Apoptosis and the pathogenesis of IDDM: a question of life and death

In type 1 diabetes, an immune-mediated process leads to the destruction of pancreatic beta-cells. In the last decade, considerable progress has been made in understanding the cellular and biochemical pathogenic processes of the disease. However, more needs to be learned about the immune mechanisms leading to the development of autoreactive immune cells and the molecular mechanisms of beta-cell death. The study of apoptosis of autoreactive lymphocytes as well as apoptosis of beta-cells may give answers to many still unsolved questions. This review focuses on the possible role of apoptosis both in the regulation of immune mechanisms involved in the pathogenesis of type 1 diabetes and as a way for beta-cells to die. The advancement in the knowledge of the possible role of apoptosis and its regulation in the pathogenesis of type 1 diabetes may provide new therapeutic tools for the prevention of the disease.