Proinsulin is a key autoantigen in type 1 diabetes. Evidence in the mouse has underscored the importance of the insulin B chain region in autoimmunity to pancreatic beta cells. In man, a majority of proteasome cleavage sites are predicted by proteasome cleavage algorithms within this region. To study CD8 ؉ T cell responses to the insulin B chain and adjacent C peptide, we selected 8-to 11-mer peptides according to proteasome cleavage patterns obtained by digestion of two peptides covering proinsulin residues 28 to 64. We studied their binding to purified HLA class I molecules and their recognition by T cells from diabetic patients. Peripheral blood mononuclear cells from 17 of 19 recent-onset and 12 of 13 long-standing type 1 diabetic patients produced IFN-␥ in response to proinsulin peptides as shown by using an ELISPOT assay. In most patients, the response was against several class I-restricted peptides. Nine peptides were recognized within the proinsulin region covering residues 34 to 61. Four yielded a high frequency of recognition in HLA-A1 and -B8 patients. Three peptides located in the proinsulin region 41-51 were shown to bind several HLA molecules and to be recognized in a high percentage of diabetic patients.autoimmunity ͉ beta cell ͉ CD8 T cells ͉ human autoantigens ͉ proteasome T ype 1 diabetes is characterized by the activation of lymphocytes against autoantigens expressed by pancreatic beta cells. T lymphocytes play a key role in the disease process. Diabetes has been reported in a patient deprived of B lymphocytes (1). In the nonobese diabetic (NOD) mouse, CD8 ϩ T cells play a pivotal role in the initiation of autoimmunity (2). Beta 2 microglobulindeficient NOD mice do not develop insulitis unless beta cell class I expression is restored (3). CD8 ϩ T cells are responsible for beta cell destruction in transgenic mice over expressing beta cell-specific CD8 ϩ T cells (2). In man, CD8 ϩ T cells and IFN-␥-positive cells are major components of insulitis (4-9). Recurrent diabetes in recipients of isografts from a discordant identical twin is accompanied by predominant CD8 ϩ T cell infiltration (10). However, few studies have characterized recognition of beta cell antigens by CD8 ϩ T cells (11,12).Proinsulin has been ascribed a key role in diabetes. Insulin and proinsulin are targets of autoantibodies (13-15) and T cells (16)(17)(18)(19)(20)(21)(22)(23) in diabetic and prediabetic subjects. Anti-insulin antibodies are the first autoantibodies detected in children at risk for diabetes (15). In the NOD mouse, transfer of insulin-specific T cells accelerates diabetes (24), and insulin exposure prevents diabetes (25). Diabetes development is altered in mice lacking the expression of proinsulin genes (26-28). Evidence in the mouse has underscored the importance of the proinsulin region encompassing the insulin B chain in diabetes autoimmunity (25,29). CD8 ϩ T cells that transfer diabetes in the NOD recognize an insulin B chain epitope (30). In man, a majority of proteasome cleavage sites are predicted within ...