1
|
Wiboonpong P, Setthawatcharawanich S, Korathanakhun P, Amornpojnimman T, Pruphetkaew N, Chongphattararot P, Sathirapanya C, Sathirapanya P. Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3039. [PMID: 36833734 PMCID: PMC9959777 DOI: 10.3390/ijerph20043039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Early thymectomy is suggested in all clinically indicated myasthenia gravis (MG) patients. However, short-term clinical response after thymectomy in MG patients has been limitedly described in the literature. This study aimed to compare the 5-year post-thymectomy outcomes between thymoma (Th) and non-thymoma (non-Th) MG patients. (2) Methods: MG patients aged ≥18 years who underwent transsternal thymectomy and had tissue histopathology reports in Songklanagarind Hospital between 2002 and 2020 were enrolled in a retrospective review. The differences in the baseline demographics and clinical characteristics between ThMG and non-Th MG patients were studied. We compared the time-weighted averages (TWAs) of daily required dosages of pyridostigmine, prednisolone or azathioprine to efficiently maintain daily living activities and earnings between the MG patient groups during 5 consecutive years following thymectomy. Post-thymectomy clinical status, exacerbations or crises were followed. Descriptive statistics were used for analysis with statistical significance set at p < 0.05. (3) Results: ThMG patients had significantly older ages of onset and shorter times from the MG diagnosis to thymectomy. Male gender was the only significant factor associated with ThMG. TWAs of the daily MG treatment drug dosages required showed no differences between the groups. Additionally, the rates of exacerbations and crises were not different, but decremental trends were shown in both groups after the thymectomies. (4) Conclusions: The daily dosage requirements of MG treatment drugs were not different. There was a trend of decreasing adverse event rates despite no statistically significant differences during the first 5 years after thymectomy in ThMG and non-ThMG patients.
Collapse
Affiliation(s)
- Phattamon Wiboonpong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | | | - Pat Korathanakhun
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Thanyalak Amornpojnimman
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Nannapat Pruphetkaew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pensri Chongphattararot
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Chutarat Sathirapanya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| |
Collapse
|
2
|
Epigenetics of Thymic Epithelial Tumors. Cancers (Basel) 2023; 15:cancers15020360. [PMID: 36672310 PMCID: PMC9856807 DOI: 10.3390/cancers15020360] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
Thymic epithelial tumors (TETs) arise from the epithelial cells of the thymus and consist in the 1% of all adult malignancies, despite the fact that they are the most common lesions of the anterior mediastinum. TETs can be divided mainly into thymomas, thymic carcinomas, and the rarest ad aggressive neuroendocrine forms. Despite the surgical resection is quite resolving, the diagnosis of TETs is complicated by the absence of symptoms and the clinical presentation aggravated by several paraneoplastic disorders, including myasthenia gravis. Thus, the heterogeneity of TETs prompts the search for molecular biomarkers that could be helpful for tumor characterization and clinical outcomes prediction. With these aims, several researchers investigated the epigenetic profiles of TETs. In this manuscript, we narratively review the works investigating the deregulation of epigenetic mechanisms in TETs, highlighting the need for further studies combining genetic, epigenetic, and expression data to better characterize the different molecular subtypes and identify, for each of them, the most relevant epigenetic biomarkers of clinical utility.
Collapse
|
3
|
Iaiza A, Tito C, Ganci F, Sacconi A, Gallo E, Masciarelli S, Fontemaggi G, Fatica A, Melis E, Petrozza V, Venuta F, Marino M, Blandino G, Fazi F. Long Non-Coding RNAs in the Cell Fate Determination of Neoplastic Thymic Epithelial Cells. Front Immunol 2022; 13:867181. [PMID: 35529877 PMCID: PMC9073009 DOI: 10.3389/fimmu.2022.867181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Thymic Epithelial Tumors (TETs) arise from epithelial cells of the thymus and are very rare neoplasms comprising Thymoma, Thymic carcinoma, and Thymic Neuroendocrine tumors that still require in-depth molecular characterization. Long non-coding RNAs (lncRNAs) are emerging as relevant gene expression modulators involved in the deregulation of several networks in almost all types of human cancer, including TETs. LncRNAs act at different control levels in the regulation of gene expression, from transcription to translation, and modulate several pathways relevant to cell fate determination under normal and pathological conditions. The activity of lncRNAs is strongly dependent on their expression, localization, and post-transcriptional modifications. Starting from our recently published studies, this review focuses on the involvement of lncRNAs in the acquisition of malignant traits by neoplastic thymic epithelial cells, and describes the possible use of these molecules as targets for the design of novel therapeutic approaches specific for TET. Furthermore, the involvement of lncRNAs in myasthenia gravis (MG)-related thymoma, which is still under investigation, is discussed.
Collapse
Affiliation(s)
- Alessia Iaiza
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Section of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Claudia Tito
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Section of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Federica Ganci
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Sacconi
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Masciarelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Section of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
- Department of Life Science and Public Health, Histology and Embryology Unit, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giulia Fontemaggi
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Fatica
- Department of Biology and Biotechnology ‘Charles Darwin’, Sapienza University of Rome, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Petrozza
- Pathology Unit, ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Sapienza University of Rome, Rome, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Francesco Fazi, ; Giovanni Blandino, ; Mirella Marino,
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Francesco Fazi, ; Giovanni Blandino, ; Mirella Marino,
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Section of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Francesco Fazi, ; Giovanni Blandino, ; Mirella Marino,
| |
Collapse
|
4
|
Kosaka T, Nakahashi H, Nakazawa S, Ibe T, Yajima T, Shirabe K. Taste disorder in a patient with invasive thymoma without myasthenia gravis: a rare case report. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:9. [PMID: 35340830 PMCID: PMC8841547 DOI: 10.21037/med-21-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Taste disorder has been reported as a non-motor symptom caused by myasthenia gravis (MG)-related autoimmune mechanism. Taste disorder in some cases recovered along with MG treatment, such as thymothymectomy or immunosuppressive treatment. However, symptom of taste disorder in thymoma patients without MG is very rare. Here, we reported a case of invasive thymoma without MG which had concurrent taste disorder. The taste disorder was successfully treated with cyclosporine. A female in her seventies had an anterior mediastinal tumor of 78-mm in diameter and pleural dissemination. She also had taste disorder, limited to sweet taste, and pure red cell aplasia (PRCA). Symptoms and physical findings showed no feature of MG. Pre-operative blood examination revealed no elevation of anti-acetylcholine receptor antibody . Extended total thymothymectomy and resection of all detectable pleural disseminations was performed. Pathological examination showed type B3 thymoma. Clinical stage was Masaoka stage IVa. After operation, there was no improvement in taste disorder and PRCA. Six months after operation, cyclosporine was administered for PRCA. In parallel with gradual improvement of anemia, taste disorder also gradually improved. Three months after the first administration of cyclosporine, taste disorder had completely recovered. This is the first case of taste disorder without any myasthenic status, which recovered with immunosuppressive drug. Our case suggested the potency of immunosuppressive treatment for taste disorder associate with thymoma without MG.
