Biography:

Albeit diagnosed and defined as a “sugar disease of the adult”; i.e., namely a disease of the carbohydrate metabolism by mostly authors; So called type 2 diabetes mellitus should be better defined as a “No Man’s Land” state of disease in adults, at most diagnosed by, in the majority of cases, a fasting glycemia equal or higher than 126 mg/dL. And Why That? Because in a global epidemic, which is badly out of control, there is not much time to lose. So let’s get into some facts! Despite all controversies surrounding the etiology, pathogenesis, and therapeutic roles for hyperglycemia in type 2 diabetes mellitus, newer anti-hyper-glycemic drugs are still getting onto the market at a high speed, due to the overconfidence in HbA1c as a surrogate outcome for micro-vascular complications; albeit. All large recent randomized clinical trials and meta-analysis have shown that trying to achieve glycemic levels close to the normal range did not reduce the most clinically important micro-vascular or macro-vascular hard endpoints as end-stage renal disease, vision loss, cardiovascular and total mortality, with the added harm of substantial increase in the number of hypoglycemic episodes, and even death rates. Is it not too soon for us to forget about the rosiglitazone saga? The above, among other core issues, will be covered in our talk.

Abstract:

Jose Mario F De Oliveira is an Associate Professor of Medicine in the Department of Medicine of Universidad Federal Fluminense, in the State of Rio de Janeiro, Brazil. He is also one of the Deputy Editors for Diabetes of The British Medical Journal. He has published a number of papers and served as a reviewer or author and co-author for many prestigious medical journals like “Hypertension”, “The American Journal of Hypertension”, “The Journal of the American Society of Nephrology”, “The British Medical Journal”, and the “New England Journal of Medicine”. His main interests are in the clinical research of diabetes and hypertension. He is a Certified Preventive Cardiologist, Nephrologist and Adult Intensive Care Unit Physician. Finally, he was a Post-Doctoral Clinical and Research Fellow at the Endocrinology-Hypertension-Diabetes Division of the Brigham & Women’s Hospital at Harvard Medical School, in Boston, USA and is one of the two authors of the recent electronic Diabetes e-book published and edited by The British Medical Journal for all doctors world-wide.

Biography:

Kunk completed medical school at the University of Tennessee in 2011 and internal medicine training at the University of Virginia in 2014.  He is currently Chief Fellow of Hematology-Oncology at the University of Virginia.  Active in the field of gastrointestinal malignancies, he received the Joesph H. Farrow Research Award to analyze the immune microenvironment of cholangiocarcinoma.  He has published more than 15 papers in reputable journals and presented at several national meetings.

Abstract:

Immunotherapy is an exciting and growing field.  It has caused a paradigm shift in the treatment of metastatic melanoma and its role in many other cancers is growing. With the explosion of novel immune targets, completed and ongoing clinical trials and exciting combination therapies, immunotherapy is becoming ubiquitous in the daily life of an oncologist. Yet pancreatic cancer remains a fatal cancer with few effective therapies. Pancreatic cancer has been considered as a disease that may not be amendable to immunotherapy given the paucity of infiltrating immune cells in the tumor microenvironment. However, mounting evidence suggests that the pancreatic immune microenvironment is more complex, involving cells and receptors that transform the pancreas from its normal architecture into a complex mix of suppressor immune cells and dense extracellular matrix that allows for the unrestricted growth of cancer cells. Despite early studies showing little to activity, more recent studies shown more promising results.

Biography:

Raji Sundararajan completed her PhD in EE from Arizona State University, USA and is serving as a Professor at Purdue University.  She has over 35 journal papers and 130 conference papers, and is the Editor of the book, Electroporation-based therapies for cancer: From Basics to Clinical Applications.  She is a reviewer of electroporation proposals of various governmental agencies, including NIH of USA and Ireland.  She is also a sought-after reviewer of a number of scholarly journals and member of Editorial boards of repute.

Abstract:

With ~40,000 deaths per year out of ~46,000 incidences in the US, pancreatic cancers is one of the deadliest cancers.  It is the 4^th leading cause of death for both men and women and one in 4 deaths in the US is due to it.  Pancreatic adenocarcinoma (PAC) is the most common (90%) pancreatic cancer.  Pancreatic surgery involves removal of head or that part of the pancreas, where the tumor occurred, lymph nodes draining that part, part of bile duct, gall bladder and part of small bowel-at the least.  Total pancreatectomy involves the removal of the whole pancreas, spleen, and the rest of parts as above.  All these lead to poor quality of life with enormous pain and suffering.  In addition, only 20% of the pancreatic tumors are removed by surgery.  Both stages III and IV cancers and metastatic tumors cannot be removed by surgery.

