Type 1 diabetes

Microenvironment-Dependent MSC Immunoregulation in Type 1 Diabetes: Insights From IFNγ Preconditioning

Interferon-gamma (IFNγ) plays a crucial role in the pathogenesis of type 1 diabetes (T1D) and is widely utilized to license mesenchymal stem/stromal cells (MSCs) to enhance their immunosuppressive properties through a process known as preconditioning or priming. This study investigates the interaction of MSCs preconditioned with (IFNγ+) or without (IFNγ-) IFNγ, with peripheral blood mononuclear cells (PBMCs) from healthy controls (HC) and T1D patients. We assessed the effects of these interactions on anti-inflammatory gene expression, chemokine and receptor profiles, and the induction of regulatory T (Treg) cells. Our findings reveal contrasting responses in HC and T1D PBMCs when exposed to IFNγ+ and IFNγ- MSCs, particularly in the expression of key genes such as CXCR3 and its ligands (CXCL9, CXCL10), CXCR6, CCR5, and its ligands (CCL3 and CCL4). Pathway enrichment analysis further showed that IFNγ preconditioning tailors MSC responses to specific immune microenvironments. These differential gene expression patterns were also reflected in the proportions of Treg cells, which varied depending on whether paracrine signaling or direct cell contact was involved. Collectively, our results demonstrate that IFNγ+ and IFNγ- MSCs create distinct immunomodulatory microenvironments in T1D PBMCs compared to HC PBMCs, emphasizing the potential for tailored MSC-based therapies in T1D treatment.

Engineered promoter-free insulin-secreting cells provide closed-loop glycemic control

Diabetes mellitus is currently a priority health issue worldwide, but existing therapies suffer from insufficient donors, inability to provide glucose-dependent endogenous insulin secretion, transplantation risks, and immune rejection. Especially, reported engineered cells are mostly promoter-induced glucose-independent insulin producing cells. Here we constructed a closed-loop of insulin secretion with glucose-dependent IRES to achieve glucose-sensitive endogenous insulin secretion. Those cells successfully reversed hyperglycemia in diabetic mice for at least 60 days after transplantation without any significant immune rejection, demonstrating that our constructed engineered cellular grafts have good biocompatibility. Our findings hold great promise in the field of diabetes treatment and provide a new, glucose-dependent genetic engineering approach to insulin production, which is expected to solve many of the current problems faced in the clinical treatment of diabetes mellitus.

Association of early-onset diabetes with socioeconomic, and health factors: a matched case-control study controlling for age, gender, and BMI

Objectives

This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

Methods

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

Results

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

Conclusion

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

Distribution of glutathione peroxidase-1 immunoreactive cells in pancreatic islets from type 1 diabetic donors and non-diabetic donors with and without islet cell autoantibodies is variable and independent of disease

During type 1 diabetes (T1D), oxidative stress in beta cells may cause early beta cell dysfunction and initiate autoimmunity. Mouse islets express lower levels of reactive oxygen species (ROS) clearing enzymes, such as glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase than several other tissues. It remains unclear if human beta cells show a similar deficiency during T1D or exhibit a higher degree of intrinsic resistance to oxidative stress. We compared islet cell distributions and determined graded intensities of glutathione peroxidase1 (GPX1), a key enzymatic mediator involved in detoxifying hydrogen peroxide, by applying combined immunohistochemistry for GPX1, insulin and glucagon, in pancreatic sections from new-onset T1D (group 1), non-diabetic autoantibody-negative (group 2), non-diabetic autoantibody-positive (group 3) and long-term diabetic (group 4) donors. Islets from all study groups demonstrated either uniform but graded staining intensities for GPX1 in almost all islet cells or strong staining in selective islet cells with weaker intensities in the remaining cells. GPX1 was present in selective glucagon cells and insulin cells, including in cells negative for both hormones, with stronger intensities in a higher percentage of glucagon than insulin cells. It was absent in a higher percentage of beta cells than glucagon cells independent of disease or autoantibody positivity. We conclude that a proportion of human beta cells and glucagon cells express GPX1 but show heterogeneity in its distribution and intensities, independent of disease or autoantibody status. Our studies highlight important differences in the expression of GPX1 in islet cell-types between mice and humans.

Impact of switching from neutral protamine hagedorn insulin (NPH) to glargine insulin on glycemic control and clinical outcomes in pediatric patients with type 1 diabetes

Background

Treatment of type 1 diabetes requires insulin therapy, and various types of insulin can be used. Insulin glargine has been shown to provide effective glycemic control with reduced hypoglycemia. However, there are no prior studies investigating the effects of switching from neutral protamine hagedorn (NPH) insulin to glargine insulin in Sudan, due to limited use of glargine insulin and funding constraints.

Objective

This study aimed to assess the impact of switching from NPH insulin to glargine insulin on glycemic control in children with type 1 diabetes, and to identify factors precipitating the switch.

Methods

This observational cross-sectional study included 221 children (aged 1-19 years) with type 1 diabetes who switched from NPH insulin to glargine insulin at Mohamed Alamin Hamid Pediatric Hospital. Simple random sampling was used to select participants.

Results

Of the 221 participants, 83 (37.5 %) switched to glargine insulin, 60 (27.1 %) continued on NPH insulin, and 78 (32.5 %) started on glargine from the beginning. Switching to glargine insulin was associated with a statistically significant reduction in HbA1c (P < 0.001) and a significant decrease in fasting blood glucose (FBG) levels (P < 0.001). Additionally, 69.9 % of participants experienced an increase in their insulin dose (P < 0.001). The primary reason for switching, as reported by 57.8 % of caregivers, was that mixed insulin had not effectively controlled blood glucose, with 60.4 % of these participants experiencing hypoglycemia. Of those who switched, 94 % were satisfied, with 33.3 % reporting better blood sugar control and 89.7 % indicating improvements in general health. A significant increase in weight was observed after switching to insulin glargine (P = 0.0001).

Conclusion

Switching from NPH to glargine insulin among Sudanese pediatric patients with type 1 diabetes offer significant benefits in glycemic control, as reflected by improved HbA1c and FBG levels. Additionally, insulin dose and weight increased, contributing to enhanced overall health and blood glucose management. Hypoglycemia was a major reason for switching.

Cellular therapies in rheumatic and musculoskeletal diseases

A substantial proportion of patients diagnosed with rheumatologic and musculoskeletal diseases (RMDs) exhibit resistance to conventional therapies or experience recurrent symptoms. These diseases, which include autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus, are marked by the presence of autoreactive B cells that play a critical role in their pathogenesis. The persistence of these autoreactive B cells within lymphatic organs and inflamed tissues impairs the effectiveness of B-cell-depleting monoclonal antibodies like rituximab. A promising therapeutic approach involves using T cells genetically engineered to express chimeric antigen receptors (CARs) that target specific antigens. This strategy has demonstrated efficacy in treating B-cell malignancies by achieving long-term depletion of malignant and normal B cells. Preliminary data from patients with RMDs, particularly those with lupus erythematosus and dermatomyositis, suggest that CAR T-cells targeting CD19 can induce rapid and sustained depletion of circulating B cells, leading to complete clinical and serological responses in cases that were previously unresponsive to conventional therapies. This review will provide an overview of the current state of preclinical and clinical studies on the use of CAR T-cells and other cellular therapies for RMDs. Additionally, it will explore potential future applications of these innovative treatment modalities for managing patients with refractory and recurrent manifestations of these diseases.

The global health burden of pediatric chronic kidney disease: An analysis of the Global Burden of Disease database from 1990 to 2021

BACKGROUND

Chronic kidney disease (CKD) poses a significant global health challenge; however, its burden on pediatric populations remains underexplored. This study assesses the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric CKD attributable to type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, and congenital anomalies of the kidney and urinary tract from 1990 to 2021.

METHODS

Data were extracted from the Global Burden of Disease (GBD) 2021 database. CKD burden was stratified by etiology, age, sex, sociodemographic index (SDI), and geography. Average annual percentage changes (AAPCs) in incidence, prevalence, mortality, and DALYs were calculated.

RESULTS

Globally, CKD-related mortality and DALYs decreased for type 1 diabetes mellitus (-2.176% AAPC), type 2 diabetes mellitus (-1.556%), glomerulonephritis (-0.854%), hypertension (-0.800%), and congenital anomalies of the kidney and urinary tract (-2.143%). The incidence of hypertension incidence increased (+1.299%). Boys experienced higher incidence and prevalence rates for all etiologies, while girls had more significant reductions in mortality and DALYs. High-SDI regions showed the steepest declines in CKD burden, while low-SDI regions experienced limited reductions and increasing hypertension prevalence.

