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Evidence of unrestrained beta-cell proliferation and neogenesis in a patient with hyperinsulinemic hypoglycemia after gastric bypass surgery

机译：胃旁路手术后具有高胰岛素血症低血糖症的患者无拘无束的β细胞增殖和新生的证据

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Hyperinsulinemic hypoglycemia syndrome (HIHG) is a rare complication of roux-en-Y gastric bypass surgery. The pathology is associated with an excessive function of pancreatic beta-cells, and requires pancreas resection in patients that are recalcitrant to nutritional and pharmacological interventions. The exact prevalence is not clearly understood and the underlying mechanisms not yet fully characterized. We herein sought to perform histological and molecular examination of pancreatic sections obtained from a patient who developed HIHG as a complication of gastric bypass compared to 3 weight-matched controls. We studied markers of cellular replication and beta-cell differentiation by immunohistochemistry and immunofluorescence. HIHG after gastric bypass was characterized by a profound increase in beta-cell mass. Cellular proliferation was increased in islets and ducts compared to controls, suggesting unrestrained proliferation in HIHG. We also detected beta-cell differentiation markers in duct cells and occasional duct cells displaying both insulin and glucagon immunoreactivity. These histological observations suggest that beta-cell differentiation from ductal progenitor cells could also underly beta-cell mass expansion in HIHG. Altogether, our results can be construed to demonstrate that HIHG after gastric bypass is characterized by abnormal beta-cell mass expansion, resulting from both unrestrained beta-cell replication and neogenesis.
机译：高胰岛素血症低血糖综合征（HIHG）是Roux-ZH-Y胃旁路手术的罕见并发症。病理学与胰腺β细胞的过度函数有关，并且需要对糖尿病患者的患者切除胰腺切除术。确切的普遍存在不清楚，尚未完全表征的潜在机制。我们在此寻求对从患者获得的胰腺部分的组织学和分子检查，该患者与3重量匹配对照相比胃旁路的并发症。我们研究了免疫组织化学和免疫荧光的细胞复制和β细胞分化的标志物。胃旁路后的HiHg的特征在于β细胞质量的深刻增加。与对照相比，胰岛和管道中的细胞增殖增加，表明HIHG的无限制性。我们还发现了导管细胞中的β细胞分化标志物和偶尔的管道细胞，显示胰岛素和胰高血糖素免疫反应性。这些组织学观察表明，来自导管祖细胞的β细胞分化也可以在HIHG中迄今为止β细胞质量膨胀。完全，我们的结果可以解释为证​​明胃旁路后的HiHg以异常的β细胞质量膨胀为特征，由无拘束的β细胞复制和新生产生。

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