1
|
Patti ME, Goldfine AB, Hu J, Hoem D, Molven A, Goldsmith J, Schwesinger WH, La Rosa S, Folli F, Kulkarni RN. Heterogeneity of proliferative markers in pancreatic β-cells of patients with severe hypoglycemia following Roux-en-Y gastric bypass. Acta Diabetol 2017; 54:737-747. [PMID: 28512677 PMCID: PMC5515485 DOI: 10.1007/s00592-017-1001-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/06/2017] [Indexed: 12/17/2022]
Abstract
AIMS Severe postprandial hypoglycemia with neuroglycopenia is an increasingly recognized, debilitating complication of Roux-en-Y gastric bypass (RYGB) surgery. Increased secretion of insulin and incretin hormones is implicated in its pathogenesis. Histopathologic examination of pancreas has demonstrated increased islet size and/or nuclear diameter in post-RYGB patients who underwent pancreatectomy for severe refractory hypoglycemia with neuroglycopenia (RYGB + NG). We aimed to determine whether β-cell proliferation or apoptosis is altered in RYGB + NG. METHODS We performed an observational study to analyze markers of proliferation, apoptosis, cell cycle, and transcription factor expression in pancreatic tissue from affected RYGB + NG patients (n = 12), normoglycemic patients undergoing pancreatic surgery for benign lesions (controls, n = 6), and individuals with hypoglycemia due to insulinoma (n = 52). RESULTS Proliferative cell nuclear antigen (PCNA) expression was increased in insulin-positive cells in RYGB + NG patients (4.5-fold increase, p < 0.001 vs. controls) and correlated with β-cell mass. Ki-67 immunoreactivity was low in both RYGB + NG and controls, but did not differ between groups. Phospho-histone H3 levels did not differ between RYGB + NG and controls. PCNA and Ki-67 were both significantly lower in both controls and RYGB + NG than insulinomas. Markers of apoptosis and cell cycle (M30, p27, and p21) did not differ between groups. PDX1 and menin exhibited similar expression patterns, while FOXO1 appeared to be more cytosolic in RYGB + NG. CONCLUSIONS Markers of proliferation are heterogeneous in patients with severe post-RYGB hypoglycemia. Increased β-cell proliferation in some individuals may contribute to increased β-cell mass observed in severely affected patients.
Collapse
Affiliation(s)
- Mary-Elizabeth Patti
- Research Division, Joslin Diabetes Center, and Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA.
| | - Allison B Goldfine
- Research Division, Joslin Diabetes Center, and Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA
| | - Jiang Hu
- Research Division, Joslin Diabetes Center, and Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA
| | - Dag Hoem
- Department of Surgery, Haukeland University Hospital, 5021, Bergen, Norway
| | - Anders Molven
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Jeffrey Goldsmith
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Wayne H Schwesinger
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Stefano La Rosa
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, 1011, Lausanne, Switzerland
| | - Franco Folli
- Department of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
- Faculdade de Ciencias Medicas (FCM), Departamento de Clinica Medica, Obesity and Comorbidities Research Center (O.C.R.C.), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
- Endocrinology and Metabolic Diseases, Department of Health Sciences, University of Milano, Via A. Di Rudini', 8, 20149, Milan, Italy
| | - Rohit N Kulkarni
- Research Division, Joslin Diabetes Center, and Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA.
| |
Collapse
|
2
|
Gjelberg HK, Hoem D, Verbeke CS, Eide J, Cooper JG, Molven A. Hypoglycemia and decreased insulin requirement caused by malignant insulinoma in a type 1 diabetic patient: when the hoof beats are from a zebra, not a horse. Clin Case Rep 2017; 5:761-768. [PMID: 28588806 PMCID: PMC5457997 DOI: 10.1002/ccr3.927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/05/2017] [Indexed: 12/30/2022] Open
Abstract
Insulinomas are uncommon tumors, and in patients with diabetes mellitus they are extremely rare. We describe a patient with type 1 diabetes who developed malignant insulinoma. When hypoglycemic episodes persist in a patient with diabetes and treatment‐induced and other causes of hypoglycemia have been ruled out, an insulin‐producing tumor should be considered.
Collapse
Affiliation(s)
- Hilde K Gjelberg
- Department of Pathology Haukeland University Hospital Bergen Norway
| | - Dag Hoem
- Department of Gastrointestinal Surgery Haukeland University Hospital Bergen Norway
| | - Caroline S Verbeke
- Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Pathology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Johan Eide
- Department of Pathology Haukeland University Hospital Bergen Norway
| | - John G Cooper
- Department of Medicine Stavanger University Hospital Stavanger Norway
| | - Anders Molven
- Department of Pathology Haukeland University Hospital Bergen Norway.,Gade Laboratory for Pathology Department of Clinical Medicine University of Bergen Bergen Norway.,KG Jebsen Center for Diabetes Research Faculty of Medicine and Dentistry University of Bergen Bergen Norway
| |
Collapse
|