CONCLUSIONS

Pediatric CKD burden reflects disparities by etiology, geography, and SDI. Interventions to improve early diagnosis, healthcare access, and targeted management strategies, particularly in low-SDI regions, are essential. Addressing obesity and improving treatment for glomerulonephritis are priorities. Standardized diagnostic criteria and broader global efforts are needed to mitigate the burden of pediatric CKD.

Attention-Deficit/Hyperactivity Disorder Symptoms Are Common and Associated with Worse Glycemic Control in Adults with Type 1 Diabetes

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: In total, 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%). Of 273 completing ASRS, 87 med ADHD criteria (ASRS positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men. ADHD symptoms decreased with age, but remained significantly higher than the general population levels. HbA1c levels were positively associated with the ASRS scores (Spearman's r = 0.28, p < 0.0001). ASRS positive individuals had worse glycemic control (HbA1c ≥ 8.0%, adjusted OR 2.3, 95%CI: 1.3-4.1, p < 0.0001) and higher PHQ-9 scores (10 ± 7.3 vs. 6.1 ± 6, χ2(1) = 9.2, p = 0.002) than the ASRS negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusions: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group.

Restoration of intestinal secondary bile acid synthesis: A potential approach to improve pancreatic β cell function in type 1 diabetes

This study investigates the roles of gut microbiome and secondary bile acid dysfunctions in type 1 diabetes (T1D) and explores targeted interventions to address them. It finds that T1D is associated with reduced gut microbial diversity and imbalance favoring harmful bacteria over beneficial ones. Additionally, patients with T1D exhibited impaired secondary bile acid metabolism. Interventions aimed at modulating the gut microbiome and metabolites are safe and improve glycemic control, reduce daily insulin dose, and reduce inflammation. These interventions reshape the gut microbiome toward a healthier state and enhance secondary bile acid production. Responders to the interventions show increased levels of beneficial bacteria and secondary bile acids, along with improved C-peptide responses. Overall, these findings suggest that targeted modulation of the gut microbiome and secondary bile acid metabolism could be a promising therapeutic approach for T1D management. The trial is registered at Chinese Clinical Trial Registry (ChiCTR-ONN-17011279).

Immune perturbations in human pancreas lymphatic tissues prior to and after type 1 diabetes onset

Autoimmune destruction of pancreatic β cells results in type 1 diabetes (T1D), with pancreatic immune infiltrate representing a key feature in this process. However, characterization of the immunological processes occurring in human pancreatic lymphatic tissues is lacking. Here, we conduct a comprehensive study of immune cells from pancreatic, mesenteric, and splenic lymphatic tissues of non-diabetic control (ND), β cell autoantibody-positive non-diabetic (AAb+), and T1D donors using flow cytometry and CITEseq. Compared to ND pancreas-draining lymph nodes (pLN), AAb+ and T1D donor pLNs display decreased CD4+ Treg and increased stem-like CD8+ T cell signatures, while only T1D donor pLNs exhibit naive T cell and NK cell differentiation. Mesenteric LNs have modulations only in CD4+ Tregs and naive cells, while splenocytes lack these perturbations. Further, T cell expression of activation markers and IL7 receptor correlate with T1D genetic risk. These results demonstrate tissue-restricted immune changes occur before and after T1D onset.

Nano-Based Drug Delivery Systems for Managing Diabetes: Recent Advances and Future Prospects

Diabetes mellitus is a chronic metabolic disorder, which is characterized by high blood glucose levels, and this can lead to serious diabetic complications. According to the World Health Organization, approximately 830 million adults worldwide are living with diabetes in 2024, with its prevalence continuing to rise steadily over the years. To treat this disease, researchers have developed a variety of first-line drugs, such as sulfonylureas and thiazolidinediones. Despite their long clinical use, there are still many drawbacks and limitations. One of the main drawbacks is low bioavailability, this causes the diabetic patients to take the drugs frequently to lower the blood glucose levels continuously. Some patients may have to take multiple drugs to increase the effectiveness of lowering blood glucose levels. To address these limitations, nano-based drug delivery systems have emerged to overcome these problems. It has emerged as a promising approach for diabetes management, which offers controlled and localized release of anti-diabetic drugs, thus enhancing therapeutic efficacy. This review discusses recent advances in the field of nano-based drug delivery systems for diabetes management, safety and toxicity profiles of anti-diabetic drugs, and future perspectives for the development of nanomedicine in diabetic treatment. Literature search was conducted using electronic databases, and only English literatures were used and published between 2014 and 2024. Recent advancements in nanotechnology have facilitated the development of various nanocarriers, such as polymeric carrier nanoparticles, nanoliposomes, nanocrystals, nanosuspension and inorganic nanoparticles, which enhance drug stability, bioavailability, and efficacy. These systems can deliver anti-diabetic drugs and natural compounds more effectively, thereby minimizing side effects and improving patient compliance. As the field continues to evolve, the successful clinical implementation of nanodrugs could revolutionize the management of diabetes and improve the quality of life for millions of diabetic patients worldwide.

Pancreatic Comorbidities in Pediatric Celiac Disease: Exocrine Pancreatic Insufficiency, Pancreatitis, and Diabetes Mellitus

Celiac disease (CD) is a chronic and immune-mediated disorder triggered by the ingestion of gluten in some genetically predisposed individuals. CD can be associated with extra-gastrointestinal manifestations and diseases affecting several organs. In this review, the aim is to analyze and discuss the pancreatic alterations and/or comorbidities that could arise in the context of pediatric CD. Exocrine pancreatic insufficiency (EPI) can be observed in a variable fraction (up to 30%) of children diagnosed with CD at the diagnosis; indeed, it usually resolves after the implementation of a gluten-free diet (GFD). The main pathophysiological mechanisms of EPI could be represented by the impaired pattern of gastrointestinal hormones in CD patients. Conversely, pancreatitis seems to be a very rare comorbidity in CD children, since very few cases have been described in children. Therefore, there is no evidence that pancreatitis (including autoimmune forms) represents a relevant comorbidity in pediatric CD. Type 1 diabetes mellitus (T1DM) is a well-known and frequent comorbidity in CD children. The main determinant of this epidemiological association is the common HLA-related predisposing background, even if other (non-HLA-related) genetic and environmental factors (viruses, gut microbiome, and others) are likely to be also implicated in the development of both these autoimmune diseases. T1DM children with concomitant CD may experience specific challenges in the adherence to GFD, which has no negative impact on the glycemic and, in general, metabolic control of diabetes, if it is properly implemented and followed up.

Therapeutic potential of anti-thymocyte globulin in type 1 diabetes: A systematic review

BACKGROUND

Type 1 diabetes (T1D) is an autoimmune condition characterized by the destruction of insulin-producing beta cells in the pancreas. Anti-Thymocyte Globulin (ATG) has emerged as a promising immunomodulatory therapy aimed at preserving beta-cell function and altering the disease course. This systematic review synthesizes current evidence from the clinical trials evaluating the efficacy and safety of low-dose ATG in individuals with T1D.

METHODS

We conducted a comprehensive literature search of electronic databases, including PubMed (MEDLINE), Science Direct, Scopus, EMBASE, and ClinicalTrials.gov, to identify studies investigating ATG in T1D in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The Joanna Briggs Institute (JBI) Critical Appraisal Tools for randomized clinical trials and case-control studies were used to assess the quality and evaluate the risk of bias in the eligible studies.

RESULTS

The primary outcomes assessed were preservation of C-peptide levels, glycemic control, and adverse events. Results indicated that ATG showed potential in preserving beta-cell function and improving clinical outcomes in recent-onset T1D. However, the incidence of adverse events, such as cytokine release syndrome and lymphopenia, necessitated careful monitoring and management.

CONCLUSION

Low-dose ATG presents a promising therapeutic approach for modifying the progression of T1D. While early-phase trials demonstrate potential benefits in preserving beta-cell function, further large-scale, long-term studies are essential to establish optimal dosing regimens, long-term efficacy, and safety profiles. This review highlights the importance of continued research to fully elucidate the role of ATG in T1D management.

Type 1 Diabetes Mellitus and Vitamin D

Type 1 diabetes mellitus (T1DM) is a multifactorial disease in which environmental factors and genetic predisposition interact to induce an autoimmune response against pancreatic β-cells. Vitamin D promotes immune tolerance through immunomodulatory and anti-inflammatory functions. The aim of this study is to provide a narrative review about the association between vitamin D status in the pathogenesis of T1DM and the role of vitamin D supplementation in the prevention and treatment of T1DM. Although vitamin D deficiency is more prevalent in children/adolescents with new-onset T1DM than in healthy individuals, there does not appear to be an association between vitamin D status before diagnosis and the onset of T1DMD later in life. The results of vitamin D as adjuvant therapy have, at best, a positive short-term effect in newly diagnosed T1DM patients. Intervention studies have been conducted in the clinical phase of T1DM, but it would be desirable to do so in the early stages of the autoimmune process (pre-diabetes).

