Quantifying β-Cells in Health and Disease: The Past, the Present, and the Need

Abstract

Through the studies of a number of pathologists, the past has taught us a great deal about islet pathology. A reduction in the quantity of β-cells in hyperglycemic individuals was described over 110 years ago by Eugene Opie (1) in an elegant report that included hand-drawn color micrographs. These illustrations clearly bring attention to the fact that the islet has lost numerous cells and that it also contains hyaline deposits, which we now recognize may be part of the destructive process. The past also included quantification of the number of endocrine cells by MacLean and Ogilvie (2) who demonstrated that β-cell mass is decreased in patients with phenotypic type 2 diabetes, but that the mass of α-cells is not diminished. And then, over 50 years ago, Bell (3) published a report of his studies of hyalinosis in islets that were based on the examination of pancreas sections from 3,959 individuals who were not known to have diabetes and 1,661 with diabetes. He observed hyaline to be more frequent in individuals with diabetes and that the number of affected individuals increased with age. While diabetes was certainly not the epidemic we now face, Bell stated in his commentary that “Hyaline islets are an expression of unrecognized or potential diabetes”—a clear recognition of the link of these deposits to diabetes and the problem of undiagnosed diabetes. The present includes the study by Saisho et al. (4), which appears in this issue of Diabetes Care . This article builds on the past and the present. The authors describe their findings in pancreas samples obtained at …