1
|
Wright JJ, Eskaros A, Windon A, Bottino R, Jenkins R, Bradley AM, Aramandla R, Philips S, Kang H, Saunders DC, Brissova M, Powers AC. Exocrine Pancreas in Type 1 and Type 2 Diabetes: Different Patterns of Fibrosis, Metaplasia, Angiopathy, and Adiposity. Diabetes 2024; 73:1140-1152. [PMID: 37881846 PMCID: PMC11189834 DOI: 10.2337/db23-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/18/2023] [Indexed: 10/27/2023]
Abstract
The endocrine and exocrine compartments of the pancreas are spatially related but functionally distinct. Multiple diseases affect both compartments, including type 1 diabetes (T1D), pancreatitis, cystic fibrosis, and pancreatic cancer. To better understand how the exocrine pancreas changes with age, obesity, and diabetes, we performed a systematic analysis of well-preserved tissue sections from the pancreatic head, body, and tail of organ donors with T1D (n = 20) or type 2 diabetes (T2D) (n = 25) and donors with no diabetes (ND; n = 74). Among ND donors, we found that the incidence of acinar-to-ductal metaplasia (ADM), angiopathy, and pancreatic adiposity increased with age, and ADM and adiposity incidence also increased with BMI. Compared with age- and sex-matched ND organs, T1D pancreata had greater rates of acinar atrophy and angiopathy, with fewer intralobular adipocytes. T2D pancreata had greater rates of ADM and angiopathy and a higher total number of T lymphocytes, but no difference in adipocyte number, compared with ND organs. Although total pancreatic fibrosis was increased in both T1D and T2D, the patterns were different, with periductal and perivascular fibrosis occurring more frequently in T1D pancreata and lobular and parenchymal fibrosis occurring more frequently in T2D. Thus, the exocrine pancreas undergoes distinct changes as individuals age or develop T1D or T2D. ARTICLE HIGHLIGHTS
Collapse
Affiliation(s)
- Jordan J. Wright
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Adel Eskaros
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Annika Windon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Rita Bottino
- Imagine Islet Center, Imagine Pharma, Pittsburgh, PA
- Institute of Cellular Therapeutics, Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, PA
| | - Regina Jenkins
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amber M. Bradley
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Radhika Aramandla
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sharon Philips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Diane C. Saunders
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Human Pancreas Analysis Program, Nashville, TN; Philadelphia, PA; and Gainesville, FL
| | - Marcela Brissova
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Human Pancreas Analysis Program, Nashville, TN; Philadelphia, PA; and Gainesville, FL
| | - Alvin C. Powers
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
- Human Pancreas Analysis Program, Nashville, TN; Philadelphia, PA; and Gainesville, FL
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
2
|
Ciccarelli G, Di Giuseppe G, Soldovieri L, Quero G, Nista EC, Brunetti M, Cinti F, Moffa S, Capece U, Tondolo V, Mari A, Gasbarrini A, Pontecorvi A, Alfieri S, Giaccari A, Mezza T. Beta-cell function and glucose metabolism in patients with chronic pancreatitis. Eur J Intern Med 2024:S0953-6205(24)00246-2. [PMID: 38871564 DOI: 10.1016/j.ejim.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
AIMS Chronic pancreatitis (CP) is - along with acute pancreatitis - the most frequent cause of diabetes of the exocrine pancreas (DEP). Although insulin deficiency is widely accepted as the major feature of DEP, it is still unclear whether diabetes associated with CP is characterized by additional or different functional defects of the insulin secretory machinery. To identify possible functional defects specifically induced by CP, we performed a cross-sectional study in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM) comparing patients with and without CP (CP vs. NCP). METHODS We administered an oral glucose tolerance test (OGTT) to all participants and, according to their glucose tolerance, classified them as NGT, IGT and DM. Insulin sensitivity and beta-cell functional parameters were derived from OGTT, hyperglycemic clamp and hyperinsulinemic euglycemic clamp. RESULTS Studying 146 subjects, we found that beta-cell function and insulin secretion were significantly lower in CP compared to NCP patients. However, when we classified the subjects according to OGTT-derived glucose tolerance, we found no differences in beta-cell function or in insulin sensitivity between CP and NCP with the same glucose tolerance status. Of note, we found that arginine-stimulated insulin secretion is reduced only in subjects with CP and DM compared to NCP subjects with DM. CONCLUSIONS Patients with CP had no specific alterations in insulin secretion and beta-cell function. However, in patients diagnosed with diabetes, we found a lower arginine-stimulated insulin secretion, a marker of reduced functional mass.
Collapse
Affiliation(s)
- Gea Ciccarelli
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Di Giuseppe
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Soldovieri
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Quero
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Celestino Nista
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Michela Brunetti
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cinti
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Moffa
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Capece
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Giaccari
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Teresa Mezza
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| |
Collapse
|
3
|
Burke JA, Zhu Y, Zhang X, Rios PD, Joshi I, Lopez D, Nasir H, Roberts S, Rodriguez Q, McGarrigle J, Cook D, Oberholzer J, Luo X, Ameer GA. Phase-changing citrate macromolecule combats oxidative pancreatic islet damage, enables islet engraftment and function in the omentum. SCIENCE ADVANCES 2024; 10:eadk3081. [PMID: 38848367 PMCID: PMC11160476 DOI: 10.1126/sciadv.adk3081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/03/2024] [Indexed: 06/09/2024]
Abstract
Clinical outcomes for total-pancreatectomy followed by intraportal islet autotransplantation (TP-IAT) to treat chronic pancreatitis (CP) are suboptimal due to pancreas inflammation, oxidative stress during islet isolation, and harsh engraftment conditions in the liver's vasculature. We describe a thermoresponsive, antioxidant macromolecule poly(polyethylene glycol citrate-co-N-isopropylacrylamide) (PPCN) to protect islet redox status and function and to enable extrahepatic omentum islet engraftment. PPCN solution transitions from a liquid to a hydrogel at body temperature. Islets entrapped in PPCN and exposed to oxidative stress remain functional and support long-term euglycemia, in contrast to islets entrapped in a plasma-thrombin biologic scaffold. In the nonhuman primate (NHP) omentum, PPCN is well-tolerated and mostly resorbed without fibrosis at 3 months after implantation. In NHPs, autologous omentum islet transplantation using PPCN restores normoglycemia with minimal exogenous insulin requirements for >100 days. This preclinical study supports TP-IAT with PPCN in patients with CP and highlights antioxidant properties as a mechanism for islet function preservation.
Collapse
Affiliation(s)
- Jacqueline A. Burke
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yunxiao Zhu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xiaomin Zhang
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Ira Joshi
- CellTrans Inc., Chicago, IL 60612, USA
| | | | | | | | | | | | | | | | - Xunrong Luo
- Duke Transplant Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Guillermo A. Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Chemistry of Life Processes Institute, Northwestern University, Evanston, IL 60208 USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA
- International Institute for Nanotechnology, Northwestern University, Evanston, IL 60208, USA
| |
Collapse
|
4
|
Li R, Yang T, Zhang M, Ren K, Li J, Sato I, Yi SQ. A new histopathological phenomenon: Pancreatic islet cell loss in the elderly population. Dig Liver Dis 2024; 56:1039-1045. [PMID: 38065700 DOI: 10.1016/j.dld.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 05/28/2024]
Abstract
BACKGROUND We observed the phenomenon of pancreatic islet cell loss (ICL) in our previous histopathological study. Multiple studies have reported that a decrease in β-cells is correlated with diabetes or chronic pancreatitis. Few studies have reported ICL in a healthy population. METHODS Thirty-three pancreatic tissue samples were obtained from cadavers (age: 65-104 years) who had never been diagnosed with any pancreatic diseases before death. The pancreatic body sections were used for an immunohistochemical study of pancreatic islet cells, and area calculations were performed using ImageJ to determine the degree of ICL and islet cell proportions. RESULTS The proportion of β-cells showed a downward trend as the degree of ICL increased (r=-0.414, P = 0.011), and the proportion of women with severe ICL was significantly higher than that of men with severe ICL (P = 0.016). The probability of severe ICL decreased with age in the population over 70 years of age (P = 0.069, linear correlation). Severe ICL may be associated with higher pancreatic intraepithelial neoplasia lesions (P = 0.059). CONCLUSION The phenomenon of ICL in the elderly population was mainly due to pancreatic β-cell reduction. It may be one of the direct causes of age-related diabetes.
Collapse
Affiliation(s)
- Rujia Li
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 116-8551 Tokyo, Japan
| | - Ting Yang
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 116-8551 Tokyo, Japan
| | - Mingshou Zhang
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 116-8551 Tokyo, Japan
| | - Ke Ren
- Faculty of Physical Education, Qu Jing Normal University, Yun Nan, China
| | - Jun Li
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Iwao Sato
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Shuang-Qin Yi
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 116-8551 Tokyo, Japan.
| |
Collapse
|
5
|
Wu L, Carlino MS, Brown DA, Long GV, Clifton-Bligh R, Mellor R, Moore K, Sasson SC, Menzies AM, Tsang V, Gunton JE. Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus Is Characterized by C-peptide Loss and Pancreatic Atrophy. J Clin Endocrinol Metab 2024; 109:1301-1307. [PMID: 37997380 PMCID: PMC11031227 DOI: 10.1210/clinem/dgad685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To conduct a multicenter case series characterizing the clinical characteristics at presentation and pancreatic volume changes of patients with checkpoint inhibitor-associated autoimmune diabetes (CIADM). RESEARCH DESIGN AND METHODS Electronic medical records were reviewed with 36 consecutive patients identified with CIADM, as defined by (1) previous immune checkpoint inhibitor (ICI) therapy, (2) new-onset hyperglycemia (blood glucose level ≥ 11.1 mmol/L and/or glycosylated hemoglobin ≥ 6.5%), and (3) insulin deficiency [C-peptide <0.4 nmol/L or diabetic ketoacidosis (DKA)] within 1 month of presentation. Pancreatic volume was available and measured using computed tomography volumetry for 17 patients with CIADM and 3 sets of control patients: 7 with ICI-related pancreatitis, 13 with asymptomatic ICI-related lipase elevation, and 11 ICI-treated controls for comparison. RESULTS All patients had either anti-programmed cell death protein 1 or anti-programmed cell death ligand 1 therapy. Median time from ICI commencement to CIADM diagnosis was 15 weeks. At presentation, 25 (69%) had DKA, 27 (84%) had low C-peptide, and, by 1 month, 100% had low C-peptide. Traditional type 1 diabetes autoantibodies were positive in 15/35 (43%). Lipase was elevated in 13/27 (48%) at presentation. In 4 patients with longitudinal lipase testing, elevated levels peaked 1 month prior to CIADM diagnosis. Pancreatic volume was lower pre-ICI in CIADM patients compared with controls and demonstrated a mean decline of 41% from pretreatment to 6 months post-CIADM diagnosis. CONCLUSION Pronounced biochemical and radiologic changes occur during CIADM pathogenesis. Rapid loss of C-peptide is a distinct characteristic that can be used to aid diagnosis as autoantibodies are often negative.