Insulin Resistance in Type 1 Diabetes: Pathophysiological, Clinical, and Therapeutic Relevance

People with type 1 diabetes (T1D) are usually considered to exclusively exhibit β-cell failure, but they frequently also feature insulin resistance. This review discusses the mechanisms, clinical features, and therapeutic relevance of insulin resistance by focusing mainly on human studies using gold-standard techniques (euglycemic-hyperinsulinemic clamp). In T1D, tissue-specific insulin resistance can develop early and sustain throughout disease progression. The underlying pathophysiology is complex, involving both metabolic- and autoimmune-related factors operating synergistically. Insulin treatment may play an important pathogenic role in predisposing individuals with T1D to insulin resistance. However, the established lifestyle-related risk factors and peripheral insulin administration inducing glucolipotoxicity, hyperinsulinemia, hyperglucagonemia, inflammation, mitochondrial abnormalities, and oxidative stress cannot always fully explain insulin resistance in T1D, suggesting a phenotype distinct from type 2 diabetes. The mutual interaction between insulin resistance and impaired endothelial function further contributes to diabetes-related complications. Insulin resistance should therefore be considered a treatment target in T1D. Aside from lifestyle modifications, continuous subcutaneous insulin infusion can ameliorate insulin resistance and hyperinsulinemia, thereby improving glucose toxicity compared with multiple injection insulin treatment. Among other concepts, metformin, pioglitazone, incretin-based drugs such as GLP-1 receptor agonists, sodium-glucose cotransporter inhibitors, and pramlintide can improve insulin resistance, either directly or indirectly. However, considering the current issues of high cost, side effects, limited efficacy, and their off-label status, these agents in people with T1D are not widely used in routine clinical care at present.

Intervention to reduce barriers to type 1 diabetes self-management: Diabetes Journey study design and participant characteristics

Most adolescents with type 1 diabetes (T1D) encounter barriers to achieving optimal glycemia, including effective planning and monitoring their T1D and problem-solving, and following through with T1D treatment decisions. Thus, the overall aim of Diabetes Journey, a randomized controlled clinical trial, was to assess the feasibility, acceptability, and preliminary efficacy of a novel, amusement park-themed, web-based mobile health (mHealth) intervention tailored for adolescents who experienced barriers to T1D self-management. Secondary aims included examining post-intervention changes in T1D health-related quality of life, T1D self-management behaviors, and hemoglobin A1c (HbA1c). This article describes the study rationale, recruitment, design, and baseline characteristics of the adolescents (aged 12-17 years) who were randomized to one of two groups: Diabetes Journey or Enhanced Standard of Care. Diabetes Journey focused on reducing challenges related to stress, burnout, time pressure, and planning through the delivery of 5-8 intervention sessions using a problem-solving framework. Enhanced Standard of Care participants attended 4 education sessions focused on similar topics through the T1D Toolkit© website (educational content and brief videos about T1D). Adolescents (N = 195) were recruited with n = 162 randomized (Mage = 14.8 ± 1.6 years; 50 % female, 88 % White; HbA1c% = 8.2 ± 1.8; 86 % on insulin pumps). Diabetes Journey was impacted by COVID-19 and modifications to the study design were warranted. Future directions include examining the impact of Diabetes Journey on primary and secondary outcomes, while accounting for the impact of COVID-19.

Exploring Environmental and Cardiometabolic Impacts Associated with Adherence to the Sustainable EAT-Lancet Reference Diet: Findings from the China Health and Nutrition Survey

BACKGROUND

To contribute to the growing evidence on the potential co-benefits of the EAT-Lancet reference diet for cardiometabolic health and sustainability, we investigated this topic in a nationwide prospective cohort of Chinese adults. Adherence to this diet has been measured using several indices, including the World Index for Sustainability and Health (WISH) and the Planetary Health Diet Index (PHDI).

OBJECTIVES

We aimed to investigate the associations between adherence to the EAT-Lancet reference diet, as evaluated by WISH and PHDI, with risk of new-onset cardiometabolic diseases (CMDs), risk of all-cause mortality, and greenhouse gas (GHG) emissions.

METHODS

We included adults (n = 14,652 for CMDs and 15,318 for all-cause mortality) from the China Health and Nutrition Survey (1997-2015) in the analysis. Dietary intake data were collected, and WISH and PHDI scores were computed with established methods. CMDs included myocardial infarction (MI), type 2 diabetes mellitus (T2DM), and stroke. We used Cox proportional hazard regression models to analyze data with a mean of 10 years of follow-up from the date of baseline to the end of study or until the occurrence of the event of interest, whichever came first. We adjusted for sociodemographic, anthropometric, lifestyle, and dietary characteristics of participants as confounders.

RESULTS

Greater adherence to the EAT-Lancet reference diet, as reflected by higher WISH or PHDI scores, was inversely associated with risk of MI {Q4 vs. Q1: hazard ratio  ( HR ) = 0.68 [95% confidence interval (CI): 0.48, 0.96] for WISH and 0.14 (95% CI: 0.07, 0.29) for PHDI}, T2DM [Q4 vs. Q1: HR = 0.81 (95% CI: 0.67, 0.96) for WISH and 0.68 (95% CI: 0.57, 0.82) for PHDI], and all-cause mortality [Q4 vs. Q1: HR = 0.80 (95% CI: 0.68, 0.95) for WISH and 0.60 (95% CI: 0.46, 0.80) for PHDI] in fully adjusted models (all p -trend < 0.05 ). Both WISH and PHDI were inversely associated with GHG emissions in fully adjusted models (all p -trend < 0.05 ). WISH and PHDI were not significantly associated with risk of stroke.

CONCLUSIONS

Our findings supported the co-benefits of the EAT-Lancet reference diet for both cardiometabolic health and environmental sustainability. Long-term adherence to this reference diet as effectively indicated by either higher WISH or PHDI scores may reduce the risk and burden of CMDs and all-cause mortality in Chinese adults. https://doi.org/10.1289/EHP15006.

Modeling the number of new cases of childhood type 1 diabetes using Poisson regression and machine learning methods; a case study in Saudi Arabia

Diabetes mellitus stands out as one of the most prevalent chronic conditions affecting pediatric populations. The escalating incidence of childhood type 1 diabetes (T1D) globally is a matter of increasing concern. Developing an effective model that leverages Key Performance Indicators (KPIs) to understand the incidence of T1D in children would significantly assist medical practitioners in devising targeted monitoring strategies. This study models the number of monthly new cases of T1D and its associated KPIs among children aged 0 to 14 in Saudi Arabia. The study involved collecting de-identified data (n=377) from diagnoses made between 2010 and 2020, sourced from pediatric diabetes centers in three cities across Saudi Arabia. Poisson regression (PR), and various machine learning (ML) techniques, including random forest (RF), support vector machine (SVM), and K-nearest neighbor (KNN), were employed to model the monthly number of new T1D cases using the local data. The performance of these models was assessed using both numbers of KPIs and metrics such as the coefficient of determination ([Formula: see text]), root mean squared error (RMSE), and mean absolute error (MAE). Among various Poisson and ML models, both model considering birth weight over 3.5 kg, maternal age over 25 years at the child's birth, family history of T1D, and nutrition history, specifically early introduction to cow milk and model taking into account birth weight over 3.5 kg, maternal age over 25 years at the child's birth, and nutrition history (early introduction to cow milk) emerged as the best-reduced models. They achieved [Formula: see text] of (0.89,0.88), RMSE (0.82, 0.95) and MAE(0.62,0.67). Additionally, models with fewer KPIs, like model that considers maternal age over 25 years and early introduction to cow milk, achieved consistently high [Formula: see text] values ranging from 0.80 to 0.83 across all models. Notably, this model demonstrated smaller values of RMSE (0.92) and MAE (0.67) in the KNN model. Simplified models facilitate the efficient creation and monitoring of KPIs profiles. The findings can assist healthcare providers in collecting and monitoring influential KPIs, enabling the development of targeted strategies to potentially reduce, or reverse, the increasing incidence rate of childhood T1D in Saudi Arabia.

T helper 17 cells and interleukin-17 immunity in type 1 diabetes: From pathophysiology to targeted immunotherapies

Type 1 diabetes (T1D) is a chronic organ-specific autoimmune disorder characterized by a progressive loss of the insulin-secreting pancreatic beta cells, which ultimately results in insulinopenia, hyperglycemia and lifelong need for exogenous insulin therapy. In the pathophysiological landscape of T1D, T helper 17 cells (Th17 cells) and their hallmark cytokine, interleukin (IL)-17, play pivotal roles from disease onset to disease progression. In this narrative mini-review, we discuss the dynamic interplay between Th17 cells and IL-17 in the context of T1D, providing insights into the underlying immunologic mechanisms contributing to the IL-17-immunity-mediated pancreatic beta-cell destruction. Furthermore, we summarized the main animal and clinical studies that investigated Th17- and IL-17-targeted interventions as promising immunotherapies able to alter the natural history of T1D.