Chemotherapy is not that efficient for the pancreatic tumors due to resistance to drug by most of the pancreatic cell lines.  Radiation is not used much due to the proximity of nearby major vessels and organs.

This indicates that the current standard treatments are inadequate and there is an urgent and critical need for effective alternate therapies.  Towards this we propose the administration of electrochemotherapy to arrest the uncontrolled growth of pancreatic cancer cells.  This technique involves enhanced uptake of chemodrugs due to the opening of pores, caused by the electrical pulses, allowing generally impermeable or less permeable chemo drug molecules to enter into the cells.  A number of cancers have been successfully treated using this technique and we studied its efficacy for pancreatic cancer.  For this purpose, both Panc-1 and Pance-28 cell lines were studied.  The chemo drug used was Gemcitabine at a concentration of 100µM.  Both high intensity, short duration pulses (1200V/cm, 100µs, 8 pulses at one second interval) and low intensity, long duration (500V/cm, 1, 10, 20 and 25ms pulses) were studied.  The results indicate that reduced viability, as low as 13% were obtained using this technique for Panc-28 cells.  The lowest viability was 31% in the case of panc-1 cells.  The corresponding viability using drug only is 60% or above, for both cell lines.  This indicates the efficacy of electrochemotherapy in treating the PAC cells effectively using the synergy effects of both the drug and the electrical pulses to enhance their uptake.  This technique shows enormous potential to be transferred to the clinics.

Biography:

Zeng has completed his PhD at the age of 30 years from Harbin Medical University. He is the vice director of General Surgery in the 2nd affiliated hospital of Harbin Medical University.

Abstract:

Pancreatic fistula (PF) is the most serious complication after pancreaticoduodenectomy (PD). Numerous techniques have been developed to treat PF, although none has effectively reduced its rate. Herein, we report our preliminary experience using a new technique known as pancreaticojejunostomy (PJ).

Methods: Twenty-two patients underwent PD for the treatment of neoplasms, with end-to-side sealing PJ in combination with duct-parenchyma-to-mucosa-seromuscular one-layer anastomosis, between January 2014 and March 2014. The postoperative outcomes of the patients were analyzed.

Results: The mean time of the PJ procedure was 18.5 min (range 12-30 min). One patient exhibited a grade A PF (4.5%). Three patients developed other complications, including a surgical site infection, pneumonia and a gastric stress ulcer with bleeding. The overall morbidity rate was 18.2%. There were no operative or hospital deaths.

Conclusion: This novel PJ technique was easy to perform and reliable, and it significantly reduced the occurrence of postoperative PF. Notably, this approach can be applied for any size duct and any consistency of pancreas

Biography:

G. Roeyen is senior staff member,  department of Hepatobiliary, Endocrine and Transplantation Surgery at the Antwerp University Hospital. Recently a paper on pancreatogenic diabetes in patients referred for pancreatic surgery has been published in ‘Pancreatology’

Abstract:

Objective:

Recently, pancreaticogastrostomy (PG) regained interest as reconstruction technique after pancreaticoduodenectomy (PD) because this technique might imply a lower risk of clinical pancreatic fistula than reconstruction by pancreaticojejunostomy (PJ). We hypothesize that PEI (pancreatic exocrine insufficiency) is more common during clinical follow up after PG than after PJ.

Research Design and Methods:

This study compares the prevalence of PEI in patients undergoing PD for malignancy reconstructed by PG versus reconstruction by PJ. PEI during the first year of follow up was defined as intake of pancreatic enzyme replacement therapy (PERT) within 1 year postoperatively and / or an abnormal exocrine function test.

Results:

In total 186 patients operated at 2 University Hospitals, were included. PEI during the first year postoperatively was present in 75.0% of the patients with PG compared with 45.7% with PJ (p<0.001). Intake of PERT within 1 year after surgery is more prevalent in the PG group: 75.8% versus 38.5% (p<0.001). There was a trend towards more disturbed exocrine function tests after PG (p=0.061). 

Conclusions:

PEI is more common with PG than with PJ reconstruction after pancreaticoduodenectomy for malignancy.

Biography:

Naomi Walsh completed her PhD in Dublin City University, Dublin Ireland, a holds a Masters of Public Health (MPH) from University College Dublin, Ireland. She conducted her post-doctoral research as a Cancer Prevention Fellow at the National Cancer Institute, USA. She is currently a Health Research Board/Irish Cancer Society Cancer Prevention Fellow in the National Institute for Cellular Biotechnology, DCU, Ireland. She has published extensively in the area of pancreatic cancer, and has 12 first author journal publications. She serves as a committee member for the Irish Association for Cancer Research (IACR).

