HLA-DQ2/8 heterozygous individuals are at far greater risk for type 1 diabetes (T1D) development by expressing HLA-DQ8trans on antigen-presenting cells compared with HLA-DQ2 or -DQ8 homozygous individuals. Dendritic cells (DC) initiate and shape adaptive immune responses by presenting HLA-epitope complexes to naïve T cells. To dissect the role of HLA-DQ8trans in presenting natural islet epitopes, we analyzed the islet peptidome of HLA-DQ2, -DQ8, and -DQ2/8 by pulsing DC with preproinsulin (PPI), IA-2, and GAD65. Quality and quantity of islet epitopes presented by HLA-DQ2/8 differed from -DQ2 or -DQ8. We identified two PPI epitopes solely processed and presented by HLA-DQ2/8 DC: an HLADQ8trans-binding signal-sequence epitope previously identified as CD8 T-cell epitope and a second epitope that we previously identified as CD4 T-cell epitope with increased binding to HLA-DQ8trans upon posttranslational modification. IA-2 epitopes retrieved from HLA-DQ2/8 and -DQ8 DC bound to HLA-DQ8cis/trans. No GAD65 epitopes were eluted from HLA-DQ. T-cell responses were detected against the novel islet epitopes in blood from patients with T1D but scantly detected in healthy donor subjects. We report the first PPI and IA-2 natural epitopes presented by highest-risk HLADQ8trans. The selective processing and presentation of HLA-DQ8trans-binding islet epitopes provides insight in the mechanism of excessive genetic risk imposed by HLA-DQ2/8 heterozygosity and may assist immune monitoring of disease progression and therapeutic intervention as well as provide therapeutic targets for immunotherapy in subjects at risk for T1D.Type 1 diabetes (T1D) is an autoimmune disease characterized by autoreactive T-cell-mediated destruction of the insulin-producing pancreatic b-cells (1-4). The search for naturally processed and presented epitopes (NPPE) for high-risk HLA class II as a target for autoreactive CD4 T cells in T1D has been focus of attention over the years. Most attention was given to HLA-DR-binding epitopes (5,6), whereas HLA-DQ-binding epitopes deserve investigation, too. Indeed, subjects heterozygous for HLA-DQ2 and -DQ8 are endorsed with by far the highest risk for development of T1D, but what functional consequences explain this synergistically increased risk compared with a double dose of HLA-DQ2 or -DQ8 remain unclear. We previously revealed the unique peptide binding properties of HLA-DQ molecules composed of the products of DQA1*0201 (coding for the a-chain of DQ2) and DQB1*0302 (coding for the b-chain of DQ8), the so-called HLA-DQ8trans molecule (7-9). The islet epitopes presented by HLA-DQ8trans are largely unknown. Importantly, HLA-DQ8cis/trans-restricted CD4 T-cell clones have been isolated from human insulitis lesions, and T-cell autoreactivity was confirmed for several proinsulin peptides, underscoring the potential relevance of preproinsulin (PPI) peptides presented by HLA-DQ in diabetogenesis (10-13). We contend that knowledge of the HLA-DQ8trans islet peptidome provides insight in the mechanism by which HLA-DQ2/8 hete...