The role of CRISPR-Cas9 and CRISPR interference technologies in the treatment of autoimmune diseases

Autoimmune disorders can be described as inappropriate immune responses directed against self-antigens, which account for substantial healthcare concerns around the world. Immunosuppression or immune modulation are the main therapeutic modalities for autoimmune disorders. These modalities, however, impair the ability of the immune system to fight against infections, thereby predisposing to opportunistic diseases. This review explores existing therapies for autoimmune disorders, highlighting their limitations and challenges. Additionally, it describes the potential of CRISPR-Cas9 technology as a novel therapeutic approach to address these challenges.

Study on the collaborative protective mechanism of Scutellariae Radix and Paeoniae Radix Alba against diabetic cardiomyopathy through the gut-heart axis

The modification of gut microbiota has been linked to diabetic cardiomyopathy, yet the precise mechanisms through which gut microbes impact cardiac injury remain unclear. Our study concentrated on the gut microorganisms, the intestinal mucosal barrier, and the metabolic pathways involving glucose and lipids in mice afflicted with diabetic cardiomyopathy, while also investigating the cardioprotective properties of Scutellariae Radix and Paeoniae Radix Alba. Using a db (Leptin receptor gene-deficient mouse) mouse model of diabetic cardiomyopathy, we observed that these mice exhibited a decline in the diversity of intestinal microbes, alterations in the abundance of diabetes-related microorganisms, a decrease in Firmicutes, an increase in Helicobacter, and an overall rise in intestinal microbial populations. We pinpointed the inflammatory response and the compromised permeability of the intestinal lining as key contributors to the decline of the intestinal mucosal barrier, subsequently leading to cardiac injury. Administering Scutellariae Radix and Paeoniae Radix Alba was shown to restore the equilibrium of the intestinal microbiota, modify metabolic pathways involving glycerophospholipids, arachidonic acid, and additional metabolites within the myocardial tissue through bile acid, taurine, and associated metabolic processes, resulting in lessened cardiac dysfunction, hypertrophy, and fibrosis in the diabetic cardiomyopathy mice. In conclusion, our findings indicate that the intestinal microbiota, intestinal mucosal barrier, and glycolipid metabolism are disrupted in mice with diabetic cardiomyopathy; however, Scutellariae Radix and Paeoniae Radix Alba may effectively reverse these alterations. These results offer valuable insights for creating therapeutic strategies aimed at mitigating cardiac damage linked to diabetes by focusing on the gut microbiota and glucose and lipid metabolism.

Salt-inducible kinases transduce mechanical forces into the specification of the pancreatic endocrine lineage

The extracellular matrix-F-actin-Yes-associated protein 1 (YAP1)-Notch mechanosignaling axis is a gatekeeper in the fate decisions of bipotent pancreatic progenitors (bi-PPs). However, the link between F-actin dynamics and YAP1 activity remains poorly understood. Here, we identify salt-inducible kinases (SIKs) as mediators of F-actin-triggered changes in YAP1 activity. Interestingly, sodium chloride treatment promotes the differentiation of bi-PPs into NEUROG3+ endocrine progenitors (EPs) through enhanced SIK expression. Consistently, the pan-SIK inhibitor HG-9-09-01 (HG) inhibits latrunculin B (LatB)-induced EP differentiation via nuclear YAP1 accumulation. Unexpectedly, withdrawal of HG after a 12-h treatment increased SIK expression by a negative feedback mechanism, leading to significantly enhanced endocrinogenesis. Therefore, the combined treatment of bi-PPs with LatB and HG for 12 h boosted endocrinogenesis, ultimately leading to an increased number of beta cells. In summary, we identify SIKs as new transducers of mechanotransduction-triggered induction of pancreatic endocrine cell fates.

Long-term gamma-aminobutyric acid (GABA) treatment fails to regain beta-cell function in longstanding type 1 diabetes in a randomized trial

Gamma-amino butyric acid (GABA) has in experimental studies been found to promote beta-cell proliferation, enhance insulin secretion and reduce inflammation, positioning it as a candidate drug for type 1 diabetes (T1D) therapy. This phase I/II randomized controlled trial assessed the safety and efficacy of long-term treatment with Remygen® (Diamyd Medical), a controlled-release oral GABA formulation, as a potential beta-cell regenerative therapy in adults with long-standing T1D. Thirty-five male subjects with T1D (≥ 5 years) were randomized into three arms receiving the study drug(s) once daily for 6 months: GABA 200 mg (Arm 1), GABA 600 mg (Arm 2) and GABA 600 mg + alprazolam 0.5 mg for 3 months followed by GABA 600 mg alone for 3 months (Arm 3). Safety measures, hormonal counter-regulation during hypoglycemic clamps, fasting- and stimulated C-peptide levels, were assessed at multiple timepoints. Safety concerns included elevated aspartate aminotransferase (AST) in nine subjects, leading to the withdrawal of two subjects. Most elevations were, however, transient with no dose-differences. No effects were observed on fasting- or stimulated C-peptide levels, CGM metrics or HbA1c. Hypoglycemic hormonal counter-regulation was unaltered. To conclude, we found no clinical evidence of a beta-cell regenerative effect of GABA, but side effects were commonly observed.

Integrative Proteogenomic Analyses Provide Novel Interpretations of Type 1 Diabetes Risk Loci Through Circulating Proteins

ARTICLE HIGHLIGHTS

Identification of circulating proteins that may play a role in the pathogenesis of type 1 diabetes can provide promising targets for biomarker and drug target identification. Supported by multiple lines of evidence, circulating abundances of CTSH, IL27RA, SIRPG, and PGM1 were associated with the risk of type 1 diabetes. Tissues and cell types with enrichment of target protein-coding gene expression were identified. CTSH, IL27RA, SIRPG, and PGM1 may be explored as biomarkers or drug targets for type 1 diabetes.

Empagliflozin Reduces High Glucose-Induced Cardiomyopathy in hiPSC-Derived Cardiomyocytes : Glucose-induced Lipotoxicity in hiPSC-Derived Cardiomyocytes

Human-induced pluripotent stem cell (hiPSC) technology has been applied in pathogenesis studies, drug screening, tissue engineering, and stem cell therapy, and patient-specific hiPSC-derived cardiomyocytes (hiPSC-CMs) have shown promise in disease modeling, including diabetic cardiomyopathy. High glucose (HG) treatment induces lipotoxicity in hiPSC-CMs, as evidenced by changes in cell size, beating rate, calcium handling, and lipid accumulation. Empagliflozin, an SGLT2 inhibitor, effectively mitigates the hypertrophic changes, abnormal calcium handling, and contractility impairment induced by HG. Glucose concentration influences SGLT2 expression in cardiomyocytes, highlighting its potential role in diabetic cardiomyopathy. These findings support the potential utility of hiPSC-CMs in studying diabetic cardiomyopathy and the efficacy of empagliflozin in ameliorating HG-induced cardiomyocyte dysfunction. Such research may advance developments in precision medicine and therapeutic interventions for patients with diabetic cardiomyopathy.

The association between air pollution and three types of diabetes: An umbrella review of systematic reviews and meta-analyses

BACKGROUND

Despite numerous meta-analyses showing an association between air pollutants and diabetes, there is considerable heterogeneity between studies.

OBJECTIVES

This study aims to evaluate the cumulative evidence regarding the association between air pollution and type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) through systematic reviews and meta-analyses.

METHODS

Following the PRISMA 2020 guidance, a comprehensive review across three databases, including Web of Science, Embase, and PubMed, from inception to September 30, 2024. The quality of the included systematic reviews was assessed using the AMSTAR 2 tool. The research protocol has been registered in PROSPERO (CRD42024594953).

RESULTS

A total of 19 meta-analyses were identified in this review, including two articles investigating the impact of air pollution on T1DM, nine on T2DM, and ten on GDM. Due to limited data, no significant relationship between air pollution and T1DM was found. There is evidence that exposure to particulate matter (PM2.5 and PM10) may significantly increase the risk of T2DM. However, meta-analyses concerning GDM exhibit a less consistent association between air pollution and GDM risk, which varies by pollutant and duration of exposure.

CONCLUSION

Results suggest that exposure to air pollution may increase diabetes risk to some extent, particularly for T2DM. However, due to limited available studies, further prospective cohort studies are warranted to elucidate the role of air pollutants in diabetes, particularly for T1DM. Additionally, understanding potential mechanisms by which air pollution affects diabetes is crucial for future investigations.

