Organisation of the human pancreas in health and in diabetes
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REVIEW
Organisation of the human pancreas in health and in diabetes Mark A. Atkinson 1,2
&
Martha Campbell-Thompson 1,3
&
Irina Kusmartseva 1
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Klaus H. Kaestner 4
Received: 5 March 2020 / Accepted: 24 April 2020 / Published online: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract For much of the last century, our knowledge regarding the pancreas in type 1 and type 2 diabetes was largely derived from autopsy studies of individuals with these disorders or investigations utilising rodent models of either disease. While many important insights emanated from these efforts, the mode for investigation has increasingly seen change due to the availability of transplant-quality organ-donor tissues, improvements in pancreatic imaging, advances in metabolic assessments of living patients, genetic analyses, technological advances for laboratory investigation and more. As a result, many long-standing notions regarding the role for and the changes that occur in the pancreas in individuals with these disorders have come under question, while, at the same time, new issues (e.g., beta cell persistence, disease heterogeneity, exocrine contributions) have arisen. In this article, we will consider the vital role of the pancreas in human health and physiology, including discussion of its anatomical features and dual (exocrine and endocrine) functions. Specifically, we convey changes that occur in the pancreas of those with either type 1 or type 2 diabetes, with careful attention to the facets that may contribute to the pathogenesis of either disorder. Finally, we discuss the emerging unknowns with the belief that understanding the role of the pancreas in type 1 and type 2 diabetes will lead to improvements in disease diagnosis, understanding of disease heterogeneity and optimisation of treatments at a personalised level.
Keywords Anatomy . Endocrine . Exocrine . Function . Pancreas . Review . Type 1 diabetes . Type 2 diabetes Abbreviations IAPP Islet amyloid polypeptide PP Pancreatic polypeptide (cells)
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-020-05203-7) contains a slideset of the figures for download, which is available to authorised users. * Mark A. Atkinson [email protected] 1
Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida Diabetes Institute, Box 100275, 1275 Center Dr., BMSB J593, Gainesville, FL 32610, USA
2
Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
3
Department of Biomedical Engineering, University of Florida College of Engineering, Gainesville, FL, USA
4
Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Pancreas anatomy and its exocrine and endocrine functions In the normal, healthy human adult, the pancreas weighs approximately 100 g, has a length of 14 to 25 cm [1], a volume of approximately 72.4 ± 25.8 cm3 [2] and is both lobular and elongated in shape (revie
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