CA 19-9 is a tumor-associated antigen which is elevated in pancreatic cancers, cancers of the upper gastrointestinal tract, ovarian cancer, hepatocellular cancer, colorectal cancer, inflammatory conditions of the hepatobiliary system, and in thyroid diseases.
CA 19-9 is used in the diagnosis of pancreatic cancer but is also a marker of pancreatic tissue damage which might be caused by diabetes. The association between diabetes, pancreatic cancer and elevated levels of Ca 19-9 has not been investigated until now.
A research article published in October 28 issue of the World Journal of Gastroenterology addresses this association. The research group led by Dr Oya Uygur-Bayramicli from Istanbul examined 76 type 2 diabetics and matched them with control subjects of the same age and gender in order to get reliable comparisons. Ca 19-9 levels were statistically significantly higher in the diabetic group but there was not any case of pancreatic cancer in that group, which was confirmed with the help of abdominal CT.
One conclusion reported by the researchers is that diabetes can be accepted as the last step of chronic pancreatitis with the new developing concepts of pathogenesis and that the elevation of Ca 19-9 is due to chronic pancreatitis and not to pancreatic cancer.
As a solution to the problem they suggest using higher cut-off values of Ca 19-9 in diabetic patients to differentiate benign and malignant pancreatic disease. Furthermore, subtle elevations of CA 19-9 in diabetics should be considered an indication of exocrine pancreatic dysfunction.
The study was performed in a large teaching hospital in Istanbul, Turkey, with a special interest in diabetes and gastrointestinal oncology and is therefore quite representative of the population.
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They are studying a mouse model with a slightly elevated homocysteine level that simulates a low-folate diet in humans; a version of the mouse that also has diabetes, which goes hand-in-hand with cardiovascular disease and retinopathy; and a second model of the rare genetic defect that results in extraordinarily high homocysteine levels.
They will follow the mice over their lifetime, putting them on diets that elevate and lower folate levels, measuring resultant homocysteine levels and the impact on the retina. Next year, they will test the animals' vision in conjunction with the Cleveland Clinic.
They hypothesize that sustained elevation will compromise retinal function and degrade the once well-stratified tissue. They have shown in pilot studies that adding diabetes to the mix makes bad matters worse.
At any point in your life, too much homocysteine can be problematic, whether you are talking about pregnant women, cardiovascular disease or dementia, says Dr. Smith. If homocysteine is not converted into methionine or cysteine (by vitamin B6) to aid protein synthesis, it can do something bad.
Dr. Ganapathy notes that people need only about 1 microgram per day of vitamin B12, which comes from microorganisms common in animals' gastrointestinal tract. Strict vegetarians are typically the only Americans who have problems with B12 deficiency, he says. People need about 400 micrograms of folate daily. Pregnant women as well as those trying to become pregnant need at least double that.
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