MORPHOLOGICAL AND FUNCTIONAL RECOVERY OF THE PANCREATIC ISLANDS IN DIABETIC CATS TREATED WITH INSULIN

The Remission Phase in Type 1 Diabetes: Role of Hyperglycemia Rectification in Immune Modulation

The remission phase (or honeymoon period) is a spontaneous "temporary cure stage" in type 1 diabetes course, which provides a good human model for studying β-cell protection. The exact mechanisms are still uncertain, but one of the generally recognized mechanisms is that correction of "glucotoxicity" by exogenous insulin therapy leads to "β-cell rest" and β-cell recovery. Beyond this, the remission phase is accompanied by changes in various immune cells and immune molecules, indicating downregulation of immune response, and induction of immune tolerance. The role of hyperglycemia rectification in the regulation of immune response should be emphasized because glucose metabolism is critical to maintain the normal function of immune system. Here, recent evidence of immune modulation based on the rectification of hyperglycemia from multiple aspects such as immune cells, inflammatory cytokines, biomolecules, and cell antigenicity was reviewed. It should be noteworthy that the interaction between glucose metabolism and immune plays an important role in the pathogenesis of the remission phase. The best intervention strategy may be the combination of strict glycemic control and immune modulation to protect β-cell function as early as possible.

THE HYPOPHYSIS AND SECRETION OF INSULIN

The ability of the pancreas, from various types of dogs, to correct diabetic hyperglycemia has been studied (Table XI). The pancreas from one animal was united by a vascular union with the neck blood vessels of another dog which had been pancreatectomized for 20 hours. The time necessary to reduce the blood sugar level to 120 mg. per cent was determined. 1. Pancreas from 6 hypophysectomized dogs produced a normal insulin secretion, showing that an anterior pituitary hormone is not necessary for its production or maintenance. 2. In 14 of 17 normal dogs given anterior pituitary extract for 3 or more consecutive days and presenting diabetes (fasting blood sugar 150 mg. per cent or more) the pancreas showed diminished insulin production. 3. In animals which remained diabetic after discontinuing the injections of hypophyseal extract, the pancreas islands were markedly pathologic and the insulin secretion was practically nil. 4. When hyperglycemia existed on the 2nd to 5th day but fell later, the insulin secretion of 5 dogs was normal in 2, supernormal in 1, and less than normal in 2. Histologic examination showed a restoration of beta cells. 5. In 14 dogs resistant to the diabetogenic action of anterior pituitary extract, as shown by little or no change in blood sugar, the pancreatic secretion of insulin was normal in 6 cases, supernormal in 3, and subnormal in 5 cases. Clear signs of hyperfunction of B cells were observed. In 6 resistant animals a high blood sugar (150 mg. per cent) appeared shortly before transplanting, but insulin secretion was normal in 4, supernormal in 1, and subnormal in 1 case. 6. With one injection of extract and 1 day of hyperglycemia the capacity of the pancreas to secrete insulin was not altered. 7. A high blood sugar level lasting 4 days does not alter the islets. The hypophyseal extract acts, therefore, by some other mechanism. In normal dogs, the continuous intravenous infusion of glucose for 4 days maintained the blood sugar at levels as high as those after pituitary extract. In these animals the B cells were hyperplastic and insulin secretion normal. 8. Anterior hypophyseal hyperglycemia is due at first to extrapancreatic factors which are the most important, and last only during the injections of extracts. Pancreatic factors appear afterwards and are responsible for permanent diabetes. Hypophyseal extract produces histological changes in many tissues and damages the Langerhans islands. The coexistent high blood sugar probably exhausts the B cells and exaggerates their injury. 9. In all cases there is a relation between the cytology of the islet B cells and the insulin secreting capacity.

COMPARATIVE DIABETOGENIC ACTION OF THE HYPOPHYSIS FROM VARIOUS ANIMALS

Of all the anterior hypophyses tested, those of the human produced the most marked diabetogenic action in the dog with its pancreatic tissue reduced to 4 gm., and in the hypophysectomized and pancreatectomized toad. The human hypophysis also produced diabetogenic action in the normal dog on daily doses of 1.26 mg. per kilo per day for 2 days. The hypophysectomized dog with its pancreas reduced to 4 gm. is very sensitive to the anterior hypophyseal diabetogenic action and is the best test animal for demonstrating such action in mammals. The anterior hypophysis of man, toad, rat, and chicken produces in such animals a diabetogenic action with doses of from 10 to 15 mg. per kilo per day. The bovine anterior hypophysis has identical action in 20 mg. doses. That of canine origin was much less active in a few though inconclusive experiments. It was impossible to demonstrate a diabetogenic action with either guinea pig hypophysis or with that of fish probably because insufficient doses were injected. The diabetogenic action was not obtained by the injection of other organ extracts of toads, dogs and oxen, of corticosterone (30, 40, and 60 mg. in 4 days) or of desoxycorticosterone (80 mg. and 200 mg. in 4 days). The toad (Bufo arenarum Hensel), deprived of its hypophysis and pancreas is the most sensitive biological reactor for testing the diabetogenic action. In this animal the diabetogenic action of anterior hypophyses from varied sources decreased in the following order: man, dog, toad (Bufo arenarum Hensel), white rat, guinea pig, chicken (whole hypophysis), ox, serpent (Constrictor constrictor (L.)), the fish "corvina" Micropogon opercularis (Quoy and Gaimard, 1824), and "merluza" Merlucius hubbsi (Marini, 1933).

ENDOCRINE FUNCTION OF THE SURGICALLY REDUCED PANCREAS

The pancreas reduced to 4 or 10 gm. weeks or months previously by partial resection, is able to maintain a normal glycemic level in dogs of about 10 kilos in good condition. When the pancreas is reduced to 4 gm. the capacity for secreting insulin under certain conditions of strain is diminished whereas a pancreas reduced to 10 gm. may have a normal or decreased capacity. This decreased functional capacity is shown: (1) by a longer hyperglycemic curve after the intravenous injection of 1 gm. of glucose per kilo; (2) by the requirement of smaller doses of extract of anterior hypophysis to produce diabetes; and (3) by the longer time required to correct the diabetic hyperglycemia if reduced pancreas is grafted in the neck of pancreatectomized animals. The time to recover is in inverse ratio to the weight of the transplanted pancreatic tissue.