Collapse
Affiliation(s)
- Linda Wu
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft 2065, NSW, Australia
| | - Matteo Salvatore Carlino
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft 2065, NSW, Australia
- Department of Oncology, Westmead Hospital, Westmead 2145, NSW Australia
| | - David Alexander Brown
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Institute of Clinical Pathology and Medical Research, Department of Immunology, NSW Health Pathology, Westmead 2145, NSW, Australia
- Department of of Immunology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Georgina Venetia Long
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Roderick Clifton-Bligh
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Rhiannon Mellor
- Department of Oncology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Krystal Moore
- Department of Radiology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Sarah Christina Sasson
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of of Immunology, Westmead Hospital, Westmead 2145, NSW Australia
| | - Alexander Maxwell Menzies
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Venessa Tsang
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
| | - Jenny Elizabeth Gunton
- Westmead Institute for Medical Research, Centre for Diabetes and Endocrinology, Westmead 2145, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Westmead 2145, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
| |
Collapse
|
6
|
Jose JR, Shankar T, Arora P, S P, Jayachandran S. Diabetic Ketoacidosis: A Rare Complication of Type 3c Diabetes. Cureus 2024; 16:e57873. [PMID: 38725776 PMCID: PMC11078895 DOI: 10.7759/cureus.57873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/12/2024] Open
Abstract
Recently termed pancreoprivic diabetes, type 3c diabetes refers to high blood sugar values secondary to disease of the exocrine pancreas. The disease is most commonly misdiagnosed as type 2 diabetes mellitus (DM) and is overlooked by physicians and the general public. Chronic pancreatitis (CP) accounts for most cases of type 3c diabetes. Diabetic ketoacidosis (DKA) is a rare occurrence in type 3c diabetes as both alpha and beta cell dysfunction occur concurrently. In this case, the major hormones involved in lipolysis and ketone body production would be catecholamines, cortisol, and growth hormone. We report a case of a 37-year-old female with a history of endocrine pancreatic insufficiency secondary to CP who presented with DKA, one of the life-threatening but preventable complications of diabetes. Noncompliance with insulin and concurrent urinary tract infection were the inciting factors. Her condition improved with DKA management according to standard protocol, intravenous antibiotics, and other supportive care. She got discharged after optimization of insulin therapy, with proper advice for home blood sugar monitoring and regular follow-up. A patient with pancreatic pathology may present to the emergency with DKA as the first manifestation, and if not properly evaluated, the diagnosis of type 3c diabetes can be missed.
Collapse
Affiliation(s)
- Jewel Rani Jose
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Takshak Shankar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Poonam Arora
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Parvathy S
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sreejith Jayachandran
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| |
Collapse
|
7
|
Wynn L, Hodges V, Criswell S. Mast Cell Concentrations in Pancreatic Disease Processes. Appl Immunohistochem Mol Morphol 2024; 32:163-168. [PMID: 37982564 DOI: 10.1097/pai.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
Mast cells enumeration has been performed using various histologic staining techniques with the goal of elucidating the influence mast cells exert on pathologic processes. In this study, 77 human pancreatic tissues evidencing morphologically normal pancreas, benign fibrotic changes, endocrine tumors, and adenocarcinoma were evaluated using Wright stain and immunohistochemistry markers for tryptase and CD117. Mast cell counts were similar with tryptase and CD117 but were both significantly higher than counts obtained with the Wright stain. Furthermore, all analyses demonstrated that endocrine tumors and morphologically normal pancreatic tissues had significantly lower mast cell counts as compared with benign fibrosis and adenocarcinoma suggesting that the highly fibrotic nature of both pancreatitis and adenocarcinoma are related to increased mast cell concentrations.
Collapse
Affiliation(s)
- Lindsey Wynn
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center
| | - Victoria Hodges
- Department of Pathology, Methodist University Hospital, Memphis, TN
| | - Sheila Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center
| |
Collapse
|
8
|
Kimita W, Skudder-Hill L, Shamaitijiang X, Priya S, Petrov MS. Associations of pancreas fat content and size with markers of iron metabolism. Obes Res Clin Pract 2024; 18:56-63. [PMID: 38278667 DOI: 10.1016/j.orcp.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To comprehensively investigate the associations of pancreas fat content and size with circulating markers of iron metabolism. METHODS A total of 116 individuals underwent magnetic resonance imaging and spectroscopy on a 3.0 Tesla scanner, exclusively for the purpose of the COSMOS research programme. Intra-pancreatic fat deposition, total pancreas volume, liver fat content, visceral and subcutaneous fat volumes were quantified. Plasma levels of hepcidin and ferritin were measured. Multiple linear regression analysis was conducted, adjusting for body mass index, age, and sex. RESULTS Total intra-pancreatic fat deposition was inversely associated with hepcidin (β = -0.54, 95 % confidence interval -1.02 to -0.07) whereas total pancreas volume was not associated with hepcidin (β = 0.36, 95 % confidence interval -7.12 to 7.84) in the most adjusted model. Neither total intra-pancreatic fat deposition (β = -0.03, 95 % confidence interval -0.39 to 0.33) nor total pancreas volume (β = -1.02, 95 % confidence interval -6.67 to 4.63) was associated with ferritin in the most adjusted model. Subcutaneous fat, visceral fat, and liver fat were not associated with hepcidin. Subcutaneous fat was inversely associated with ferritin (β = -0.06, 95 % CI -0.11 to -0.01) whereas visceral fat (β = 0.05, 95 % CI -0.01 to 0.14) and liver fat (β = 0.09, 95 % CI -0.04 to 0.34) were not associated with ferritin in the most adjusted model. CONCLUSIONS Increased intra-pancreatic fat deposition, but not other fat depots, is associated with reduced circulating levels of hepcidin. Deranged iron metabolism may play a role in the pathogenesis of fatty change of the pancreas.
Collapse
Affiliation(s)
- Wandia Kimita
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - Sunitha Priya
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
9
|
Fukukura Y, Kanki A. Quantitative Magnetic Resonance Imaging for the Pancreas: Current Status. Invest Radiol 2024; 59:69-77. [PMID: 37433065 DOI: 10.1097/rli.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is important for evaluating pancreatic disorders, and anatomical landmarks play a major role in the interpretation of results. Quantitative MRI is an effective diagnostic modality for various pathologic conditions, as it allows the investigation of various physical parameters. Recent advancements in quantitative MRI techniques have significantly improved the accuracy of pancreatic MRI. Consequently, this method has become an essential tool for the diagnosis, treatment, and monitoring of pancreatic diseases. This comprehensive review article presents the currently available evidence on the clinical utility of quantitative MRI of the pancreas.
Collapse
Affiliation(s)
- Yoshihiko Fukukura
- From the Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | | |
Collapse
|
10
|
Satoi S, Kimura Y, Shimizu R, Matsumoto M, Kawaguchi K, Yoshida Y, Murase T, Kamei K, Matsumoto I, Nakai T, Takeyama Y. Gastrectomy reduces pancreatic secretory function via pancreatic atrophy. Surg Today 2023; 53:1372-1379. [PMID: 37084095 PMCID: PMC10678800 DOI: 10.1007/s00595-023-02685-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. METHODS The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. RESULTS After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). CONCLUSIONS The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.
Collapse
Affiliation(s)
- Shumpei Satoi
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Yutaka Kimura
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Rie Shimizu
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masataka Matsumoto
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kohei Kawaguchi
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yuta Yoshida
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takaaki Murase
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Keiko Kamei
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Ippei Matsumoto
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| |
Collapse
|
11
|
Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Persohn SA, Dasyam AK, Shah ZK, Venkatesh SK, Takahashi N, Wachsman A, Li L, Li Y, Pandol SJ, Park WG, Vege SS, Hart PA, Topazian M, Andersen DK, Fogel EL. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol (NY) 2023; 48:3162-3173. [PMID: 37436452 PMCID: PMC10650972 DOI: 10.1007/s00261-023-04000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls. METHODS This prospective study performed abdominal MRI scans at seven institutions, using 1.5 T Siemens and GE scanners, in 50 control and 51 definite CP participants, from February 2019 to May 2021. MRI parameters included the T1-weighted signal intensity ratio of the pancreas (T1 score), arterial-to-venous enhancement ratio (AVR) during venous and delayed phases, pancreas volume, and diameter. We evaluated the diagnostic performance of these parameters individually and two semi-quantitative MRI scores derived using logistic regression: SQ-MRI Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume). RESULTS When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively. CONCLUSION Semi-quantitative parameters of the pancreatic parenchyma, including T1 score, enhancement ratio, pancreas volume, diameter and multi-parametric models combining these parameters are helpful in diagnosis of CP. Longitudinal analyses including more extensive population are warranted to develop new diagnostic criteria for CP.
Collapse
Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA.
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Darwin L Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Paul R Territo
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Scott A Persohn
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Ashley Wachsman
- Department of Imaging, University of California in Los Angeles, Los Angeles, CA, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Walter G Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Evan L Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
12
|
Al-Ani Z, Ko J, Petrov MS. Intra-pancreatic fat deposition across the pancreatitis spectrum and the influence of gut hormones. Dig Liver Dis 2023; 55:1081-1090. [PMID: 36878840 DOI: 10.1016/j.dld.2023.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/13/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND AND AIMS Acute pancreatitis (AP) and chronic pancreatitis (CP) often represent parts of the spectrum of disease. While growing evidence indicates that intra-pancreatic fat deposition (IPFD) plays an important role in the pathogenesis of pancreatitis, no study of living individuals has investigated IPFD in both AP and CP. Further, the associations between IPFD and gut hormones remain to be elucidated. The aims were to investigate the associations of IPFD with AP, CP, and health; and to study whether gut hormones affect these associations. METHODS Magnetic resonance imaging on the same 3.0 Tesla scanner was used to determine IPFD in 201 study participants. These participants were arranged into the health, AP, and CP groups. Gut hormones (ghrelin, glucagon-like peptide-1, gastric inhibitory peptide, peptide YY, and oxyntomodulin) were measured in blood, both after an 8-hour overnight fasting and after ingestion of a standardised mixed meal. A series of linear regression analyses was run, accounting for age, sex, ethnicity, body mass index, glycated haemoglobin, and triglycerides. RESULTS Both the AP group and CP group had significantly higher IPFD in comparison with the health group, consistently across all models (p for trend 0.027 in the most adjusted model). Ghrelin in the fasted state had a significant positive association with IPFD in the AP group (but not the CP or health group), consistently across all models (p = 0.019 in the most adjusted model). None of the studied gut hormones in the postprandial state was significantly associated with IPFD. CONCLUSION Fat deposition in the pancreas is similarly high in individuals with AP and those with CP. The gut-brain axis, and more specifically overexpression of ghrelin, may contribute to increased IPFD in individuals with AP.
Collapse
Affiliation(s)
- Zena Al-Ani
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Juyeon Ko
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
13
|
Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frøkjær JB. Quantification of parenchymal fibrosis in chronic pancreatitis: relation to atrophy and pancreatic function. Acta Radiol 2023; 64:936-944. [PMID: 35915988 DOI: 10.1177/02841851221114772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-invasive modalities for assessing chronic pancreatitis (CP) are needed in clinical practice. PURPOSE To investigate the correlation between magnetic resonance elastography (MRE)-derived stiffness and T1 relaxation times (as proxies of fibrosis) and explore their relationships to gland volume and pancreatic functions in patients with CP and healthy controls (HCs). MATERIAL AND METHODS In 49 patients with CP and 35 HCs, pancreatic stiffness, T1 relaxation times, and gland volume were assessed. Fecal elastase and the presence of diabetes were used to evaluate pancreatic exocrine and endocrine functions. Uni- and multivariable linear regression models were used to analyze correlations between imaging parameters. RESULTS There was a positive correlation between MRE-derived stiffness and T1 relaxation times in patients with CP (R2 = 0.42; P < 0.001) and HCs (R2 = 0.14; P = 0.028). There was no correlation between MRE-derived stiffness and gland volume in patients (R2 = 0.007; P = 0.065) or HCs (R2 = 0.010; P = 0.57). T1 relaxation time was correlated to gland volume (R2 = 0.19; P = 0.002) in patients with CP but not in the HCs (P = 0.056). Severity of pancreatic functional impairment was reflected by increased fibrosis-related parameters in patients without functional impairment, followed by a further increase in fibrosis-related parameters and reduction in gland volume in patients with pancreatic functional impairments. CONCLUSION Pancreatic MRE-derived stiffness and T1 relaxation times might reflect early pathophysiological changes in CP. The dynamic correlation with pancreatic function suggests that these parameters may be useful for the non-invasive and early identification of CP.
