Important experts gathered, what are the highlights of this Guangdong-Hong Kong-Macao Greater Bay Area Neuroimmune Basic and Clinical Translation Symposium?

*It is only for medical professionals to read and refer to the wonderful content of the conference.
You are invited to take a look
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 On December 25, 2021, the Guangdong-Hong Kong-Macao Greater Bay Area Neuroimmune Basic and Clinical Transformation Seminar was held in Guangzhou in the form of a combination of online and offline
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Experts and scholars in the field of neuroimmunity from Hong Kong, Macau, China and the Mainland jointly participated in the conference, star-studded to discuss the cutting-edge progress of neuroimmune diseases, and exchange clinical diagnosis and treatment experience
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 Professor Hu Xueqiang from the Third Affiliated Hospital of Sun Yat-Sen University, chairman of the Neuroimmunology Branch of the Chinese Society of Immunology, said in his opening speech that the neuroimmunology career in Guangdong Province started relatively late, and clinicians need to continuously improve their professional knowledge, learn and spread international advances.
Technology and concepts, and under the leadership of relevant societies, vigorously promote and popularize neuroimmunological diseases related guidelines, promote the planning and standardization of diagnosis and treatment, and at the same time, it is necessary to do a good job in the transformation of basic clinical research into clinical practice, so as to enhance the career of neuroimmunology The overall level
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 Picture 1: Professor Hu Xueqiang The academic content sharing session of this conference was wonderful.
Next, the editor will take you to briefly review the hot topics in this academic feast
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 Stem cell therapy has a promising future and is expected to solve the problem of neurological disease treatment.
In recent years, stem cell basic research and clinical trials have developed rapidly
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So far, on ClinicalTrials.
gov, there are more than 200 phase III clinical trials related to stem cells, and the indications involve many different fields such as neurological diseases and cardiovascular diseases
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 At this meeting, the regeneration of the central nervous Guangdong, Hong Kong Institute of Jinan University Kwok-Fai academicians to "stem cells to repair spinal cord injury" to do the report for the title
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Spinal cord injury is a central nervous system injury disease that is difficult to recover and has a high disability rate.
The incidence in China is increasing year by year.
The annual cost of spinal cord injury exceeds 60 billion, which brings patients, their families, and society.
A heavy burden of disease
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The development of stem cell technology gives new hope to diseases involving the repair of nerve function, including spinal cord injury
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 At present, there are a variety of transplanted cells that can be used for the treatment of spinal cord injury.
Among them, mesenchymal stem cells (MSC) from different tissue sources (such as spinal cord, umbilical cord) are safer
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Studies have shown that after transplantation of human adipose-derived mesenchymal stem cells in the cynomolgus monkey spinal cord injury model, the gait cycle is significantly restored and the swing phase is significantly increased.
At the same time, the size of the spinal cord injury cavity is effectively improved, and the model's nerve regeneration is promoted
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It is expected that as more and more clinical studies are transformed into clinical applications, the nerve regeneration and the recovery of motor and sensory functions of spinal cord injury can be truly realized
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 Figure 2: Application of stem cell therapy in spinal cord injury Professor Guan Yangtai, Renji Hospital, Shanghai Jiaotong University School of Medicine, also shared the progress of human umbilical cord mesenchymal stem cells (hUC-MSC) in the treatment of neuromyelitis optica spectrum disease (NMOSD)
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NMOSD has optic neuritis, myelitis, etc.
as the main clinical manifestations, with high recurrence, high disability and degeneration.
However, currently NMOSD still lacks effective therapeutic drugs, and most therapeutic drugs can only improve the clinical symptoms in the acute phase.
Therefore, new types of treatments have been developed The way is urgent
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 In 2019, the Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, officially launched the "Prospective Multicenter Randomized Controlled Study of Umbilical Cord Mesenchymal Stem Cells for the Treatment of Neuromyelitis Optician Spectrum Diseases".
Clinical research on NMOSD stem cell therapy filed by the Commission
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Professor Guan said that as of December 1, 2021, 30 patients have been enrolled in the study.
After different doses of stem cell infusion treatment, the overall safety of the patients has been observed to be good.

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In addition, Professor Guan specifically introduced the effect of stem cell therapy on a patient with obvious bladder dysfunction before enrollment.
At present, after 5 doses, the patient’s bladder function has basically returned to normal, and the Extended Disability Status Scale (EDSS ) The score has also dropped from 2.
5 points to 1 point
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 Figure 3: The curative effect of hUC-MSC in the treatment of NMOSD patients.
Focus on the new advances in the diagnosis and treatment of multiple sclerosis and promote the rapid development of the discipline Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system.
