2. 1.PANCREAS AND ILETS OF LANGERHANE
PANCREAS AND ILETS OF LANGERHANE
•The pancreas is a dual function organ situated in the loop of the
stomach and duodenum.
•It has both exocrine and endocrine glands .
• In adults, it is about 12–15 centimetres long, lobulated, and
salmon-coloured in appearance.
•Anatomically, the pancreas is divided into a head, neck, body,
and tail.
•The pancreas stretches from the inner curvature of the duodenum,
where the head surrounds two blood vessels, the superior mesenteric
artery, and vein.
• The body of the pancreas travels from the head, separated by a
short neck.
•The neck is about 2 cm wide, and sits in front of the portal vein.
The body is the largest part of the pancreas, and mostly lies behind
the stomach.
3. •The pancreas narrows towards the tail, which sits next to
the spleen.
•It is usually between 1.3–3.5 cm long, and sits between the
layers of the ligament between the spleen and the left
kidney.
•The exocrine gland that histologically composed of pancreatic
acini, which are serous in character and are lined by cuboidal
epithelium.
•Acini synthesis digestive enzymes called pancreatic juice that
drain into the duodenum through the pancreatic ducts.
•Two ducts, the main pancreatic duct and a smaller accessory
pancreatic duct, run through the body of the pancreas, joining
with the common bile duct.
5. Anatomy of the Endocrine Pancreas
• The endocrine portion of the pancreas contains many
small clusters of cells called islets of Langerhans.
• The cells are ovoid bodies, 75 – 175 µm (0.1mm)
diameters in size.
•They are scattered throughout the pancreas, but more
numbers in the tail of the pancreas.
•A healthy adult human has 3 million islets and form 1
to 2% of the mass of the pancreas.
•Each is separated from the surrounding pancreatic tissue
by a thin fibrous connective tissue capsule which is
continuous with the fibrous connective tissue that is
interwoven throughout the rest of the pancreas
6. Pancreatic islets have five cell types ,each of
which produces a different endocrine product:
1. Alpha cells (A cells) found 20% of the total islets cells.
They are large granular cells secrete the
hormone glucagon.
2. Beta cells (B cells) are the most abundant of the islet
cells found 70%. They are smaller granular cells
produce insulin and Amylin.
3. Delta cells (D cells) are found 5 – 8% and secrete the
hormone somatostatin, which is also produced by a
number of other endocrine cells in the body.
4. PP cells (gamma cells or F cells) found less than 5% and
producing pancreatic polypeptide.
5. Epsilon cells found 1% producing ghrelin.
7. The different cell types within an islet are not randomly
distributed - beta cells occupy the central portion of the
islet and are surrounded by a "rind" of alpha and delta
cells.
Islets have rich blood supply, they receive about 10
to 15% of the pancreatic blood flow.
They allowing their secreted hormones enter to the
blood and pass first to the liver via portal circulation
before reaching the systemic circulation.
Additionally, they are innervated by parasympathetic and
sympathetic neurons, and nervous signals clearly modulate
secretion of insulin and glucagon.
9. • .
PANCREATIC HORMONES AND THEIR FUNCTION
•The pancreas is a composite organ, which has exocrine and
endocrine functions.
• The endocrine portion is arranged as discrete islets of
Langerhans, which are composed of five different endocrine cell
types (alpha, beta, delta, epsilon, and upsilon) secreting at
least five hormones including
•glucagon,
•insulin,
• somatostatin,
• ghrelin, and
•pancreatic polypeptide, respectively
10. • .
•
1. Insulin
•Insulin is a peptide hormone secreted by the Beta cells of islets of
the pancreas.
•It made up of two polypeptides A and B chain that are held
together by a disulphide bond .
• The A chain contains 30 amino acids and the B chain contains 21
amino acids.
• So it has 51 amino acids with a molecular weight of 6000 Da.
• In A chain N-terminal amino acid is glycine and C-treminal amino
acid is asparagines.
•In B-chain N-terminal amino acid is phenyl alanine and C-terminal
amino acid is threonine.
•Both the chains are held together by two S-S linkage Cys-7 and
Cys-20 of A chain are jointed to Cys-7 and Cys-19 of B chain
respectively.
• In addition the A chain carries an intra chain S-S linkage between
Cys-6 and Cys-11.