Collapse
Affiliation(s)
- Takayuki Kosaka
- Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | - Seshiru Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Ibe
- Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiki Yajima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
5
|
Bi Z, Cao Y, Lin J, Zhang Q, Liu C, Gui M, Bu B. Long-Term Improvement in a Chinese Cohort of Glucocorticoid-Resistant Childhood-Onset Myasthenia Gravis Patients Treated With Tacrolimus. Front Neurol 2022; 13:820205. [PMID: 35211085 PMCID: PMC8860838 DOI: 10.3389/fneur.2022.820205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives To evaluate the long-term outcome of tacrolimus for childhood-onset myasthenia gravis (CMG) with an inadequate response to glucocorticoids, and investigate factors associated with favorable outcomes following tacrolimus treatment. Methods A retrospective, observational cohort study was performed for CMG patients who had not improved satisfactorily after sufficient prednisone therapy for at least 8 weeks. All patients were given tacrolimus in doses of 2–3 mg for more than 6 months. The primary efficacy outcome was assessed using the prednisone dose, quantitative MG (QMG), and MG-activity of daily living (ADL) scores. The participants were divided into improved and unimproved groups based on changes in QMG scores to investigate the risk factors that affected tacrolimus efficacy. Results A total of 149 glucocorticoid resistant CMG patients were finally enrolled in our study, with 113 (75.8%) responding well to tacrolimus (defined as minimal manifestation status or better). One month after initiating tacrolimus, there was a noticeable improvement in prednisone dose, QMG, and ADL scores, which continued to improve throughout the study. More importantly, the prednisone was eventually stopped in 89 of the patients (78.8%). Thymus type [odds ratio (OR) = 3.156, 95% confidence interval (CI) 1.427–6.978; P = 0.005] and pre-intervention status (OR = 0.284, 95%CI 0.109–0.741; P = 0.010) were independent predictors of tacrolimus efficacy after controlling for confounding factors in multiple logistic regression. Conclusion The majority of glucocorticoid-resistant CMG patients have a good long-term prognosis after adding tacrolimus. Thymus type and pre-intervention status can serve as potential predictors affecting the efficacy of tacrolimus.
Collapse
Affiliation(s)
- Zhuajin Bi
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yayun Cao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jing Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengcui Gui
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Sun F, Tavella-Burka S, Li J, Li Y. Positive acetylcholine receptor antibody in non-myasthenic patients. Muscle Nerve 2022; 65:508-512. [PMID: 35037718 DOI: 10.1002/mus.27500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS This study aims to investigate the frequency of acetylcholine receptor (AChR) binding antibody positivity via neuroautoimmunity panel testing, and describe its occurrence in a group of non-myasthenic disorders. METHODS This is a retrospective analysis of patients who underwent neuroautoimmunity antibody panel testing from 2010 to 2018 at Cleveland Clinic. RESULTS A total of 10,855 patients received neuroautoimmunity antibody panel testing, and 224 (2.1%) patients were positive for AChR binding antibody. Fifty-eight patients with known myasthenia gravis (MG) diagnosis and 11 patients with incomplete follow-up were excluded. Among the remaining 155 patients, 30 had newly diagnosed MG and 125 were non-myasthenic. In 35 patients, MG was within the initial differential diagnosis based on the clinical presentation. In contrast to non-myasthenic patients, myasthenic patients were more likely to have an initial clinical presentation raising suspicion for MG (73.3% versus 10.4%, p<0.001), higher mean AChR binding antibody titer (8.2 ±15.6 versus 0.4±1.6 nM, p=0.011) and higher frequency of abnormal AChR modulating antibody (89.3% versus 23.9%, p<0.001). A combination of AChR binding antibody of >0.5 nM and modulating antibody of >20% in patients with a clinical suspicion of MG is virtually diagnostic of MG. A total of 31 (24.8%) non-myasthenic patients carried coexisting autoimmune conditions. DISCUSSION Elevated titers of AChR binding antibody can be found frequently in non-myasthenic patients. Combined analysis of clinical presentation, AChR binding antibody titer and AChR modulating antibody results can be helpful in confirming an MG diagnosis. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Fang Sun
- Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sabrina Tavella-Burka
- Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Yuebing Li
- Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
7
|
Yen CC, Huang WL, Li SS, Chen YP, Tseng YL, Yen YT, Chu CY, Hsu YT, Chen TY. Pure Red Cell Aplasia and Other Haematological Diseases Associated With Thymoma: A Case Series and Systematic Review. Front Med (Lausanne) 2021; 8:759914. [PMID: 34966753 PMCID: PMC8710742 DOI: 10.3389/fmed.2021.759914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Thymoma-associated haematological diseases (HDs), such as pure red cell aplasia (PRCA) and Good's syndrome, are extremely rare, and due to the paucity of large-scale studies, the characteristics, remission after thymectomy, and long-term evaluation remain undetermined. Methods: We retrospectively assessed patients with thymoma and associated HDs from Jan 2005 to Dec 2020. All patients received thymectomy and/or additional treatments for HDs. A comparison with thymoma-associated myasthenic gravis (MG), and a systematic review from PubMed/MEDLINE and Embase were conducted. Results: In the median follow-up of 56 months, 130 patients were enrolled. Patients with thymoma-associated MG (n = 46) and HDs [n = 8; PRCA (n = 5), PRCA and Good's syndrome (n = 2) and autoimmune haemolytic anaemia (n = 1)] were evaluated. Patients with MG had a significantly higher remission rate after thymectomy (50 vs. 17%; p = 0.0378) as compared to those with other autoimmune diseases. Two of seven patients with PRCA experienced remission with thymectomy alone, and an additional two patients achieved remission with thymectomy plus immunosuppressive therapy (IST). In the systematic review, 60 studies (case reports, n = 46; case series including the present study, n = 14) were evaluated. Forty-four percent of patients were diagnosed with PRCA after thymoma, and 61% achieved remission with thymectomy plus IST; however, Good's syndrome was unaffected. Conclusions: Our study indicates that patients with thymoma-associated autoimmune diseases other than MG have a lower remission rate than those with MG. Remission of thymoma-associated PRCA can be achieved by thymectomy and IST. This study provides insight into extremely rare but puzzling autoimmune manifestations.