Its clinical symptoms and imaging manifestations have Heterogeneity, there is currently no cure for MS, which brings a heavy burden of disease to patients and society
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At this conference, many experts shared the latest academic progress in the field of MS
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 Third Affiliated Hospital of Sun Yat-sen Professor Qiu Wei conference on the latest developments in MS ECTRIMS 2021 are summarized, concern COVID-19, the relationship between the vaccine and the disease-modifying therapy (DMT) of the moment include; clinical research progress and so on
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 The world is currently shrouded by the cloud of the new crown epidemic.
Among them, MS patients have low immune function and are prone to COVID-19
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Studies have shown that age, maleness, progressive disease, EDSS score, anti-CD20 monoclonal antibody, etc.
are harmful factors that affect the outcome of MS patients with COVID-19, while interferon and teriflunomide are protective factors
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Vaccination is an effective measure to reduce infections in MS patients.
However, some patients have concerns about whether DMT drugs affect the effectiveness of the new crown vaccine
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The CovaXiMS study evaluated the response of different COVID-19 vaccines under different DMT, and the results showed that the humoral response of vaccines such as CD20 monoclonal antibody was reduced
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 Figure 4: Antibody levels based on DMT and vaccine types.
In terms of treatment, there are currently a variety of new therapeutic drugs under study.
Among them, the family of anti-CD20 antibodies will be further expanded, including the upcoming Ublituximab; in addition, BTK inhibitors are also available It has received widespread attention.
It can cross the blood-brain barrier, inhibit central and peripheral inflammation, and also has an effect on slowly expanding lesions (SEL).
It is expected that more therapeutic drugs will enter the clinic in the future to benefit MS patients
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 Professor Liu Yulin from the Faculty of Medicine of the Chinese University of Hong Kong gave a report on "Smoldering Lesion in MS"
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According to the research progress of MR imaging and histopathology, MS lesions are currently divided into active lesions (early and late), smoldering lesions (slowly expanding lesions), inactive lesions and shadow lesions (complete remyelination plaques)
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Among them, the immune cells in the CNS, including microglia and CNS-resident B cells, are related to the pathophysiology of smoldering lesions
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Chronic smoldering lesions can cause the loss of brain volume.
Studies have shown that more smoldering lesions are related to more severe disability and cognitive impairment in MS patients.
Therefore, therapeutic drugs targeting smoldering lesions are essential to improve the prognosis of patients.

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Teriflunomide takes into account both peripheral anti-inflammatory and central protective functions, and may delay the occurrence of brain atrophy by affecting glial cells
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 Figure 5: The characteristics of MS disease activity are composed of acute focal inflammation and chronic smoldering lesions.
Professor Xu Zhuping from the Earls General Hospital of Macau gave a report on "The Current Status of Multiple Sclerosis Treatment"
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Professor Xu said that although MS is a rare disease, its incidence has been increasing in recent years
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For the diagnosis of MS, the 2017 revised McDonald MS diagnostic criteria is widely used in clinical practice.
However, the current diagnosis of MS is still difficult and misdiagnosed.
This is mainly due to the lack of specific clinical manifestations of MS, and the clinicians in primary hospitals are more sensitive to MS.
Insufficient understanding can easily lead to missed diagnosis and misdiagnosis, leading to delays in treatment of patients
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 Figure 6: Misdiagnosis and delayed diagnosis of MS.
DMT treatment in remission can reduce the frequency of patient relapses, reduce the degree of deterioration, delay the natural progression of the disease and improve the patient's prognosis
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At present, a variety of DMT drugs have been approved in the clinic for the treatment of MS patients.
When choosing specific DMT drugs, the patient’s disease severity and activity, degree of disability progression, drug safety, economic burden, and drugs should be fully considered when choosing specific DMT drugs.
compliance and so on
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 Professor Dan He from the First Affiliated Hospital of Sun Yat-sen University gave a report on "T/B Dual Control-Application in the Field of MS"
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In recent years, the research on the disease mechanism of MS has continued to deepen, from focusing on T cells to focusing on B cells
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Peripheral activated T cells cross the blood-brain barrier and enter the CNS, and are activated and secrete cytokines to exert their effector functions
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B cells can not only activate T cells, but also can cross the blood-brain barrier, form an ectopic germinal center in the CNS, and promote central nervous system inflammation
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 Judging from the current evidence, treatments that only target one of these mechanisms always have various limitations.
Only dual control of TB can better control the progression of the disease
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Teriflunomide inhibits the proliferation of T and B lymphocytes and protects nerves through the classical pathway of the mitochondrial enzyme dihydroorotate dehydrogenase (DHODH).
There have been a number of evidence-based evidence that it has outstanding advantages in controlling brain atrophy and delaying the progression of disability
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 Figure 7: Teriflunomide's TB dual-control and nerve-protecting effect has highlighted its advantages in controlling brain atrophy.
Since then, Professor Wang Hongxuan from Sun Yat-sen Memorial Hospital of Sun Yat-sen University shared a classic case of adolescent MS with optic neuritis as the first manifestation.