Collapse
Affiliation(s)
- Emily Steinkohl
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, 53141Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| |
Collapse
|
14
|
van Wilpe R, Hulst AH, Siegelaar SE, DeVries JH, Preckel B, Hermanides J. Type 1 and other types of diabetes mellitus in the perioperative period. What the anaesthetist should know. J Clin Anesth 2023; 84:111012. [PMID: 36427486 DOI: 10.1016/j.jclinane.2022.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Diabetes mellitus is often treated as a uniform disease in the perioperative period. Type 2 diabetes is most commonly encountered, and only a minority of surgical patients have been diagnosed with another type of diabetes. Patients with a specific type of diabetes can be particularly prone to perioperative glycaemic dysregulation. In addition, certain type-related features and pitfalls should be taken into account in the operating theatre. In this narrative review, we discuss characteristics of types of diabetes other than type 2 diabetes relevant to the anaesthetist, based on available literature and data from our clinic.
Collapse
Affiliation(s)
- Robert van Wilpe
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Abraham H Hulst
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Sarah E Siegelaar
- Department of Endocrinology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands.
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, the Netherlands
| |
Collapse
|
15
|
Single- and multiparameter magnetic resonance imaging for diagnosing and severity grading of chronic pancreatitis. Abdom Radiol (NY) 2023; 48:630-641. [PMID: 36477631 DOI: 10.1007/s00261-022-03760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The study aimed to determine the performance of advanced magnetic resonance imaging (MRI), including a multiparametric MRI-index, for diagnosing and severity grading of chronic pancreatitis (CP) at various functional stages with focus on detection of CP with preserved pancreatic function. METHODS Fifty-four CP patients and 35 healthy controls underwent MRI including assessment of pancreatic volume, main pancreatic duct (MPD) diameter, T1 relaxation time, magnetic resonance elastography (MRE) derived stiffness, and intravoxel incoherent motion (IVIM) diffusion-weighted imaging. Patients were categorized into three subgroups: Preserved pancreatic function (n = 14), partial pancreatic insufficiency (exocrine insufficiency or diabetes, n = 25), and complete pancreatic insufficiency (exocrine insufficiency and diabetes, n = 15). A multiparametric MRI-index was based on ordinal logistic regression analysis. Diagnostic performances of MRI parameters for diagnosing CP at different functional stages were determined using receiver operating characteristic (ROC) analysis. RESULTS All MRI parameters differed across CP subgroups and healthy controls (all P < 0.001), except for IVIM. T1 relaxation time (ROC area under the curve (ROC-AUC) 0.82), MRE (ROC-AUC 0.88), and MRI-index (ROC-AUC 0.86) showed the highest performance for detecting patients with preserved pancreatic function (early CP) vs. healthy controls. For detecting preserved pancreatic function vs. partial insufficiency, pancreatic volume, MRI-index, and T1 relaxation time performed best (all ROC-AUC > 0.75), with the MRI-index tending to outperform MRE (ROC-AUC 0.77 vs. 0.63; P = 0.10). CONCLUSION Quantitative assessments of T1 relaxation time and MRE-derived stiffness seem promising for diagnosing CP at different functional stages and may together with multiparametric MRI-index be used for early identification, staging and monitoring of CP.
Collapse
|
16
|
Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation. Transplant Direct 2022; 8:e1367. [PMID: 36204182 PMCID: PMC9529061 DOI: 10.1097/txd.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
Islet and β-cell function is intrinsic to glucose homeostasis. Pancreatectomy and islet autotransplantation (PIAT) for chronic pancreatitis (CP) treatment is a useful model for assessing islet function in the absence of immune-suppression and to perform extensive presurgical metabolic evaluations not possible from deceased donors. We recently showed that in CP-PIAT patients, preoperative islet identity loss presented with postoperative glycemic loss. Here, we examine presurgical islet function using Homeostatic Model Assessment-Beta Cell Function (%) (HOMA-β) and glycemic variables and compared them with postsurgical insulin independence and their predicted alignment with Secretory Unit of Islet Transplant Objects (SUITO) and beta cell score after transplantation (BETA-2) scores.
Collapse
|
17
|
Kweon B, Kim DU, Oh JY, Oh H, Kim YC, Mun YJ, Bae GS, Park SJ. Arecae pericarpium water extract alleviates chronic pancreatitis by deactivating pancreatic stellate cells. Front Pharmacol 2022; 13:941955. [PMID: 36105227 PMCID: PMC9465814 DOI: 10.3389/fphar.2022.941955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/02/2022] [Indexed: 01/30/2023] Open
Abstract
Chronic pancreatitis (CP) is a chronic inflammatory disease of the pancreas with irreversible morphological changes. Arecae pericarpium (ARP), known to improve gastrointestinal disorders, has not yet been reported to inhibit fibrosis in CP. Therefore, we investigated the beneficial effects of ARP on cerulein-induced CP. Cerulein (50 μg/kg) was administered intraperitoneally to mice every hour, six times a day, four times a week for a total of 3 weeks to induce CP. To ascertain the prophylactic effects of ARP, ARP water extract (50, 100, or 200 mg/kg) or saline was administered intraperitoneally 1 h before the onset of CP. To determine the therapeutic effects of ARP, ARP water extract (200 mg/kg) or saline was administered for a total of 1 week or 2 weeks, starting 2 weeks or 1 week after the onset of CP. The pancreas was collected immediately for histological analysis. Additionally, to determine the effectiveness and mechanism of ARP in alleviating pancreatic fibrosis, pancreatic stellate cells (PSCs) were isolated. ARP treatment considerably improved glandular atrophy and inflammation and repressed collagen deposition in the pancreas. Furthermore, ARP water extract inhibited extracellular matrix (ECM) constituents such as alpha-smooth muscle actin (α-SMA), collagen I, and fibronectin 1 (FN1) in pancreatic tissue and PSCs. ARP also suppressed transforming growth factor-β (TGF-β) signaling by inhibiting Smad2 phosphorylation. Our study suggests that ARP exhibits anti-fibrotic effects in cerulein-induced CP by inhibiting TGF-β/Smad signaling.
Collapse
Affiliation(s)
- Bitna Kweon
- Department of Pharmacology, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Dong-Uk Kim
- Hanbang Cardio-Renal Syndrome Research Center, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Jin-Young Oh
- Department of Pharmacology, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Hyuncheol Oh
- Hanbang Cardio-Renal Syndrome Research Center, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- Institute of Pharmaceutical Research and Development, College of Pharmacy, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Youn-Chul Kim
- Institute of Pharmaceutical Research and Development, College of Pharmacy, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Yeun-Ja Mun
- Department of Anatomy, College of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
| | - Gi-Sang Bae
- Department of Pharmacology, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- Hanbang Cardio-Renal Syndrome Research Center, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- *Correspondence: Gi-Sang Bae, ; Sung-Joo Park,
| | - Sung-Joo Park
- Hanbang Cardio-Renal Syndrome Research Center, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- Department of Herbology, School of Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, South Korea
- *Correspondence: Gi-Sang Bae, ; Sung-Joo Park,
| |
Collapse
|
18
|
Cai J, Guo X, Wang K, Zhang Y, Zhang D, Zhang X, Wang X. Automatic quantitative evaluation of normal pancreas based on deep learning in a Chinese adult population. Abdom Radiol (NY) 2022; 47:1082-1090. [PMID: 35064795 DOI: 10.1007/s00261-021-03327-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop a 3D U-Net-based model for the automatic segmentation of the pancreas using the diameters, volume, and density of normal pancreases among Chinese adults. METHODS A total of 2778 pancreas images (dataset 1) were retrospectively collected and randomly divided into training (n = 2252), validation (n = 245), and test (n = 281) datasets. The segmentation model for the pancreas was constructed through cascaded application of two 3D U-Net networks. The segmentation efficiency for the pancreas was evaluated by the Dice similarity coefficient (DSC). Another dataset of 3189 normal pancreas CT images (dataset 2) was obtained for external validation, including 1063 non-contrast images, 1063 arterial phase images, and 1063 portal venous phase images. The pancreas segmentation in dataset 2 was assessed objectively and manually revised by two radiologists. Then, the pancreatic volume, diameters, and average CT value for each phase of pancreas images in dataset 2 were calculated. The relationships between pancreas volume and age, sex, height, and weight were analyzed. RESULTS In dataset 1, a mean DSC of 0.94 for the test dataset was achieved. In dataset 2, the objective assessment yielded a 90% satisfaction rate for the automatic segmentation of the pancreas as external validation. The diameters of the pancreas were 43.71-44.28 mm, 67.40-68.15 mm, and 114.53-117.06 mm, respectively. The average pancreatic volume was 63,969.06-65,247.75 mm3, which was greatest at the age of 18-38 and then decreased to a minimum at the age of 69-85. The CT value of the pancreas also decreased with age, from a maximum value of 38.87 ± 9.70 HU to a minimum of 27.72 ± 10.85 HU. CONCLUSION The pancreas segmentation tool based on deep learning can segment the pancreas on CT images and measure its normal diameter, volume, and CT value accurately and effectively.
Collapse
Affiliation(s)
- Jinxiu Cai
- Department of Radiology, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xiaochao Guo
- Department of Radiology, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ke Wang
- Department of Radiology, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yaofeng Zhang
- Beijing Smart Tree Medical Technology Co.Ltd, Beijing, China
| | - Dadou Zhang
- Beijing Smart Tree Medical Technology Co.Ltd, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, China.
| |
Collapse
|
19
|
Lv Y, Zhang J, Yang T, Sun J, Hou J, Chen Z, Yu X, Yuan X, Lu X, Xie T, Yu T, Su X, Liu G, Zhang C, Li L. Non-Alcoholic Fatty Liver Disease (NAFLD) Is an Independent Risk Factor for Developing New-Onset Diabetes After Acute Pancreatitis: A Multicenter Retrospective Cohort Study in Chinese Population. Front Endocrinol (Lausanne) 2022; 13:903731. [PMID: 35692404 PMCID: PMC9174455 DOI: 10.3389/fendo.2022.903731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous studies validated frequent glucose dysfunction in patients with acute pancreatitis (AP). However, the prevalence of new-onset diabetes in individuals after a first episode of AP varies widely among previous studies. This study aims to determine the incidence of post-acute pancreatitis diabetes mellitus (PPDM-A) in Chinese people and further identify potential risk factors that influence diabetes development in patients with AP. METHODS This was a multi-center retrospective cohort study including 6009 inpatients with a first attack of AP. A total of 1804 patients with AP without known endocrine pancreatic disorders or other pancreatic exocrine diseases were eligible for analysis. Data was collected from medical records by hospital information system and telephone follow-ups after discharge. The multiple logistic regression analysis was established to evaluate the potential influencing factors of PPDM-A. RESULTS The prevalence of newly diagnosed diabetes after a first episode of AP in China was 6.2%. Data showed that patients who developed PPDM-A were more likely to be younger (X2 = 6.329, P = 0.012), experienced longer hospital stays (X2 = 6.949, P = 0.008) and had a higher frequency of overweight or obesity (X2 = 11.559, P = 0.003) compared to those with normal glycemia. The frequency of stress hyperglycemia on admission (X2 = 53.815, P < 0.001), hyperlipidemia (X2 = 33.594, P < 0.001) and non-alcoholic fatty liver disease (NAFLD) (X2 = 36.335, P < 0.001) were significantly higher among individuals with PPDM-A compared with control group. Also, patients with PPDM-A were more likely to be hyperlipidemic AP (X2 = 16.304, P = 0.001) and show a higher degree of severity (X2 = 7.834, P = 0.020) and recurrence rate (X2 = 26.908, P < 0.001) of AP compared to those without diabetes. In addition, multiple logistic regression analysis indicated that stress hyperglycemia, hyperlipidemia, NAFLD and repeated attacks of AP were the independent influence factors for developing PPDM-A. CONCLUSION Our study first demonstrated the prevalence of secondary diabetes in Chinese patients after AP. The disorder of glucose metabolism in individuals with AP should be regularly evaluated in clinical practice. Further studies are needed to verify the relationship between liver and pancreas in keeping glucose homeostasis under AP condition.
