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Diffuse congenital hyperinsulinism in infancy (CHI-D) arises from mutations inactivating the KATP channel; however, the phenotype is difficult to explain from electrophysiology alone. Here we studied wider abnormalities in the β-cell and other pancreatic lineages. Islets were disorganized in CHI-D compared with controls. PAX4 and ARX expression was decreased. A tendency toward increased NKX2.2 expression was consistent with its detection in two-thirds of CHI-D δ-cell nuclei, similar to the fetal pancreas, and implied immature δ-cell function. CHI-D δ-cells also comprised 10% of cells displaying nucleomegaly. In CHI-D, increased proliferation was most elevated in duct (5- to 11-fold) and acinar (7- to 47-fold) lineages. Increased β-cell proliferation observed in some cases was offset by an increase in apoptosis; this is in keeping with no difference in INSULIN expression or surface area stained for insulin between CHI-D and control pancreas. However, nuclear localization of CDK6 and P27 was markedly enhanced in CHI-D β-cells compared with cytoplasmic localization in control cells. These combined data support normal β-cell mass in CHI-D, but with G1/S molecules positioned in favor of cell cycle progression. New molecular abnormalities in δ-cells and marked proliferative increases in other pancreatic lineages indicate CHI-D is not solely a β-cell disorder.

Original publication




Journal article



Publication Date





3182 - 3188


Case-Control Studies, Cell Lineage, Cell Proliferation, Child, Child, Preschool, Congenital Hyperinsulinism, Cyclin-Dependent Kinase 6, Cyclin-Dependent Kinase Inhibitor p27, Fetus, Glucagon-Secreting Cells, Homeodomain Proteins, Humans, Infant, Infant, Newborn, Insulin, Insulin-Secreting Cells, Mutation, Paired Box Transcription Factors, Potassium Channels, Inwardly Rectifying, Somatostatin-Secreting Cells, Sulfonylurea Receptors, Transcription Factors