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Paramasivan S, Psaltis AJ, Wormald PJ, Vreugde S. Tertiary Lymphoid Organs: A Primer for Otolaryngologists. Laryngoscope 2020; 131:1697-1703. [PMID: 33179781 DOI: 10.1002/lary.29261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Lymphoid neogenesis or the development of organised, de novo lymphoid structures has been described increasingly in chronically inflamed tissues. The presence of tertiary lymphoid organs (TLOs) has already been demonstrated to result in significant consequences for disease pathology, severity, prognosis and patient outcomes. Whilst the wider medical community has embraced TLOs as important markers of disease and potential therapeutic targets, the otolaryngology field has only begun turning to these entities in an academic capacity. This review aims to outline the role of tertiary lymphoid organs in disease and summarise key early findings in the ENT field. We also an overview of TLOs, their developmental process and clinicopathological implications. STUDY DESIGN Literature review. METHODS A literature search for all relevant peer-reviewed publications pertaining to TLOs and ENT diseases. Search was conducted using PubMed, Embase and CINAHL databases. RESULTS A total of 24 studies were identified relevant to the topic. The majority of TLO research in ENT fell into the areas of oral squamous cell carcinoma (SCC) and chronic rhinosinusitis (CRS). CONCLUSIONS Early research into both oral SCC and CRS suggests that TLOs have significant roles within ear, nose and throat (ENT) diseases. At this point in time, however, TLOs remain somewhat a mystery amongst otolaryngologists. As information in this field increases, we may develop a better understanding of how lymphoid neogenesis can influence disease outcomes amongst our patients and, ultimately, how they can be utilised in an immunotherapeutic manner. Laryngoscope, 131:1697-1703, 2021.
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Affiliation(s)
- Sathish Paramasivan
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Kranich J, Krautler NJ. How Follicular Dendritic Cells Shape the B-Cell Antigenome. Front Immunol 2016; 7:225. [PMID: 27446069 PMCID: PMC4914831 DOI: 10.3389/fimmu.2016.00225] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/26/2016] [Indexed: 12/21/2022] Open
Abstract
Follicular dendritic cells (FDCs) are stromal cells residing in primary follicles and in germinal centers of secondary and tertiary lymphoid organs (SLOs and TLOs). There, they play a crucial role in B-cell activation and affinity maturation of antibodies. FDCs have the unique capacity to bind and retain native antigen in B-cell follicles for long periods of time. Therefore, FDCs shape the B-cell antigenome (the sum of all B-cell antigens) in SLOs and TLOs. In this review, we discuss recent findings that explain how this stromal cell type can arise in almost any tissue during TLO formation and, furthermore, focus on the mechanisms of antigen capture and retention involved in the generation of long-lasting antigen depots displayed on FDCs.
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Affiliation(s)
- Jan Kranich
- Institute for Immunology, Ludwig Maximilian University Munich, Munich, Germany
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3
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Vrolix K, Fraussen J, Losen M, Stevens J, Lazaridis K, Molenaar PC, Somers V, Bracho MA, Le Panse R, Stinissen P, Berrih-Aknin S, Maessen JG, Van Garsse L, Buurman WA, Tzartos SJ, De Baets MH, Martinez-Martinez P. Clonal heterogeneity of thymic B cells from early-onset myasthenia gravis patients with antibodies against the acetylcholine receptor. J Autoimmun 2014; 52:101-12. [PMID: 24439114 DOI: 10.1016/j.jaut.2013.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Myasthenia gravis (MG) with antibodies against the acetylcholine receptor (AChR-MG) is considered as a prototypic autoimmune disease. The thymus is important in the pathophysiology of the disease since thymus hyperplasia is a characteristic of early-onset AChR-MG and patients often improve after thymectomy. We hypothesized that thymic B cell and antibody repertoires of AChR-MG patients differ intrinsically from those of control individuals. Using immortalization with Epstein-Barr Virus and Toll-like receptor 9 activation, we isolated and characterized monoclonal B cell lines from 5 MG patients and 8 controls. Only 2 of 570 immortalized B cell clones from MG patients produced antibodies against the AChR (both clones were from the same patient), suggesting that AChR-specific B cells are not enriched in the thymus. Surprisingly, many B cell lines from both AChR-MG and control thymus samples displayed reactivity against striated muscle proteins. Striational antibodies were produced by 15% of B cell clones from AChR-MG versus 6% in control thymus. The IgVH gene sequence analysis showed remarkable similarities, concerning VH family gene distribution, mutation frequency and CDR3 composition, between B cells of AChR-MG patients and controls. MG patients showed clear evidence of clonal B cell expansion in contrast to controls. In this latter aspect, MG resembles multiple sclerosis and clinically isolated syndrome, but differs from systemic lupus erythematosus. Our results support an antigen driven immune response in the MG thymus, but the paucity of AChR-specific B cells, in combination with the observed polyclonal expansions suggest a more diverse immune response than expected.