Collapse
Affiliation(s)
- Chih-Chieh Yen
- Division of Haematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital Douliou Branch, Yunlin, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sin-Syue Li
- Division of Haematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Chen
- Division of Haematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Yao Chu
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ya-Ting Hsu
- Division of Haematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Ya-Ting Hsu
| | - Tsai-Yun Chen
- Division of Haematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Tsai-Yun Chen
| |
Collapse
|
8
|
Song X, Fan J, Zhu L, Wang Z, He Y, Zhou C. The efficacy and safety of immunotherapy in thymic epithelial tumors: more effective, more risky: a systematic review. J Thorac Dis 2021; 13:5093-5103. [PMID: 34527346 PMCID: PMC8411126 DOI: 10.21037/jtd-21-290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
Background Thymic epithelial tumors (TETs) are rare malignant neoplasms originating from thymic epithelial cells. The current treatment for localized TETs is surgical removal. However, 20-30% of thymomas and 70-80% of thymic carcinomas are unresectable, recurrent, or metastatic at the time of detection. The standard therapy for these patients is chemotherapy, but the effect is limited. With a deeper understanding of tumor immunity, immunotherapy for various cancers has rapidly developed. Antibodies against cytotoxic T-lymphocyte antigen-4, programmed death-1, and programmed death-ligand 1 have been approved for the treatment of many solid tumors. Compared with traditional treatments, these immune checkpoint inhibitors (ICIs) have better efficacy and lower toxicity. Recently, ICIs have been used more enthusiastically in the treatment of TETs. However, due to the unique biological characteristics of the thymus, immunotherapy usually causes severe immune-related adverse events (irAEs). Most previous studies on immunotherapy in TETs had small sample sizes and reported diverse conclusions. Methods We collected relevant studies in PubMed during the last five years and analyzed the available data to discuss the efficacy and safety of ICIs in TETs. Results According to 14 previous studies in the past five years, all TETs showed expression of programmed death-ligand 1, while thymic carcinomas showed 100% expression. The best median progression-free survival (mPFS) among the five studies was 6.5 months, and the best median overall survival (mOS) was 24.9 months. In addition, the most common irAEs were myasthenic symptoms, liver enzyme elevation, and elevated creatine phosphokinase levels. Conclusions ICIs can be used in TET treatment, especially for thymic carcinomas, in the absence of standard second-line treatment. However, more attention should be paid to irAEs.
Collapse
Affiliation(s)
- Xinyu Song
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai First People's Hospital, First People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Liang Zhu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Zhehai Wang
- Department of Medical Oncology, Shandong Cancer Hospital, Jinan, China
| | - Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| |
Collapse
|
9
|
Liu Z, Zhu Y, Yuan Y, Yang L, Wang K, Wang M, Yang X, Wu X, Tian X, Zhang R, Shen B, Luo H, Feng H, Feng S, Ke Z. 3D DenseNet Deep Learning Based Preoperative Computed Tomography for Detecting Myasthenia Gravis in Patients With Thymoma. Front Oncol 2021; 11:631964. [PMID: 34026611 PMCID: PMC8132943 DOI: 10.3389/fonc.2021.631964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myasthenia gravis (MG) is the most common paraneoplastic syndromes of thymoma and closely related to thymus abnormalities. Timely detecting of the risk of MG would benefit clinical management and treatment decision for patients with thymoma. Herein, we developed a 3D DenseNet deep learning (DL) model based on preoperative computed tomography (CT) as a non-invasive method to detect MG in thymoma patients. Methods A large cohort of 230 thymoma patients in a hospital affiliated with a medical school were enrolled. 182 thymoma patients (81 with MG, 101 without MG) were used for training and model building. 48 cases from another hospital were used for external validation. A 3D-DenseNet-DL model and five radiomic models were performed to detect MG in thymoma patients. A comprehensive analysis by integrating machine learning and semantic CT image features, named 3D-DenseNet-DL-based multi-model, was also performed to establish a more effective prediction model. Findings By elaborately comparing the prediction efficacy, the 3D-DenseNet-DL effectively identified MG patients and was superior to other five radiomic models, with a mean area under ROC curve (AUC), accuracy, sensitivity, and specificity of 0.734, 0.724, 0.787, and 0.672, respectively. The effectiveness of the 3D-DenseNet-DL-based multi-model was further improved as evidenced by the following metrics: AUC 0.766, accuracy 0.790, sensitivity 0.739, and specificity 0.801. External verification results confirmed the feasibility of this DL-based multi-model with metrics: AUC 0.730, accuracy 0.732, sensitivity 0.700, and specificity 0.690, respectively. Interpretation Our 3D-DenseNet-DL model can effectively detect MG in patients with thymoma based on preoperative CT imaging. This model may serve as a supplement to the conventional diagnostic criteria for identifying thymoma associated MG.
Collapse
Affiliation(s)
- Zhenguo Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Zhu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institution of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujie Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kefeng Wang
- Department of Thoracic Surgery, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minghui Wang
- Department of Thoracic Surgery, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Wu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Tian
- Advanced Institute, Infervision, Beijing, China
| | | | - Bingqi Shen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Honghe Luo
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shiting Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zunfu Ke
- Institution of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
10
|
Martín C, Enrico D, Mas L, Patane AK, Arrieta O, Soria T, Cardona AF, Ruiz‐Patiño A, Ruiz R, Rioja P, Lozano S, Zatarain‐Barrón ZL, Barrón F, Puparelli C, Tsou F, Corassa MP, Freitas HC, Cordeiro de Lima VC, Rojas L, Ordóñez‐Reyes C, Corrales L, Sotelo C, Rodríguez J, Ricaurte L, Ávila J, Archila P, Rosell R, Cuello M, Remon J. Characteristics and outcomes of thymomas in Latin America: Results from over 10 years of experience (CLICaP-LATimus). Thorac Cancer 2021; 12:1328-1335. [PMID: 33729676 PMCID: PMC8088938 DOI: 10.1111/1759-7714.13901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Thymomas are a group of rare neoplasms of the anterior mediastinum. The objective of this study was to describe the demographics, clinical characteristics and treatment approaches in Latin America. METHODS This was a retrospective multicenter cohort study including patients with histologically proven thymomas diagnosed between 1997 and 2018. Demographics, clinicopathological characteristics and therapeutic outcomes were collected locally and analyzed in a centralized manner. RESULTS A total of 135 patients were included. Median age at diagnosis was 53 years old (19-84), 53.3% (n = 72) of patients were female and 87.4% had an ECOG performance score ranging from 0-1. A total of 47 patients (34.8%) had metastatic disease at diagnosis. Concurrent myasthenia gravis occurred in 21.5% of patients. Surgery was performed in 74 patients (54.8%), comprising 27 (20%) tumorectomies and 47 (34.8%) thymectomies. According to the Masaoka-Koga system, overall survival (OS) at five-years was 73.4%, 63.8% and 51%, at stages I-II, III-IVA and IVB, respectively (p = 0.005). Furthermore, patients with low lactate dehydrogenase (LDH) (≤373 IU/L) at baseline and myasthenia gravis concurrence showed significantly better OS (p = 0.001 and p = 0.008, respectively). In multivariate analysis, high LDH levels (HR 2.8 [95% confidence interval [CI]: 1.1-7.8]; p = 0.036) at baseline and not performing a surgical resection (HR 4.1 [95% CI: 1.3-12.7]; p = 0.016) were significantly associated with increased risk of death. CONCLUSIONS Our data provides the largest insight into the clinical characteristics and outcomes of patients with thymomas in Latin America. Survival in patients with thymomas continues to be very favorable, especially when subjected to adequate local control.
