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.
Bibliographical noteFunding 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: firstname.lastname@example.org). 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
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Copyright 2020 Elsevier B.V., All rights reserved.
- pancreatic polypeptide
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't