Human diabetes mellitus (IDDM; type I diabetes) is a T cellmediated disease that is closely modeled in non-obese diabetic (NOD) mice. The pathogenesis of IDDM involves the transmigration of autoimmune T cells into the pancreatic islets and the subsequent destruction of insulin-producing  cells. Therapeutic interventions leading to  cell regeneration and the reversal of established IDDM are exceedingly limited. We report here that specific inhibition of T cell intra-islet transmigration by using a small molecule proteinase inhibitor restores  cell functionality, increases insulin-producing  cell mass, and alleviates the severity of IDDM in acutely diabetic NOD mice. As a result, acutely diabetic NOD mice do not require insulin injections for survival for a significant time period, thus providing a promising clue to effect IDDM reversal in humans. The extensive morphometric analyses and the measurements of both the C-peptide blood levels and the proinsulin mRNA levels in the islets support our conclusions. Diabetes transfer experiments suggest that the inhibitor specifically represses the T cell transmigration and homing processes as opposed to causing immunosuppression. Overall, our data provide a rationale for the pharmacological control of the T cell transmigration step in human IDDM.The pathogenesis of IDDM 2 involves the activation of autoimmune T killer cells. Activated autoimmune T cells transmigrate from the bloodstream through the pancreatic endothelium and into the islets of Langerhans, where they destroy insulin-producing  cells. We suggested and then proved in our current work that the inhibition of T cell transmigration and homing would effectively control islet destruction and stimulate the functional recovery of the insulin-producing  cells and the regeneration of the pancreatic islets.Mice of the NOD inbred strain develop a spontaneous disease closely resembling human IDDM and have been widely and successfully used as a model of IDDM (1-3). CD8ϩ T lymphocytes are involved in diabetogenesis in NOD mice; mice lacking CD8 ϩ T cells do not develop diabetes (4, 5). The cell surface CD44 levels are elevated in activated T cells (6). Via its interactions with endothelial hyaluronan, CD44 functions as a prominent adhesion receptor in autoimmune T cell adhesion on the endothelium and the subsequent transmigration events (7-11). Membrane type-1 matrix metalloproteinase (MT1-MMP) (12, 13) is the most important cell surface-associated proteinase that contributes to the shedding CD44 in the adherent autoimmune CD8 ϩ T cells (11,14). As demonstrated in our earlier cell-based tests (8, 9, 14), MT1-MMP cleavage releases the extracellular domain of CD44 from T cell surfaces and inactivates the CD44 cell receptor function. Similarly, the cleavage of CD44 by MT1-MMP plays a significant role in the regulation of tumor cell migration (15, 16). By means of this regulatory proteolysis, which our earlier data suggest (8, 9, 14), MT1-MMP appears to control the severity of the diabetic disease and mediates the transit...