Collapse
Affiliation(s)
- Claudio Martín
- Thoracic Oncology UnitAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Diego Enrico
- Clinical Oncology DepartmentAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Luis Mas
- Thoracic Oncology Unit, Oncology DepartmentInstituto Nacional de Enfermedades Neoplásicas – INENLimaPeru
| | | | - Oscar Arrieta
- Thoracic Oncology UnitInstituto Nacional de Cancerología‐ INCanMéxico CityMexico
| | - Tannia Soria
- Thoracic Oncology UnitHospital SOLCAQuitoEcuador
| | - Andrés F. Cardona
- Clinical and Traslational Oncology GroupClinica del CountryBogotáColombia
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
- Molecular Oncology and Biology Systems Research Group (Fox‐G)Universidad el BosqueBogotáColombia
| | - Alejandro Ruiz‐Patiño
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
- Molecular Oncology and Biology Systems Research Group (Fox‐G)Universidad el BosqueBogotáColombia
| | - Rossana Ruiz
- Thoracic Oncology Unit, Oncology DepartmentInstituto Nacional de Enfermedades Neoplásicas – INENLimaPeru
| | - Patricia Rioja
- Thoracic Oncology Unit, Oncology DepartmentInstituto Nacional de Enfermedades Neoplásicas – INENLimaPeru
| | - Sophia Lozano
- Thoracic Oncology Unit, Oncology DepartmentInstituto Nacional de Enfermedades Neoplásicas – INENLimaPeru
| | | | - Feliciano Barrón
- Thoracic Oncology UnitInstituto Nacional de Cancerología‐ INCanMéxico CityMexico
| | - Carmen Puparelli
- Thoracic Oncology UnitAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Florencia Tsou
- Thoracic Oncology UnitAlexander Fleming Cancer InstituteBuenos AiresArgentina
| | | | - Helano C. Freitas
- Department of Medical OncologyA C Camargo Cancer CenterSão PauloBrazil
| | | | - Leonardo Rojas
- Clinical and Traslational Oncology GroupClinica del CountryBogotáColombia
- Molecular Oncology and Biology Systems Research Group (Fox‐G)Universidad el BosqueBogotáColombia
- Oncology DepartmentClínica ColsanitasBogotáColombia
| | | | - Luis Corrales
- Thoracic Oncology UnitHospital San Juan de Dios/Centro de Investigación y Manejo del Cáncer (CIMCA)San JoséCosta Rica
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
| | - Jenny Ávila
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research – FICMACBogotáColombia
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program at the Catalan Institute of OncologyHospital Germans Trias i PujolBarcelonaSpain
| | - Mauricio Cuello
- Medical Oncology Department, Hospital de ClínicasUniversidad de la Republica – UdeLARMontevideoUruguay
| | - Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM‐CIOCC)Hospital HM Delfos, HM HospitalesBarcelonaSpain
| | | |
Collapse
|
11
|
Takahashi A, Miyauchi T, Tatsumoto N, Lin MY, Hou J, Doi T, Masaki T, Yamashita M. The histopathological spectrum of kidney biopsies in patients with thymoma and myasthenia gravis: a report of 24 biopsies from a single institution. Clin Kidney J 2021; 14:2090-2100. [PMID: 35261763 PMCID: PMC8894933 DOI: 10.1093/ckj/sfaa276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Background Nephropathy in patients with thymic diseases such as thymoma and myasthenia gravis (MG) is rare and has been described mostly as isolated case reports. Here we evaluate a series of kidney biopsies from patients with thymoma and/or MG from a single institution in order to better define the spectrum and relative frequencies of thymic disease–associated nephropathies. Methods We conducted a retrospective case series study of 32 462 native kidney biopsies from January 2005 through December 2019 at Cedars-Sinai Medical Center, Los Angeles, CA, USA. Results Twenty-four biopsy specimens (0.07%) from patients with a history of thymoma and/or MG were identified. Two patients had repeat biopsies. The most common pathologic diagnosis that could be immunologically attributed to thymic disease was minimal change disease (MCD; 45%), followed by tubulointerstitial nephritis (TIN; 14%), immune complex (IC)-mediated glomerulonephritis (9%), membranous nephropathy (5%) and immunoglobulin A (IgA) nephropathy (5%). Interestingly, 50% of the MCD and 67% of TIN cases concomitantly showed mild IgG-dominant IC deposition in mesangial areas and/or in tubular basement membranes. In the two patients with repeat biopsies, mild mesangial IC deposition developed in the MCD patient but disappeared in the TIN patient with the second biopsy. Pathologic diagnoses unlikely related to the underlying thymic disease were diabetic glomerulosclerosis (9%), acute tubular necrosis (9%) and monoclonal Ig deposition disease (5%). Conclusions Thymic disease is associated with a wide spectrum of kidney diseases affecting the glomerular and tubulointerstitial compartments, often with low-grade IC deposition. These findings suggest a role of immunologic dysregulation in the pathogenesis of thymic disease–associated nephropathy.
Collapse
Affiliation(s)
- Akira Takahashi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takamasa Miyauchi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Narihito Tatsumoto
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mercury Y Lin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Toshiki Doi
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Michifumi Yamashita
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
12
|
Lefeuvre CMJ, Payet CA, Fayet OM, Maillard S, Truffault F, Bondet V, Duffy D, de Montpreville V, Ghigna MR, Fadel E, Mansuet-Lupo A, Alifano M, Validire P, Gossot D, Behin A, Eymard B, Berrih-Aknin S, Le Panse R. Risk factors associated with myasthenia gravis in thymoma patients: The potential role of thymic germinal centers. J Autoimmun 2020; 106:102337. [DOI: 10.1016/j.jaut.2019.102337] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
|
13
|
Onuki T, Ueda S, Otsu S, Yanagihara T, Kawakami N, Yamaoka M, Inagaki M. Thymectomy during Myasthenic Crisis under Artificial Respiration. Ann Thorac Cardiovasc Surg 2019; 25:215-218. [PMID: 29515082 PMCID: PMC6698714 DOI: 10.5761/atcs.cr.17-00176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022] Open
Abstract
A 34-year-old man was diagnosed with thymoma, which was evaluated preoperatively as stage II or III, with myasthenia gravis (MG). The size of the tumor was 70 × 44 × 80 mm. No invasion to neighboring organs was observed. Prednisolone was prescribed for stabilization of MG. However, a myasthenic crisis (MC) occurred, and intensive care, including emergent endobronchial intubation followed by artificial ventilation, pulse steroid therapy, high-dose intravenous immunoglobulin, and tacrolimus hydrate, was initiated. A chest computed tomography on day 6 revealed tumor reduction to 50 × 30 × 60 mm. An extended total thymectomy by median sternotomy was performed, and artificial ventilation was continued after that. Scheduled artificial ventilation and steroid therapy together can, therefore, enable complete resection of thymoma in patients undergoing treatment for MC. While ventilation helps avert a respiratory failure, the steroid therapy temporarily reduces the tumor size, making resection easier.
