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The endocrine pancreas in chronic pancreatitis

Immunocytochemical and ultrastructural studies

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Summary

The endocrine pancreatic tissue from patients with severe primary chronic pancreatitis (n=6), secondary chronic pancreatitis due to duct obstruction by carcinoma (n=6) and non-diabetic, non-pancreatitic controls (n=4) was studied qualitatively and quantitatively using specific immunocytochemistry and electron microscopy. Grouping of variously sized islets in the sclerotic tissue (sclerosis islets), islet neoformation by ductuloinsular proliferation, and intrainsular fibrosis were the main qualitative findings. Immunocytochemical quantitation of the distribution of insulin (B), glucagon (A), somatostatin (D) and pancreatic polypeptide (PP) producing cells revealed a significant relative increase in the number of A cells and a decrease in the number of B cells of the sclerosis islets in primary chronic pancreatitis (B-44.1±9.3%:A-38.3±2.4%:D-8.6±5.1%:PP-4.6±4.1%) as well as in secondary chronic pancreatitis (B-38.0±14.3%:A-38.4±19.0%:D-9.1±5.8%:PP-14.5±23.4%) compared with controls (B-71.1±8.1%:A-24.3±5.5%:D-8.0±2.8%:PP-0.5±0.4%). The number of PP cells was significantly increased in primary chronic pancreatitis only. It is suggested that scarring of the exocrine pancreas affects islet composition, probably by impairment of the local circulation and of glucose diffusion, thus leading to reduction of the number and glucose sensitivity of B cells. The hyperplasia of A and PP cells appears to be a secondary phenomenon due to the loss of B cells.

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References

  • Anderson, M.F., Davison, S.H.H., Dick, A.P., Hales, C.N., Owens, J.: Plasma insulin in pancreatic disease. Gut 11, 524–531 (1970)

    Google Scholar 

  • Bank, S., Jackson, W.P.U., Keller, P., Marks, I.N.: Serum-insulin response to glucose in pancreatic diabetes. Postgrad. Med. J. 44, 214–217 (1968)

    Google Scholar 

  • Bank, S., Marks, I.N., Vinic, A.I.: Clinical and hormonal aspects of pancreatic diabetes. Amer. J. Gastroenterol. 64, 13–22 (1975)

    Google Scholar 

  • Becker, V.: Bauchspeicheldrüse (Inselapparat ausgenommen). In: Spezielle pathologische Anatomie, Bd. 6. Ed. W. Doerr, G. Seifert, E. Uehlinger. Berlin-Heidelberg-New York: Springer 1973

    Google Scholar 

  • Böcker, W., Seifert, G.: Zur Pathologie der Alkoholpankreatitis. HÄufigkeit, Klassifikation und Pathogenese. Dtsch. med. Wschr. 97, 803–808 (1972)

    Google Scholar 

  • Bommer, G., Heitz, P.U., Klöppel, G.: Immunhistologische und ultrastrukturelle Untersuchungen des endokrinen Pankreas bei chronischer Pankreatitis. Verh. Dtsch. Ges. Path. 60, 485 (1976)

    Google Scholar 

  • Capella, C., Solcia, E., Frigerio, B., Buffa, R., Usellini, L., Fontana, P.: The endocrine cells of the pancreas related tumours. Ultrastructural study and classification. Virchoes Arch. A Path. Anat. and Histol. 373, 327–352 (1977)

    Google Scholar 

  • Deconinck, J.F., Potvliege, P.R., Gepts, W.: The ultrastructure of the human pancreatic islets. I. The islets of adults. Diabetologia 7, 266–282 (1971)

    Google Scholar 

  • Doerr, W.: Pathogenese der akuten und chronischen Pankreatitis. Verh. dtsch. Ges. inn. Med. 70, 718–758 (1964)

    Google Scholar 

  • Ebert, R., Creutzfeldt, W., Brown, J.C., Frerichs, H., Arnold, R.: Response of gastric inhibitory polypeptide (GIP) to test meal in chronic pancreatitis-relationship to endocrine and exocrine insufficiency. Diabetologia 12, 609–612 (1976)

    Google Scholar 

  • Eder, M.: Regressive and progressive VerÄnderungen der Langerhansschen Inseln. Untersuchungen an Bauchspeicheldrüsen bei Gangverschlu\ durch Pankreaskopfcarcinom. Beitr. path. Anat. 115, 157–177 (1955)