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Affiliation(s)
- Kathleen Vrolix
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Judith Fraussen
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Mario Losen
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jo Stevens
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | | | - Peter C Molenaar
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Veerle Somers
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Maria Alma Bracho
- Centre Superior d'Investigació en Salut Pública (CSISP), Àrea de Genòmica i Salut, Conselleria de Sanitat, Generalitat Valenciana, València, Spain; Institut "Cavanilles" de Biodiversitat i Biologia Evolutiva (ICBiBE), Universitat de València, València, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Spain
| | - Rozen Le Panse
- UPMC UM 76/INSERM U974/CNRS UMR7215/Institute of Myology, 105 Bd de l'hôpital, Paris, France
| | - Piet Stinissen
- Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Sonia Berrih-Aknin
- UPMC UM 76/INSERM U974/CNRS UMR7215/Institute of Myology, 105 Bd de l'hôpital, Paris, France
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands
| | - Leen Van Garsse
- Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands
| | - Wim A Buurman
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Socrates J Tzartos
- Department of Biochemistry, Hellenic Pasteur Institute, GR 11521 Athens, Greece
| | - Marc H De Baets
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Neuroimmunology group, Biomedical Research Institute and Transnationale Universiteit Limburg, School of Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pilar Martinez-Martinez
- Department of Neuroscience, School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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CD8+ T-Cell Deficiency, Epstein-Barr Virus Infection, Vitamin D Deficiency, and Steps to Autoimmunity: A Unifying Hypothesis. Autoimmune Dis 2012; 2012:189096. [PMID: 22312480 PMCID: PMC3270541 DOI: 10.1155/2012/189096] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/03/2011] [Accepted: 10/16/2011] [Indexed: 12/16/2022] Open
Abstract
CD8+ T-cell deficiency is a feature of many chronic autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, dermatomyositis, primary biliary cirrhosis, primary sclerosing cholangitis, ulcerative colitis, Crohn's disease, psoriasis, vitiligo, bullous pemphigoid, alopecia areata, idiopathic dilated cardiomyopathy, type 1 diabetes mellitus, Graves' disease, Hashimoto's thyroiditis, myasthenia gravis, IgA nephropathy, membranous nephropathy, and pernicious anaemia. It also occurs in healthy blood relatives of patients with autoimmune diseases, suggesting it is genetically determined. Here it is proposed that this CD8+ T-cell deficiency underlies the development of chronic autoimmune diseases by impairing CD8+ T-cell control of Epstein-Barr virus (EBV) infection, with the result that EBV-infected autoreactive B cells accumulate in the target organ where they produce pathogenic autoantibodies and provide costimulatory survival signals to autoreactive T cells which would otherwise die in the target organ by activation-induced apoptosis. Autoimmunity is postulated to evolve in the following steps: (1) CD8+ T-cell deficiency, (2) primary EBV infection, (3) decreased CD8+ T-cell control of EBV, (4) increased EBV load and increased anti-EBV antibodies, (5) EBV infection in the target organ, (6) clonal expansion of EBV-infected autoreactive B cells in the target organ, (7) infiltration of autoreactive T cells into the target organ, and (8) development of ectopic lymphoid follicles in the target organ. It is also proposed that deprivation of sunlight and vitamin D at higher latitudes facilitates the development of autoimmune diseases by aggravating the CD8+ T-cell deficiency and thereby further impairing control of EBV. The hypothesis makes predictions which can be tested, including the prevention and successful treatment of chronic autoimmune diseases by controlling EBV infection.
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Dobson R, Meier UC, Giovannoni G. More to come: humoral immune responses in MS. J Neuroimmunol 2011; 240-241:13-21. [PMID: 22019113 DOI: 10.1016/j.jneuroim.2011.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 09/15/2011] [Accepted: 09/20/2011] [Indexed: 01/14/2023]
Abstract
Interest in the role of B-cells in multiple sclerosis (MS) pathogenesis has increased, and a number of B-cell targeted therapies are currently in clinical trials. B-cells are key mediators of the humoral immune response, with roles including antibody production and acting as antigen presenting cells. Whilst previously, the presence of B-cells within MS plaques has been thought to be secondary to T-cell dysregulation, it is now becoming clear that B-cells play an independent role in disease. In this review we will discuss the potential role of B-cells in MS, how this influences our understanding of the disease, and potential therapeutic implications.
