Studies of pancreas tissues from organ donors support a link between enterovirus infections and type 1 diabetes – published 17/03/2025

The association of viruses with type 1 diabetes has been debated for decades. Several (but not all) studies in case–control and prospective cohorts, studying serum and stool samples, support an association. Limited data from pancreas tissue exist, and are primarily from historical autopsy collections or a few pancreas biopsies from patients near diagnosis. In this issue, three papers (Rodriguez-Calvo and Laiho et al, Laiho and Oikarinen et al and Richardson, Rodriguez-Calvo, Laiho and Kaddis et al) provide the most comprehensive analysis to date of pancreas (and other disease-related tissues) from a large cohort of organ donors with type 1 diabetes, assembled over the last two decades by the Network for the Pancreatic Organ Donor with Diabetes (nPOD). The cohort includes donors at the preclinical stage and after diagnosis, encompassing a broad range of age and disease duration. The nPOD Virus Group, an international collaboration, coordinately applied multiple methodologies to comprehensively examine markers of viral infections. Multiple markers of enterovirus infection were associated with type 1 diabetes in the presence of residual beta cells. These data suggest infections evolved into a chronic, low grade, persistent state, which is consistent with epidemiological studies in clinical cohorts. The authors conclude that these findings provide critical additional rationale for vaccination trials, which will ultimately be needed to ascertain a role for enteroviruses in type 1 diabetes.

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