Collapse
Affiliation(s)
- Yingqi Lv
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jun Zhang
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ting Yang
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jinfang Sun
- Key Laboratory of Environmental, Medicine Engineering, Ministry of Education, school of Public Health, Southeast University, Nanjing, China
| | - Jiaying Hou
- Department of Endocrinology, Changji Branch, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Zhiwei Chen
- Department of Endocrinology, Hunan Provincial People’s Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Xuehua Yu
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang, China
| | - Xuelu Yuan
- Department of Endocrinology, Yixing Second People’s Hospital, Wuxi, China
| | - Xuejia Lu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ting Yu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xianghui Su
- Department of Endocrinology, Changji Branch, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Gaifang Liu
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang, China
- *Correspondence: Ling Li, ; Chi Zhang, ; Gaifang Liu,
| | - Chi Zhang
- Department of Endocrinology, Hunan Provincial People’s Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, China
- *Correspondence: Ling Li, ; Chi Zhang, ; Gaifang Liu,
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- *Correspondence: Ling Li, ; Chi Zhang, ; Gaifang Liu,
| |
Collapse
|
20
|
Qi L, Wei Q, Ni M, Liu D, Bao J, Lv Y, Xia H, Wang Q, Wang L, Su J, Sj P, Li L. Pancreatic and gut hormone responses to mixed meal test in post-chronic pancreatitis diabetes mellitus. DIABETES & METABOLISM 2021; 48:101316. [PMID: 34929379 DOI: 10.1016/j.diabet.2021.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE . - More than one-third of chronic pancreatitis patients will eventually develop diabetes, recently classified as post-chronic pancreatitis diabetes mellitus (PPDM-C). This study was aimed to investigate the pancreatic and gut hormone responses to a mixed meal test in PPDM-C patients, compared with non-diabetic chronic pancreatitis (CP), and type 2 diabetes patients or healthy controls. DESIGN AND METHODS .- Sixteen patients with PPDM-C, 12 with non-diabetic CP as well as 10 with type 2 diabetes and healthy controls were recruited. All participants underwent mixed meal tests, and blood samples were collected for measurements of blood glucose, C-peptide, insulin, glucagon, pancreatic polypeptide (PP), ghrelin, peptide YY, glucagon like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP). Indices of insulin sensitivity and secretion were calculated. Repeated measures analysis of variance was performed. RESULTS . - Participants with PPDM-C exhibited decreases in both fasting and postprandial responses of C-peptide (P < 0.001), insulin (P < 0.001), ghrelin (P < 0.001) and PYY (P = 0.006) compared to participants with type 2 diabetes and healthy controls. Patients with CP showed blunted glucagon, PP and incretin reactions, while the responses were increased in patients with PPDM-C compared to controls. The level of insulin sensitivity was higher for PPDM-C than type 2 diabetes (P < 0.01), however the indices for early/late-phase and overall insulin secretion (P < 0.01) were lower. CONCLUSIONS .- Patients with PPDM-C are characterized by decreased C-peptide, insulin, ghrelin and PYY responses, and similar levels of glucagon, PP, GIP and GLP-1 compared to those with type 2 diabetes. The above findings, when confirmed in a larger population, may prove helpful to establish the diagnosis of PPDM-C, and should promote study on underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Liang Qi
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiong Wei
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Institute of Pancreas, Southeast University, Nanjing, China
| | - Muhan Ni
- Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Dechen Liu
- Institute of Pancreas, Southeast University, Nanjing, China; Department of Clinical Science and Research, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jiantong Bao
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yingqi Lv
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hong Xia
- Department of Endocrinology, Jintan District People's Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Qian Wang
- Department of Endocrinology, Jintan District People's Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Lei Wang
- Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
| | - Jianhua Su
- Jintan District People's Hospital Affiliated to Jiangsu University, Changzhou, China.
| | - Pandol Sj
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Institute of Pancreas, Southeast University, Nanjing, China.
| |
Collapse
|
21
|
Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frøkjær JB. T1 relaxation times and MR elastography-derived stiffness: new potential imaging biomarkers for the assessment of chronic pancreatitis. Abdom Radiol (NY) 2021; 46:5598-5608. [PMID: 34524501 DOI: 10.1007/s00261-021-03276-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Non-invasive imaging methods to detect morphological changes of the pancreas in patients with mild chronic pancreatitis (CP) are needed. This study aimed to compare magnetic resonance imaging-based parameters, pancreatic volume, T1 mapping, magnetic resonance elastography (MRE), and proton density fat fraction between CP patients and controls, and determine the diagnostic performance for diagnosing different stages of CP. METHODS Nineteen patients with mild CP (Cambridge grade 2 or less or recurring acute pancreatitis; n = 19), 30 with moderate/severe CP (Cambridge grade 3 and 4), and 35 healthy controls underwent pancreatic magnetic resonance imaging to assess the above mentioned magnetic resonance imaging-based parameters. The diagnostic performance of each parameter for detecting any mild and moderate/severe CP was determined using receiver operating characteristic analysis. RESULTS Pancreatic volume, T1 relaxation times, MRE-derived stiffness, and proton density fat fraction differed significantly between patients with mild CP, moderate/severe CP, and healthy controls (all p < 0.05). T1 mapping and MRE showed a very high diagnostic performance for distinguishing the mild CP group from the control group (T1 mapping: receiver operating characteristic area under the curve (ROC-AUC): 0.94; sensitivity: 84%; specificity: 91%, MRE: ROC-AUC: 0.93; sensitivity: 89%; specificity: 94%). T1 mapping and MRE also had the highest performance for diagnosing the presence of any CP from the control group (ROC-AUCs of 0.98 and 0.97, respectively). CONCLUSION Quantitative assessments of T1 relaxation time and MRE-derived stiffness had high performance in detecting mild CP and could probably reflect the early fibrotic changes in CP.
Collapse
Affiliation(s)
- Emily Steinkohl
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark.
| |
Collapse
|
22
|
Simon L, Torres D, Saravia A, Levitt DE, Vande Stouwe C, McGarrah H, Coleman L, Dufour JP, Amedee AM, Molina PE. Chronic binge alcohol and ovariectomy-mediated impaired insulin responsiveness in SIV-infected female rhesus macaques. Am J Physiol Regul Integr Comp Physiol 2021; 321:R699-R711. [PMID: 34524906 PMCID: PMC8616623 DOI: 10.1152/ajpregu.00159.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022]
Abstract
Aging people living with HIV (PLWH), especially postmenopausal women may be at higher risk of comorbidities associated with HIV, antiretroviral therapy (ART), hypogonadism, and at-risk alcohol use. Our studies in simian immunodeficiency virus (SIV)-infected male macaques demonstrated that chronic binge alcohol (CBA) reduced acute insulin response to glucose (AIRG), and at-risk alcohol use decreased HOMA-β in PLWH. The objective of this study was to examine the impact of ovariectomy (OVX) on glucose-insulin dynamics and integrity of pancreatic endocrine function in CBA/SIV-infected female macaques. Female macaques were administered CBA (12-15 g/kg/wk) or isovolumetric water (VEH) intragastrically. Three months after initiation of CBA/VEH administration, all macaques were infected with SIVmac251, and initiated on antiretroviral therapy (ART) 2.5 mo postinfection. After 1 mo of ART, macaques were randomized to OVX or sham surgeries (n = 7 or 8/group), and euthanized 8 mo post-OVX (study endpoint). Frequently sampled intravenous glucose tolerance tests (FSIVGTT) were performed at selected time points. Pancreatic gene expression and islet morphology were determined at study endpoint. There was a main effect of CBA to decrease AIRG at Pre-SIV and study endpoint. There were no statistically significant OVX effects on AIRG (P = 0.06). CBA and OVX decreased the expression of pancreatic markers of insulin docking and release. OVX increased endoplasmic stress markers. CBA but not OVX impaired glucose-insulin expression dynamics in SIV-infected female macaques. Both CBA and OVX altered integrity of pancreatic endocrine function. These findings suggest increased vulnerability of PLWH to overt metabolic dysfunction that may be exacerbated by alcohol use and ovarian hormone loss.
Collapse
Affiliation(s)
- Liz Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Diego Torres
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ari Saravia
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Danielle E Levitt
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Curtis Vande Stouwe
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Heather McGarrah
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Larry Coleman
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jason P Dufour
- Division of Veterinary Medicine, Tulane National Primate Research Center, Covington, Louisiana
| | - Angela M Amedee
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| |
Collapse
|
23
|
Sasaki H, Saisho Y, Inaishi J, Itoh H. Revisiting Regulators of Human β-cell Mass to Achieve β-cell-centric Approach Toward Type 2 Diabetes. J Endocr Soc 2021; 5:bvab128. [PMID: 34405128 PMCID: PMC8361804 DOI: 10.1210/jendso/bvab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes (T2DM) is characterized by insulin resistance and β-cell dysfunction. Because patients with T2DM have inadequate β-cell mass (BCM) and β-cell dysfunction worsens glycemic control and makes treatment difficult, therapeutic strategies to preserve and restore BCM are needed. In rodent models, obesity increases BCM about 3-fold, but the increase in BCM in humans is limited. Besides, obesity-induced changes in BCM may show racial differences between East Asians and Caucasians. Recently, the developmental origins of health and disease hypothesis, which states that the risk of developing noncommunicable diseases including T2DM is influenced by the fetal environment, has been proposed. It is known in rodents that animals with low birthweight have reduced BCM through epigenetic modifications, making them more susceptible to diabetes in the future. Similarly, in humans, we revealed that individuals born with low birthweight have lower BCM in adulthood. Because β-cell replication is more frequently observed in the 5 years after birth, and β cells are found to be more plastic in that period, a history of childhood obesity increases BCM. BCM in patients with T2DM is reduced by 20% to 65% compared with that in individuals without T2DM. However, since BCM starts to decrease from the stage of borderline diabetes, early intervention is essential for β-cell protection. In this review, we summarize the current knowledge on regulatory factors of human BCM in health and diabetes and propose the β-cell–centric concept of diabetes to enhance a more pathophysiology-based treatment approach for T2DM.
Collapse
Affiliation(s)
- Hironobu Sasaki
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Saisho
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Inaishi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
24
|
van Wilpe R, Hulst AH, Polderman JAW, Hollmann MW, DeVries JH, Preckel B, Hermanides J. Less common types of diabetes mellitus: Incidence and glucose control in the perioperative setting. J Clin Anesth 2021; 75:110460. [PMID: 34274602 DOI: 10.1016/j.jclinane.2021.110460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Robert van Wilpe
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| | - Abraham H Hulst
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| | - Jorinde A W Polderman
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands.
