 citation statements)

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“…[29,30] Octreotide is capable of inhibiting pancreatic uptake of plasma amino acids, and this inhibition could be an important mechanism by which octreotide decreases pancreatic enzyme secretion. [31] It is thought that octreotide could prevent ASNaseinduced pancreatic injury through its physiopathologic properties. Recently, Muwakkit et al have also suggested that allopurinol, which is an inhibitor of xanthine oxidase, has a preventive effect on ASNase-induced pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

et al. 2012

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Background: The use of L-asparaginase (ASNase) to modify amino acid metabolism is one of the most effective chemotherapeutic means of inducing remission in acute lymphoblastic leukemia (ALL). However, severe pancreatitis sometimes occurs in patients receiving ASNase, because of an unknown mechanism. Objective: The purpose of the present study was to evaluate the relationship between ASNase-induced pancreatic injury and plasma amino acid levels in patients undergoing ASNase therapy. Methods: A total of 29 children aged 1-13.25 years (median age 4 years; male : female ratio 19 : 10) with ALL, who received induction therapy according to the Tokyo Children's Cancer Study Group L04-16 protocol, were studied. Levels of plasma amino acids and serum rapid turnover proteins (RTPs), pancreatic enzymes, and pancreatic protease inhibitors were measured before and 1, 2, 3, 4, 5, and 7 weeks after the first administration of ASNase. Results: Plasma asparagine levels were significantly lower after the first injection of ASNase (p < 0.01) and had almost recovered 2 weeks after the last ASNase injection. At 4 weeks after the first ASNase injection, serum aspartic acid, trypsin, and pancreatic secretory trypsin inhibitor (PSTI) levels remained significantly higher than those before the first ASNase injection (p < 0.01), and serum levels of prealbumin and transferrin remained significantly lower than those before the first ASNase injection (p < 0.01). Plasma amino acid and serum RTP levels gradually normalized after the last ASNase injection. Conclusions: Levels of serum trypsin and PSTI were elevated during the 2 weeks after administration of ASNase, which suggested the presence of subclinical pancreatitis. This period is similar to the time period in the present

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Section: Discussionmentioning

confidence: 99%

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

et al. 2012

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“…[29,30] Octreotide is capable of inhibiting pancreatic uptake of plasma amino acids, and this inhibition could be an important mechanism by which octreotide decreases pancreatic enzyme secretion. [31] It is thought that octreotide could prevent ASNase-induced pancreatic injury through its physiopathologic properties. Recently, Muwakkit et al have also suggested that allopurinol, which is an inhibitor of xanthine oxidase, has a preventive effect on ASNase-induced pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

et al. 2012

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BackgroundThe use of L-asparaginase (ASNase) to modify amino acid metabolism is one of the most effective chemotherapeutic means of inducing remission in acute lymphoblastic leukemia (ALL). However, severe pancreatitis sometimes occurs in patients receiving ASNase, because of an unknown mechanism.ObjectiveThe purpose of the present study was to evaluate the relationship between ASNase-induced pancreatic injury and plasma amino acid levels in patients undergoing ASNase therapy.MethodsA total of 29 children aged 1–13.25 years (median age 4 years; male:female ratio 19:10) with ALL, who received induction therapy according to the Tokyo Children’s Cancer Study Group L04–16 protocol, were studied. Levels of plasma amino acids and serum rapid turnover proteins (RTPs), pancreatic enzymes, and pancreatic protease inhibitors were measured before and 1, 2, 3, 4, 5, and 7 weeks after the first administration of ASNase.ResultsPlasma asparagine levels were significantly lower after the first injection of ASNase (p<0.01) and had almost recovered 2 weeks after the last ASNase injection. At 4 weeks after the first ASNase injection, serum aspartic acid, trypsin, and pancreatic secretory trypsin inhibitor (PSTI) levels remained significantly higher than those before the first ASNase injection (p<0.01), and serum levels of prealbumin and transferrin remained significantly lower than those before the first ASNase injection (p<0.01). Plasma amino acid and serum RTP levels gradually normalized after the last ASNase injection.ConclusionsLevels of serum trypsin and PSTI were elevated during the 2 weeks after administration of ASNase, which suggested the presence of subclinical pancreatitis. This period is similar to the time period in the present study when the levels of plasma amino acids changed, thus suggesting that ASNase-induced pancreatic injury could be caused by the imbalance of plasma amino acid levels.

