Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2023; 14(5): 494-511
Published online May 15, 2023. doi: 10.4239/wjd.v14.i5.494
Mechanism of immune attack in the progression of obesity-related type 2 diabetes
Hua-Wei Wang, Jun Tang, Li Sun, Zhen Li, Ming Deng, Zhe Dai
Hua-Wei Wang, Jun Tang, Li Sun, Zhe Dai, Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Zhen Li, Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Ming Deng, Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Author contributions: Wang HW, Tang J, and Dai Z took part in the conception and wrote the review; Sun L, Li Z, and Deng M made intellectual contributions to the writing and revision of this review; Wang HW and Dai Z contributed to the design of figures and revised thoroughly the final version; Dai Z was responsible for supervision, manuscript writing and editing, and funding acquisition.
Supported by the National Science Foundation of China, No. 81500593; and the Science and Technology Innovation Platform Project of Zhongnan Hospital of Wuhan University, No. PTXM2021016.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhe Dai, MD, Doctor, Department of Endocrinology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei Province, China. daizhe@znhospital.cn
Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: February 20, 2023
Revised: March 6, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: May 15, 2023
Processing time: 138 Days and 8.3 Hours
Abstract

Obesity and overweight are widespread issues in adults, children, and adolescents globally, and have caused a noticeable rise in obesity-related complications such as type 2 diabetes mellitus (T2DM). Chronic low-grade inflammation is an important promotor of the pathogenesis of obesity-related T2DM. This proinflammatory activation occurs in multiple organs and tissues. Immune cell-mediated systemic attack is considered to contribute strongly to impaired insulin secretion, insulin resistance, and other metabolic disorders. This review focused on highlighting recent advances and underlying mechanisms of immune cell infiltration and inflammatory responses in the gut, islet, and insulin-targeting organs (adipose tissue, liver, skeletal muscle) in obesity-related T2DM. There is current evidence that both the innate and adaptive immune systems contribute to the development of obesity and T2DM.

Keywords: Type 2 diabetes mellitus; Obesity; Insulin resistance; Immune cells; Inflammation; Pathological mechanism

Core Tip: Obesity is closely associated with the occurrence and development of insulin resistance and type 2 diabetes mellitus (T2DM). Previous studies have demonstrated the important role of immune cell infiltration and inflammatory response in obesity-related T2DM. This review presents immune responses in the gut with respect to metabolic challenges. We also highlight the effects of immune attacks and proinflammatory shifts on insulin-secreting and targeting organs.