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location AMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105, AZ, Amsterdam, the Netherlands
| |
Collapse
|
25
|
Talukdar R, Reddy DN, Tandan M, Gupta R, Lakhtakia S, Ramchandani M, Kalapala R, Basha J, Nabi Z, Reddy M, Darishetty S, Koppoju V, Pradeep R, Rao GV. Impact of ductal interventions on diabetes in patients with chronic pancreatitis. J Gastroenterol Hepatol 2021; 36:1226-1234. [PMID: 33000865 DOI: 10.1111/jgh.15279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/29/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Even though ductal interventions in chronic pancreatitis (CP) are known to improve pain, its impact on diabetes is unclear. In this cohort study, we evaluated the impact of ductal interventions on diabetes in these patients. METHODS Consecutive patients with CP visiting the pancreas clinic between August 1, 2011, and July 21, 2012, were enrolled and followed until December 2018. Detailed clinical, laboratory, imaging, and treatment data were recorded at enrolment and follow-up. Patients were followed up every 6 months through hospital visit and/or telephonic interview. Risk factors for diabetes were evaluated using logistic regression. The impact of ductal interventions on diabetes was evaluated using Kaplan-Meier survival analyses and Cox proportional hazards. RESULTS A total of 644 patients were enrolled of which 137 were excluded. Of these, 326 (64.3%) patients had idiopathic CP, and 283 (55.8%) patients underwent ductal intervention. The cumulative incidence of diabetes was 57.9%. Median duration between symptom onset and ductal intervention was similar irrespective of diabetes (2.6 [0.6-6.0] vs 3.0 [1.0-5.5] years; P = 0.69). Alcohol intake and pancreatic ductal calculi were independent risk factors for diabetes (odds ratio [95% confidence interval] of 2.05 (1.18-3.55), P = 0.01, and 2.05 (1.28-3.28), P = 0.003, respectively). Kaplan-Meier analyses revealed that diabetes free interval was significantly longer in patients undergoing ductal interventions, predominantly in those with idiopathic CP with obstructive ductal calculi (hazard ratio [95% confidence interval] 0.39 [0.28-0.55]; P < 0.0001). There were no differences in glycemic status in patients with non-idiopathic CP and those with pre-existing diabetes. CONCLUSION Early ductal intervention could delay development of diabetes in patients with idiopathic CP with obstructive ductal calculi.
Collapse
Affiliation(s)
- Rupjyoti Talukdar
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.,Wellcome DBT Laboratories, Institute of Basic Sciences and Translational Research, Hyderabad, India.,Pancreas Research Group, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jahangeer Basha
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manohar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Santosh Darishetty
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Vinod Koppoju
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - R Pradeep
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - G Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| |
Collapse
|
26
|
Swentek L, Chung D, Ichii H. Antioxidant Therapy in Pancreatitis. Antioxidants (Basel) 2021; 10:657. [PMID: 33922756 PMCID: PMC8144986 DOI: 10.3390/antiox10050657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pancreatitis is pathologic inflammation of the pancreas characterized by acinar cell destruction and oxidative stress. Repeated pancreatic insults can result in the development of chronic pancreatitis, characterized by irreversible fibrosis of the pancreas and many secondary sequelae, ultimately leading to the loss of this important organ. We review acute pancreatitis, chronic pancreatitis, and pancreatitis-related complications. We take a close look at the pathophysiology with a focus on oxidative stress and how it contributes to the complications of the disease. We also take a deep dive into the evolution and current status of advanced therapies for management including dietary modification, antioxidant supplementation, and nuclear factor erythroid-2-related factor 2-Kelch-like ECH-associated protein 1(Nrf2-keap1) pathway activation. In addition, we discuss the surgeries aimed at managing pain and preventing further endocrine dysfunction, such as total pancreatectomy with islet auto-transplantation.
Collapse
Affiliation(s)
| | | | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, CA 92868, USA; (L.S.); (D.C.)
| |
Collapse
|
27
|
Jung W, Kim H, Kwon W, Jang JY. Atrophy of remnant pancreas after pancreatoduodenectomy: Risk factors and effects on quality of life, nutritional status, and pancreatic function. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:239-249. [PMID: 33773065 DOI: 10.1002/jhbp.949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Factors aggravating remnant pancreas atrophy following pancreatoduodenectomy and the effects of atrophy have not been extensively studied. This study aimed to evaluate the clinical factors affecting remnant pancreas atrophy and assess the effects of atrophy on quality of life, nutritional status, and pancreatic exocrine and endocrine functions. METHODS Data collected prospectively from 122 patients who completed 12 months of follow-up, including computed tomography and the quality-of-life questionnaire, were analyzed. Pancreas volume was measured using a computed tomography volumetry program. Endocrine and exocrine functions were evaluated. RESULTS Malignancy and adjuvant chemoradiotherapy were associated with severity of atrophy. At 12 postoperative months, quality-of-life scores and nutritional indexes were mostly not associated with atrophy, but stool elastase level decreased significantly and incidence of new-onset diabetes mellitus was higher in the severe atrophy group. Postprandial 2-hour blood glucose and glycosylated hemoglobin levels were also higher in this group. CONCLUSIONS Remnant pancreas atrophy was more severe in patients with malignant disease who received adjuvant chemoradiotherapy and was associated with pancreatic exocrine and endocrine functions. More careful monitoring and active management of exocrine and endocrine deficiencies are necessary for patients who underwent pancreatoduodenectomy for malignant disease and received chemoradiotherapy.
Collapse
Affiliation(s)
- Woohyun Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
28
|
Goess R, Mutgan AC, Çalışan U, Erdoğan YC, Ren L, Jäger C, Safak O, Stupakov P, Istvanffy R, Friess H, Ceyhan GO, Demir IE. Patterns and Relevance of Langerhans Islet Invasion in Pancreatic Cancer. Cancers (Basel) 2021; 13:cancers13020249. [PMID: 33440856 PMCID: PMC7826785 DOI: 10.3390/cancers13020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pancreatic cancer-associated diabetes mellitus (PC-DM) is present in most patients with pancreatic cancer, but its pathogenesis remains poorly understood. Therefore, we aimed to characterize tumor infiltration in Langerhans islets in pancreatic cancer and determine its clinical relevance. METHODS Langerhans islet invasion was systematically analyzed in 68 patientswith pancreatic ductal adenocarcinoma (PDAC) using histopathological examination and 3D in vitro migration assays were performed to assess chemoattraction of pancreatic cancer cells to isletcells. RESULTS Langerhans islet invasion was present in all patients. We found four different patterns of islet invasion: (Type I) peri-insular invasion with tumor cells directly touching the boundary, but not penetrating the islet; (Type II) endo-insular invasion with tumor cells inside the round islet; (Type III) distorted islet structure with complete loss of the round islet morphology; and (Type IV)adjacent cancer and islet cells with solitary islet cells encountered adjacent to cancer cells. Pancreatic cancer cells did not exhibit any chemoattraction to islet cells in 3D assays in vitro. Further, there was no clinical correlation of islet invasion using the novel Islet Invasion Severity Score (IISS), which includes all invasion patterns with the occurrence of diabetes mellitus. However, Type IV islet invasion was related to worsened overall survival in our cohort. CONCLUSIONS We systematically analyzed, for the first time, islet invasion in human pancreatic cancer. Four different main patterns of islet invasion were identified. Diabetes mellitus was not related to islet invasion. However, moreresearch on this prevailing feature of pancreatic cancer is needed to better understand underlying principles.
Collapse
Affiliation(s)
- Ruediger Goess
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Ayse Ceren Mutgan
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Umut Çalışan
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Yusuf Ceyhun Erdoğan
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Lei Ren
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Carsten Jäger
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Okan Safak
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Pavel Stupakov
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Rouzanna Istvanffy
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
| | - Güralp O. Ceyhan
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
- Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul 34684, Turkey
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, D-81675 Munich, Germany; (R.G.); (A.C.M.); (U.Ç.); (Y.C.E.); (L.R.); (C.J.); (O.S.); (P.S.); (R.I.); (H.F.); (G.O.C.)
- Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul 34684, Turkey
- German Cancer Consortium (DKTK), Partner Site Munich, D-81675 Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, D-81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-4140-5868
| |
Collapse
|
29
|
Wei Q, Qi L, Lin H, Liu D, Zhu X, Dai Y, Waldron RT, Lugea A, Goodarzi MO, Pandol SJ, Li L. Pathological Mechanisms in Diabetes of the Exocrine Pancreas: What's Known and What's to Know. Front Physiol 2020; 11:570276. [PMID: 33250773 PMCID: PMC7673428 DOI: 10.3389/fphys.2020.570276] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
The clinical significance of diabetes arising in the setting of pancreatic disease (also known as diabetes of the exocrine pancreas, DEP) has drawn more attention in recent years. However, significant improvements still need to be made in the recognition, diagnosis and treatment of the disorder, and in the knowledge of the pathological mechanisms. The clinical course of DEP is different from type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). DEP develops in patients with previous existing exocrine pancreatic disorders which damage both exocrine and endocrine parts of pancreas, and lead to pancreas exocrine insufficiency (PEI) and malnutrition. Therefore, damage in various exocrine and endocrine cell types participating in glucose metabolism regulation likely contribute to the development of DEP. Due to the limited amount of clinical and experimental studies, the pathological mechanism of DEP is poorly defined. In fact, it still not entirely clear whether DEP represents a distinct pathologic entity or is a form of T2DM arising when β cell failure is accelerated by pancreatic disease. In this review, we include findings from related studies in T1DM and T2DM to highlight potential pathological mechanisms involved in initiation and progression of DEP, and to provide directions for future research studies.
Collapse
Affiliation(s)
- Qiong Wei
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Pancreas, Southeast University, Nanjing, China
| | - Liang Qi
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hao Lin
- Institute of Pancreas, Southeast University, Nanjing, China.,Department of Clinical Science and Research, ZhongDa Hospital, Southeast University, Nanjing, China
| | - Dechen Liu
- Institute of Pancreas, Southeast University, Nanjing, China.,Department of Clinical Science and Research, ZhongDa Hospital, Southeast University, Nanjing, China
| | - Xiangyun Zhu
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Pancreas, Southeast University, Nanjing, China
| | - Yu Dai
- Nanjing Foreign Language School, Nanjing, China
| | - Richard T Waldron
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Aurelia Lugea
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ling Li
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Pancreas, Southeast University, Nanjing, China
| |
Collapse
|
30
|
Pancreatic Islet Changes in Human Whole Organ Pancreas Explants: What Can Be Learned From Explanted Samples? Transplant Direct 2020; 6:e613. [PMID: 33134489 PMCID: PMC7575169 DOI: 10.1097/txd.0000000000001059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/24/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background. Whole pancreas transplantation (Tx) is a successful treatment for type 1 diabetes resulting in independence from antidiabetic therapies. Transplant-related factors contributing to pancreatic islet failure are largely unknown; both recurring insulitis and pancreatitis have been implicated. The aim was to determine if cellular changes in islets and exocrine tissue are evident early in Tx, which could contribute to eventual graft failure using well-preserved tissue of grafts explanted from largely normoglycemic recipients. Methods. Histological specimens of explants (n = 31), Tx duration 1 day–8 years (median 29 d), cold ischemia time 7.2–17.3 hours (median 11.1 h), donor age 13–54 years (median 38 y) were examined; sections were labeled for inflammation, islet amyloidosis, and tissue fibrosis, and morphometry performed on immunolabeled insulin and glucagon positive islet cells. Data were related to clinical details of donor, recipient, and features of Tx. Results. Islet inflammation consistent with recurrent insulitis was not seen in any sample. Insulin-labeled islet cell proportion decreased with donor age (P < 0.05) and cold ischemia (P < 0.01) in explants from 26 normoglycemic patients; glucagon-labeled area proportion increased with cold ischemia (P < 0.05). Clinical pancreatitis was the explant reason in 12 of 28 normoglycemic cases. Exocrine fibrotic area/pancreas was variable (0.7%–55%) and unrelated to clinical/pathological features. Islet amyloid was present in 3 normoglycemic cases (donor ages 58, 42, and 31 y; Tx duration 8 y, 31 and 33 d, respectively). In 1 patient receiving antidiabetic therapy, the insulin-labeled area was reduced but with no evidence of islet inflammation. Conclusions. Explant histological changes after short-term Tx are similar to those seen in type 2 diabetes and occur in the absence of immunologic rejection without causing hyperglycemia. This suggests that factors associated with Tx affect islet stability; persistent deterioration of islet integrity and exocrine tissue fibrosis could impact on sustainability of islet function.