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“…Experimental and clinical evidence that prolonged the administration of the peptide and lowered the levels of the enzymes in the pancreas led us to investigate the prophylactic effect of 3 × 200 μg/day of octreotide, starting 24 h before the endoscopic procedure, for the prevention of post‐ERCP pancreatitis in subjects with patient‐related risk factors for this complication 35 , . 36 …”

Section: Discussionmentioning

confidence: 99%

“…34 Experimental and clinical evidence that prolonged the administration of the peptide and lowered the levels of the enzymes in the pancreas led us to investigate the prophylactic effect of 3´200 lg/day of octreotide, starting 24 h before the endoscopic procedure, for the prevention of post-ERCP pancreatitis in subjects with patient-related risk factors for this complication. 35,36 The rationale for the trial was: (i) administration of the cheapest drug available known to profoundly inhibit exocrine pancreatic secretion; (ii) marked reduction of enzyme content in the pancreas at the time of ERCP, obtained by strong, prolonged reduction of amino acid uptake by pancreatic acinar cells; (iii) 24-h prophylaxis, that could be started the day before the procedure, either in hospital, without requiring additional time once the procedure is decided, or at home by the patients themselves if hospital admission is scheduled for the same day as the procedure; (iv) no excitatory effects on the sphincter of Oddi, because the peptide is not given immediately before the procedure, but at least 1 h before (the peak serum level of subcutaneous octreotide is reached within 30 min, with a half-life of about 113 min); (v) no prolonged medication required after the procedure, so prophylaxis is possible for patients scheduled for discharge the same day; (vi) prophylaxis only given to subjects with patient-related risk factors, who probably have the highest risk of developing post-procedure pancreatitis. We decided not to use a placebo arm, because the signi®cant ef®cacy of long-term subcutaneous octreotide on the post-procedure serum amylase curve and pain had already been documented in a blind, placebocontrolled trial.…”

Section: Discussionmentioning

confidence: 99%

Octreotide 24‐h prophylaxis in patients at high risk for post‐ERCP pancreatitis: results of a multicenter, randomized, controlled trial

Testoni

Bagnolo

Andriulli

et al. 2001

Aliment Pharmacol Ther

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The main questions still debated relating to the diagnostic and therapeutic endoscopic procedures involving Vater's papilla (ERCP) are post-procedure pancreatitis and its prevention. Acute post-ERCP pancreatitis is still the most frequent and feared complication. A recent review of prospective series found a mean prevalence of 5.2% after diagnostic procedures and 4.1% after therapeutic procedures. 1 However, in recent prospective studies in non-selected cases the rate of this complication has been reported to range widely, from 1.3% to 7.6%. 2±9 The varying SUMMARYBackground: Pharmacological prophylaxis of post-ERCP pancreatitis is costly and not useful in most non-selected patients, in whom the incidence of pancreatitis is 5% or less. However, it could be useful and probably costeffective, in patients at high risk for this complication, where the post-procedure pancreatitis rate is 10% and more. Aim: To assess the ef®cacy of octreotide in reducing the incidence and severity of post-ERCP pancreatitis and procedure-related hospital stay, in subjects with known patient-related risk factors. Methods: A total of 120 patients were randomly allocated to receive octreotide or not, in a multicentre, randomized, controlled trial. The drug was given subcutaneously, 200 lg t.d.s., starting 24 h before the ERCP procedure, in patients with either sphincter of Oddi dysfunction, or a history of relapsing pancreatitis

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Effect of Octreotide, a Long-Acting Somatostatin Analogue, on Plasma Amino Acid Uptake by the Pancreas

Cited by 11 publications

References 0 publications

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

Octreotide 24‐h prophylaxis in patients at high risk for post‐ERCP pancreatitis: results of a multicenter, randomized, controlled trial

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