AI-guided analysis of human pancreatic islet sociology reveals distinct cell compositional changes in type 1 diabetes.

Human pancreatic islets exhibit greater anatomic and cellular heterogeneity than previously appreciated, raising fundamental questions about how their composition varies with age, sex, region, and islet size and how type 1 diabetes (T1D) alters these relationships. Yet these questions remained largely unresolved due to the bottleneck of manual tissue inspection. Here, we developed an integrated artificial intelligence (AI)-guided imaging, processing, and statistical pipeline enabling unbiased, high-throughput analysis of more than 2 million candidate islets from 106 non-diabetic (ND) and T1D donors. We identified age-, region-, sex-, and islet size-dependent differences in islet distribution and composition between ND and T1D donors. Profound β-cell loss in T1D was accompanied by reciprocal α-cell expansion, whereas δ-cells and pancreatic polypeptide cells were largely resilient. Cell area and pseudotime analyses uncovered regional and age-dependent trajectories of islet remodeling across T1D progression, along with distinct patterns of cytoarchitectural reorganization of the endocrine pancreas.