Collapse
|
31
|
Takahashi R, Nunobe S, Sai N, Makuuchi R, Ida S, Kumagai K, Ohashi M, Sano T. Pancreatic atrophy after gastrectomy for gastric cancer. Surg Today 2020; 51:432-438. [PMID: 32885349 DOI: 10.1007/s00595-020-02131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the phenomenon of pancreatic atrophy after gastrectomy for gastric cancer, using computed tomography (CT) volumetry. METHODS The subjects of this retrospective study were 77 patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for pStage I gastric cancer in 2014. The relative pancreatic volume ratio was assessed preoperatively, and then 1 and 5 years postoperatively and the results were compared between surgical procedures RESULTS: A total of 14 patients underwent TG with Roux-en-Y (RY) reconstruction, 24 underwent DG with Billroth-I (BI) reconstruction, and 39 underwent DG with RY reconstruction. We observed that the pancreatic volume continued to decrease over the 5 years after DG or TG. Furthermore, the incidence of pancreatic atrophy 5 years postoperatively was significantly greater after TG than after DG. In patients who underwent DG, a greater incidence of pancreatic atrophy was observed after RY reconstruction than after BI reconstruction, 5 years postoperatively. CONCLUSION The pancreatic volume continued to decrease after DG and TG for gastric cancer 5 years after treatment. TG was associated with a significantly greater incidence of pancreatic atrophy than DG 5 years postoperatively, as was RY reconstruction vs. BI reconstruction after DG.
Collapse
Affiliation(s)
- Ryo Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.,Department of General Surgery, Hekinan Municipal Hospital, Aichi, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Naohito Sai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| |
Collapse
|
32
|
Ueberberg S, Nauck MA, Uhl W, Montemurro C, Tannapfel A, Clark A, Meier JJ. Islet Amyloid in Patients With Diabetes Due to Exocrine Pancreatic Disorders, Type 2 Diabetes, and Nondiabetic Patients. J Clin Endocrinol Metab 2020; 105:5818378. [PMID: 32271378 DOI: 10.1210/clinem/dgaa176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Amyloid deposits are a typical finding in pancreatic islets from patients with type 2 diabetes. Whether this is linked to the pathogenesis of type 2 diabetes is currently unknown. Therefore, we compared the occurrence of islet amyloid in patients with type 2 diabetes, diabetes secondary to pancreatic disorders, and nondiabetic individuals. PATIENTS AND METHODS Pancreatic tissue from 15 nondiabetic patients, 22 patients with type 2 diabetes, and 11 patients with diabetes due to exocrine pancreatic disorders (chronic pancreatitis, pancreatic carcinoma) were stained for insulin, amyloid, and apoptosis. β-cell area, amyloid deposits, and β-cell apoptosis were quantified by morphometric analysis. RESULTS The proportion of islets containing amyloid deposits was significantly higher in both type 2 diabetes and diabetes due to exocrine pancreatic disorders than in healthy subjects. Islets with both amyloid and apoptosis were observed more frequently in type 2 diabetes and significantly more so in diabetes due to exocrine pancreatic disorders. In both diabetic groups, apoptotic ß-cells were found significantly more frequently in islets with more prominent amyloid deposits. CONCLUSIONS The occurrence of amyloid deposits in both type 2 diabetes and diabetes secondary to exocrine pancreatic disorders suggests that islet amyloid formation is a common feature of diabetes mellitus of different etiologies and may be associated with a loss of pancreatic ß-cells.
Collapse
Affiliation(s)
- Sandra Ueberberg
- Diabetes Division St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Michael A Nauck
- Diabetes Division St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Chiara Montemurro
- Diabetes Division St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- David Geffen School of Medicine, University of California, Los Angeles, CA, US
| | | | - Anne Clark
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Juris J Meier
- Diabetes Division St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
33
|
Roy A, Sahoo J, Kamalanathan S, Naik D, Mohan P, Pottakkat B. Islet cell dysfunction in patients with chronic pancreatitis. World J Diabetes 2020; 11:280-292. [PMID: 32843931 PMCID: PMC7415230 DOI: 10.4239/wjd.v11.i7.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/02/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic pancreatitis (CP) is characterized by progressive inflammation and fibrosis of the pancreas that eventually leads to pancreatic exocrine and endocrine insufficiency. Diabetes in the background of CP is very difficult to manage due to high glycemic variability and concomitant malabsorption. Progressive beta cell loss leading to insulin deficiency is the cardinal mechanism underlying diabetes development in CP. Alpha cell dysfunction leading to deranged glucagon secretion has been described in different studies using a variety of stimuli in CP. However, the emerging evidence is varied probably because of dependence on the study procedure, the study population as well as on the stage of the disease. The mechanism behind islet cell dysfunction in CP is multifactorial. The intra-islet alpha and beta cell regulation of each other is often lost. Moreover, secretion of the incretin hormones such as glucagon like peptide-1 and glucose-dependent insulinotropic polypeptide is dysregulated. This significantly contributes to islet cell disturbances. Persistent and progressive inflammation with changes in the function of other cells such as islet delta cells and pancreatic polypeptide cells are also implicated in CP. In addition, the different surgical procedures performed in patients with CP and antihyperglycemic drugs used to treat diabetes associated with CP also affect islet cell function. Hence, different factors such as chronic inflammation, dysregulated incretin axis, surgical interventions and anti-diabetic drugs all affect islet cell function in patients with CP. Newer therapies targeting alpha cell function and beta cell regeneration would be useful in the management of pancreatic diabetes in the near future.
Collapse
Affiliation(s)
- Ayan Roy
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Pazhanivel Mohan
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| |
Collapse
|
34
|
Nanno Y, Wilhelm JJ, Heller D, Schat R, Freeman ML, Trikudanathan G, Kirchner VA, Pruett TL, Beilman GJ, Hering BJ, Bellin MD. Combination of pancreas volume and HbA1c level predicts islet yield in patients undergoing total pancreatectomy and islet autotransplantation. Clin Transplant 2020; 34:e14008. [DOI: 10.1111/ctr.14008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Yoshihide Nanno
- Schulze Diabetes Institute University of Minnesota School of Medicine Minneapolis MN USA
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Joshua J. Wilhelm
- Schulze Diabetes Institute University of Minnesota School of Medicine Minneapolis MN USA
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - David Heller
- Schulze Diabetes Institute University of Minnesota School of Medicine Minneapolis MN USA
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Robben Schat
- Department of Radiology University of Minnesota School of Medicine Minneapolis MN USA
| | - Martin L. Freeman
- Department of Medicine University of Minnesota School of Medicine Minneapolis MN USA
| | - Guru Trikudanathan
- Department of Medicine University of Minnesota School of Medicine Minneapolis MN USA
| | - Varvara A. Kirchner
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Timothy L. Pruett
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Gregory J. Beilman
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Bernhard J. Hering
- Schulze Diabetes Institute University of Minnesota School of Medicine Minneapolis MN USA
- Department of Surgery University of Minnesota School of Medicine Minneapolis MN USA
| | - Melena D. Bellin
- Schulze Diabetes Institute University of Minnesota School of Medicine Minneapolis MN USA
- Department of Pediatrics University of Minnesota School of Medicine Minneapolis MN USA
| |
Collapse
|
35
|
Tariq M, Jajja MR, Maxwell DW, Galindo RJ, Sweeney JF, Sarmiento JM. Diabetes development after distal pancreatectomy: results of a 10 year series. HPB (Oxford) 2020; 22:1034-1041. [PMID: 31718897 DOI: 10.1016/j.hpb.2019.10.2440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/05/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited literature is available on the postoperative development of impaired glucose tolerance (IGT) and new-onset diabetes mellitus (NODM) following Distal Pancreatectomy (DP). We aimed to study the post-surgical clinical evolution of IGT/DM and its association with preoperative glycemic profiles of patients undergoing DP. METHODS Pre- and postoperative glycemic laboratories were measured in patients undergoing DP by the senior author from 2007-2017. Multivariate risk factor analysis was performed to determine risk factors for new-onset IGT/DM after DP. Kaplan-Meier curves were constructed for development of NODM postoperatively. RESULTS Of 216 included patients, n = 63, n = 68 and n = 85 were preoperatively diagnosed with no-diabetes (No-DM), pre-diabetes (Pre-DM), and diabetes (DM), respectively. At 2-year follow-up, n = 37, n = 80 and n = 99 were classified as No-DM, Pre-DM or DM, respectively. Pre-diabetics had a higher risk of developing postoperative dysglycemia (RR 2.230, 95% CI 1.732-2.870, p = 0.001). Preoperative OGTT>130, HbA1c >6.0, and chronic pancreatitis were risk factors for postoperative DM. CONCLUSION 40% of patients undergoing DP were unaware of their dysglycemic status (pre-DM or DM) pre-operatively. At 2-year follow-up, 36% non-diabetic and 57% pre-diabetic patients had developed NODM. Appropriate pre-operative diabetic assessment is warranted for all patients undergoing pancreatic resections.
Collapse
Affiliation(s)
- Marvi Tariq
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad R Jajja
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel W Maxwell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rodolfo J Galindo
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
36
|
Morphological advantages of endoscopic treatment in obstructive chronic pancreatitis. Pancreatology 2020; 20:199-204. [PMID: 31899135 DOI: 10.1016/j.pan.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND and study aims: Chronic pancreatitis is associated with recurrent or persistent abdominal pain over the course of the disease. Ductal hypertension showing obstructed and dilated pancreatic duct has been suggested as a major factor in the mechanism of pain in chronic pancreatitis. Many studies investigating pain relief after endoscopic treatment of pancreatic duct (PD) are available, but the number of studies regarding the morphological changes to pancreas such as changes in PD caliber, pancreatic parenchyma, and especially pancreatic volume is far fewer. As such, we analyzed the changes of ductal caliber and parenchymal volume after endoscopic treatment of PD in patients with obstructive chronic pancreatitis. PATIENTS AND METHODS In this retrospective study, we compared two groups of patients with obstructive chronic pancreatitis that either received endoscopic management of PD or conservative treatment without such endoscopic management. After we obtained age, sex, etiology of chronic pancreatitis, diabetic status, smoking and alcohol abuse status from the database, we compared the incidence for changes in pancreatic parenchymal volume and PD caliber between two groups. RESULT In our study population, total of 480 patients was diagnosed with chronic pancreatitis between January 2006 and December 2016, and 166 (34.5%) of these patients were diagnosed with obstructive chronic pancreatitis with obstructed and dilated PD. After reviewing the population with the exclusion criteria, 71 patients were available for the final analysis. 28 of those patient received endoscopic treatment of pancreatic duct and 43 received conservative treatment without any endoscopic treatment of PD. Statistical analysis with Cox proportional hazards models showed that diabetes and endoscopic PD management were significant predictors for progression of PD caliber and in pancreatic parenchyma, and that only PD management influenced the pancreatic volume loss. CONCLUSION Endoscopic management of PD in obstructive chronic pancreatitis have advantages on morphologic change such as pancreatic volume loss and progression of PD caliber in long follow-up period.
