Type 1 diabetes (T1D) is an autoimmune disease, the clinical onset of which most frequently presents in children and adolescents
who are genetically predisposed. T1D is characterized by specific insulin-producing beta cell destruction. The well-differentiated
and specialized islet beta cells seem to physiologically retain the ability to compensate for the cells lost by reproducing
themselves, whereas undifferentiated cell sources may help in generating new ones, even while the autoimmune process takes
place. Diabetes clinical onset, i.e., establishment of a detectable, chronic hyperglycemia, occurs at a critical stage when
autoimmunity, having acted for a while, supersedes the regenerative effort and reduces the number of beta cells below the
physiologic threshold at which the produced insulin becomes insufficient for the body's needs. Clinical solutions aimed at
avoiding cumbersome daily insulin administrations by the reestablishment of physiologic insulin production, like whole pancreas
or pancreatic islet allotransplantation, are limited by the scarcity of pancreas donors and by the toxic effects of the immunosuppressive
drugs administered to prevent rejection. However, new accumulating evidence suggests that, once autoimmunity is abrogated,
the endocrine pancreas properties may be sufficient to allow the physiological regenerative process to restore endogenous
insulin production, even after the disease has become clinically manifest. Knowledge of these properties of the endocrine
pancreas suggests the testing of reliable and clinically translatable protocols for obliterating autoimmunity, thus allowing
the regeneration of the patient's own endocrine cells. The safe induction of an autoimmunity-free status might become a new
promising therapy for T1D.
Key Words adult stem cells - autoimmunity - beta cell regeneration - islet transplantation - type 1 diabetes