Collapse
Affiliation(s)
- Takuya Onuki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Sho Ueda
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinichi Otsu
- Department of Neurology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masatoshi Yamaoka
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masaharu Inagaki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| |
Collapse
|
14
|
Wang S, Breskovska I, Gandhy S, Punga AR, Guptill JT, Kaminski HJ. Advances in autoimmune myasthenia gravis management. Expert Rev Neurother 2018; 18:573-588. [PMID: 29932785 PMCID: PMC6289049 DOI: 10.1080/14737175.2018.1491310] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Myasthenia gravis (MG) is an autoimmune neuromuscular disorder with no cure and conventional treatments limited by significant adverse effects and variable benefit. In the last decade, therapeutic development has expanded based on improved understanding of autoimmunity and financial incentives for drug development in rare disease. Clinical subtypes exist based on age, gender, thymic pathology, autoantibody profile, and other poorly defined factors, such as genetics, complicate development of specific therapies. Areas covered: Clinical presentation and pathology vary considerably among patients with some having weakness limited to the ocular muscles and others having profound generalized weakness leading to respiratory insufficiency. MG is an antibody-mediated disorder dependent on autoreactive B cells which require T-cell support. Treatments focus on elimination of circulating autoantibodies or inhibition of effector mechanisms by a broad spectrum of approaches from plasmapheresis to B-cell elimination to complement inhibition. Expert commentary: Standard therapies and those under development are disease modifying and not curative. As a rare disease, clinical trials are challenged in patient recruitment. The great interest in development of treatments specific for MG is welcome, but decisions will need to be made to focus on those that offer significant benefits to patients.
Collapse
Affiliation(s)
- Shuhui Wang
- Department of Neurology, George Washington University, Washington DC 20008
| | - Iva Breskovska
- Department of Neurology, George Washington University, Washington DC 20008
| | - Shreya Gandhy
- Department of Neurology, George Washington University, Washington DC 20008
| | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Jeffery T. Guptill
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Henry J. Kaminski
- Department of Neurology, George Washington University, Washington DC 20008
| |
Collapse
|
15
|
Trujillo-Reyes JC, Martínez-Téllez E, Belda-Sanchis J. Thymoma. A Systemic Disease? Arch Bronconeumol 2018; 55:235-236. [PMID: 29801679 DOI: 10.1016/j.arbres.2018.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Belda-Sanchis
- Servicio de Cirugía Torácica, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
16
|
Cacho-Díaz B, Salmerón-Moreno K, Lorenzana-Mendoza NA, Texcocano J, Arrieta O. Myasthenia gravis as a prognostic marker in patients with thymoma. J Thorac Dis 2018; 10:2842-2848. [PMID: 29997948 DOI: 10.21037/jtd.2018.04.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Thymoma is the most common mediastinal tumor, representing <1% of all cancers. It is usually associated with paraneoplastic disorders, mainly myasthenia gravis (MG). The aim of the present study was to describe patients with thymoma and the differences between those with MG and those without it. Methods A retrospective 10-year database of the patients with thymoma treated at a single cancer referral hospital (National Institute of Cancer, Mexico City), was analyzed. Results Sixty-four files from patients with thymoma were analyzed, 18 of them had MG. The symptoms that occurred most frequently in patients with MG were ptosis, diplopia, appendicular weakness, dysphonia and dysphagia. The most frequent Myasthenia Gravis Foundation of America (MGFA) stage was IIIb followed by stage I. Almost all the patients with MG had positive Acetylcholine Receptor antibodies (P<0.001), with not specified antibodies in four patients. The median overall survival showed a trend to be higher among the patients with MG, but there were no significant differences. Conclusions In patients with thymoma MG manifests with different clinical and autoimmune traits, but not survival differences. A larger multi-centric study should be encouraged to evaluate the prognostic implications of having MG in patients with thymoma.
Collapse
Affiliation(s)
| | | | | | - Julia Texcocano
- Neuroscience Unit, Instituto Nacional de Cancerología, México City, México
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
| |
Collapse
|
17
|
Liu ZH, Xu JZ, Shen H. Fetal sequential multiorgan autoimmunity associated with recurrent post thymectomy thymoma. Autoimmun Rev 2017; 16:1090-1091. [DOI: 10.1016/j.autrev.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 12/29/2022]
|
18
|
Qi G, Liu P, Dong H, Gu S, Yang H, Xue Y. Therapeutic Potential of Docetaxel plus Cisplatin Chemotherapy for Myasthenia Gravis Patients with Metastatic Thymoma. TOHOKU J EXP MED 2017; 241:281-286. [PMID: 28381664 DOI: 10.1620/tjem.241.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prognosis of myasthenia gravis (MG) in association with invasive or metastatic thymoma is usually worse, and therapeutic options are quite limited. Here, we retrospectively reported the therapeutic effect of docetaxel plus cisplatin (docetaxel/cisplatin) chemotherapy in 7 MG patients with metastatic thymoma. Previously, all patients underwent thymectomy at the first onset of thymoma. After the metastasis of thymoma, none of the patients received thymectomy due to unresectable conditions after surgeon's evaluation for great risk of myasthenic crisis (n = 5) or patients' refusal (n = 2). All patients received docetaxel (75 mg/m2) and cisplatin (70 mg/m2) on day 1 (d1) every 21 days, with the cycle ranging from 1 to 4. After docetaxel/cisplatin chemotherapy, one patient achieved partial response, and 6 with stable disease of the tumors. The clinical symptoms of MG were alleviated in all patients, 2 with complete remission and the other 5 with marked improvement. Myelosuppression was the major adverse event, occurring in 2 patients (grade II and IV). MG relapse occurred in one patient during the follow-up. Our study presented a series of MG patients with metastatic thymoma who underwent docetaxel/cisplatin chemotherapy. Besides the improved/stabilized thymoma, markedly improvement of MG with the tolerable adverse events was achieved. Docetaxel/cisplatin chemotherapy appears to be an effective treatment for selected patients with MG in association with unresectable metastatic thymoma. Further follow-up of these patients and additional subjects will be needed to determine whether the therapeutic benefits are durable.
Collapse
Affiliation(s)
- Guoyan Qi
- Myasthenia Gravis Treatment Center of Hebei Province, First Hospital of Shijiazhuang
| | | | | | | | | | | |
Collapse
|
19
|
Bando H, Iguchi G, Okimura Y, Odake Y, Yoshida K, Matsumoto R, Suda K, Nishizawa H, Fukuoka H, Mokubo A, Tojo K, Maniwa Y, Ogawa W, Takahashi Y. A novel thymoma-associated autoimmune disease: Anti-PIT-1 antibody syndrome. Sci Rep 2017; 7:43060. [PMID: 28216655 PMCID: PMC5316939 DOI: 10.1038/srep43060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/17/2017] [Indexed: 12/20/2022] Open
Abstract
Anti-PIT-1 antibody syndrome has recently been reported and characterized by acquired growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) deficiencies associated with autoimmunity to a pituitary specific transcription factor PIT-1, which plays an essential role in GH-, PRL-, and TSH-producing cells. Although circulating anti-PIT-1 antibody and PIT-1-reactive cytotoxic T cells (CTLs) were detected in the patients, the pathophysiology and precise mechanisms for the autoimmunity remain unclarified. During the follow up, thymoma was diagnosed in all 3 cases with anti-PIT-1 antibody syndrome. Immunohistochemical analysis revealed that PIT-1 was strongly expressed in neoplastic cortical thymic epithelial cells. Importantly, after thymectomy, the titer of anti-PIT-1 antibody decreased and reactivity of CTLs toward PIT-1 diminished. These data strongly suggest that the aberrant expression of PIT-1 in the thymoma plays a causal role in the development of this syndrome. Thus, we define that this syndrome is a novel thymoma-associated autoimmune disease.
