Tiago P Guedes1, Sofia Martins1, Madalena Costa1, Sofia S Pereira1, Tiago Morais1, Agostinho Santos2, Mário Nora3, Mariana P Monteiro4. 1. Department of Anatomy, Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS, University of Porto, Portugal. 2. Instituto Nacional de Medicina Legal e Ciências Forenses (IMNL) and Faculty of Medicine, University of Porto, Porto, Portugal. 3. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Portugal. 4. Department of Anatomy, Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS, University of Porto, Portugal. Electronic address: mpmonteiro@icbas.up.pt.
Abstract
BACKGROUND: Incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1), are physiologic stimulants of insulin release that have been implicated in diabetes remission after bariatric surgery. The detailed distribution of incretin cells along the human small gut, so far unknown, is of utmost importance for the understanding of the metabolic changes observed after bariatric surgery because diabetes remission rate varies according to the type of anatomic rearrangement. OBJECTIVE: To characterize the distribution of incretin producing cells along the human jejunum-ileum. SETTING: Academic public institution. METHODS: Small intestines (n = 30) from autopsies were sampled every 20 cm along their entire length and tissue microarrays were constructed. The percentage of immunohistochemistry-stained cell areas for GLP-1, GIP, and chromogranin A at each segment length was quantified using a computer-aided analysis tool. RESULTS: The percentage of stained area for GLP-1 immunoreactive cells was found to be significantly higher from 200 cm from Treitz ligament onward compared with the first 80 cm of the small intestine, whereas GIP immunoreactive cells were predominant expressed in the first 80 cm. In contrast, chromogranin A expression was constant along the entire jejunum-ileum. CONCLUSION: The uneven distribution of GLP-1-expressing cells, with a higher density from 200 cm of the jejunum-ileum, could contribute to explain the improvement of glycemic profile of diabetic patients observed after anatomic rearrangement of the intestinal tract, in particular when subjected to gastric bypass with longer biliopancreatic limbs.
BACKGROUND: Incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1), are physiologic stimulants of insulin release that have been implicated in diabetes remission after bariatric surgery. The detailed distribution of incretin cells along the human small gut, so far unknown, is of utmost importance for the understanding of the metabolic changes observed after bariatric surgery because diabetes remission rate varies according to the type of anatomic rearrangement. OBJECTIVE: To characterize the distribution of incretin producing cells along the human jejunum-ileum. SETTING: Academic public institution. METHODS: Small intestines (n = 30) from autopsies were sampled every 20 cm along their entire length and tissue microarrays were constructed. The percentage of immunohistochemistry-stained cell areas for GLP-1, GIP, and chromogranin A at each segment length was quantified using a computer-aided analysis tool. RESULTS: The percentage of stained area for GLP-1 immunoreactive cells was found to be significantly higher from 200 cm from Treitz ligament onward compared with the first 80 cm of the small intestine, whereas GIP immunoreactive cells were predominant expressed in the first 80 cm. In contrast, chromogranin A expression was constant along the entire jejunum-ileum. CONCLUSION: The uneven distribution of GLP-1-expressing cells, with a higher density from 200 cm of the jejunum-ileum, could contribute to explain the improvement of glycemic profile of diabeticpatients observed after anatomic rearrangement of the intestinal tract, in particular when subjected to gastric bypass with longer biliopancreatic limbs.
Authors: Tina Jorsal; Nicolai A Rhee; Jens Pedersen; Camilla D Wahlgren; Brynjulf Mortensen; Sara L Jepsen; Jacob Jelsing; Louise S Dalbøge; Peter Vilmann; Hazem Hassan; Jakob W Hendel; Steen S Poulsen; Jens J Holst; Tina Vilsbøll; Filip K Knop Journal: Diabetologia Date: 2017-09-28 Impact factor: 10.122
Authors: Austin Cottam; Daniel Cottam; Mitchell Roslin; Samuel Cottam; Walter Medlin; Christina Richards; Amit Surve; Hinali Zaveri Journal: Obes Surg Date: 2016-10 Impact factor: 4.129