Insulitis Revisited

摘要

Restricted access to the inflammatory lesions in patients with type 1 diabetes (T1D) has slowed insight into human insulitis. The conception of a network collecting pancreases of donors with diabetes (Network for Pancreatic Organ Donors with Diabetes [nPOD]; www.jdrfnpod.org) has focused the international diabetes research community on islet inflammation in new tissue for the first time in decades, leading to an overhaul in insight in human insulitis. In this issue of Diabetes, Campbell-Thompson et al. (1) present the latest status of insulitis in relation to β-cell mass, serving the diabetes research community some unexpected findings. The investigators studied the frequency and composition of insulitis in relation to (3-cell mass throughout the natural history of T1D, i.e., from seropositive donors without diabetes to donors with newly diagnosed and long-standing disease. Insulitis in donors with islet autoantibodies was rare (none of the 13 donors with a single antibody, 2 out of 5 with multiple antibodies, with the proportion of inflamed islets ranging from 1.4 to 6.4%), whereas a large proportion of patients with long-lasting disease lacked islet autoantibodies, even if insulitis persisted. The few donors with recent-onset T1D all showed insulitis; in those individuals with established disease, the frequency of insulitis in both individual islets and within patients was less, irrespective of the age of disease onset.