Collapse
Affiliation(s)
- Hironori Bando
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Yasuhiko Okimura
- Department of Nutrition and Food Science, Kobe Women’s University Graduate School of Life Sciences, Kobe, Japan
| | - Yukiko Odake
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Yoshida
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryusaku Matsumoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Suda
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Nishizawa
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | | | - Katsuyoshi Tojo
- Division of Diabetes and Endocrinology, Department of Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yoshimasa Maniwa
- Department of General Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
20
|
A case report of subclinical hypercortisolism due to adrenal incidentaloma complicated by myasthenia gravis after adrenalectomy. TUMORI JOURNAL 2016; 102:6EDBF158-D494-4315-80A6-726346E9D490. [PMID: 27103206 DOI: 10.5301/tj.5000503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2016] [Indexed: 11/20/2022]
Abstract
A 62-year-old woman was admitted for evaluation of an incidentally discovered adrenal mass and hypertension. CT scan revealed a 7 cm mass in the right adrenal gland. After careful examination, the patient was diagnosed with subclinical hypercortisolism (SH). Adrenalectomy was performed. Histopathological examination showed an adrenocortical adenoma. Symptoms and signs of myasthenia gravis appeared 5 months later. CT of the chest showed a solid tissue mass in the mediastinum. The patient underwent a sternotomy with excision of the tumor, which histologically proved to be a type 2B thymoma. We describe a rare case of SH due to an incidentally discovered adrenocortical adenoma in a patient who manifested myasthenia gravis after surgical remission of the cortisol excess.
Collapse
|
21
|
The Effect of Immunonutrition on the Postoperative Complications in Thymoma with Myasthenia Gravis. Mediators Inflamm 2016; 2016:8781740. [PMID: 27956763 PMCID: PMC5121463 DOI: 10.1155/2016/8781740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/11/2016] [Accepted: 10/20/2016] [Indexed: 01/10/2023] Open
Abstract
Object. To test whether preoperative immunonutrition is efficacious in reducing postoperative complications in patients of thymoma with myasthenia gravis (MG). Material and Methods. A total of 244 patients operated on for thymoma with myasthenia gravis were prospectively assigned to two groups, each receiving seven-day preoperative and seven-day postoperative nutrition. The patients in immunonutrition group were given oral immunonutrition (IN). The patients in control group received oral standard nutrition. Immunonutritional and inflammatory biomarkers (IgA, IgG, IgM, CD3t, CD4t, CD8t, CD4t/CD8t ratio, NK-cell, prealbumin, albumin, white blood cells counts, and C-reactive protein) and clinical variables (age, gender, BMI, performance status, type of thymoma, type of MG, operative time, pathology, operative approach, postoperative complications, quantity of drainage, hospital stays) were examined. Results. A significant reduction in the length of hospital stay, quantity of drainage, and postoperative complications was observed in the IN group (p < 0.05). An increase in the level of IgA, IgG, IgM, CD3+T, CD4+T, CD4+T/CD8+T, WBC, CRP, and NK-cell in the IN group was observed after thymectomy, while a decrease was seen with regard to prealbumin and albumin (p < 0.05). Conclusion. Preoperative immunonutrition support is effective in reducing postoperative complications in patients of thymoma with MG. It helps to lower the risk of postoperative infectious complications and hospital stays.
Collapse
|
22
|
Kitano T, Kinoshita M, Shimazu K, Fushimi H, Omori K, Hazama T. A case of relapsing encephalitis positive for gamma aminobutyric acid (GABA) A receptor antibody associated with Type B3 thymoma. Rinsho Shinkeigaku 2016; 56:764-768. [PMID: 27773905 DOI: 10.5692/clinicalneurol.cn-000930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 87-year-old female presented with subacute progression of cognitive decline. Fluid-attenuated inversion recovery images of brain MRI showed multifocal high-intensity lesions. Thoracic CT image revealed the presence of thymoma, and serum autoantibody screening showed positivity for anti-gamma aminobutyric acid (GABA)A receptor antibody. Histopathological analysis confirmed type B3 thymoma after thymectomy. The patient received both plasmapheresis and intravenous methylprednisolone therapy, and showed remarkable amelioration of clinical symptoms and MRI abnormal high intensity. However, after 2 month from the clinical recovery, the patient showed recurrence of brain lesions and intravenous methylprednisolone monotherapy was performed. Continuation of oral steroid therapy was required to maintain the quienscent state of inflammation within the central nervous system. Anti-GABAA receptor antibody is a recently discovered novel autoantibody associated with autoimmue encephalitis. Due to the limited number of literature reported, clinical course and therapeutic response of GABAA receptor antibody encephalitis remains elusive. Here we reported a rare case of GABAA receptor antibody encephalitis with type B3 thymoma. Clinical, radiological and therapeutic courses described in our report highlight the importance of immunotherapy for treatment of the disease.
Collapse
Affiliation(s)
- Takaya Kitano
- Department of Neurology, Osaka General Medical Center
| | | | | | | | | | | |
Collapse
|
23
|
Sasson SC, Davies S, Chan R, Davies L, Garsia R. Cerebral toxoplasmosis in a patient with myasthenia gravis and thymoma with immunodeficiency/Good's syndrome: a case report. BMC Infect Dis 2016; 16:457. [PMID: 27576953 PMCID: PMC5004299 DOI: 10.1186/s12879-016-1801-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 08/23/2016] [Indexed: 01/01/2023] Open
Abstract
Background Patients with thymoma with immunodeficiency (TWI)/Good’s syndrome characteristically have evidence of combined immunodeficiency including low or absent B-cells, hypogammaglobulinemia and defects in T-cell mediated immunity. These patients can present with common or opportunistic infections. Case presentation A 54-year-old female was diagnosed with cerebral toxoplasmosis. This occurred on a background of metastatic thymoma previously treated with chemotherapy and myasthenia gravis (MG) treated with mycophenolate mofetil, monthly intravenous immunoglobulin (IVIG) and pyridostigmine. She reported recurrent herpes zoster infection. The patient had clinical and radiological progression of cerebral infection despite completing standard induction and maintenance therapy with sulfadiazine and pyrimethamine. Investigations found a complete absence of B-cells and evidence for hypogammaglobulinemia which, together with evidence of defects in T-cell mediated immunity and thymoma, lead to a diagnosis of TWI/Good’s Syndrome. The patient has undergone prolonged high-dose therapy for toxoplasmosis and a reduction in immunosuppression with no evidence of recurrent toxoplasmosis or flare of MG. Conclusions TWI/Good’s Syndrome should be suspected in patients with thymoma and recurrent, persistent or unusual infections. If suspected serum immunoglobulins and lymphocyte subsets should be measured. These patients may need closer monitoring, higher dose and prolonged treatment of infections, and weaning of concurrent immunosuppression may be considered.