Are children and adolescents with type 1 diabetes mellitus prone to psychiatric issues? A cross-sectional comparative study

Background

Type 1 Diabetes mellitus (T1DM) is a common chronic disorder, among the children and adolescents, posing both physical and psychological challenges.

Aims

To assess and compare the prevalence of emotional and behavioral problems in children and adolescents with T1DM to healthy controls. Secondly, to evaluate differences in emotional and behavioral problems across various sociodemographic and clinical variables within the T1DM group.

Methods

Children aged 6-18 with T1DM and age-matched controls were assessed using the Child Behavioral Checklist and the Strengths and Difficulties Questionnaire. Statistical analyses examined associations between emotional and behavioral problems and socio-demographic or clinical factors.

Results

Among 62 cases and 63 controls, T1DM patients showed significantly higher internalizing, externalizing, and total problems (P < 0.05). Psychological issues were linked to factors like celiac disease comorbidity, poor peer adjustment, and temperament. Additionally, higher SDQ scores were observed in cases with more than 2 hours of daily screen time.

Conclusion

Those with T1DM experience more emotional and behavioral problems than controls, highlighting the need for psychiatric screening and interventions in T1DM management.

RAGE gene polymorphism (rs1800625) and type 1 diabetes mellitus: A potential new model for early diagnosis and risk prediction

Studies have associated advanced glycation end-products (AGEs) and the polymorphism of the AGEs receptor (RAGE) gene with clinical disorders, such as diabetes, in certain ethnic groups. However, its association with type 1 diabetes mellitus (T1DM) in Egyptians has not yet been explored. The aim of this study was to investigate the association between the RAGE gene polymorphism rs1800625 and T1DM susceptibility in Egyptians. A case- control study was conducted with 177 T1DM patients and 177 age- and sex-matched healthy controls. Variables included glycemic markers (fasting blood glucose (FBG), postprandial blood glucose (PBG), hemoglobin A1c (HbA1c)), anthropometric measurements (waist circumference, body mass index (BMI)), lipid profile (total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL)), renal function (albumin-to-creatinine ratio (A/C ratio), serum creatinine), and history of hypertension and smoking. Genotype distribution and allele frequency of the RAGE rs1800625 polymorphism (TT, TC, CC genotypes; T and C alleles) were assessed. This study identified the RAGE rs1800625 polymorphism as a significant genetic factor associated with T1DM susceptibility. The CC genotype was significantly more prevalent in patients compared to controls (29.9% vs 11.9%; OR: 3.62; 95%CI: 1.87-6.97; p < 0.001). Similarly, the C allele was more common in patients (54.5% vs 41.0%, OR: 1.73; 95%CI: 1.28-2.33; p < 0.001). Multivariate analysis revealed that HbA1c (adjusted OR (aOR):  12.97; 95%CI: 4.00-42.05; p < 0.001), FBG (aOR: 8.96; 95%CI: 1.59-50.47; p = 0.010), and the rs1800625 polymorphism (aOR: 1.82; 95%CI: 1.146-2.876; p = 0.010) were significant predictors of T1DM. In conclusion, a genetic association was found between the RAGE gene polymorphism rs1800625 and T1DM susceptibility, with the CC genotype and C allele being more common in T1DM patients. FBG, HbA1c, and rs1800625 were identified as key predictors for T1DM, with HbA1c being the strongest. These findings highlight the importance of integrating genetic and metabolic factors in managing T1DM.

Regulatory T cell-based therapies for type 1 diabetes: a narrative review

Type 1 diabetes (T1D) is an autoimmune disease caused by the destruction of pancreatic insulin-secreting beta cells, resulting in hyperglycemia and a lifelong need for exogenous insulin therapy. Regulatory T cells (Tregs) are essential for maintaining immune tolerance and preventing autoimmune reactions. It has been shown that dysfunctional Tregs participate in the pathophysiology of T1D. Therapeutic approaches designed to enhance Treg stability, survival, and function have progressively emerged as a promising treatment strategy for T1D. This narrative review explores the potential of Treg cell-based therapy as a therapeutic tool to alter the natural history of T1D. It discusses different pharmacological strategies to enhance Treg stability and function, as well as the latest advances in Treg cell-based therapies, including adoptive Treg cell therapy and genetic engineering of Tregs. It also outlines current challenges and future research directions for integrating Treg cell-based therapy into clinical practice, aiming to provide a comprehensive overview of its potential benefits and limitations as an innovative therapeutic intervention for T1D.

Dysregulation and therapeutic prospects of regulatory T cells in type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune disease that selectively destroys β-cells in the pancreas that produce insulin. Several studies have implicated and elaborated the significant role of regulatory T cells (Tregs) in the pathogenesis of T1D. Tregs are a specialized subset of T cells and are critical regulators of peripheral self-tolerance. However, if the number, function, or stability of these cells is altered, it can lead to autoimmunity. This review summarizes the current knowledge and understanding about Treg function in both health and T1D, Tregs dysregulation, and various factors, including microRNAs, that affect their dysregulation in T1D. The review also focuses on the advantages and challenges of Treg-based therapies for T1D.

A Multidisciplinary Approach of Type 1 Diabetes: The Intersection of Technology, Immunotherapy, and Personalized Medicine

Background: Type 1 diabetes (T1D) is a chronic autoimmune disorder characterized by the destruction of pancreatic β-cells, leading to absolute insulin deficiency. Despite advancements in insulin therapy and glucose monitoring, achieving optimal glycemic control remains a challenge. Emerging technologies and novel therapeutic strategies are transforming the landscape of T1D management, offering new opportunities for improved outcomes. Methods: This review synthesizes recent advancements in T1D treatment, focusing on innovations in continuous glucose monitoring (CGM), automated insulin delivery systems, smart insulin formulations, telemedicine, and artificial intelligence (AI). Additionally, we explore biomedical approaches such as stem cell therapy, gene editing, immunotherapy, gut microbiota modulation, nanomedicine-based interventions, and trace element-based therapies. Results: Advances in digital health, including CGM integration with hybrid closed-loop insulin pumps and AI-driven predictive analytics, have significantly improved real-time glucose management. AI and telemedicine have enhanced personalized diabetes care and patient engagement. Furthermore, regenerative medicine strategies, including β-cell replacement, CRISPR-based gene editing, and immunomodulatory therapies, hold potential for disease modification. Probiotics and microbiome-targeted therapies have demonstrated promising effects in maintaining metabolic homeostasis, while nanomedicine-based trace elements provide additional strategies to regulate insulin sensitivity and oxidative stress. Conclusions: The future of T1D management is shifting toward precision medicine and integrated technological solutions. While these advancements present promising therapeutic avenues, challenges such as long-term efficacy, safety, accessibility, and clinical validation must be addressed. A multidisciplinary approach, combining biomedical research, artificial intelligence, and nanotechnology, will be essential to translate these innovations into clinical practice, ultimately improving the quality of life for individuals with T1D.

BASTA, a simple whole-blood assay for measuring β cell antigen-specific CD4+ T cell responses in type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune disease where T cells mediate the destruction of the insulin-producing β cells found within the islets of Langerhans in the pancreas. Autoantibodies to β cell antigens are the only tests available to detect β cell autoimmunity. T cell responses to β cell antigens, which are known to cause T1D, can only be measured in research settings because of the complexity of assays and the large blood volumes required. Here, we describe the β cell antigen-specific T cell assay (BASTA). BASTA is a simple whole-blood assay that can detect human CD4+ T cell responses to β cell antigens by measuring antigen-stimulated interleukin-2 (IL-2) production. BASTA is both more sensitive and specific than the CFSE (carboxyfluorescein diacetate succinimidyl ester)-based proliferation assay. We used BASTA to identify the regions of preproinsulin that stimulated T cell responses specifically in blood from people with T1D. BASTA can be done with as little as 2 to 3 milliliters of blood. We found that effector memory CD4+ T cells are the primary producers of IL-2 in response to preproinsulin peptides. We then evaluated responses to individual and pooled preproinsulin peptides in a cross-sectional study of pediatric patients: without T1D, without T1D but with a first-degree relative with T1D, or diagnosed with T1D. In contrast with other preproinsulin peptides, full-length C-peptide (PI33-63) showed high specificity for T1D [area under the curve (AUC) = 0.86)]. We suggest that BASTA will be a useful tool for monitoring changes in β cell-specific CD4+ T cell responses both in research and clinical settings.