11. Biosynthesis of insulin: Insulin is a small peptide hormone
that is formed directly by the genetic translation (gene) via
insulin mRNA.
1. A single-chain polypeptide insulin precursor called
preproinsulin is synthesized in the ribosome of the
rough endoplasmic reticulum membrane of the beta cells
of the islets. It has 109 amino acids with a molecular
weight of 11,500 Da.
2. Pre-proinsulin synthesized is transferred to lumen of the
rough endoplasmic reticulum cisternae. From which in
N-terminal 23 amino acids are split by an enzyme
called signal pepdidase and become folded and linked
by disulphide bond to form proinsulin. It has 86 amino
acids. Molecular weight is 9000.
12. 3 . The proinsuline containing small vesicle are detached from E.R and
fused with the cisternae of Golgi body. In the Golgi body, proinsulin
is acted upon by a trypsin like protease enzyme which hydrolyzes the
peptide chain at two sites. So that an inactive connective C peptide is
removed (31 amino acids) and two active peptide chains are left
which forms A and B chain.
4. A carboxypeptidase B like enzyme split the C-terminal basic
amino acid from both chain. Arg 63, Lys 62 from A-chain and Arg-
31, Arg-32 from B chain to form an active insulin (see fig 5.3, b).
The insulin are packaged and stored in the granules that originated
from the Golgi body of the beta cells. The granules are moved to the
peripheral region of the cells. In response to the stimulus, Insulin is
secreted from the cell by exocytosis and diffuses into islet capillary
blood.
• C-peptide is also secreted into the blood in a 1:1 molar ratio with
insulin. Although C-peptide has no established biological action, it is
used as a useful marker for insulin secretion.
14. •The average daily secretion is about 2 mg (50 units).
• One unit of insulin is defined as 1/3 of the amount of insulin
that will lower the blood sugar level of a 2 kg fasting rabbit to
the convolution value in 3 hours.
• The total insulin content of the pancreas is about 200 to 250
units. Insulin secretion is continuous, but the rate of secretion is
influenced by a variety of factors.
•The half life of insulin is about 5 minutes. It is metabolized
chiefly in liver and kidney.
• About half is inactivated during first pass in the liver by the
enzyme insulin glutathione transhydogenase which cleaves the
molecule into A and B chains.
•The rest are inactivated in the kidney and other tissues by
enzymes insulinases.
15. REGULATION OF ITS SECRETION:
•Plasma glucose level (70 -110mg/dl) is the main regulator of
insulin secretion.
•The change in the concentration of plasma glucose that occurs in
response to feeding or fasting is the main determinant of insulin
secretion.
• Modest increases in plasma glucose level provoke a marked
increase in plasma insulin concentration.
•Glucose is taken up by beta cells via glucose transporters
(GLUT2).
•The subsequent metabolism of glucose increases cellular adenosine
triphosphate (ATP) concentrations and closes ATP-dependent
potassium (KATP) channels in the beta cell membrane, causing
membrane depolarization and an influx of calcium.
16. •Increased calcium intracellular concentration results in an
increase of insulin secretion.
•Thus there is a feedback mechanism that exists between
the blood glucose level and the secretion of insulin by the
beta cell
•Increased plasma amino acid and free fatty acid
concentrations induce insulin secretion as well.
•Glucagon is also known to be a strong insulin secretion.
17. PHYSIOLOGICAL FUNCTIONS:
Insulin’s main actions are
•Insulin plays an important role to keep plasma glucose value
within a relatively narrow range (70-110mg/dl) throughout the day
(glucose homeostasis) under varying conditions of food intake,
fasting, exercise, etc,.
• In the liver, insulin promotes glycolysis and storage of glucose as
glycogen (glycogenesis), as well as conversion of glucose to
triglycerides.
•In muscle, insulin promotes the uptake of glucose in all cells
except brain, renal and intestinal mucosa and its storage as
glycogen.
•In adipose tissue, insulin promotes uptake of glucose and its
conversion to triglycerides for storage.
• Since insulin promotes protein synthesis by increasing entry of
amino acids into the cells and makes availability of energy from
increased oxidation of glucose, it has a promising role in the
growth of an organism.
18. .
• .
Clinical Significance:
Diabetes Mellitus (DM) is a chronic disease that
occurs when the pancreas cannot produce enough
insulin, or the body cannot effectively utilize insulin,
which results in high glucose plasma level
(hyperglycemia). Nearly 10% of Indian population
have this disease. Diabetes mellitus means excessive
excretion of sweet urine.
