Ultrastructural study of the pancreas in AIDS.
BACKGROUND
Frequent histologic changes (90%) in the pancreas suggesting protein-energy malnutrition were found in a previous necropsy study of pancreas morphology in patients with AIDS. However, additional studies were required to clarify subcellular changes.


OBJECTIVE
To ultrastructurally analyze pancreas changes in AIDS patients through transmission electron microscopy.


RESULTS
Pancreas specimens for necropsy were obtained from nine consecutive AIDS patients and four normal controls. A semiquantitative histologic and ultrastructural analysis of exocrine pancreas was carried out with the following findings: preserved pancreas structure with little autolysis, marked decrease in zymogen granules (100%), increased lipofuscin pigment (80%), augmented and dilated rough endoplasmic reticulum (100%), and increased number and size of mitochondria. The Golgi complex could be identified only in two cases. In all cases, acinar nuclei were decreased in size, with peripherally condensed chromatin and undulated membrane suggesting early apoptosis. In addition, immunohistochemical evaluation of the pancreas was carried out to detect opportunistic agents.


CONCLUSIONS
Decreased zymogen granules, acinar atrophy, increased lipofuscin pigment, and rarefying Golgi complex represent the morphologic substrate of protein-energy malnutrition in AIDS patients. The combination of rough endoplasmic reticulum and mitochondria changes could be due to the need for supplying vital plasma proteins rather than exportation protein synthesis associated, or not, with the deleterious effects of inflammatory cytokines and/or therapy for disease.
Chehter
Ethel Zimberg
EZ
Clinic Gastroenterology Division, Gastroenterology Department, , Medicine School of the São Paulo University, São Paulo, Brazil. chehter.ops@zaz.com.br
Duarte
Maria Irma Seixas
MI
Takakura
Cleusa Fumica Hirata
CF
Longo
Maria Antonieta
MA
Laudanna
Antonio Atílio
AA
D000163:Acquired Immunodeficiency Syndrome; D000328:Adult; D001344:Autopsy; D005260:Female; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D010179:Pancreas / Q000473:pathology / Q000648:ultrastructure*