von Herrath · Expert review of clinical immunology 2026 · narrative review · n=?

Our understanding of the interactions between immune cells and beta cells in the pancreas: autoimmune mechanisms leading to type 1 diabetes.

Level 5 - mechanism / opinion, no new human data

Narrative review synthesizing mechanistic, translational, and clinical literature without primary data or systematic search methodology.

PubMed 42555817 · doi:10.1080/1744666X.2026.2702447 · record verified 2026-08-26

What was done

This narrative review synthesized experimental, translational, and clinical literature on the bidirectional interactions between pancreatic beta cells and the immune system in Type 1 diabetes pathogenesis. It evaluated intrinsic beta-cell stress mechanisms—such as endoplasmic reticulum stress, impaired protein processing, neoantigen generation, and MHC class I upregulation—and reviewed therapeutic concepts combining beta-cell protection with immune modulation.

What was found

The abstract reports no quantitative data or effect estimates. It presents a conceptual paradigm in which beta-cell vulnerability and intrinsic dysfunction actively increase immunogenicity and trigger autoimmune recognition, challenging the classical view that beta cells are purely passive victims of autoimmune destruction.

Why it matters

Reframing Type 1 diabetes as a two-sided interaction suggests that durable prevention or disease delay will require combination therapies targeting both beta-cell resilience and immune tolerance rather than immune suppression alone.

Limits

The abstract provides no quantitative metrics, systematic search criteria, or specific study counts. As a narrative synthesis of conceptual and mechanistic pathways, it does not present primary clinical trial data or quantify the efficacy of specific dual-targeting interventions.