Integrated histopathology of the human pancreas throughout stages of type 1 diabetes progression

Type 1 diabetes (T1D) is a progressive autoimmune condition that culminates in the loss of insulin-producing beta cells. Pancreatic histopathology provides essential insights into disease initiation and progression yet an integrated perspective of in situ pathogenic processes is lacking due to limited sample availability, the dispersed nature of anatomical lesions, and often restricted analytical dimensionality. Here, we combined multiplexed immunostaining, high-magnification whole-slide imaging, digital pathology, and semi-automated image analysis strategies to interrogate pancreatic tail and head regions obtained from organ donors across T1D stages including at-risk and at-onset cases. Deconvolution of architectural features, endocrine cell composition, immune cell burden, and spatial relations of ~25,000 islets revealed a series of novel histopathological correlates especially in the prodromal disease stage preceding clinical T1D. Altogether, our comprehensive "single-islet" analyses permit the reconstruction of a revised natural T1D history with implications for further histopathological investigations, considerations of pathogenetic modalities, and therapeutic interventions.

Current status, trend changes, and future predictions of the disease burden of type 1 diabetes kidney disease in global and China

Objective

This study analyzes the global and China trends in the prevalence, disease burden, and future projections of Type 1 Diabetic Nephropathy (T1DN) over the past three decades, providing data to inform public health policies and clinical interventions.

Methods

Data from the Global Burden of Disease (GBD) 2021 database were used to analyze the incidence, prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) of T1DN globally and in China from 1990 to 2021. Trend analysis was conducted using R and Joinpoint software, and the ARIMA model was applied to predict future trends in T1DN prevalence for the next 20 years. A significance level of p<0.05 was applied.

Results

Globally, deaths from T1DN increased from 49,300(95% CI: 39,088-61,207) in 1990 to 94,020 (95% CI: 71,456-119,984)in 2021, with the age-standardized mortality rate remaining stable. DALYs rose from 2,227,518(95% CI: 1,835,372-2,679,207) in 1990 to 3,875,628 (95% CI: 3,062,395-4,845,503) in 2021, though the age-standardized rate slightly decreased. In China, the mortality rate declined significantly, and DALYs decreased, with the age-standardized DALYs dropping from 80.915/100,000(95% CI: 65.121-98.391)to 47.953/100,000(95% CI: 36.9-60.734). Globally, both incidence and prevalence increased, with global incidence reaching 95,140(95% CI: 82,236-111,471) cases and prevalence rising to 6,295,711 (95% CI: 5,459,693-7,114,345)cases. In China, incidence showed a declining trend, but prevalence continued to rise. The ARIMA model forecasts global incidence will reach 115,000 cases, with prevalence reaching 7,000,000 by 2041. In China, incidence is expected to stabilize, while prevalence may increase to approximately 2,500,000 cases.

Conclusion

The burden of T1DN is rising globally, especially in terms of prevalence, while China has made progress in reducing mortality and disease burden. However, challenges remain in chronic disease management. Over the next 20 years, global prevalence is projected to continue increasing, while China's prevalence may stabilize. Targeted interventions for different age groups and genders will be essential in reducing the T1DN burden.

Clinical Features and HLA Genetics Differ in Children at Type 1 Diabetes Onset by Hispanic Ethnicity

CONTEXT

Type 1 diabetes incidence continues to increase in children, especially among Hispanic White (HW) children.

OBJECTIVE

We investigated the clinical, immunologic, and genetic characteristics of HW and non-Hispanic White (NHW) children who presented at type 1 diabetes diagnosis.

METHODS

In this single-center, observational study, children who were diagnosed with type 1 diabetes (≤20 years old) and tested for islet autoantibodies within 1 year of diagnosis were included in the study and divided into 2 groups by Hispanic ethnicity.

RESULTS

Of 1297 children, 398 HW children presented with a younger age at diabetes onset (10.2 ± 3.9 vs 11.1 ± 4.1 years, P < .001) and more diabetic ketoacidosis (62.4% vs 51.9%, P < .001) than NHW children (n = 899). There was no difference in sex, A1c levels, or the number and prevalence of islet autoantibodies between the 2 cohorts. A subset of our cohort was human leukocyte antigen (HLA) typed as specific alleles confer strong genetic risk for type 1 diabetes (eg, HLA-DR4 and DQ8). Among 637 HLA-typed children, HW children had a significantly higher prevalence of the DR4-DQ8 haplotype than NHW children (79.1% vs 60.1%, P < .001), and this frequency was much higher than a reference Hispanic population (OR 6.5, 95% CI 4.6-9.3).

CONCLUSION

Hispanic White children developing type 1 diabetes have a high prevalence of HLA DR4-DQ8, which can be utilized to select individuals for immune monitoring with islet autoantibodies to lessen diabetic ketoacidosis and potentially prevent diabetes onset.

Multilayered Freestanding Porous Polycarbonate Nanosheets with Directed Protein Permeability for Cell-Encapsulated Devices

Implantable pancreatic β cell-encapsulated devices are required for the treatment of type 1 diabetes. Such devices should enable a semipermeable membrane to release insulin in response to glucose levels while avoiding immune reactions. Micrometer-thick track-etched porous polycarbonate (PC) membranes have been used for this purpose. However, the immediate release of insulin remains a challenge in the development of such semipermeable membranes. Herein, we attempted to develop a freestanding polymeric ultrathin film (nanosheet) with a porous structure that can be used in a cell-encapsulated device. Specifically, we fabricated a nonbiodegradable, porous PC nanosheet to enhance molecular permeability. The nanosheet was multistacked to ensure the controlled permeability of proteins of various molecular weights, such as insulin and IgG. The porous PC nanosheet was prepared by gravure coating using a blend solution comprising PC and polystyrene (PS) to induce macro-phase separation of the PC and PS. When the PC:PS weight ratio of the mixture was reduced to 3:1, we succeeded in fabricating a porous PC nanosheet (thickness: 100 nm, diameter: < 2.5 μm). A triple layer of such porous nanosheets with various pore sizes demonstrated 10 times less protein clogging, 10 times higher insulin permeability, and comparable IgG-blocking capability compared with commercially available porous PC membranes (thickness: 10 μm). Finally, we demonstrated that a cell-encapsulated device equipped with the multilayered porous PC nanosheet as a permeable membrane preserved the glucose response level of insulin-producing cells before, during, and after the cell-encapsulation process. We believe that cell-encapsulated devices equipped with such porous PC nanosheets will enable immediate insulin release in response to changes in glucose levels.

Glucose-Responsive Materials for Smart Insulin Delivery: From Protein-Based to Protein-Free Design

Over the last four decades, glucose-responsive materials have emerged as promising candidates for developing smart insulin delivery systems, offering an alternative approach to treating diabetes. These materials replicate the pancreas's natural "closed loop" insulin secretion function by detecting changes in blood glucose levels and releasing insulin accordingly. This perspective highlights the evolution of glucose-responsive materials from protein-based materials, such as glucose oxidase (GOx), and glucose-binding proteins, such as concanavalin A (ConA), to protein-free materials, including phenylboronic acid (PBA) and their applications in smart insulin delivery. We first describe protein-based glucose-responsive systems that depend on different macromolecules, including enzymes and proteins, that interact directly with glucose to promote insulin release. However, these systems encounter significant stability, scalability, and immunogenicity challenges. In contrast, protein-free systems include hydrogels, nanogels/microgels, and microneedle patches, offering long-term stability and storability. In this direction, we discuss the design principles, mechanisms of glucose/pH sensitivity, and the disintegration of both protein-based and protein-free systems into different glucose environments. Finally, we outline the key challenges, potential solutions, and prospects for developing smart insulin delivery systems.

The type 1 diabetes candidate genes PTPN2 and BACH2 regulate novel IFN-α-induced crosstalk between the JAK/STAT and MAPKs pathways in human beta cells

Type 1 diabetes (T1D) is a chronic autoimmune disease that leads to the progressive loss of pancreatic beta cells. Interferons (IFNs) contribute to the initiation and amplification of beta cell autoimmunity. STAT1 is the main mediator of IFN signalling but little is known on its complex activation processes and role in the progression of beta cell failure. We presently show that two T1D candidate genes (i.e. PTPN2 and BACH2) modulate STAT1 activation via two different pathways, namely the JAK/STAT, involved in the short-term phosphorylation of its tyrosine residue (Y701), and the MAPKs pathway, involved in the long-term phosphorylation of its serine residue (S727). Each STAT1 phosphorylation type can independently induce expression of the chemokine CXCL10, but both residues are necessary for the expression of MHC class I molecules. IFN-α-induced STAT1 activation is dynamic and residue-dependent, being STAT1-Y701 fast (detectable after 4h) but transitory (back to basal by 24h) while STAT1-S727 increases slowly (peak at 48h) and is associated with the long-term effects of IFN-α exposure. These pathways can be chemically dissociated in human beta cells by the use of JAK1/2, TYK2 or JNK1 inhibitors. The present findings provide a novel understanding of the dynamics of STAT1 activation and will be useful to develop novel and hopefully targeted (i.e. favouring individuals with particular polymorphisms) therapies for T1D and other autoimmune diseases.

