Editor's note: On April 19~21, the 19th Xiangya International Diabetes Immunology Forum was successfully held in Changsha, Hunan. On the basis of "precision diabetes" in the past two sessions, this year's forum takes "clinical orientation, science and technology empowerment, precision prevention and control" as the theme, and sets up sections such as precision diagnosis, precision treatment, precision nutrition, and precision management, and strives to carry out precision diabetes to the end. The conference was full of highlights and stars, and dedicated an academic feast to the participants with authoritative interpretation and wonderful interaction. This journal is honored to invite Professor Zhou Zhiguang from the National Clinical Research Center for Metabolic Diseases and the Second Xiangya Hospital of Central South University to conduct an on-site interview on the planning and hot topics of this forum.
International Diabetes: Since 2006, the Xiangya International Diabetes Immunology Forum has been held for 19 sessions.
Professor Zhou Zhiguang
The Xiangya International Diabetes Immunology Forum has been held for 19 sessions so far, and in the last three sessions, we have mainly focused on the design of the corresponding section of "precision diabetes". With the rise of precision medicine, the diagnosis, treatment, prediction, monitoring, and prevention of diabetes have entered a new stage. In addition to the fact that precision diagnosis is a necessary prerequisite for achieving precision treatment, this year's forum has further added two major sections: "precision nutrition" and "precision management" on the basis of the past two sessions of "precision diabetology".
This year, there have been new advances in precision diagnosis, especially around the heterogeneity of diabetes. Heterogeneity in type 1 diabetes was a key topic of discussion at the forum, including endotypes and phenotypes. In terms of intrinsic type, the focus of this conference is on genetic associations (e.g., HLA-DR3, HLA-DR4), immunology, autoantibodies, histopathology, cytopathology (T lymphocyte and B lymphocyte infiltration ratio), and response to immunotherapy in type 1 diabetes.
In addition, in terms of accurate diagnosis, we specifically talked about the detection of diabetes autoantibodies. With the past 30 years of research and the advancement of the detection of pancreatic autoantibodies, we have now developed a platform system that can detect diabetic autoantibodies by automatic electrochemiluminescence method, especially the detection of pancreatic autoantibodies such as GADA and IA-2A. At present, the best and most widely used method for autoimmune diabetes is the determination of pancreatic islet autoantibodies, so the islet autoantibody detection system based on electrochemiluminescence jointly developed by the National Clinical Research Center for Metabolic Diseases is also the focus of the "Precise Diagnosis" section. Regarding precision nutrition, we regard it as an important part of precision therapy, such as how to supplement the nutrient vitamin D, and when to supplement it.
International Diabetes: This forum has invited a number of well-known domestic and international experts to participate, what are the hot spots worth paying attention to in this conference? Or what are the new highlights?
Professor Zhou Zhiguang
In terms of precision therapy, for example, anti-CD3 monoclonal antibodies can treat autoimmune diabetes in etiology through immune regulation, delay the disease process, and can be used in combination with insulin to exert therapeutic effects. Originally, insulin therapy only supplemented insufficient insulin secretion, but if immune intervention for the cause of the disease could be used in the early stage, it could delay or even block the occurrence of autoimmune diabetes and delay the progression of the disease, which was the focus of this forum. In addition, therapeutic targets are also the focus of attention, such as B lymphocytes and intestinal microbiota as targets for immune intervention. At the same time, in the clinical hot discussion session, there are also relevant hot debates on improving the function of pancreatic islet β cells, delaying the disease process, improving blood sugar control, and the impact of immunotherapy on pancreatic islet function.
Diabetes International: Regarding the topic of your presentation at this forum, please share the role of B cells in the pathogenesis of type 1 diabetes and its intervention prospects.
Professor Zhou Zhiguang
In the past, our research on autoimmune type 1 diabetes mainly focused on T cells, and there were more studies related to T cells, but not much attention on B cells. Through research in recent years, our research group and international collaborations have proven that B cells are indispensable in the development and progression of autoimmune type 1 diabetes. From a pathogenesis point of view, "No B No Type 1", if there is no B cell abnormality, type 1 diabetes will not occur, which is a very important concept.
Current and future studies will further focus on the immune checkpoints on B lymphocytes, the relationship between B cells and intestinal microbiota, and the effects of B cells and energy metabolism, especially the effects of glucose metabolism on the activation of B cells. In fact, B cells are involved in the pathogenesis of type 1 diabetes in three ways. First, B cells, as antigen-presenting cells (APCs), sense the antigen signals of the islets themselves, and present them to CD8+ T cells through antigen-presenting molecules, such as MHC class I molecules, and MHC class II molecules to CD4+ T cells, and transmit specific immune signals through this interaction between B lymphocytes and T lymphocytes, causing specific immune attacks. Second, B cells can also release cytokines, such as TNF-α, IL-6, etc., which can directly participate in the inflammatory process on the one hand, and migrate to the site of inflammatory response by chemoattractant immune cells on the other hand. Third, B cells themselves can produce autoantibodies, which can be used as immune signals for the diagnosis of diabetes and the detection of disease progression.
Therefore, through more than ten years of research on B cells, we have increasingly recognized the role of B cells in the development and development of autoimmune type 1 diabetes. For example, the above-mentioned B cells are involved in the pathogenesis of type 1 diabetes from three aspects, and the antibodies produced by B cells can be used as markers for diagnosis in the diagnosis process, as well as more importantly, possible intervention targets, such as immune checkpoint ICOSL, IgA secreted by B cells, and the relationship with the intestinal flora, as well as the activity changes of B cells themselves related to energy metabolism pathways such as glucose metabolism, which may become targets for treatment, and then intervene in autoimmune type 1 diabetes.
Expert Profile
Professor Zhou Zhiguang
Professor, first-class chief physician, doctoral supervisor, Xiangya famous doctor
Director of the National Clinical Research Center for Metabolic Diseases
He is the leader of the national key discipline of internal medicine (endocrinology and metabolic diseases) and the leader of the innovation team of the Ministry of Education
Director of the Key Laboratory of Diabetes Immunology of the Ministry of Education, Director of the National Clinical Research Center for Metabolic Diseases (Changsha).
Honorary President of the Endocrinology and Metabolism Branch of the Chinese Medical Doctor Association
Chairman of the Cardiometabolic Medicine Professional Committee of the National Committee of Cardiovascular Diseases
Vice President of Hunan Medical Association, Chairman of Endocrinology Professional Committee of Hunan Medical Association
《中国医师杂志》主编，《中华糖尿病杂志》、《中国动脉硬化杂志》、《Frontiers in Immunology》等杂志副主编，《Diabetes Metabolism Research and Reviews》、《Diabetes Research and Clinical Practice》等5本英文杂志编委。
He has undertaken more than 50 diabetes projects at home and abroad, such as the National 973, 863, Science and Technology Support Program, National Key R&D Program and Key International Cooperation Projects of the National Natural Science Foundation of China, focusing on the diagnosis and treatment of diabetes immunity and the research on immune pathogenesis. He led the formulation of the first "Guidelines for the Diagnosis and Treatment of Type 1 Diabetes in China" and "LADA Diagnosis and Treatment Consensus", and published 382 SC papers. A total of 179 doctoral and master's students have been trained. He has won 3 National Science and Technology Progress Awards and 10 Provincial and Ministerial Science and Technology Awards. In 2001, he was selected into the "Cross-Century Talent" training program of the Ministry of Education, and has been enjoying the special government allowance of the State Council since 1993.