Pancreatic Diseases and Microbiota: A Literature Review and Future Perspectives

Abstract

Gut microbiota represent an interesting worldwide research area. Several studies confirm that microbiota has a key role in human diseases, both intestinal (such as inflammatory bowel disease, celiac disease, intestinal infectious diseases, irritable bowel syndrome) and extra intestinal disorders (such as autism, multiple sclerosis, rheumatologic diseases). Nowadays, it is possible to manipulate microbiota by administering prebiotics, probiotics or synbiotics, through fecal microbiota transplantation in selected cases. In this scenario, pancreatic disorders might be influenced by gut microbiota and this relationship could be an innovative and inspiring field of research. However, data are still scarce and controversial. Microbiota manipulation could represent an important therapeutic strategy in the pancreatic diseases, in addition to standard therapies. In this review, we analyze current knowledge about correlation between gut microbiota and pancreatic diseases, by discussing on the one hand existing data and on the other hand future possible perspectives.

Current and New Challenges in the Management of Pancreatic Neuroendocrine Tumors: The Role of miRNA-Based Approaches as New Reliable Biomarkers

“…Poorly differentiated tumors do not express or have low somatostatin-receptor expression [9,10]. Functional imaging using radiolabeled somatostatin analogs with 111 In-pentetreotide single-photon emission computed tomography and 68 Ga-DOTA-SSA positron emission computed tomography (PET/CT) allows for tumor detection and accurate assessment of disease burden with higher sensitivity and specificity than conventional imaging. Furthermore, functional imaging is essential for well-differentiated tumors with high somatostatin-receptor expression for selection of candidates for targeted peptide receptor radionuclide therapy (PRRT) using 77 Lu or 90 Y [11].…”

“…Furthermore, functional imaging is essential for well-differentiated tumors with high somatostatin-receptor expression for selection of candidates for targeted peptide receptor radionuclide therapy (PRRT) using 77 Lu or 90 Y [11]. Additionally, various studies have shown that 68 Ga-DOTA-SSA PET/CT has a high sensitivity for detecting both lymphatic and distant metastases and has a significant prognostic value and a standardized tumor-uptake value associated with tumor differentiation, Ki-67, and survival [12][13][14]. 68 Ga-DOTA-SSA PET/CT strongly influences selection of the optimal treatment strategy, leading to management changes in 50-60% of cases [15,16].…”

“…Additionally, various studies have shown that 68 Ga-DOTA-SSA PET/CT has a high sensitivity for detecting both lymphatic and distant metastases and has a significant prognostic value and a standardized tumor-uptake value associated with tumor differentiation, Ki-67, and survival [12][13][14]. 68 Ga-DOTA-SSA PET/CT strongly influences selection of the optimal treatment strategy, leading to management changes in 50-60% of cases [15,16]. 18 F-Fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET/CT) has a low sensitivity for well-differentiated tumors and may help assess high-grade tumors that often display low somatostatin-receptor expression [11].…”

“…18 F-Fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET/CT) has a low sensitivity for well-differentiated tumors and may help assess high-grade tumors that often display low somatostatin-receptor expression [11]. However, as some high-grade tumors still benefit from 68 Ga-DOTA-SSA PET/CT, further research is needed to select patients that should be assessed using both 18 F-FDG PET/CT and 68 Ga-DOTA-SSA PET/CT.…”

“…Alterations of the microbiota have also been associated with pancreatic disorders, such as acute and chronic pancreatitis [63,64], type 1 diabetes [65], preneoplastic pancreatic lesions [66,67], and pancreatic cancer. Microbiota are implicated in pancreatic cancer oncogenesis by suppressing the innate and adaptive immune systems and through upregulation of carcinogenetic cellular pathways [68]. Murine models were used to analyze microbiome involvement in pancreatic adenocarcinoma carcinogenesis.…”