Double Diabetes: A Converging Metabolic and Autoimmune Disorder Redefining the Classification and Management of Diabetes

This review explores the pathophysiology, clinical implications, and management of double diabetes. The increasing prevalence of obesity, sedentary lifestyles, and genetic predisposition has blurred the difference between type 1 and type 2 diabetes, leading to diagnostic and therapeutic challenges. Double diabetes presents with overlapping symptoms from both diabetes types, making accurate diagnosis crucial. Biomarkers, such as C-peptide levels, autoantibody testing, and insulin resistance markers, help differentiate double diabetes from classic diabetes subtypes. Early intervention is necessary because of the condition's elevated risk of microvascular and macrovascular consequences, such as retinopathy, nephropathy, and cardiovascular disease. Effective management integrates pharmacological and lifestyle approaches. Metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin therapy adjustments all boost glycemic control and metabolic results. Additionally, structured exercise, dietary modifications, and weight management are essential for reducing insulin resistance and preserving beta-cell activity. The potential of precision medicine, artificial intelligence (AI)-driven healthcare, and continuous glucose monitoring (CGM) offers promising advancements for personalized treatment strategies. Future research should focus on targeted immunotherapies, genetic profiling, and refined clinical guidelines to improve early detection and individualized treatment, with long-term outcomes. The review emphasizes the need for a multidisciplinary approach in managing double diabetes, ensuring early diagnosis, optimized treatment, and improved metabolic health to mitigate long-term complications.

TCL1A in naïve B cells as a therapeutic target for type 1 diabetes

BACKGROUND

Type 1 diabetes (T1D) is an autoimmune disease characterised by the attack of pancreatic β cells by "self" immune cells. Although previous studies demonstrated that B cells contribute to T1D through antigen presentation and autoantibody production, the involvement of different populations of B cells, particularly in the early stages of T1D, has not been fully elucidated.

METHODS

In this study, we employed single-cell RNA sequencing (scRNA-seq) and flow cytometry to investigate immune cell populations in patients with newly diagnosed T1D, their relative controls and age-matched healthy controls. Phosphoprotein microarray analysis was employed to investigate changes in protein phosphorylation in B cells. Furthermore, we developed a siRNA-based nanomedicine and evaluated its therapeutic potential in the NOD mouse. The integration of scRNA-seq, flow cytometry, phosphoprotein microarrays, and functional assays established a robust framework for understanding and targeting B cell-mediated autoimmunity in T1D.

FINDINGS

Using single-cell RNA sequencing, we discovered that patients with T1D exhibited increased humoural immunity in the early stage of T1D. Specifically, the population of naïve B cells increased in patients with newly diagnosed T1D who expressed elevated levels of the AKT kinase coactivator TCL1A. Using a protein phosphorylation microarray, we confirmed that TCL1A knockdown specifically impaired AKT2 phosphorylation and affected B cell survival and proliferation. Notably, we discovered that the naïve B cell population increased and TCL1A expression was upregulated in NOD mice that developed T1D. Both the levels of naïve B cells and TCL1A were strongly associated with glucose intolerance in T1D mice. Importantly, treatment with a siRNA-based nanomedicine targeting Tcl1a mRNA effectively reduced the number of naïve B cells, prevented the loss of pancreatic β cells, and improved glucose intolerance in T1D mice.

INTERPRETATION

Using single-cell RNA-seq, we have not only uncovered a naïve B cell specific gene that may contribute to the pathogenesis of T1D but also highlighted the potential of siRNA-based nanomedicine for treating T1D. The clinical translation of these findings offers a new approach for the treatment of T1D.

FUNDING

See Acknowledgements.

Unveiling the Therapeutic Potential of the Second-Generation Incretin Analogs Semaglutide and Tirzepatide in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

Deep learning-based prediction of autoimmune diseases

Autoimmune Diseases are a complex group of diseases caused by the immune system mistakenly attacking body tissues. Their etiology involves multiple factors such as genetics, environmental factors, and abnormalities in immune cells, making prediction and treatment challenging. T cells, as a core component of the immune system, play a critical role in the human immune system and have a significant impact on the pathogenesis of autoimmune diseases. Several studies have demonstrated that T-cell receptors (TCRs) may be involved in the pathogenesis of various autoimmune diseases, which provides strong theoretical support and new therapeutic targets for the prediction and treatment of autoimmune diseases. This study focuses on the prediction of several autoimmune diseases mediated by T cells, and proposes two models: one is the AutoY model based on convolutional neural networks, and the other is the LSTMY model, a bidirectional LSTM network model that integrates the attention mechanism. Experimental results show that both models exhibit good performance in the prediction of the four autoimmune diseases, with the AutoY model performing slightly better in comparison. In particular, the average area under the ROC curve (AUC) of the AutoY model exceeded 0.93 in the prediction of all the diseases, and the AUC value reached 0.99 in two diseases, type 1 diabetes and multiple sclerosis. These results demonstrate the high accuracy, stability, and good generalization ability of the two models, which makes them promising tools in the field of autoimmune disease prediction and provides support for the use of the TCR bank for the noninvasive detection of autoimmune disease non-invasive detection is supported.

The epidemiology of type 1 diabetes mellitus in older adults

Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.

Effects of switching from MiniMed™ 640G to 770G on continuous glucose monitoring metrics and DTR-QOL scores: An observational study of Japanese people with type 1 diabetes mellitus

AIMS/INTRODUCTION

We evaluated the effect of the MiniMed™ 770G, an insulin pump using hybrid closed-loop technology, on blood glucose management and quality of life in Japanese people with type 1 diabetes.

MATERIALS AND METHODS

This was a 52-week, prospective, observational study. Fifty Japanese people with type 1 diabetes switched from the MiniMed™ 640G to 770G, and we analyzed the continuous glucose monitoring data of 24 subjects who used auto mode throughout the study. We also analyzed the scores of the Diabetes Therapy-Related Quality of Life questionnaire completed by 26 auto-mode users before and after the treatment change.

RESULTS

The baseline time in range 70-180 mg/dL was 67.3 (54.8-78.4)%, with a significant improvement beginning 8 weeks after the switch and lasting until 52 weeks. The baseline time below range <70 mg/dL was 1.9 (0.6-3.6)%, with a significant increase at week 8; however, the mean value was less than 4% throughout the study period. On the other hand, the number of blood glucose measurements significantly increased. While there was no significant difference in the overall change in the total Diabetes Therapy-Related Quality of Life score, there was a significant decrease in the treatment satisfaction score.

CONCLUSIONS

Use of the MiniMed™ 770G improved continuous glucose monitoring metrics. However, treatment satisfaction decreased, probably due to the increased frequency of blood glucose monitoring necessary to maintain auto mode.

Nutritional Diet Knowledge and Barriers to Dietary Recommendations Adherence Among Diabetic Patients in Central Region, Ghana: A Cross-Sectional Study

Background and Aim

Diabetes mellitus (DM) presents significant health risks due to elevated blood sugar levels, necessitating adherence to dietary recommendations for effective management. However, diabetic patients often encounter barriers hindering their adherence to dietary guidelines. This study sought to investigate the determinants of good nutritional diet knowledge and adherence to dietary recommendations beyond the barriers faced by diabetic patients in Ghana.

Methods

This was a cross-sectional prospective study that collected data using a tested and structured questionnaire from 100 diabetic patients from January 2024 to June 2024. Data was entered and analyzed using Microsoft Excel 2019 and SPSS (version 26). Bivariate and multivariable logistic regression was used to identify associations between dependent and independent variables. Statistical significance was set at a p-value ≤ 0.05.

Results

The mean age of the participants was 56.97 ± 11.98 years. Overall, about 74.44% had good nutritional diet knowledge. Being female (adjusted odds ratio [AOR] = 0.65, 95% confidence interval [CI] = [0.41-0.83]), and having complete tertiary education (AOR = 2.05, 95% CI = 0.96-3.82) were the factors associated with good nutritional diet knowledge. About 39% stopped their dietary plan without informing their doctor, and 60% stopped when they felt their condition was under control. The overall adherence to dietary recommendations was poor as only 48% adhered to the recommendations. Being female (AOR = 0.83, 95% CI = [0.49-2.11]), being 75 years or older (AOR = 2.74, 95% CI = 0.99-4.14), and having good nutritional knowledge (AOR = 2.80, 95% CI = 1.61-4.16) were the factors associated with good adherence to dietary recommendation.

Conclusion

The participants had good nutritional diet knowledge but poor adherence to dietary recommendations. Being female and having completed tertiary education were the determinants of good nutritional diet knowledge while being female, being 75 years or older, and having good nutritional knowledge were the factors associated with good adherence. The leading adherence barriers were the discomforts associated with cooking meals that meet their dietary requirements, dietary restrictions, and financial difficulties.

