Modestly increased beta cell apoptosis but no increased beta cell replication in recent-onset type 1 diabetic patients who died of diabetic ketoacidosis

• Published in: Diabetologia Vol. 50; no. 11; pp. 2323 - 2331
• Main Authors: Butler, A. E, Galasso, R, Meier, J. J, Basu, R, Rizza, R. A, Butler, P. C
• Format: Journal Article
• Language: English
• Published: Berlin Berlin/Heidelberg : Springer-Verlag 01.11.2007; Springer; Springer Nature B.V
• Subjects: Acidosis; Adolescent; Adult; Apoptosis; Autopsies; Autopsy; Beta cell replication; Beta cells; Biological and medical sciences; Cell Division; Cells; Child; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - mortality; Diabetes. Impaired glucose tolerance; Diabetic ketoacidosis; Diabetic Ketoacidosis - mortality; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hyperglycemia; Insulin; Insulin - analysis; Insulin-Secreting Cells - pathology; Islet degeneration and damage; Islets; Ketoacidosis; Male; Medical sciences; Pancreas; Pancreas - pathology; Patients; Prediction of type 1 diabetes; Prevention of type 1 diabetes; Recent-onset type 1 diabetes; Reference Values; Replication; Review boards; Spleen; Los Angeles California; United States > US; Endocrinopathy; Human; Immunopathology; Langerhans islet; Prediction; Autoimmune disease; Acid base balance disorder; Beta cell replication; Prevention of type 1 diabetes; Prevention; Metabolic disorder; Cell death; Type 1 diabetes; Ketoacidosis; Prediction of type 1 diabetes; Replication; Degeneration; Islets; β Cell; Recent-onset type 1 diabetes; Endocrine pancreas; Apoptosis; WHO; Islet degeneration and damage
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-007-0794-x

Aims/hypothesis Type 1 diabetes is characterised by a deficit in beta cell mass thought to be due to immune-mediated increased beta cell apoptosis. Beta cell turnover has not been examined in the context of new-onset type 1 diabetes with diabetic ketoacidosis. Methods Samples of pancreas were obtained at autopsy from nine patients, aged 12 to 38 years (mean 24.3±3.4 years), who had had type 1 diabetes for less than 3 years before death due to diabetic ketoacidosis. Samples of pancreas obtained at autopsy from nine non-diabetic cases aged 11.5 to 38 years (mean 24.2±3.4 years) were used as control. Fractional beta cell area (insulin staining), beta cell replication (insulin and Ki67 staining) and beta cell apoptosis (insulin and TUNEL staining) were measured. Results In pancreas obtained at autopsy from recent-onset type 1 diabetes patients who had died of diabetic ketoacidosis, the beta cell deficit varied from 70 to 99% (mean 90%). The pattern of beta cell loss was lobular, with almost all beta cells absent in most pancreatic lobules; islets in lobules not devoid of beta cells had reduced or a near-normal complement of beta cells. Beta cell apoptosis was increased in recent-onset type 1 diabetes, but to a surprisingly modest degree given the marked hyperglycaemia (30 mmol/l), acidosis and presumably high NEFA. Beta cell replication, scattered pancreatic beta cells and beta cells in exocrine ducts were not increased in recent-onset type 1 diabetes. Conclusions/interpretation These findings do not support the notion of active beta cell regeneration by replication in new-onset type 1 diabetes under conditions of diabetic ketoacidosis. The gluco-lipotoxicity reported in isolated human islets may be less evident in vivo.