Collapse
Affiliation(s)
- Sarah C Sasson
- Department of Clinical Immunology, Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Sarah Davies
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Raymond Chan
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Leo Davies
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Roger Garsia
- Department of Clinical Immunology, Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
24
|
Zhang Z, Cui Y, Jia R, Xue L, Liang H. Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy. Oncol Lett 2016; 11:4177-4182. [PMID: 27313762 DOI: 10.3892/ol.2016.4528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/18/2016] [Indexed: 12/21/2022] Open
Abstract
Thymomas are the most common adult tumors in the anterior mediastinal compartment, and a significant amount of thymomas are complicated by myasthenia gravis (MG). Extended thymectomy (ET) is the primary treatment method for thymomas and is used to completely resect possible ectopic thymus to avoid recurrence. Studies on the effect of MG in thymoma patients following ET are limited. The aim of the present study was to determine whether the presence of MG affects the prognosis of patients with thymoma. The present study consisted of 104 patients with thymoma that underwent ET; 61 men (58.7%) and 43 women (41.3%) (mean age, 54.6 years). In total, 38 patients had MG (36.5%). MG was most frequently observed in World Health Organization (WHO) classification type B2 thymoma compared with other types of thymoma. During the 5-year follow-up period, 11 patients succumbed to a recurrence of thymoma or respiratory failure due to MG. The overall 5-year survival rate in patients without MG or with MG was 89.1 and 76.0%, respectively. The overall survival (OS) rate in patients with Masaoka stages I + II and III + IV was 90.0 and 68.0%, respectively. The OS rate in patients with WHO type A + AB + B1 and type B2 + B3 was 96.9 and 76.8%, respectively. The patients with MG (P=0.026), Masaoka stages III + IV (P=0.008) and WHO type B2 + B3 (P=0.032) had a poorer prognosis compared with patients without these characteristics. Furthermore, multivariate analysis by Cox regression revealed that age [P=0.032; relative risk (RR)=1.097; 95% confidence interval (CI)=1.097-1.192] and MG (P=0.042; RR=0.167; 95% CI=0.037-0.940) significantly affected OS rate. In summary, ET is a reliable method for the treatment of thymoma. Long-term survival is expected for patients at early Masaoka stages, and for patients without MG. The prognosis of patients with thymomas with MG is poorer compared with patients without MG. The present findings provide useful information for the future management of patients with thymomas.
Collapse
Affiliation(s)
- Zhefeng Zhang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Youbin Cui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Rui Jia
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Lei Xue
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Huagang Liang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| |
Collapse
|
25
|
|
26
|
Bernard C, Frih H, Pasquet F, Kerever S, Jamilloux Y, Tronc F, Guibert B, Isaac S, Devouassoux M, Chalabreysse L, Broussolle C, Petiot P, Girard N, Sève P. Thymoma associated with autoimmune diseases: 85 cases and literature review. Autoimmun Rev 2016; 15:82-92. [DOI: 10.1016/j.autrev.2015.09.005] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/20/2015] [Indexed: 11/30/2022]
|
27
|
Motoishi M, Okamoto K, Kaku R, Sawai S, Hanaoka J. Thymoma-Associated Graft-Versus-Host-Like Disease With Skin Manifestations Improved by Complete Resection of Thymoma. Ann Thorac Surg 2015; 100:1078-80. [PMID: 26354632 DOI: 10.1016/j.athoracsur.2014.10.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/09/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022]
Abstract
A 69-year-old woman with refractory skin eruptions, which had first appeared 3 years previously, was examined, and an anterior mediastinal tumor was detected. The tumor was resected, and a diagnosis of type B2 thymoma, stage III disease (according to the World Health Organization classification), was made. Retrospectively, histologic findings of the skin before the operation were consistent with graft-versus-host disease. The final diagnosis of her skin lesions was thymoma-associated graft-versus-host-like disease. The skin lesions improved gradually during the 1-month period after resection with only a topical steroid, and further improvement was seen at 3 months.
Collapse
Affiliation(s)
- Makoto Motoishi
- Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
| | - Keigo Okamoto
- Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ryosuke Kaku
- Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Satoru Sawai
- Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Jun Hanaoka
- Department of Thoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
28
|
Østergaard ML, Petersen RH, Kalhauge A. A chondrosarcoma in the anterior mediastinum mimicking a thymoma. Acta Radiol Open 2015; 4:2058460115595659. [PMID: 26413313 PMCID: PMC4568935 DOI: 10.1177/2058460115595659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/18/2015] [Indexed: 11/25/2022] Open
Abstract
A chondrosarcoma in the anterior mediastinum is a rare finding with a relatively good prognosis. We describe a case of a 75-year-old man with a 2-year history of neck discomfort and weight loss. Imaging showed a homogenous tumor with a minor compression on the anterior part of the heart. It had close relation to the ribs, no surrounding fat, and a thymoma was suspected. Biopsy prior to surgery was impossible due to the location of the tumor. Unfortunately, final pathology from the surgical specimen revealed a chondrosarcoma.
Collapse
Affiliation(s)
| | - Rene H Petersen
- Department of Cardiothoracic Surgery Rigshospitalet, Copenhagen, Denmark
| | - Anna Kalhauge
- Department of Radiology Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
29
|
Hague DW, Humphries HD, Mitchell MA, Shelton GD. Risk Factors and Outcomes in Cats with Acquired Myasthenia Gravis (2001-2012). J Vet Intern Med 2015; 29:1307-12. [PMID: 26308738 PMCID: PMC4858034 DOI: 10.1111/jvim.13596] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/26/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
Background Acquired myasthenia gravis (MG) in cats most commonly causes generalized weakness without megaesophagus and is more often associated with a cranial mediastinal mass, compared to dogs. Hypothesis/Objectives To extend the clinical findings described in the report of 2000 on MG in cats (J Am Vet Med Assoc 215:55–57). Animals Two hundred and thirty‐five cats with MG. Methods Retrospective case study to evaluate the long‐term outcome and incidence of spontaneous remission in myasthenic cats. Information including signalment, clinical presentation, presence of and type of cranial mediastinal mass, treatment including surgical versus medical, survival time, and outcome including spontaneous remissions was collected and analyzed in cats diagnosed at the Comparative Neuromuscular Laboratory, University of California San Diego by detection of acetylcholine receptor antibody titers >0.3 nmol/L by immunoprecipitation radioimmunosassay. Results Acquired MG in cats is associated with a euthanasia rate of 58%. Abyssinian and Somali cats had an increased incidence of MG compared to mixed breed cats or cats of other breeds. A cranial mediastinal mass, most commonly thymoma, was observed in 52% of the cats, which is higher than in the previous report. Spontaneous remission is not a characteristic of MG in cats. Conclusions and clinical importance Myasthenia gravis in cats is a chronic disease associated with a high incidence of a cranial mediastinal mass. Spontaneous remission is not common and clinicians should warn owners of the necessity for long‐term treatment. The clinical outcome with a cranial mediastinal mass did not differ between surgical or medical treatment.