Abstract:

Pancreatic cancer is a devastating disease. The lethality of pancreatic cancer is related to its rapid growth and tendency to invade adjacent organs and metastasise at an early stage. Identification of targets which play a role in the highly invasive phenotype of pancreatic cancer may help to better understand the biological behaviour and the rapid progression of this cancer. A systematic evaluation of miRNA and mRNA expression profiling was performed in highly invasive and non-invasive sub-clones derived from the MiaPaCa-2 cell line. Differential expression between the highly invasive and non-invasive clones revealed 522 genes and 12 miRNAs altered (p<0.05; fold change > 2). The integrated analysis of miRNA:mRNA found significant anti-correlation with 11 genes co-regulated by eight miRs. Validation of the miRNA:mRNA interactions was performed in seven pancreatic cancer cell lines and corresponded with invasive capabilities. Furthermore, expression of 4 miRs (mir-9, mir-135b, mir-148a and let-7c) was independently established in 20 pancreatic cancer and adjacent normal tissue specimens. Functional miR-gene targeting was validated in primary cell lines (n=4) derived from pancreatic tissue and established pancreatic cancer cell lines. Let-7c was found to be down-regulated in highly invasive cell lines and lowly expressed in pancreatic tumour tissue. Let-7c negatively regulates SOX13 expression. SOX13 is a direct target of SHH signalling and RNAi knockdown of SOX13 reduced proliferation and invasion of pancreatic cancer cells. The identification of key miRNA:mRNA gene interactions and networks provide potential diagnostic and therapeutic strategies for better treatment options for pancreatic cancer patients.

Biography:

Mark Podberezin has completed his MD and PhD degrees, as well as Clinical Hematology Fellowship, from National Hematology Center in Moscow, Russia. He did his Anatomic and Clinical Pathology Residency training from the University of Illinois at Chicago and Hematopathology Fellowship from Texas Methodist Hospital in Houston, TX. He has published 14 papers and has presented many at national as well as international conferences.

Abstract:

Pancreas can be involved in about 30-40% of patients with non-Hodgkin lymphoma. However, primary pancreatic lymphomas (PPL) are exquisitely rare and comprise less than 1% of extranodal lymphomas and approximately 0.5% of all pancreatic malignancies. PPLs are most commonly located in head of the pancreas and, therefore, they can present with symptoms similar to those of pancreatic adenocarcinomas, i.e. abdominal pain, jaundice, and weight loss. Invasive tumor growth not respecting anatomic boundaries, as well as absence of significant dilatation of main pancreatic duct, raise degree of suspicion for PPL rather than adenocarcinoma. However, systemic and extra-pancreatic lymphomas, with involvement of pancreas, are much more common than PPLs. We observed a case of 78 y/o man who presented with rapidly progressive weight loss and jaundice. CT scan demonstrated ill-defined lesion in pancreatic head, 2 cm in size, with massive peripancreatic lymphadenopathy and 6 cm splenic mass. Core needle biopsy led to the diagnosis of high grade diffuse large B-cell lymphoma (DLBCL). Patient’s status progressively deteriorated, and he expired before initiation of chemotherapy. Autopsy demonstrated involvement of pancreas, spleen, and peripancreatic lymph nodes by lymphoma. However, due to presence of splenic involvement, with dominant mass in the spleen, DLBCL of spleen with secondary pancreatic involvement was diagnosed. Diagnostic criteria, which favor PPL, vs. secondary pancreatic involvement by lymphoma, are following: No superficial or mediastinal lymphadenopathy; Normal leukocyte count; Main mass in the pancreas with lymph node involvement confined to peripancreatic region; and no hepatic or splenic involvement.

Biography:

Christine Mehner has completed her MD at the University of Witten/Herdecke, Germany and became a Post-doctoral fellow at the Mayo Clinic Cancer Center, Jacksonville, FL. She has published multiple first author papers in the field of cancer research, in reputed journals that have been recognized by the Faculty of 1000 and have been featured in news and media. She has been serving as an Editorial Board Member and constant reviewer for various journals.

