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Validation and early qualification of pancreatic fat deposition as an imaging biomarker of pancreatic cancer risk
[Thesis]. Manchester, UK: The University of Manchester; 2016.
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Abstract
Introduction Pancreatic cancer is the 10th most common cause of cancer in the United Kingdom (UK) yet the 5th most common cause of cancer related death. Although excess adiposity, measured as body mass index (BMI), is a risk factor for the development of pancreatic cancer the increase in relative risk is modest. Animal models suggest that the intra-organ deposition of lipids may be more specific to disease risk than anthropometric measurements. There is therefore a need to develop non-invasive methods to quantify intra-pancreatic fat deposition as a potential biomarker for pancreatic cancer predisposition. Cancer Research UK (CRUK) sets out clear guidelines for biomarker discovery and development. Potential biomarkers must go through a process of discovery and assay development followed by qualification. Methods Three streams of research: (i) Stage-one of the PanORAMA project. Assessment of accuracy through comparison of CS-MR and MRS quantified intra-pancreatic fat with histologically quantified intra-pancreatic fat in 12 patients undergoing pancreatic surgery. (ii) Stage-two of the PanORAMA study. Assessment of precision (reproducibility) and comparison with other anthropometric markers of excess adiposity in healthy volunteers (n=15). Refinement of MRS protocols and repeated assessment of precision in healthy volunteers (n=10). (iii) The Breast Risk Reduction Intermittent Dietary Evaluation 2 (BRRIDE-2) trial. Comparison of the effects of Intermittent Energy Restriction (IER) with Daily Energy Restriction (DER) on intra-pancreatic and intra-hepatic fat stores and metabolic markers of disease risk (n=26). Results (i) CS-MR and MRS had agreement with histological assessment of intra-pancreatic fat, but correlations were only moderate to good (rho 0.672 and 0.781 respectively). (ii) CS-MR, and after refinement, MRS, have clinically acceptable precision. This study tested this principle in intra-pancreatic fat in healthy volunteers with a range of intra-pancreatic fat consistent with the literature on the healthy population. (iii) I found no differences in reduction in intra-hepatic or intra-pancreatic fat when comparing IER with DER. Overall, I found that significant reductions (mean: 6.5%) in both of these ectopic fat stores could be achieved with eight-weeks of dietary intervention. Discussion More recent hypotheses on the link between excess adiposity and cancer have focused on the importance of within organ local ectopic fat as an abnormal micro-environment favouring cancer development and progression. Importantly, this hypothesis explains the specificity of epidemiological associations between excess adiposity and cancer risk. The observations that within a given individual, in the presence of short-term weight reduction, there are differential changes in local within organ fats – hepatic fat and pancreatic fat – support the specificity hypothesis. This thesis has put us in position to scale-up and explore the importance of intra-organ fats using non-invasive imaging techniques.