Collapse
Affiliation(s)
- D W Hague
- College of Veterinary Medicine, University of Illinois, Urbana, IL
| | - H D Humphries
- Department of Pathology, School of Medicine, University of California, San Diego, CA
| | - M A Mitchell
- College of Veterinary Medicine, University of Illinois, Urbana, IL
| | - G D Shelton
- Department of Pathology, School of Medicine, University of California, San Diego, CA
| |
Collapse
|
30
|
Systems biology of myasthenia gravis, integration of aberrant lncRNA and mRNA expression changes. BMC Med Genomics 2015; 8:13. [PMID: 25889429 PMCID: PMC4380247 DOI: 10.1186/s12920-015-0087-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background A novel class of transcripts, long non-coding RNAs (lncRNAs), has recently emerged as a key player in several biological processes, and important roles for these molecules have been reported in a number of complex human diseases, such as autoimmune diseases, neurological disorders, and various cancers. However, the aberrant lncRNAs implicated in myasthenia gravis (MG) remain unknown. The aim of the present study was to explore the abnormal expression of lncRNAs in peripheral blood mononuclear cells (PBMCs) and examine mRNA regulatory relationship networks among MG patients with or without thymoma. Methods Microarray assays were performed, and the outstanding differences between lncRNAs or mRNA expression were verified through RT-PCR. The lncRNAs functions were annotated for the target genes using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) biological pathway. The potential regulatory relationships between the lncRNAs and target genes were analyzed using the ‘cis’ and ‘trans’ model. Outstanding lncRNAs were organized to generate a TF-lncRNA-gene network using Cytoscape software. Results The lncRNA and mRNA expression profile analysis revealed subsets of differentially expressed genes in MG patients with or without thymoma. A total of 12 outstanding dysregulated expression lncRNAs, such as lncRNA oebiotech_11933, were verified through real-time PCR. Several GO terms including the cellular response to interferon-γ, platelet degranulation, chemokine receptor binding and cytokine interactions were very important in MG pathogenesis. The chromosome locations of some lncRNAs and associated co-expression genes were demonstrated using ‘cis’ analysis. The results of the ‘trans’ analysis revealed that some TFs (i.e., CTCF, TAF1and MYC) regulate lncRNA and gene expression. The outstanding lncRNAs in each group were implicated in the regulation of the TF-lncRNA-target gene network. Conclusion The results of the present study provide a perspective on lncRNA expression in MG. We identify a subset of aberrant lncRNAs and mRNAs as potential biomarkers for the diagnosis of MG. The GO and KEGG pathway analysis provides an annotation to determine the functions of these lncRNAs. The results of the ‘cis’ and ‘trans’ analyses provide information concerning the modular regulation of lncRNAs. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0087-z) contains supplementary material, which is available to authorized users.
Collapse
|
31
|
Liu Y, Zhang H, Zhang P, Meng F, Chen Y, Wang Y, Yao Y, Qi B. Autoimmune regulator expression in thymomas with or without autoimmune disease. Immunol Lett 2014; 161:50-6. [PMID: 24768600 DOI: 10.1016/j.imlet.2014.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The autoimmune regulator (AIRE) regulates autoimmunity and self-antigen expression, such as acetylcholine receptor (AchR), in the thymus. Regulatory T cells (Tregs) can down-regulate autoimmunity, but also promote tumor growth. The objective of this study was to examine the levels of AIRE, AchR, and Foxp3 expression in thymomas. METHODS The relative levels of AIRE, AchR, and Foxp3 mRNA transcripts and the frequency of AIRE+, AchR+, and Foxp3+ cells were determined by quantitative RT-PCR and immunohistochemistry in 79 thymoma tissue samples from 21 patients with simple thymoma (the Tm group), 39 patients with myasthenia gravis (the MG group) and 19 patients with myasthenia gravis and one other autoimmune disease (the AD group). The numbers of peripheral blood CD4+CD25+Foxp3+ Tregs were determined by flow cytometry analysis. RESULTS The relative levels of AIRE and AchR mRNA transcripts in the MG group were significantly lower than that in the Tm group (p=0.04, p=0.03), but higher than that in the AD group (p=0.03, p=0.04). The relative levels of Foxp3 mRNA transcripts in the Tm group were significantly higher than that in the MG and AD groups (p=0.03 for both). A similar pattern of the percentages of AIRE+, AchR+, and Foxp3+ cells in the thymoma tissues and the numbers of peripheral blood Tregs were detected in these patients. The levels of AIRE mRNA transcripts were correlated positively with that of the AchR and Foxp3 in this population. The levels of AIRE and AchR mRNA transcripts in the A/AB/B1 types of thymomas were significantly higher than that in the B2/B3/C types of thymomas in this population. CONCLUSION Significantly lower levels of AIRE, AchR, and Foxp3 expression are associated with the development of thymoma-related autoimmune diseases.
Collapse
Affiliation(s)
- Yimei Liu
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Hui Zhang
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Peng Zhang
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China.
| | - Fanjie Meng
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Yuan Chen
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Yuanguo Wang
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Yuanyuan Yao
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| | - Bin Qi
- Department of Cardiothoracic Surgery General Hospital at Tianjin Medical University, No. 154, Anshan Road, Heping District, Tianjin300052 PR China
| |
Collapse
|
32
|
Arora Y, Li Y. Overview of myasthenia gravis. Hosp Pract (1995) 2013; 41:40-50. [PMID: 24145588 DOI: 10.3810/hp.2013.10.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Myasthenia gravis is an antibody-mediated disorder of neuromuscular transmission that is characterized by weakness and fatigue of voluntary muscles. Weakness may be ocular, bulbar, or generalized. Diagnostic evaluation of patients consists of bedside assessment, antibody testing, and electrophysiologic studies. Various therapeutic options are available, which consist of anticholinesterase inhibitors for symptomatic management, immunosuppressive agents as maintenance therapy, and thymectomy. Plasmapheresis and intravenous immunoglobulin are used in patients in crisis or those with rapidly worsening or refractory symptoms. In our article, we elaborate on key aspects of the epidemiology, pathogenesis, diagnostic evaluation, and therapeutic options for patients with myasthenia gravis.
Collapse
Affiliation(s)
- Yeeshu Arora
- Division of the Neuromuscular Center, Department of Neurology, Cleveland Clinic, Cleveland, OH
| | | |
Collapse
|