Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation

Kendall R. McEachron; Yi Yang; James S. Hodges; Gregory J. Beilman; Timothy L. Pruett; Varvara A. Kirchner; Ty B. Dunn; Martin L. Freeman; Guru Trikudanathan; Kristine E. Mulier; Peggy Ptacek; Melena D. Bellin

doi:10.1097/MPA.0000000000001582

Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation

Kendall R. McEachron, Yi Yang, James S. Hodges, Gregory J. Beilman, Timothy L. Pruett, Varvara A. Kirchner, Ty B. Dunn, Martin L. Freeman, Guru Trikudanathan, Kristine E. Mulier, Peggy Ptacek, Melena D. Bellin

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6 Scopus citations

Abstract

Objective When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones. Methods Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP). Results Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average,-52.2 pg/mL, P = 0.06). Conclusions In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.

Original language	English (US)
Pages (from-to)	806-811
Number of pages	6
Journal	Pancreas
Volume	49
Issue number	6
DOIs	https://doi.org/10.1097/MPA.0000000000001582
State	Published - Jul 1 2020

Bibliographical note

Funding Information:
From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis MN; ‡Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; and §Department of Medicine, Division of Gastroenterology, ||Department of Pediatrics, and ¶Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis MN. Received for publication December 10, 2019; accepted May 4, 2020. Address correspondence to: Kendall R. McEachron, MD, 420 Delaware St. SE, MMC 195, Minneapolis, MN 55455 (e‐mail: [email protected]). This study was supported by the National Institutes of Health (grant numbers T32DK108733 [K.R.M.] and R01DK109124 [M.D.B., Y.Y., J.S.H.]) and the National Pancreas Foundation (M.D.B.). M.D.B. has the following disclosures: research support from Dexcom, Viacyte, medical advisor for Ariel Precision Medicine, and data safety and advisory board member for Insulet. The remaining authors declare no conflicts of interest. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001582

Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

GLP-1
PYY
Roux-en-Y
autoislet
pancreatectomy
pancreatic polypeptide

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

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10.1097/MPA.0000000000001582

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@article{d49ac81da2f7474585c1fec5ec074524,

title = "Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation",

abstract = "Objective When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones. Methods Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP). Results Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average,-52.2 pg/mL, P = 0.06). Conclusions In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.",

keywords = "GLP-1, PYY, Roux-en-Y, autoislet, pancreatectomy, pancreatic polypeptide",

author = "McEachron, {Kendall R.} and Yi Yang and Hodges, {James S.} and Beilman, {Gregory J.} and Pruett, {Timothy L.} and Kirchner, {Varvara A.} and Dunn, {Ty B.} and Freeman, {Martin L.} and Guru Trikudanathan and Mulier, {Kristine E.} and Peggy Ptacek and Bellin, {Melena D.}",

note = "Funding Information: From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis MN; ‡Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; and §Department of Medicine, Division of Gastroenterology, ||Department of Pediatrics, and ¶Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis MN. Received for publication December 10, 2019; accepted May 4, 2020. Address correspondence to: Kendall R. McEachron, MD, 420 Delaware St. SE, MMC 195, Minneapolis, MN 55455 (e‐mail: [email protected]). This study was supported by the National Institutes of Health (grant numbers T32DK108733 [K.R.M.] and R01DK109124 [M.D.B., Y.Y., J.S.H.]) and the National Pancreas Foundation (M.D.B.). M.D.B. has the following disclosures: research support from Dexcom, Viacyte, medical advisor for Ariel Precision Medicine, and data safety and advisory board member for Insulet. The remaining authors declare no conflicts of interest. Copyright {\textcopyright} 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001582 Publisher Copyright: Copyright {\textcopyright} 2020 Wolters Kluwer Health, Inc. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = jul,

day = "1",

doi = "10.1097/MPA.0000000000001582",

language = "English (US)",

volume = "49",

pages = "806--811",

journal = "Pancreas",

issn = "0885-3177",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation

AU - McEachron, Kendall R.

AU - Yang, Yi

AU - Hodges, James S.

AU - Beilman, Gregory J.

AU - Pruett, Timothy L.

AU - Kirchner, Varvara A.

AU - Dunn, Ty B.

AU - Freeman, Martin L.

AU - Trikudanathan, Guru

AU - Mulier, Kristine E.

AU - Ptacek, Peggy

AU - Bellin, Melena D.

N1 - Funding Information: From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis MN; ‡Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; and §Department of Medicine, Division of Gastroenterology, ||Department of Pediatrics, and ¶Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis MN. Received for publication December 10, 2019; accepted May 4, 2020. Address correspondence to: Kendall R. McEachron, MD, 420 Delaware St. SE, MMC 195, Minneapolis, MN 55455 (e‐mail: [email protected]). This study was supported by the National Institutes of Health (grant numbers T32DK108733 [K.R.M.] and R01DK109124 [M.D.B., Y.Y., J.S.H.]) and the National Pancreas Foundation (M.D.B.). M.D.B. has the following disclosures: research support from Dexcom, Viacyte, medical advisor for Ariel Precision Medicine, and data safety and advisory board member for Insulet. The remaining authors declare no conflicts of interest. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001582 Publisher Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Objective When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones. Methods Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP). Results Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average,-52.2 pg/mL, P = 0.06). Conclusions In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.

AB - Objective When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones. Methods Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP). Results Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average,-52.2 pg/mL, P = 0.06). Conclusions In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.

KW - GLP-1

KW - PYY

KW - Roux-en-Y

KW - autoislet

KW - pancreatectomy

KW - pancreatic polypeptide

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U2 - 10.1097/MPA.0000000000001582

DO - 10.1097/MPA.0000000000001582

M3 - Article

C2 - 32541637

AN - SCOPUS:85087133790

SN - 0885-3177

VL - 49

SP - 806

EP - 811

JO - Pancreas

JF - Pancreas

IS - 6

ER -

Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation

Abstract

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Keywords

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