19. Diabetes Mellitus (DM) have the following symptoms
Poly-uria: excrete more volume of urine. As the blood glucose
level exceeds the renal threshold (180 mg/dl) glucose appears in
the urine (glycosuria) that prevent the reabsorption of water in the
proximal tubules resulting excrete large volume of water.
Polydipsia: stimulate thirsty and drinking more water. Dehydration
and loss of electrolytes in the cells stimulate thirst and cause
polydipsia.
Polyphagia: intake of more food. the high glucose level blood
enter in to the ventromedial nucleus of hypothalamus inhibits the
satiety centre of brain to stimulate increased appetite and food
intake but weight loss.
20. There are two common types of DM that account for the
majority of cases: type 1 and type 2.
Type 1 DM
It is a chronic autoimmune disease in which the beta cells
of islets of the pancreas are destroyed resulting in insulin
deficiency. It is also called Insulin Dependent Diabetes
Mellitus (IDDM). Type-1 diabetes occurs early in the life (5
-25years) so it is called juvenile onset diabetes.
21. Pathophysiology:
•It is not entirely understood yet, but it is caused by a
combination of events in genetically susceptible individuals.
•Three mechanisms lead to islet cell destruction: genetic
susceptibility, autoimmunity, and environmental insult(s).
• A virus or allergen (environmental insults) in genetically
susceptible individuals induces the production of autoantibodies
to Beta cells of the islets of the pancreas.
•This autoimmune reaction creates autoreactive T cells that
destroy beta-islet cells and cause loss of insulin secretion.
•The major symptoms are polyuria, polydipsia and glycosuria.
IDDM disease response to insulin injection.
• IDDM requires insulin therapy and careful, lifelong control of
the balance between dietary intake and insulin dose.
22. Type 2 DM or non insulin dependent diabetes mellitus
(NIDDM)
•It occurs on the later age and is referred to as maturity
onset diabetes.
• It is a progressive disease that develops due to a in
insulin sensitivity that causes hyperglycemia.
•The development and rate of progression of T2continued
decline in beta-cell function and/or due to a defect D
are influenced by both genetic and environmental factors,
such as obesity and physical inactivity.
23. •
Pathophysiology:
•Beta-cell dysfunction manifests in different ways:
•(1) reductions in insulin release,
• (2) changes in pulsatile insulin secretion,
•(3) an abnormality in the efficiency of proinsulin to insulin
conversion, and
• (4) reduces the release of amylin. Insulin resistance is present
in most patients with T2D.
• Insulin resistance is characterized by higher than expected plasma
glucose level with the prevailing plasma insulin secretion.
•In patients with T2D insulin, stimulation fails to induce normal
GLUT4 protein translocation to the sarcolemma in skeletal muscle
membrane.
• Also, excessive production of free fatty acids. Production of
ketone bodies by the accumulation of acetyle –CoA.
24. 2.Amylin (diabetes-associated peptide)
• Amylin is a peptide hormone secreted by the Beta cells
of islets of the pancreas.
• It is co-secreted with insulin in response to caloric
intake (feeding state).
25. Physiological functions:
•It suppresses glucagon secretion from the alpha cells of the
islets in the pancreas via paracrine interaction between beta
cells and alpha cells.
• Amylin also slows gastric emptying which delays absorption
of glucose from the small intestine into the circulation.
• Also, it stimulates the satiety centre of the brain to limit
food consumption.
26. 3.GLUCAGON
• Glucagon is a protein hormone.
•It is secreted by the Alpha cells of islets of the pancreas.
•It is a single chain polypeptide having 29 amino acids.
• Its molecular weight is about 3485 Da.
•There are only fifteen different amino acids in the molecule.
• Amino acid sequences has been determined.
• Histidine is the N-terminal amino acid and threonine is the C-
terminal.
• It is also known as hyperglycaemic glycogenolytic factor (HGF).
• Because, it is primarily concentrate with increases in blood
glucose level.
27. Synthesis:
•The initial gene product is the mRNA encoding
preproglucagon.
•A peptidase removes the signal sequence of
preproglucagon during translation of the mRNA in the
rough endoplasmic reticulum to yield proglucagon.
