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Non‑invasive imaging of sympathetic innervation of the pancreas in individuals with type 2 diabetes – published online 07/11/2023

Vyakaranam graphical abstract

Achyut Ram Vyakaranam, Maryama M. Mahamed, Per Hellman, Olof Eriksson, Daniel Espes, Gustaf Christoffersson, Anders Sundin

The pancreatic islets of Langerhans are highly innervated, especially from the sympathetic nervous system. Unravelling the complex interplay among neural signals, hormonal regulation and immune responses through quantifiable non-invasive imaging, such as positron emission tomography/computerised tomography (PET/CT) techniques, has been a longstanding pursuit in understanding the pathophysiology of both type 1 and type 2 diabetes. In this issue, Vyakaranam et al (https://doi.org/10.1007/s00125-023-06039-7) explore PET/CT as a potential imaging method for the pancreatic sympathetic nervous system in humans. The PET tracer 11C-hydroxy ephedrine (11C-HED), previously employed to assess cardiac innervation, was used by the authors for diagnosing tumours with a sympathetic origin. Among these individuals examined by 11C-HED-PET in the oncological setting, a lower degree of tracer uptake in the pancreas was found in those with type 2 diabetes, along with regional differences suggesting nerve mass losses. The authors conclude that this study provides a proof of concept for future investigations into pancreatic innervation in both type 1 and type 2 diabetes.

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