Abstract:

Pancreatic ductal adenocarcinoma (PDA) arises at the convergence of genetic alterations in KRAS with a fostering microenvironment shaped by immune cell influx and fibrotic changes; identification of the earliest tumorigenic molecular mediators evokes the proverbial chicken and egg problem. Matrix metalloproteinases (MMP) are key drivers of tumor progression that originate primarily from stromal cells activated by the developing tumor. Here, MMP3, known to be expressed in PDA, was found to be associated with expression of Rac1b, a tumorigenic splice isoform of Rac1, in all stages of pancreatic cancer. Using a large cohort of human PDA tissue biopsies specimens, both MMP3 and Rac1b are expressed in PDA cells, that the expression levels of the two markers are highly correlated, and that the subcellular distribution of Rac1b in PDA is significantly associated with patient outcome. Using transgenic mouse models, coexpression of MMP3 with activated KRAS in pancreatic acinar cells stimulates metaplasia and immune cell infiltration, priming the stromal microenvironment for early tumor development. Finally, exposure of cultured pancreatic cancer cells to recombinant MMP3 stimulates expression of Rac1b, increases cellular invasiveness, and activation of tumorigenic transcriptional profiles. Implications: MMP3 acts as a co-conspirator of oncogenic KRAS in pancreatic cancer tumorigenesis and progression, both through Rac1b-mediated phenotypic control of pancreatic cancer cells themselves, and by giving rise to the tumorigenic microenvironment; these findings also point to inhibition of this pathway as a potential therapeutic strategy for pancreatic cancer.

Biography:

Chrystal U Louis has obtained her MD from Tulane University School of Medicine and her MPH from Tulane University School of Public Health and Tropical Medicine. She completed her Pediatric Oncology Training from the Texas Children’s Cancer and Hematology Centers and Baylor University School of Medicine. As a member of the Center for Cell and Gene Therapy, she became a successful Translational Researcher in the field of virus-specific and chimeric antigen receptor-specific cellular immunotherapy. She has joined the Discovery division of Merrimack Pharmaceuticals in 2014 and is currently the Medical Director and Project Leader of the Istiratumab (MM-141) team.

Abstract:

Pancreatic cancer often presents as inoperable, locally-advanced or metastatic disease. With traditional forms of chemotherapy, longterm survival for patients with metastatic disease is less than 5%. Due to the heterogeneity within pancreatic lesions, investigators are beginning to tailor treatment regimens to the pathology and biology of individual tumors. Using a systems engineering approach, we have developed both targeted and untargeted nanoliposomal molecules as well as signaling inhibitors to combat malignant solid tumors like pancreatic cancer. Nal-IRI (liposomal irinotecan, ONIVYDE®), MM-310 (EphA2-targeted docetaxel nanoliposome), and istiratumab (a tetravalent IGF-1R and ErbB3 inhibitor) are three examples of novel therapeutic candidates designed to utilize the tumor biology and microenvironment to improve anti-tumor efficacy. Nal-IRI takes advantage of both leaky vasculature and tumor associated macrophages within the tumor environment to enhance delivery and activity of SN-38. With an EphA2-targeting arm, MM-310 is a next generation nanoliposome providing enhanced delivery of and specificity docetaxel to EphA2-positive malignancies. Lastly, istiratumab inhibits pro-survival signaling through the PI3K/AKT/mTOR pathway by blocking and subsequently stripping IGF-1R and ErbB3 from the surface of tumor cells. Nal-IRI is currently being investigated in combination with 5FU, leucovorin, and oxaliplatin in patients with newly diagnosed metastatic pancreatic cancer. Targeted ()biomarker-driven patient selection is being utilized in both the phase 1 study of MM-310 for patients with EphA2-positive cancers, and in the phase 2 study of istiratumab in combination with nab-paclitaxel and gemcitabine in newly diagnosed metastatic pancreatic cancer patients who have elevated levels of free IGF-1 in their serum.

Biography:

Abstract:

Biography:

Murat Acar has graduated from Istanbul University, Cerrahpasa Medical Faculty in 1996. He then completed his residency education in 2001. He worked as a research fellow at Department of Abdominal-Interventional Radiology, Brigham &Women’s Hospital, Harvard University between 2007-2008. Recently, he continued to work as a Consultant and Professor of Radiology at Department of Radiology, King Hamad University, Bahrain. His special interests are Abdominal Imaging and Non-vascular Intervention.

Abstract:

Detection of the pancreatic cystic lesions highly increased mainly due to incredible progress in the cross-sectional imaging availability and technological improvement. Increasing of detection of this lesions resulted with significantly rise in the number of surgical resections. But, resection of these lesions could be unjustified due to benign nature of many cystic lesions. Thus, it is crucial to make a correct differential diagnosis to avoid unnecessary surgeries, besides the detection of these lesions. Fortunately, most of the pancreatic cystic lesions have either characteristic imaging features or typical age and gender predominance. Radiologists also should be sufficiently aware of management of cystic lesions. Close cooperation of radiologist with surgeons and gastroenterologist also will be effective in terms of accurately diagnosis and management of the patient and it will allow avoiding from unnecessary invasive procedures or surgical interventions. In this review, we discuss briefly clinical presentations, characteristic features, differential diagnosis with a wide range of interesting cases and lastly management of the patients.