Islet autoimmunity in human type 1 diabetes: initiation and progression from the perspective of the beta cell – published online 25/07/2023

Peter J. Thompson, Jasmine Pipella, Guy A. Rutter, Herbert Y. Gaisano, Pere Santamaria

Islet autoimmunity results from a complex dialogue between the immune system and islets, eventually leading to symptomatic type 1 diabetes. In this issue, Thompson and colleagues (https://doi.org/10.1007/s00125-023-05970-z) summarise the various ways in which beta cells influence the onset and progression of islet autoimmunity in type 1 diabetes in humans. Recent work suggests that islet autoimmunity in genetically predisposed individuals results from environmental triggers that may affect beta cells early in life. Beta cells present novel antigens, undergo diverse stress responses and exhibit a functional hierarchy within the islet. Emerging work also points to alpha cells as a potential therapeutic target for arresting islet autoimmunity. Although there are many questions remaining, continued efforts to understand islet autoimmunity through the lens of the beta cell will undoubtedly improve the diagnosis and treatment of type 1 diabetes. The figures from this review are available as a downloadable slideset.

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