University of Florida researchers have identified a group of stem-like immune cells in the lymph nodes near the pancreas that appear to renew themselves and keep supplying the T cells that destroy insulin-producing beta cells in type 1 diabetes. The study was published Sept. 15 in the Journal of Clinical Investigation.
The finding helps address a long-standing question: why the immune attack in type 1 diabetes can continue for years rather than burning out. It is laboratory research on donated human tissue, not a new treatment, and it does not change care for anyone living with the disease today.
For families managing a child's diagnosis, and for adults who have lived with type 1 diabetes for decades, the work points to a goal beyond insulin: stopping the attack itself while some beta cells remain.
A Self-Renewing Source of Attacking T Cells
Researchers analyzed pancreatic tissue and nearby lymph nodes from organ donors with and without type 1 diabetes, using single-cell gene sequencing to see which genes were active in each immune cell, according to UF Health. The team found a population of stem-like T cells that can multiply and replenish the cells carrying out the autoimmune attack.
"People can generate autoimmunity occasionally, but it tends to be corralled by the body's protective mechanisms," said Todd Brusko, Ph.D., director of the University of Florida Diabetes Institute and the study's senior author.
"These T cells likely persist and continue to drive the autoimmune attack for years or even decades," Brusko said. He noted that this is the first time the process has been described in human pancreatic lymph node tissue. Leeana Peters, Ph.D., a postdoctoral fellow in Brusko's lab, is the paper's lead author.
Donated Pancreas Tissue Behind the Discovery
Scientists studying type 1 diabetes have historically relied on blood samples because pancreatic tissue is extremely difficult to obtain from living patients. This work drew on the UF-based Network for Pancreatic Organ Donors with Diabetes, or nPOD, the world's largest repository of donor pancreatic tissue.
The study is one of several recent UF reports mapping the disease inside the pancreas. In July, a separate UF Health study in Nature Metabolism analyzed about 16 million pancreatic cells and found inflammatory immune cells, including macrophages, clustered near T cells at the edges of insulin-producing islets. The new study focuses on what sustains the attack over time.
Limits of the Findings
Several cautions apply. The research used donor tissue captured at a single point, so it shows which cells are present, not how they behave over time in a living person. The UF announcement did not say how many donors were included. The study identifies potential drug targets but did not test any therapy.
"We think we can begin targeting these markers with therapeutic antibodies to halt the disease process," Brusko said. Any such treatment would need years of development and clinical trials to show it is safe and effective.
Current guidance has not changed. People with type 1 diabetes still need insulin, and no approved therapy reverses the disease.
Screening and Treatment Options Families Have Now
Some immune-based options already exist. MedicalDaily reported in June on the FDA's accelerated approval of teplizumab for certain children ages 8 to 17 who were recently diagnosed with stage 3 type 1 diabetes. Teplizumab is also approved to delay the onset of stage 3 disease in adults and children 1 year and older who have stage 2 type 1 diabetes, an earlier stage often found through screening.
That makes early detection important. Families with a close relative who has type 1 diabetes can ask a clinician about islet autoantibody screening, and programs such as TrialNet offer screening for relatives. Insurance coverage varies, so ask about costs first.
Warning signs in children often develop over weeks and include increased thirst, frequent urination or new bedwetting, hunger, unexplained weight loss, fatigue, and blurred vision. Fruity breath, vomiting, stomach pain, trouble breathing, or confusion can signal diabetic ketoacidosis, a medical emergency.
Adults living with type 1 diabetes can ask their endocrinologist about research registries and trials testing ways to protect remaining beta cells. The new finding offers a clearer picture of why the disease persists. Turning that picture into a therapy that preserves insulin-producing cells is the next, and much longer, step.
Key Questions Answered
What did UF researchers find? A group of stem-like T cells in lymph nodes near the pancreas that may renew themselves and keep feeding the immune attack in type 1 diabetes.
Is this a new treatment? No. It identifies possible drug targets, but no therapy was tested.
Why does the attack in type 1 diabetes last so long? The study suggests these self-renewing cells keep replacing the T cells that destroy beta cells, sustaining the attack for years.
What treatments target the immune system now? Teplizumab is FDA-approved for certain people with stage 2 type 1 diabetes and for some children recently diagnosed with stage 3.
Can my child be screened? Islet autoantibody blood tests can detect early type 1 diabetes. Ask a pediatrician, especially if a relative has the disease.
What symptoms need emergency care? Fruity breath, vomiting, stomach pain, trouble breathing, or confusion can signal diabetic ketoacidosis.
