Context: Pancreatic duct glands (PDGs) have been proposed as a source of regeneration in response to exocrine pancreas injury, and thus may serve as an organ stem cell niche. There is evidence to suggest ongoing beta-cell formation in longstanding type 1 diabetes (T1D), but the source is unknown. Objective: To investigate the pancreatic duct gland (PDG) compartment of the pancreas in humans with T1D for evidence of an active regenerative signature (presence of progenitor cells and increased proliferation) and, in particular, as a potential source of beta-cells. Design, Setting and Participants: Pancreas from 46 brain dead organ donors (22 with T1D, 24 nondiabetic controls) were investigated for activation (increased proliferation) and markers of pancreatic exocrine and endocrine progenitors. Results: PDG cell replication was increased in T1D (6.3 ± 1.6 vs. 0.6 ± 0.1%, p < 0.001, T1D vs. ND), most prominently in association with pancreatic inflammation. There were increased progenitor-like cells in PDGs of T1D, but predominantly with an exocrine fate.
Conclusion:The PDG compartment is activated in T1D consistent with a response to ongoing inflammation, and via resulting ductal hyperplasia may contribute to local obstructive pancreatitis and eventual pancreatic atrophy characteristic of T1D. However, there is no evidence of effective endocrine cell formation from PDGs.PRECIS: PDGs serve as a stem cell niche in the pancreas. Replication in PDGs is increased in T1D, implying ongoing inflammation, but the majority of cells in PDGs have an exocrine rather than endocrine fate.
Abbreviations:ChrgA, Chromogranin A. T1D, type 1 diabetes. ND, nondiabetic. PDGs, pancreatic duct glands.
INTRODUCTIONIn longstanding type 1 diabetes (T1D), there is a near complete loss of pancreatic beta-cells through autoimmune mediated cell death (1, 2). However, several lines of evidence suggest that there may be ongoing attempted beta-cell regeneration, although insufficient to be clinically meaningful. For example, even in individuals with longstanding T1D, there are still detectable insulin-expressing cells, often isolated and scattered in the exocrine pancreas or in small clusters in and around pancreatic ducts (3,4). Consistent with this, by use of sensitive assays, residual insulin secretion is often present in individuals with longstanding T1D (5-8). The Journal of Clinical Endocrinology & Metabolism; Copyright 2016 DOI: 10.1210/jc.2016 Theoretically, these observations may indicate that there are small populations of beta-cells that elude immune detection or that there is ongoing new beta-cell formation subject to continued autoimmune destruction. In favor of the latter explanation, auto-reactive T-cells targeted to pancreatic beta-cells are frequently detected many years after diabetes onset, implying sustained auto-reactivity (9). In pancreas of individuals with T1D who have sufficient residual beta-cells to evaluate, we previously reported immune cells in close proximity to insulin-expressing cells and an increased frequency of b...