Collapse
|
37
|
Lin CH, Yeh NC, Wang JJ, Ho CH, Her SH, Tsay WI, Chien CC. Effect of Chronic Pancreatitis on Complications and Mortality in DM Patients: A 10-year Nationwide Cohort Study. J Clin Endocrinol Metab 2020; 105:5715202. [PMID: 31974550 DOI: 10.1210/clinem/dgaa035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Chronic pancreatitis (CP), is a long-term inflammation of the pancreatic parenchyma, and might increase risk of a hyperglycemia crisis or hypoglycemia in patients with diabetes mellitus (DM); however, the relationship has not been previously investigated. OBJECTIVE To investigate the risk of diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), hypoglycemia, and long-term outcomes in DM patients with CP. DESIGN A population-based cohort study. SETTING AND PARTICIPANTS Tapping Taiwan's National Health Insurance Research Database, we identified 506 DM patients with newly diagnosed CP from 1999 to 2010 and created a control cohort consisting of 5060 age- and sex-matched DM patients without CP from the same time period. We followed those 2 cohorts from the index date to occurrence of outcomes, the date of death or 31 December 2012. MAIN OUTCOME MEASURES DKA, HHS, hypoglycemia and mortality. RESULTS DM patients with CP, who were predominantly male (88%) and younger (60% < 45 years old), had a 9.5-, 5.0-, and 3.0-fold higher risk for DKA (95% confidence interval [CI]: 6.51-13.91), HHS (95% CI: 2.85-8.62), and hypoglycemia (95% CI: 2.23-4.08), respectively. They also had lower 1-, 5-, and 10-year cumulative survival rates (98.4% vs 99.0%, 87.7% vs 96.6%, and 78.7% vs 93.6%, respectively) (log-rank test: P < .001), and a 2.43-fold higher risk for death (HR: 2.43, 95% CI: 1.82-3.27). CONCLUSIONS In Taiwan, DM patients with CP have a higher incidence of DKA, HHS, hypoglycemia, and mortality. More attention is needed for preventing hyperglycemia crisis and hypoglycemia prevention in this population.
Collapse
Affiliation(s)
- Cheng-Heng Lin
- Department of Gastroenterology, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Nai-Cheng Yeh
- Department of Endocrinology and Metabolism, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shwu-Huey Her
- Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan
| | - Wen-Ing Tsay
- Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taiwan
| | | |
Collapse
|
38
|
Progression of parenchymal and ductal findings in patients with chronic pancreatitis: A 4-year follow-up MRI study. Eur J Radiol 2020; 125:108868. [PMID: 32070871 DOI: 10.1016/j.ejrad.2020.108868] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Knowledge of the underlying mechanisms behind progression of chronic pancreatitis (CP) is needed to identify targets for new mechanism-based treatments. There is an urgent need for imaging biomarkers that can detect early morphological and functional pancreatic damage in order to initiate intervention and reduce the progression of CP at an early stage. The aim of our study was to assess and explore the potential role of structural magnetic resonance imaging (MRI) biomarkers for characterisation of disease progression in a CP patient cohort over a 4-year period. METHODS This longitudinal MRI study included twenty-five patients with definitive CP. Assessments of morphological imaging parameters at baseline and after 4 years included pancreatic gland volume, apparent diffusion coefficient (ADC) values, fat signal fraction (FSF) and main pancreatic duct (MPD) diameter. Patients were classified according to the modified Cambridge classification. RESULTS CP patients developed significantly reduced pancreatic gland volume, which decreased from mean 50.3 ± 19.6 ml at baseline to 43.5 ± 20.8 ml at follow-up (P < 0.001), decreased ADC values, meaning a higher degree of fibrosis (P < 0.001), increased FSF, meaning more fat infiltration (P < 0.001) and higher Cambridge classification scores (P = 0.033). The MPD diameter in the pancreatic head, body and tail did not change significantly over time (all P > 0.05). Only few, but no clear and systematic, associations were found between the progressions of the individual MRI measures. CONCLUSIONS Morphological progression in patients with established CP seems to be primarily parenchymal-related. The different parenchymal changes were mostly unrelated and probably reflect diverse pathophysiological processes.
Collapse
|
39
|
Relationship of pancreas volume to tobacco smoking and alcohol consumption following pancreatitis. Pancreatology 2020; 20:60-67. [PMID: 31708473 DOI: 10.1016/j.pan.2019.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/02/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tobacco smoking and alcohol consumption are established risk factors for diseases of the pancreas. With the recent advances in imaging modalities (such as magnetic resonance (MR) imaging), opportunities have arisen to study pancreas size, in both health and disease. Studies investigating the relationship between tobacco smoking, alcohol consumption, and total pancreas volume (TPV) - a holistic measure of pancreatic exocrine reserve - are lacking. The aim of the present study was to investigate the associations between MR-derived TPV and tobacco smoking/alcohol consumption. METHODS This cross-sectional study recruited individuals with a history of pancreatitis and healthy controls. A validated questionnaire was used to ascertain current and lifetime tobacco smoking and alcohol consumption. TPV was quantified using MR images by two independent raters. Generalized additive models and linear regression analyses were conducted and adjusted for demographic, metabolic, and pancreatitis-related factors. RESULTS A total of 107 individuals following pancreatitis and 38 healthy controls were included. There was no statistically significant difference in TPV between any of the tobacco smoking/alcohol consumption categories of individuals following pancreatitis and healthy controls, in both unadjusted and adjusted analyses. In individuals following pancreatitis, multivariate linear regression found no association between TPV and 7 smoking- and alcohol-related variables. Sensitivity analyses constrained to individuals who did not abstain from either smoking or drinking following their first attack of pancreatitis did not yield statistical significance with TPV. In post-hoc analysis, age was significantly inversely associated with TPV in the most adjusted model (p = 0.016). CONCLUSIONS This is the first study to investigate the association between tobacco smoking, alcohol consumption, and MR-derived TPV following pancreatitis. It appears that age, but not tobacco smoking or alcohol consumption, is associated with a significantly reduced TPV.
Collapse
|
40
|
DeSouza SV, Priya S, Cho J, Singh RG, Petrov MS. Pancreas shrinkage following recurrent acute pancreatitis: an MRI study. Eur Radiol 2019; 29:3746-3756. [DOI: 10.1007/s00330-019-06126-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/27/2022]
|
41
|
Kipp JP, Olesen SS, Mark EB, Frederiksen LC, Drewes AM, Frøkjær JB. Normal pancreatic volume in adults is influenced by visceral fat, vertebral body width and age. Abdom Radiol (NY) 2019; 44:958-966. [PMID: 30298430 DOI: 10.1007/s00261-018-1793-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim was to describe the pancreatic volume (PV) in a cohort of subjects with no prior history of pancreatic disease, and to explore the relationship between PV and conventional two-point measurements of the pancreas. Associations between PV, gender, age, abdominal body composition, and human height were explored as well. METHODS CT scans from 204 trauma patients (20-80 years, 100 males) were evaluated. PV was measured with semi-automatic segmentation. Standardized two-point measurements of the pancreas were obtained together with L1 vertebral body size (a proxy for human height) and abdominal body composition. Associations between PV and the other parameters were explored using uni- and multivariate linear regression. RESULTS The mean PV was 77.9 ± 21.7(SD) cm3 with an interindividual variability from 18.8 to 139.8 cm3. The transversal diameter of the pancreatic head showed the strongest correlation to PV (r = 0.500, p < 0.001). Age, width of the L1 vertebral body, and visceral fat cross-sectional area were all independently associated with PV (all p < 0.001), while no independent association was seen for gender (p = 0.441). CONCLUSIONS The pancreatic volume is subject to a large interindividual variability and is associated with age, human height and body composition, while gender had no independent influence on the pancreatic volume. Thus, future studies using PV as an outcome parameter should be evaluated in the context of anthropometric profiles.
Collapse
Affiliation(s)
| | - Søren Schou Olesen
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lida Changiziyan Frederiksen
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology & Hepatology, Centre for Pancreatic Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Mech-Sense, Department of Radiology, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark.
| |
Collapse
|
42
|
Puttaiah Kadyada S, Thapa BR, Kaushal K, Walia R, Rana SV, Dhaka N, Lal SB, Prasad R, Das S, Thakur R, Kamal K. Incomplete functional and morphological recovery after acute and acute recurrent pancreatitis in children. J Gastroenterol Hepatol 2019; 34:293-301. [PMID: 29791723 DOI: 10.1111/jgh.14288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/29/2018] [Accepted: 05/01/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM There is lack of data on functional and morphological recovery after an attack of acute pancreatitis (AP) or acute recurrent pancreatitis (ARP) in children. This study aims to evaluate the functional impairment and morphological changes in the pancreas after recovery. METHODS All consecutive patients presenting with AP (n = 61) or ARP (n = 35), as per standard diagnostic criteria, were enrolled. After 2 months of pancreatitis, fecal elastase-1 (FE-1) (μg/g) and 2-h oral glucose tolerance test to calculate oral disposition index (DIo ) (mmol/L) (β-cell function) were performed. Morphological changes were assessed by endoscopic ultrasound and transabdominal ultrasound. Patients with chronic pancreatitis (CP) (n = 27) and healthy children (HC) (n = 26) were included as controls for functional parameters. RESULTS At a median follow up of 12 (4-44) and 11 (2-108) months, 66.7% and 75.9% (P = 0.57) of AP and ARP demonstrated exocrine insufficiency (FE-1 < 200), respectively. Mean (SD) FE-1 was 183.64 ± 150.94 (AP), 135.70 ± 103.80 (ARP), 46.56 ± 30.20 (CP), and 240.00 ± 181.83 (HC) (P < 0.001; anova) (AP vs CP, ARP vs CP, and CP vs HC; P < 0.001). Prediabetes due to insulin resistance was seen in 16.6% and 22.6% (P = 0.56) of AP and ARP. Median (interquartile range) DIo (mmol/L) was comparable between AP (4.20 [2.36, 8.3]) and HC (5.20 [2.89, 8.68]), but was low in ARP (2.97 [1.80, 5.12]), which was comparable with CP (1.91 [1.20, 2.83]). Endoscopic ultrasound demonstrated morphological changes in 25% and 37% (P = 0.34) of AP and ARP, respectively. CONCLUSION There was high frequency of biochemical evidence of exocrine insufficiency. β-Cell function (DIo ) was preserved among AP but was poor in ARP. Nearly one-third showed morphological changes in imaging.