•Proteases in the alpha cells subsequently cleave the
proglucagon into the mature glucagon molecule.
• The plasma half life of glucagon is about 5 – 10
minutes. It is inactivated mainly in the liver, but also
kidney and other tissues.
28. Regulation of its secretion:
•The amino acids released by digestion of a protein
meal appear to be the main determinant of glucagon
secretion.
•High plasma glucose inhibits while hypoglycaemia
increases glucagon secretion.
•Free fatty acids and ketone bodies inhibits glucagon
secretion.
29. Physiological functions:
•Glucagon acts exclusively on the liver to antagonize
insulin effects on hepatocytes. It enhances glycogenolysis
and gluconeogenesis in hepatocyte cells so that increase
in blood glucose level.biiut does not stimulate muscles
glycogenolysis.
• It also promotes lipolysis (oxidation of fat), which
can lead to the formation of ketone bodies.
•It also stimulates secretion of insulin, growth hormone,
pancreatic somatostatin and hepatic bile secretion.
•In pharmacological doses it increases myocardial
contractility.
30. Clinical significance:
• Hypoglycaemia is a syndrome characterized by low plasma
glucose.
•During the first week after birth, the infant is hypoglycaemic
its plasma glucose concentration is less than 25 mg/dl of
blood. In adult, symptoms occur in acute or chronic.
• If the low plasma glucose occurs rapidly, symptoms of
sweating, shakiness, trembling, weakness and anxiety are
produced.
•If the reduction in plasma glucose occurs slowly, headache,
irritability, lethargy and other central nervous system symptoms
predominate.
• Prolonged ingestion of ethanol and other drugs may
damage liver cells and cause fasting hypoglycaemia.
•Adrenocortical insufficiency and hypopituitarism are also
associated with hypoglycaemia.
31. 4.SOMATOSTATIN
•Somatostatin is a protein hormone secreted by the Delta
cells of the islets of the pancreas, hypothalamus and D cells
of gastric glands.
•Two form of somatostatin are synthesized. They are
referred to as SS-14 and SS-28.
•Both form of somatostatin are generated by proteolytic
cleavage of prostomatostatin.
•SS-14 is the predominant form secreted by the delta cells
of islets and hypothalamus, whereas the intestine D cells
secrete SS-28.
•SS-14 has 14 amino acid residues and SS-28 has 28
amino acids residues.
32. Regulation of its secretion:
•Glucagon stimulates somatostatin secretion via paracrine
interaction between alpha cells and delta cells of the
islets of the pancreas.
33. PHYSIOLOGICAL FUNCTIONS:
Somatostatin inhibits the secretion of multiple hormones, including
growth hormone, insulin, glucagon, gastrin, vasoactive intestinal
peptide (VIP), and thyroid-stimulating hormone.
Somatostatin act on pituitary gland to inhibits secretion of
growth hormone.
It diffusing into neighbouring islets cells to inhibit secretion of
insulin, glucagon and pancreatic polypeptides.
Somatostatin secreted by the gastro intestinal tract inhibits
secretion of many other intestinal hormones such as gastin,
cholecystokinin , vasoactive intestinal peptides (VIP). It also
inhibits pancreatic exocrine secretion, bile secretion and motility.
It reduces smooth muscles contraction in gall bladder
contraction, oesophagus contraction and blood flow within the
intestine.
34. 5.GHRELIN
•Ghrelin is a polypeptide secreted by the Epsilon cells of
the islets of the pancreas, endocrine cells in the stomach
and hypothalamus.
• Ghrelin inhibits the secretion of insulin from Beta cells
of the islets of the pancreas via paracrine interaction
between delta cells and beta cells of the islets of the
pancreas.
•It also stimulates appetite and growth hormone secretion
35. 6.PANCREATIC POLYPEPTIDE (PP)
•Pancreatic polypeptide is secreted from upsilon (F) cells of
the islets of the pancreas.
•It is a single polypeptide chain containing 36 amino acids.
•It inhibits pancreatic and biliary secretion, increasing gastric
emptying time and motility of small intestine.
•It relaxes pyloric and ileocolic sphincters. Dietary intake of
nutrients alters the secretion of the pancreatic polypeptide.
•Its secretion is increased by fasting, hypoglycaemia, exercise
protein meals and some gastro intestinal hormones and
decreased by somatostatin.