TITLE:
The Predictive Value of Biopsy of the Pancreas and Its Therapeutic Impact in Autoimmune Diabetes
AUTHORS:
Wael Nassar, Mostafa A. Mostafa
KEYWORDS:
Autoimmune Diabetes Mellitus, Biopsy of the Pancreas, Insulitis
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.4,
October
20,
2014
ABSTRACT: Diabetes Mellitus is by definition an
end-stage organ failure. Type 1 diabetes mellitus (T1DM) is an autoimmune
disease. Auto-inflammatory infiltrate appears to characterize the insulitis
associated with T2DM. Recently, in 2013, Eva Corpos and
colleagues described a comprehensive composition of peri-islet capsules and
their basement membrane (BM). Virtanen I, Otonkoski T and Irving-Rodgers H.F.
have reported similar descriptions few years earlier which have not been taken
seriously as they deserve. Bluestone JA, Virtanen I and
Irving-Rodgers H.F. and other colleagues reported that accumulation of the
lymphocytes around the islets without invasion of the BM is the first step in
disease induction (non-destructive insulitis phase). Invasion of the BM
byleucocytic infiltration (destructive insulitis phase) occurs
over a period of several years offering a good window for therapeutic
intervention. Clinical symptoms appear only when 70% - 90% of β-cell
mass are destroyed. This data emphasize the importance of identification and
classification of such pathologic features by performing a biopsy of the
pancreas with histoimmunochemistry analysis at the pre-hyperglycemic stage in a
high risk genetically predisposed autoimmune suspected patient which may at
least in part help to achieve new therapeutic approaches and help in halting
the progression to end stage pancreatic disease (ESPD) known as diabetes mellitus.
In this review we are going to emphasize the predictive role biopsy of the
pancreas can build up a solid gold standard tool in diagnosis, stage and
therapeutically follow up autoimmune diabetes mellitus.