Pancreastatin NYS DOH Approved tests PFI#9065

ISI Order Code:

PST

CPT Code:

83519

Clinical Significance:

Pancreastatin is a 49 amino acid peptide hormone derived from a larger protein called Chromogranin A(CgA). Pancreastatin is emerging as a superior, more specific diagnostic and prognostic marker compared to other neuroendocrine tumor markers including its origin molecule CgA. Unlike CgA, pancreastatin levels are largely unaffected by factors such as common medications like proton pump inhibitors (PPIs), renal insufficiency, chronic atrophic gastritis, liver disease and other inflammatory or neoplastic conditions. Furthermore, recent oncology data demonstrates that higher pre-operative and circulating pancreastatin levels significantly correlate with a worse prognosis, higher risk of hepatic (liver) metastasis, and lower progression-free survival in small bowel and pancreatic NETs. Studies suggest that serial measurements of serum pancreastatin can be used to track tumor burden and identify which patients will optimally benefit from locoregional therapies like transarterial chemoembolization (TACE).  

Although primarily produced in the pancreas, pancreastatin has been found in other tissues as well with possible roles in modulating metabolic pathways. Studies have shown that pancreastatin can actually inhibit the release of insulin and as such, understanding these mechanisms could become critical in resolving insulin resistance. Recent in-vitro findings also demonstrate that pancreastatin exacerbates the aggregation of Islet Amyloid Polypeptide (IAPP) in the pancreas and liver, driving metabolic dysfunction. Finally, research on high-fructose diets shows that pancreastatin deteriorates liver lipid metabolism, suggesting that inhibiting pancreastatin could be a viable therapeutic target to reverse liver steatosis and metabolic syndrome. Perhaps in the future, blocking these negative effects of pancreastatin could help improve metabolic flexibility, thus providing benefit to people with metabolic syndrome or type 2 diabetes. The ISI plasma Pancreastatin test is NY approved and has been part of several publication and clinical studies.

Reference Range:

10 – 135 pg/ml

Procedure:

Pancreastatin is measured by direct radioimmunoassay.

Expected Turnaround Time: 

3-5 Business Days

Turnaround time is defined as the usual number of days from the date of receipt of a specimen for testing to when the result is released to the ordering provider. Testing schedules may vary.

Report:

Sample Report

Patient Preparation:

Patient should not be on any medications that may influence Insulin levels, if possible, for at least 48 hours prior to collection.

Specimen Collection:

Collect 10mL blood directly into ISI’s Z-tube^TM Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special Z-tube^TM Preservatives are available from ISI. Minimum specimen size is 1mL.

Note: one Z-tube^TM may be shared for up to three tests (Pancreastatin, NKA, and 5HIAA). . After centrifuging tube, aliquot 1mL per test in separate vials, mark with name of test and freeze.

Please contact ISI for separation using a non refrigerated centrifuge. Contact ISI for details.

The Inter Science Institute Z-tube™ collection and preservative tube is intended  for use with Inter Science Institute’s 5-Hydroxyindoleacetic acid (5-HIAA), Neurokinin A (NKA), Neuropeptide Y (NPY), Neurotensin, Pancreastatin, and Substance P assays only. It has not been validated for use with other in vitro assays. Effects of using this device other than as intended are unknown, and is not recommended.

Important Precaution:

Specimens for this assay must be collected using the Z-tube^TM. Specimens must be shipped frozen; specimens are not stable at refrigerated or room temperatures. No other specimens are acceptable.

Rejection Criteria: 

Gross hemolysis/lipemia/icteric

Special Specimens:

For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.

Shipping Instructions:

Ship specimens frozen in dry ice.

References:

1. O’Dorisio TM, Krutzik SR, Woltering EA, et al. Development of a highly sensitive and specific carboxy-terminal human Pancreastatin assay to monitor neuroendocrine tumor behavior. Pancreas. 2010;39(5):611-616.
2. Calhoun K, Toth-Fejel S, Chee J, et al. Serum peptide profiles in patients with carcinoid tumors. Am J Surg. 2003;186(1):28-31
3. Goand, U. K., Patel, I., Verma, S., Yadav, S., Maity, D., Singh, N., Vishwakarma, S., Rathaur, S., Garg, R., & Gayen, J. R. (2023). Immunometabolic impact of pancreastatin inhibitor PSTi8 in MCD induced mouse model of oxidative stress and steatohepatitis. Cytokine, 171, Article 156372.
4. Khan, T. M., Garg, M., Warner, R. R. P., Uhr, J. H., & Divino, C. M. (2016). Elevated serum pancreastatin is an indicator of hepatic metastasis in patients with small bowel neuroendocrine tumors. Pancreas, 45(7), 1032–1035.
5. Raza, S., Kumar, S., & Dey, S. (2021). Pancreastatin induces islet amyloid peptide aggregation in the pancreas, liver, and skeletal muscle: An implication for type 2 diabetes. International Journal of Biological Macromolecules, 182, 760–771.