Beyond the loss of beta cells: a quantitative analysis of islet architecture in adults with and without type 1 diabetes
Authors: Verschueren van Rees Nicolás , Ashwin Peter , McMullan Conor , Krogvold Lars , Dahl-Jørgensen Knut , Morgan Noel G. , Leete Pia , Wedgwood Kyle C. A. 
Published: February 2025

Abstract

Aims/hypothesis
The organisation and cellular architecture of islets of Langerhans are critical to the physiological regulation of hormone secretion but it is debated whether human islets adhere to the characteristic mantle–core (M-C) structure seen in rodents. It is also unclear whether inherent architectural changes contribute to islet dysfunction in type 1 diabetes, aside from the loss of beta cells. Therefore, we have exploited advances in immunostaining, spatial biology and machine learning to undertake a detailed, systematic analysis of adult human islet architecture in health and type 1 diabetes, by a quantitative analysis of a dataset of >250,000 endocrine cells in >3500 islets from ten individuals.

Methods
Formalin-fixed paraffin-embedded pancreatic sections (4 μm) from organ donors without diabetes and living donors with recent-onset type 1 diabetes were stained for all five islet hormones and imaged prior to analysis, which employed a novel automated pipeline using QuPath software, capable of running on a standard laptop. Whole-slide image analysis involved segmentation classifiers, cell detection and phenotyping algorithms to identify islets, specific cell types and their locations as (x,y)-coordinates in regions of interest. Each endocrine cell was categorised into binary variables for cell type (i.e. beta or non-beta) and position (mantle or core). A χ2 test for independence of these properties was performed and the OR was considered to estimate the effect size of the potential association between position and cell type. A quantification of the M-C structure at islet level was performed by computing the probability, r, that the observed number of non-beta cells in the mantle is due to a random arrangement. The distribution of the r values for the islets in the study was contrasted against the r values of a digital population of equivalent randomly arranged islets, termed digital siblings. Both distributions of r values were compared using the earth mover’s distance (EMD), a mathematical tool employed to describe differences in distribution patterns. The EMD was also used to contrast the distribution of islet size and beta cell fraction between type 1 diabetes and control islets.

Results
The χ2 test supports the existence of a significant (p<0.001) relationship between cell position and type. The effect size was measured via the OR <0.8, showing that non-beta cells are more likely to be found at the mantle (and vice versa). At the islet level, the EMD between the distributions of r values of the observed islets and the digital siblings was emd-1d=0.10951 (0<emd-1d<1). The transport plan showed a substantial group of islets with a small r value, thus supporting the M-C hypothesis. The bidimensional distribution (beta cell fraction vs size) of islets showed a distance emd-2d=0.285 (0<emd-2d<2) between the control and type 1 diabetes islets. The suffixes ‘-1d’ and ‘-2d’ are used to distinguish the comparison between the distribution of one and two variables.

Conclusions/interpretation
Using a novel analysis pipeline, statistical evidence supports the existence of an M-C structure in human adult islets, irrespective of type 1 diabetes status. The methods presented in the current study offer potential applications in spatial biology, islet immunopathology, transplantation and organoid research, and developmental research.

Graphical Abstract