The Predictive Value of Biopsy of the Pancreas and Its Therapeutic Impact in Autoimmune Diabetes

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.