Bihormonal cells expressing both insulin and glucagon have been described particularly in association with T2D and T1D.38-41 Although there was no association with known diabetes in the current study, we observed a trend toward higher α-cell to β-cell ratios in donors with a high percentage of cells with heterogeneous appearance (r = 0.36; P = 0.067). The gene discussed is INS; the disease is diabetes mellitus.