Collapse
Affiliation(s)
- Srikanth Puttaiah Kadyada
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram Thapa
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karanvir Kaushal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S V Rana
- Division of Biochemistry, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna B Lal
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajendra Prasad
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhamoy Das
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajini Thakur
- Division of Biochemistry, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kishore Kamal
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
43
|
Lu J, Guo M, Wang H, Pan H, Wang L, Yu X, Zhang X. Association between Pancreatic Atrophy and Loss of Insulin Secretory Capacity in Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2019; 2019:6371231. [PMID: 31467928 PMCID: PMC6701290 DOI: 10.1155/2019/6371231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/06/2019] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS To examine pancreatic volume (PV) changes among patients with different duration of type 2 diabetes and whether pancreatic atrophy was associated with loss of insulin secretory capacity. METHODS This cross-sectional study (203 patients with type 2 diabetes, 93 controls without diabetes) was conducted from January 2016 to December 2017. Patients with type 2 diabetes were divided into 3 groups: recently diagnosed (duration ≤ 2 years), midterm (duration 3-9 years), and long term (duration ≥ 10 years). All the patients were scanned with upper abdominal computerized tomography; PV was then calculated by an experienced technician. Absolute insulin deficiency was defined as fasting C - peptide < 0.9 ng/mL. RESULTS Compared with PV (cm3) in the controls, the mean PV was similar in patients with recently diagnosed type 2 diabetes (68.8 versus 71.0, P = 0.56) but significantly reduced in patients with midterm (68.8 versus 60.8, P < 0.05) and long-term (68.8 versus 53.1, P < 0.001) type 2 diabetes. A similar trend was observed for the PV index (PV adjusted for body surface area and body mass index). Furthermore, rates of pancreatic atrophy and absolute insulin deficiency increased with duration of diabetes. Multiple logistic regression analysis indicated that pancreatic atrophy was associated with higher likelihood of absolute insulin deficiency (odds ratio = 4.47, 95%confidence interval = 1.45-13.8). CONCLUSIONS PV was reduced in those with midterm and long-term type 2 diabetes compared to individuals without type 2 diabetes. Overall, pancreatic atrophy was associated with the loss of insulin secretory capacity in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Jun Lu
- Department of Endocrinology and Metabolism, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
- Department of Comprehensive Diagnosis and Treatment for Diabetes, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| | - Meixiang Guo
- Department of Endocrinology and Metabolism, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
- Department of Comprehensive Diagnosis and Treatment for Diabetes, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| | - Hongtao Wang
- Department of Endocrinology and Metabolism, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
- Department of Comprehensive Diagnosis and Treatment for Diabetes, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| | - Haibin Pan
- Department of Radiology, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614, USA
| | - Xuemei Yu
- Department of Endocrinology and Metabolism, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
- Department of Comprehensive Diagnosis and Treatment for Diabetes, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| | - Xueli Zhang
- Department of Comprehensive Diagnosis and Treatment for Diabetes, Shanghai University of Medicine & Health Sciences Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai 201499, China
| |
Collapse
|
44
|
Desouza SV, Yoon HD, Singh RG, Petrov MS. Quantitative determination of pancreas size using anatomical landmarks and its clinical relevance: A systematic literature review. Clin Anat 2018; 31:913-926. [DOI: 10.1002/ca.23217] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 12/30/2022]
Affiliation(s)
- S. V. Desouza
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - H. D. Yoon
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - R. G. Singh
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| | - M. S. Petrov
- Department of Surgery; University of Auckland; Auckland 1023 New Zealand
| |
Collapse
|
45
|
The effect of selective serotonin re-uptake inhibitors on risk of type II diabetes mellitus and acute pancreatitis: a meta-analysis. Biosci Rep 2018; 38:BSR20180967. [PMID: 30126851 PMCID: PMC6172426 DOI: 10.1042/bsr20180967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/30/2022] Open
Abstract
To explore the effect of selective serotonin re-uptake inhibitors (SSRIs) on risk of type II diabetes mellitus (T2DM) and acute pancreatitis (AP), expecting to provide guidance for clinic. Literature was retrieved by searching Pubmed, Embase, Cochrane and Scopus and hand searching of reference lists of related articles. Stata 14.0 was utilized for processing and analysis, and adjusted odds ratios (aORs) were applied. Our study included 113898 T2DM patients and 284131 controls from nine studies and 17548 AP patients and 108108 controls from four studies. The pooled aORs of SSRIs on the risk of T2DM and AP were 1.38 (95% confidence interval (CI) = 1.24–1.54) and 1.26 (95% CI = 1.13–1.40), respectively. Study design, quality, ethnicity, follow-up, and sample size of patients were the resources of heterogeneity. Subgroup analysis showed that 2 weeks is a high-risk time for AP after SSRIs use, with 1.48-fold-times as much after it. This meta-analysis provides evidence of a significant positive association between SSRIs use and risks of T2DM or AP, and duration of 2 weeks of SSRIs use has higher risk of AP, which should be paid much attention to.
Collapse
|
46
|
DeSouza SV, Singh RG, Yoon HD, Murphy R, Plank LD, Petrov MS. Pancreas volume in health and disease: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2018; 12:757-766. [PMID: 29972077 DOI: 10.1080/17474124.2018.1496015] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The pancreas plays a central role in metabolism and is involved in the pathogenesis of several diseases. Pancreas volume is a holistic quantitative measure of pancreas size but the clinical relevance of pancreas volumetry is poorly understood. Areas covered: The aim was to systematically review studies in adults that used computed tomography or magnetic resonance imaging to measure pancreas volume in health and disease, to determine normal pancreas volume range, and to quantify changes in pancreas volume that are associated with disease. Expert commentary: The normal pancreas volume range in adults is 71-83 cm3, with no statistically significant difference between men and women. Type 2 diabetes and type 1 diabetes are associated with a progressively reduced pancreas volume. Overweight and obesity are associated with a progressively increased pancreas volume. There is a paucity of studies on pancreas volume in the setting of diseases of the exocrine pancreas, which should become a research priority in the future.
Collapse
Affiliation(s)
- Steve V DeSouza
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Ruma G Singh
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Harry D Yoon
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Rinki Murphy
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Lindsay D Plank
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Maxim S Petrov
- a School of Medicine , University of Auckland , Auckland , New Zealand
| |
Collapse
|
47
|
Lee UK, Chang TI, Polanco JC, Pisegna JR, Friedlander AH. Prevalence of Panoramically Imaged Carotid Atheromas in Alcoholic Patients With Chronic Pancreatitis and Comorbid Diabetes. J Oral Maxillofac Surg 2018; 76:1929.e1-1929.e7. [PMID: 29859950 DOI: 10.1016/j.joms.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Men with alcohol-related chronic pancreatitis (ARCP) resulting in type 3c diabetes mellitus (DM) are at a uniquely elevated risk of adverse ischemic events given the role of inflammation in both the underlying disease processes and atherosclerosis. We hypothesized that their panoramic images would show a prevalence of calcified carotid artery atheromas (calcified carotid artery plaques [CCAPs]) significantly more often than a general population of similarly aged men. PATIENTS AND METHODS We implemented a retrospective observational study. The sample was composed of male patients older than 30 years having panoramic images. The predictor variable was a diagnosis of ARCP-DM, and the outcome variable was the prevalence rate of CCAPs. The prevalence of CCAPs among the patients with ARCP-DM was then compared with that of a historical general population composed of similarly aged men. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS Of the 32 men (mean age, 61.7 ± 11.2 years) with ARCP-DM, 8 (25%) (mean age, 63.3 ± 4.80 years) had atheromas (CCAPs). There was a statistically significant (P < .05) association between a diagnosis of ARCP-DM and the presence of an atheroma on the panoramic image in comparison with the 3% rate manifested by the historical general-population cohort. The presence or absence of classic atherogenic risk factors within the ARCP-DM cohort failed to distinguish between individuals with and individuals without atheroma formation on their panoramic images. CONCLUSIONS The results of this study suggest that CCAP, a risk indicator for future adverse cardiovascular events, is frequently seen on the panoramic images of male patients with ARCP-DM. Dentists treating male patients with the disorder must be uniquely vigilant for the presence of these lesions.
Collapse
Affiliation(s)
- Urie K Lee
- Oral and Maxillofacial Surgery VA Special Fellow, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tina I Chang
- Director of Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System, and Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
| | - John C Polanco
- Clinical Researcher, Hospital Regional Universitario Jose Maria Cabral y Baez, Santo Domingo, Dominican Republic
| | - Joseph R Pisegna
- Chief of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Healthcare System, and Professor in Residence Medicine-Gastroenterology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Arthur H Friedlander
- Associate Chief of Staff/Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director, Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center; and Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, Los Angeles, CA.
| |
Collapse
|
48
|
Mumme L, Breuer TGK, Rohrer S, Schenker N, Menge BA, Holst JJ, Nauck MA, Meier JJ. Defects in α-Cell Function in Patients With Diabetes Due to Chronic Pancreatitis Compared With Patients With Type 2 Diabetes and Healthy Individuals. Diabetes Care 2017; 40:1314-1322. [PMID: 28751547 DOI: 10.2337/dc17-0792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/03/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes frequently develops in patients with chronic pancreatitis. We examined the alterations in the glucagon response to hypoglycemia and to oral glucose administration in patients with diabetes due to chronic pancreatitis. RESEARCH DESIGN AND METHODS Ten patients with diabetes secondary to chronic pancreatitis were compared with 13 patients with type 2 diabetes and 10 healthy control subjects. A stepwise hypoglycemic clamp and an oral glucose tolerance test (OGTT) were performed. RESULTS Glucose levels during the OGTT were higher in patients with diabetes and chronic pancreatitis and lower in control subjects (P < 0.0001). Insulin and C-peptide levels were reduced, and the glucose-induced suppression of glucagon was impaired in both groups with diabetes (all P < 0.0001 vs. control subjects). During hypoglycemia, glucagon concentrations were reduced in patients with chronic pancreatitis and with type 2 diabetes (P < 0.05). The increase in glucagon during the clamp was inversely related to the glucose-induced glucagon suppression and positively related to β-cell function. Growth hormone responses to hypoglycemia were lower in patients with type 2 diabetes (P = 0.0002) but not in patients with chronic pancreatitis. CONCLUSIONS α-Cell responses to oral glucose ingestion and to hypoglycemia are disturbed in patients with diabetes and chronic pancreatitis and in patients with type 2 diabetes. The similarities between these defects suggest a common etiology.
Collapse
Affiliation(s)
- Lena Mumme
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas G K Breuer
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Rohrer
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina Schenker
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Björn A Menge
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jens J Holst
- Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Michael A Nauck
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Juris J Meier
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
49
|
Tillou JD, Tatum JA, Jolissaint JS, Strand DS, Wang AY, Zaydfudim V, Adams RB, Brayman KL. Operative management of chronic pancreatitis: A review. Am J Surg 2017; 214:347-357. [PMID: 28325588 DOI: 10.1016/j.amjsurg.2017.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/26/2016] [Accepted: 03/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach. RESULTS There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, etc.), resection (pancreticoduodenectomy, etc.) and combined drainage/resection procedures (Frey procedure, etc.). Additionally, many centers currently perform total pancreatectomy with islet autotransplantation, in addition to minimally invasive options that are intended to tailor therapy to individual patients. DISCUSSION Operative management of chronic pancreatitis often improves quality of life, and is associated with low rates of morbidity and mortality. The decision as to which procedure is optimal for each patient should be based on a combination of pathologic changes, prior interventions, and individual surgeon and center experience.
Collapse
Affiliation(s)
- John D Tillou
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jacob A Tatum
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Joshua S Jolissaint
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Victor Zaydfudim
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Reid B Adams
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Kenneth L Brayman
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA.
| |
Collapse
|
50
|
Ueberberg S, Jütte H, Uhl W, Schmidt W, Nauck M, Montanya E, Tannapfel A, Meier J. Histological changes in endocrine and exocrine pancreatic tissue from patients exposed to incretin-based therapies. Diabetes Obes Metab 2016; 18:1253-1262. [PMID: 27545110 DOI: 10.1111/dom.12766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 12/16/2022]
Abstract
AIMS Incretin-based therapies have been associated with an increased risk of pancreatitis. Recently, various histological abnormalities have been reported in human pancreatic tissue from brain-dead organ donors who had been exposed to incretin-based drugs. In the present study we examined pancreatic tissue collected at surgery. METHODS Human pancreatic tissue from 7 type 2-diabetic patients treated with incretin-based drugs (type 2-I), 6 diabetic patients without incretin treatment (type 2-NI), 11 patients without diabetes (no diabetes group) and 9 brain-dead organ donors (BDOD group) was examined. RESULTS Fractional beta-cell area was reduced in the type 2-NI group compared to the group without diabetes (P < .05), but there was no difference compared to the type 2-I patients. Alpha-cell area (P = .30), beta-cell replication (P = .17) and alpha-cell replication (P = .91) were not different. There were also no differences in acinar cell (P = .13) and duct cell replication (P = .099). Insulin-positive duct cells were more frequent in the type 2-I and the BDOD groups (P = .034). No co-expression of insulin and glucagon was detected. Pancreatic intraepithelial neoplasia (PanIN) lesions were very rare, all low-grade (PanIN 1a and 1b) and tended to occur more frequently in the type 2-I group (P = .084). CONCLUSIONS The present results did not reveal marked histological abnormalities in the pancreas of incretin-treated patients with type 2 diabetes. Low numbers of specimens available and a large inter-individual variability of the findings warrant caution regarding the interpretation of histological data concerning drug effects on the human pancreas.
Collapse
Affiliation(s)
- Sandra Ueberberg
- Diabetes Division, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Hendrik Jütte
- Department of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Wolfgang Schmidt
- Diabetes Division, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael Nauck
- Diabetes Division, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Eduard Montanya
- Bellvitge Hospital, Department of Endocrinology, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Andrea Tannapfel
- Department of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Juris Meier
- Diabetes Division, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|