Beneficial effects of the remifentanil/thiopental combination on cardiac function and redox status in diabetic rats

This study aimed to examine the effect of thiopental monotherapy as well as its combination with different agents used in anesthesia induction, on cardiac function and redox state of rats with type 1 diabetes mellitus (T1DM). A total of 40 Wistar albino male rats were used in this study and randomly divided into five groups: thiopental (TIO), fentanyl + thiopental (FEN + TIO), remifentanil + thiopental (REM + TIO), midazolam + thiopental (MID + TIO), and dexmedetomidine + thiopental (DEX + TIO). Animals were anesthetized by intraperitoneal injection of thiopental 85 mg/kg, fentanyl 0.005 mg/kg, remifentanil 0.04 mg/kg, midazolam 2.5 mg/kg, and dexmedetomidine 0.05 mg/kg of body weight. Four weeks after T1DM induction, all animals were subjected to a short narcosis of tested anesthetic, sacrificed by cervical dislocation and the hearts were retrogradely perfused according to Langendorff technique. Our research demonstrated that most combined anesthetics negatively influenced cardiodynamic parameters and redox state in diabetic rats. However, significantly improved cardiac contractility associated with enhanced antioxidative capacity was achieved in the combination of TIO with REM, which distinguishes this anesthetic combination as the therapy with the most pronounced positive effect on cardiac function in state of T1DM.

Low-carbohydrate diet proved effective and safe for youths with type 1 diabetes: A randomised trial

AIM

Low-carbohydrate (LC) diets have gained popularity. We compared glycaemic and metabolic parameters following an LC versus a Mediterranean (MED) diet in adolescents and youths with type 1 diabetes.

METHODS

In a six-month, open-label, randomised trial, 40 individuals were assigned to either diet. Glycaemic outcomes, based on continuous glucose monitoring, included per cent time of blood glucose in the range [3.9-10.0 mmol/L (70-180 mg/dL)] and haemoglobin A1c (HbA1c).

RESULTS

Twenty-eight (70%) were females. The median age was 18 years. After 6 months, the median time in range increased from 47% to 58% in the LC and from 52% to 64% in the MED diet group (p = 0.98). The delta values for the time in range were 16% and 7% for the respective groups (p = 0.09). The percentage of time >13.9 mmol/L (>250 mg/dL) improved more in the LC diet than in the MED diet group: -10% vs. -2% (p = 0.005). The percentage of time <3.0 mmol/L (<54 mg/dL) was comparable. The delta HbA1c improved in both groups: -0.7% vs. -0.1% (p = 0.02). Changes in BMI Z-score and lipid levels were similar.

CONCLUSION

Both diets improved glycaemic outcomes in adolescents and youths with type 1 diabetes, without increasing hypoglycaemia or cardiovascular risk factors, indicating comparable safety and efficacy.

Inhibition of CD226 co-stimulation suppresses diabetes development in the NOD mouse by augmenting regulatory T cells and diminishing effector T cell function

AIMS/HYPOTHESIS

Immunotherapeutics targeting T cells are crucial for inhibiting autoimmune disease progression proximal to disease onset in type 1 diabetes. There is an outstanding need to augment the durability and effectiveness of T cell targeting therapies by directly restraining proinflammatory T cell subsets, while simultaneously augmenting regulatory T cell (Treg) activity. Here, we present a novel strategy for preventing diabetes incidence in the NOD mouse model using a blocking monoclonal antibody targeting the type 1 diabetes risk-associated T cell co-stimulatory receptor, CD226.

METHODS

Female NOD mice were treated with anti-CD226 at 7-8 weeks of age and then monitored for diabetes incidence and therapeutic mechanism of action.

RESULTS

Compared with isotype-treated controls, anti-CD226-treated NOD mice showed reduced insulitis severity (0.84-fold, p=0.0002) at 12 weeks and decreased disease incidence (HR 0.41, p=0.015) at 30 weeks. Flow cytometric analysis performed 5 weeks post treatment demonstrated reduced proliferation of conventional CD4+ T cells (0.87-fold, p=0.030) and CD8+ (0.78-fold, p=0.0018) effector memory T cells in spleens of anti-CD226-treated mice. Phenotyping of pancreatic Tregs revealed increased CD25 expression (2.05-fold, p=0.0073) and signal transducer and activator of transcription 5 (STAT5) phosphorylation (1.39-fold, p=0.0007) following anti-CD226, with splenic Tregs displaying augmented suppression of CD4+ responder T cells (Tresps) (1.49-fold, p=0.0008, 1:2 Treg:Tresp) in vitro. Anti-CD226-treated mice exhibited reduced frequencies of islet-specific glucose-6-phosphatase catalytic subunit-related protein (IGRP)-reactive CD8+ T cells in the pancreas, using both ex vivo tetramer staining (0.50-fold, p=0.0317) and single-cell T cell receptor sequencing (0.61-fold, p=0.022) approaches. 51Cr-release assays demonstrated reduced cell-mediated lysis of beta cells (0.61-fold, p<0.0001, 1:1 effector:target) by anti-CD226-treated autoreactive cytotoxic T lymphocytes.

CONCLUSIONS/INTERPRETATION

CD226 blockade reduces T cell cytotoxicity and improves Treg function, representing a targeted and rational approach for restoring immune regulation in type 1 diabetes.

Immune checkpoint inhibitor-related type 1 diabetes incidence, risk, and survival association

AIM/INTRODUCTION

Although immune checkpoint inhibitor-related type 1 diabetes mellitus (ICI-T1DM) is a rare condition, it is of significant concern globally. We aimed to elucidate the precise incidence, risk factors, and impact of ICI-T1DM on survival outcomes.

MATERIALS AND METHODS

The study is a large retrospective cohort study, performed using the DeSC Japanese administrative claims database comprising 11 million patients. The database population is reportedly similar to the entire population of Japan. Patients administered ICI between 2014 and 2022 were enrolled in the study, including 21,121 patients. The risk factors for ICI-T1DM development and their characteristics were evaluated by logistic regression analysis. Development of a new irAE after the day following the first administration of ICI was set as the study outcome.

RESULTS

ICI-T1DM was observed in 102 (0.48%) of the 21,121 patients after ICI initiation. PD-(L)1 and CTLA-4 combination therapy was associated with an increased risk of ICI-T1DM compared with PD-1 monotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.21-4.58; P = 0.01). Patients with a prior diagnosis of diabetes mellitus (OR, 1.59; 95% CI, 1.03-2.46; P = 0.04) or hypothyroidism (OR, 2.48; 95% CI, 1.39-4.43; P < 0.01) also exhibited an increased risk of ICI-T1DM. The Kaplan-Meier analysis revealed that patients with ICI-T1DM showed higher survival rates than those without (log-lank test, P < 0.01). Multivariable Cox regression analysis demonstrated that ICI-T1DM development was associated with lower mortality (hazard ratio, 0.60; 95% CI, 0.37-0.99; P = 0.04).

CONCLUSIONS

Collectively, the results of this study demonstrate the precise incidence and risk factors of ICI-T1DM. The development of ICI-T1DM, like other irAEs, is associated with higher survival rates.

Caspase family in autoimmune diseases

Programmed cell death (PCD) plays a crucial role in maintaining tissue homeostasis, with its primary forms including apoptosis, pyroptosis, and necroptosis. The caspase family is central to these processes, and its complex functions across different cell death pathways and other non-cell death roles have been closely linked to the pathogenesis of autoimmune diseases. This article provides a comprehensive review of the role of the caspase family in autoimmune diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), type 1 diabetes (T1D), and multiple sclerosis (MS). It particularly emphasizes the intricate functions of caspases within various cell death pathways and their potential as therapeutic targets, thereby offering innovative insights and a thorough discussion in this field. In terms of therapy, strategies targeting caspases hold significant promise. We emphasize the importance of a holistic understanding of caspases in the overall concept of cell death, exploring their unique functions and interrelationships across multiple cell death pathways, including apoptosis, pyroptosis, necroptosis, and PANoptosis. This approach transcends the limitations of previous studies that focused on singular cell death pathways. Additionally, caspases play a key role in non-cell death functions, such as immune cell activation, cytokine processing, inflammation regulation, and tissue repair, thereby opening new avenues for the treatment of autoimmune diseases. Regulating caspase activity holds the potential to restore immune balance in autoimmune diseases. Potential therapeutic approaches include small molecule inhibitors (both reversible and irreversible), biological agents (such as monoclonal antibodies), and gene therapies. However, achieving specific modulation of caspases to avoid interference with normal physiological functions remains a major challenge. Future research must delve deeper into the regulatory mechanisms of caspases and their associated complexes linked to PANoptosis to facilitate precision medicine. In summary, this article offers a comprehensive and in-depth analysis, providing a novel perspective on the complex roles of caspases in autoimmune diseases, with the potential to catalyze breakthroughs in understanding disease mechanisms and developing therapeutic strategies.