    Google Scholar 

  • Gepts, W., Mey, J. De, Marichal-Pipeleers, M.: Hyperplasia of pancreatic polypeptide-cells in the pancreas of juvenile diabetics. Diabetologia 13, 27–34 (1977)

    Google Scholar 

  • Grabner, W., Phillip, J., Mayer, A., Daniel, U., Matz-Kies, F.: Nachweis inkretorischer Funktionsstörungen bei chronischer Pankreatitis. Dtsch. med. Wschr. 99, 445–448 (1974)

    Google Scholar 

  • Graham, R.C., Karnovsky, M.J.: The early stages of absorption of injected horse-radish peroxidase in the proximal tubules of mouse kidney: Ultrastructural cytochemistry by a new technique. J. Histochem. Cytochem. 14, 291–302 (1966)

    Google Scholar 

  • Grimelius, L., Capella, C., Buffa, R., Polak, J.M., Pearse, A.G.E., Solcia, E.: Cytochemical and ultrastructural differentiation of enteroglucagon and pancreatic-type glucagon cells of the gastrointestinal tract. Virchows Arch. B Cell Path. 20, 217–228 (1976)

    Google Scholar 

  • HÄcki, W.H., Kayasseh, L., Gyr, K.: Impaired release of pancreatic polypeptide in patients with chronic pancreatitis. European Pancreatic Club, X Symposium, Dublin, 1977

  • Idezuki, Y., Goetz, F.C., Lillehei, R.C.: Late effect of pancreatic duct ligation on beta cell function. Amer. J. Surg. 117, 33–39 (1969)

    Google Scholar 

  • Joffe, B.I., Bank, S., Jackson, W.P.U., Keller, P., O'Reilly, I.G., Vinik, A.I.: Insulin reserve in patients with chronic pancreatitis. Lancet 11, 890–892 (1968)

    Google Scholar 

  • Kalk, W.J., Vinik, A.I., Bank, S., Buchanan, K.D., Keller, P., Jackson, W.P.U.: Glucagon responses to arginine in chronic pancreatitis. Possible pathogenetic significance in diabetes. Diabetes 23, 257–267 (1974)

    Google Scholar 

  • Kalk, W.J., Vinik, A.I., Paul, M., Keller, P., Jackson, W.P.U.: Immunoreactive glucagon response to intravenous tolbutamide in chronic pancreatitis. Diabetes 24, 851–855 (1975)

    Google Scholar 

  • Larsson, L.-I.: Human pancreatic polypeptide, vasoactive intestinal polypeptide, and watery diarrhoea syndrome. Lancet 11, 149 (1976)

    Google Scholar 

  • Larsson, L.J., Sundler, F., Hakanson, R.: Pancreatic polypeptide. A postulated new hormone: identification of its cellular storage site by light and electron immunochemistry. Diabetologia 12, 211–226 (1976)

    Google Scholar 

  • Marks, J.N., Bank, M.B.: The aetiology, clinical features and diagnosis of pancreatitis in the south western cape. S. Afr. Med. I. 19, 1093 (1963)

    Google Scholar 

  • Martin, J.M., Lacy, P.E.: The prediabetic period in partially pancreatectomised rats. Diabetes 12, 238–242 (1963)

    Google Scholar 

  • Müller, W.A., Faloona, G.F., Unger, R.: The effect of experimental insulin deficiency on glucagon secretion. J. Clin. Invest. 50, 1992–1999 (1971)

    Google Scholar 

  • Nieschlag, E., Gilfrich, H.J., Nagel, M.: Insulinsekretion nach Pankreasresektion. Dtsch. med. Wschr. 96, 859–862 (1971)

    Google Scholar 

  • Orci, L., Baetens, D., Rufener, C., Amherdt, M., Ravazzola, M., Studer, P., Malaisse-Lagae, F., Unger, R.: Hypertrophy and hyperplasia of somatostatin-containing D-cells in diabetes. Proc. Natl. Acad. Sci. US 73, 1338–1342 (1976)

    Google Scholar 

  • Paloyan, E., Lawrence, A., Strauss II, F.H., Paloyan, D., Harper, P.V., Cummings, D.: Alpha cell hyperplasia in calcific pancreatitis associated with hyperparathyreoidism. JAMA 200, 97–101 (1967)