Experts at the meeting Have a lively discussion
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MS generally occurs in young adults, but about 2%-4% of cases appear in childhood or adolescence, and are usually relapsing-remitting
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Studies have shown that children/adolescents have 2-3 times the recurrence of MS as adults, have higher inflammatory activity, and are more prone to brain atrophy, cognitive impairment, and depression
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For the treatment of MS in children/adolescents, as in adult patients, early initiation of DMT drugs is essential
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Existing evidence-based evidence shows that teriflunomide can effectively reduce MRI active lesions in children/adolescents with MS, and the benefits are more significant in the Chinese population
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 Figure 8: The TERIKIDS study confirms that teriflunomide can effectively reduce MRI activity lesions in children/adolescents with MS.
In addition to MS, the management of myasthenia gravis (MG) is also a topic of concern at this meeting, the third affiliated to Sun Yat-sen University Professor Wang Yuge from the hospital shared the immunotherapy of MG
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Professor Wang pointed out that the treatment of MG includes symptomatic and immunotherapy.
The former is the basis of MG treatment, and the latter is the core of MG treatment
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In recent years, more and more biological agents (including complement inhibitors, Fc receptor inhibitors, B cell depleting agents, etc.
) have begun to be widely studied for the treatment of MG, providing clinicians and patients with new options and ideas
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Compared with traditional immunosuppressants with extensive effects and greater liver and kidney toxicity, biologics are safer and have clearer therapeutic targets
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It is hoped that with the in-depth research on MG, new biological treatment targets can provide more options for refractory MG, and at the same time bring hope to more MG patients
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 Table 1: MG biologics treatment (under research and approved) other neurological diseases related cutting-edge progress, you are worth knowing that neurological diseases are a type of intractable disease that has been plagued and threatened human life.
With the deepening of understanding of the relationship between diseases and genes, gene therapy is becoming a new type of treatment for central nervous system diseases that are difficult to cure by conventional methods
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 At this conference, Professor Li Xiaojiang from the Guangdong-Hong Kong-Macao Central Nervous Regeneration Research Institute of Jinan University shared the use of genetically modified large animal models to study serious brain diseases
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Professor Li used genetic modification methods to construct a variety of non-human primate genetically modified neurodegenerative disease models, including amyotrophic lateral sclerosis monkey model and Parkinson’s disease monkey model, which better simulate the typical neuropathology of the human brain Features provide advanced new tools for disease research
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 Figure 9: Professor Li Xiaojiang Dr.
Huang Ying from Tsinghua Pearl River Delta Research Institute shared the latest progress in gene therapy for neurological diseases
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Dr.
Huang pointed out that gene therapy includes both in vivo and in vitro directions.
Among them, the application range of in vivo gene therapy is relatively wider.
The main treatment strategies include gene supplementation, gene silencing and gene editing
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In the field of neurological diseases, gene therapy has been studied for the treatment of spinal muscular atrophy, Duchenne muscular dystrophy, Parkinson's disease and Alzheimer's disease
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 Figure 10: Dr.
Huang Ying The steady-state regulation of neuronal excitability is the basic condition for the normal function of the nervous system.
Unregulation of neuronal excitability homeostasis can lead to neuropsychiatric diseases such as epilepsy and schizophrenia
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 At this meeting, Professor Li Boxing of Zhongshan School of Medicine, Sun Yat-Sen University shared the mechanism of neuronal excitability homeostasis regulation
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Professor Li's research group used sodium channel blockers (TTX) to block action potentials to simulate the long-term decrease in neuronal excitability
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After TTX is withdrawn, the excitability of neurons increases compensatoryly, suggesting that neurons have a steady-state regulation of excitability
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Further mechanism studies have found that the above-mentioned excitatory homeostasis regulation is due to the reduction of the selective splicing of the potassium channel mRNA mediated by Nova-2
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 Figure 11: Professor Li Boxing Summary In recent years, the academic progress in the field of neuroimmunology has been updated rapidly, and how to transform basic research into clinical practice is one of the difficult problems faced by many researchers
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The convening of the Guangdong-Hong Kong-Macao Greater Bay Area Neuroimmune Basics and Clinical Transformation Seminar provides a professional academic exchange platform for neurological clinicians in the Guangdong-Hong Kong-Macao Greater Bay Area, and promotes the mutual exchange and learning and common progress of clinicians from Hong Kong, Macau and the Mainland.
Join hands to help the development of immune disease treatment of the nervous system
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MAT-CN-2132544 December 2023 This serial number only serves as Sanofi's confirmation of the authenticity of the source of scientific and clinical data in the therapeutic field of Sanofi-related drugs involved in this article, not as Sanofi's accuracy of the entire content of this article , Confirmation and guarantee of timeliness and completeness; this article is only used by medical and health professionals for academic exchanges or understanding medical information purposes, and does not constitute the recommendation and promotion of any drugs or treatment programs
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The information contained in this article should not replace medical advice provided by healthcare professionals
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