    Google Scholar 

  • Peters, N., Dick, A.P., Hales, C.N., Orrel, D.H., Sarner, M.: Exocrine and endocrine pancreatic function in diabetes mellitus and chronic pancreatitis. Gut 7, 277–281 (1966)

    Google Scholar 

  • Polak, J.M., Bloom, S.R., Adrian, T.E., Heitz, Ph., Bryant, M.G., Pearse, A.G.E.: Pancreatic polypeptide (PP) in insulinomas, gastrinomas, vipomas and glucagonomas. Lancet 1, 328–330 (1976)

    Google Scholar 

  • Polak, J.M., Pearse, A.G.E., Grimelius, L., Bloom, S.R., Arimura, A.: Growth hormone release-inhibiting hormone in gastrointestinal and pancreatic D cells. Lancet 1, 1220–1222 (1975)

    Google Scholar 

  • Raptis, S., Rau, R.M., Schröder, K.E., Hartman, W., Faulhaber, J.D., Clodi, P.H., Pfeiffer, E.F.: The role of the exocrine pancreas in the stimulation of insulin secretion by intestinal hormones. III. Insulin response to secretin and pancreozymin and to oral and intravenous glucose in patients suffering from chronic insufficiency of the excrine pancreas. Diabetologia 7, 160–167 (1971)

    Google Scholar 

  • Sarles, H., Sarles, J.S.: Ätiologie und Pathogenese der akuten und chronischen Pankreatitis. Europ. Pancreas-Symposium, Erlangen 1963, p. 191. Stuttgart: Schattauer 1964

    Google Scholar 

  • Seifert, G.: Das morphologische Bild der chronischen Pankreatitis. Langenbecks Arch. klin. Chir. 316, 264–276 (1966)

    Google Scholar 

  • Seifert, G., Klöppel, G.: Korrelationen zwischen exokrinem Pankreas und Inselsystem. In: Gastroenterologie und Stoffwechsel. Aktionen und Interaktionen, pp. 119–142, Ed. V. Becker. Baden-Baden-Brüssel: Witzstrock 1974

    Google Scholar 

  • Seifert, G., Bommer, G., Klöppel, G.: Die Wertigkeit der prÄoperativen Diagnostik für die chirurgische Taktik. In: Die Untersuchung der Bauchspeicheldrüse. Ed. H. Bartelheimer, M. Classen, F.-W. Ossenberg. Stuttgart: Thieme 1977

    Google Scholar 

  • Solcia, E., Polak, J.M., Pearse, A.G.E., Forssmann, W.G., Larsson, L.-I., Sundler, F., Lechago, J., Grimelius, L., Fujita, T., Creutzfeldt, W., Gepts, W., Falkmer, S., Lefranc, G., Heitz, Ph., Hage, E., Buchan, A.M.J., Bloom, S.R., Grossman, M.I.: Lausanne 1977 classification of gastroenteropancreatic endocrine cells. In: Gastrointestinal hormones. Ed. S.R. Bloom, Livingstone, Edinburgh: Churchill 1977 (in press)

    Google Scholar 

  • Sternberger, L.: The unlabeled antibody enzyme method. In: Immunocytochemistry, pp. 129–171. Englewood Cliffs, New Jersey: Prentice-Hall 1974

    Google Scholar 

  • Unger, R.H.: Diabetes and the alpha cell. Diabetes 25, 136–151 (1975)

    Google Scholar 

  • Wacjner, G.: Adenomatous hyperplasia of the islets of Langerhans in chronic pancreatitis. Bibl. Gastroent. 7, 179–188 (1965)

    Google Scholar 

  • Weber, B.: Kohlenhydratstoffwechsel bei der Mukoviszidose. Med. Welt 25, 246–248 (1974)

    Google Scholar 

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Authors and Affiliations

  1. Institutes of Pathology, Universities of Hamburg, Germany

    G. Commandeur

  2. Institutes of Pathology, Universities of Basel, Switzerland

    Ph. Heitz

  3. Pathologisches Institut der UniversitÄt, Martinistr. 52, D-2000, Hamburg 20, Federal Republic of Germany

    G. Klöppel

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  1. G. Klöppel
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  2. G. Bommer
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  3. G. Commandeur
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  4. Ph. Heitz
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Klöppel, G., Bommer, G., Commandeur, G. et al. The endocrine pancreas in chronic pancreatitis. Virchows Arch. A Path. Anat. and Histol. 377, 157–174 (1978). https://doi.org/10.1007/BF00427003

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