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Affiliation(s)
- Ruth Dobson
- Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, London E1 2AT, UK.
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Marx A, Willcox N, Leite MI, Chuang WY, Schalke B, Nix W, Ströbel P. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity 2010; 43:413-27. [PMID: 20380583 DOI: 10.3109/08916930903555935] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Paraneoplastic autoimmune diseases associate occasionally with small cell lung cancers and gynecologic tumors. However, myasthenia gravis (MG) occurs in at least 30% of all patients with thymomas (usually present at MG diagnosis). These epithelial neoplasms almost always have numerous admixed maturing polyclonal T cells (thymocytes). This thymopoiesis-and export of mature CD4(+)T cells-particularly associates with MG, though there are rare/puzzling exceptions in apparently pure epithelial WHO type A thymomas. Other features potentially leading to inefficient self-tolerance induction include defective epithelial expression of the autoimmune regulator (AIRE) gene and/or of major histocompatibility complex class II molecules in thymomas, absence of myoid cells, failure to generate FOXP3(+) regulatory T cells, and genetic polymorphisms affecting T-cell signaling. However, the strong focus on MG/neuromuscular targets remains unexplained and suggests some biased autoantigen expression, T-cell selection, or autoimmunization within thymomas. There must be further clues in the intriguing serological and cellular parallels in some patients with late-onset MG but without thymomas-and in others with AIRE mutations-and in the contrasts with early-onset MG, as discussed here.
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Affiliation(s)
- A Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, D-68135 Mannheim, Germany.
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Gilhus NE, Aarli JA, Christensson B, Matre R. Thymomas and skeletal muscle share an antigen in myasthenia gravis. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1984.tb02442.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hill ME, Shiono H, Newsom-Davis J, Willcox N. The myasthenia gravis thymus: a rare source of human autoantibody-secreting plasma cells for testing potential therapeutics. J Neuroimmunol 2008; 201-202:50-6. [PMID: 18722675 DOI: 10.1016/j.jneuroim.2008.06.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 11/17/2022]
Abstract
In early-onset myasthenia gravis (EOMG), the thymus is colonized by lymph node-like infiltrates including T cell areas and germinal centers. Our Group(1) showed (1978) spontaneous anti-acetylcholine receptor (AChR) autoantibody production by EOMG thymic cells. Especially after enzymic dispersal, these are enriched in plasma cells that are evidently autonomous, long-lived, terminally differentiated and radio-resistant. Radiolabeled AChR is highly sensitive both for localizing them in situ and detecting their ongoing antibody production in culture at limiting cell numbers. Thus EOMG thymi are a readily available source of specific autoimmune human plasma cells suitable for studying their biology and testing new therapies.
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Kendall PL, Yu G, Woodward EJ, Thomas JW. Tertiary lymphoid structures in the pancreas promote selection of B lymphocytes in autoimmune diabetes. THE JOURNAL OF IMMUNOLOGY 2007; 178:5643-51. [PMID: 17442947 DOI: 10.4049/jimmunol.178.9.5643] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Autoimmune diabetes occurs when invading lymphocytes destroy insulin-producing beta cells in pancreatic islets. The role of lymphocytic aggregates at this inflammatory site is not understood. We find that B and T lymphocytes attacking islets in NOD mice organize into lymphoid structures with germinal centers. Analysis of BCR L chain genes was used to investigate selection of B lymphocytes in these tertiary lymphoid structures and in draining pancreatic lymph nodes. The pancreatic repertoire as a whole was found to be highly diverse, with the profile of L chain genes isolated from whole pancreas differing from that observed in regional lymph nodes. A Vkappa14 L chain predominated within the complex pancreatic repertoire of NOD mice. Skewing toward Vkappa4 genes was observed in the pancreas when the repertoire of NOD mice was restricted using a fixed Ig H chain transgene. Nucleotide sequencing of expressed Vkappas identified shared mutations in some sequences consistent with Ag-driven selection and clonal expansion at the site of inflammation. Isolated islets contained oligoclonal B lymphocytes enriched for the germinal center marker GL7 and for sequences containing multiple mutations within CDRs, suggesting local T-B interactions. Together, these findings identify a process that selects B lymphocyte specificities within the pancreas, with further evolution of the selected repertoire at the inflamed site. This interpretation is reinforced by Ag-binding studies showing a large population of insulin-binding B lymphocytes in the pancreas compared with draining lymph nodes.
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Affiliation(s)
- Peggy L Kendall
- Department of Medicine, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232, USA
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10
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Abstract
The frequent observation of organized lymphoid structures that resemble secondary lymphoid organs in tissues that are targeted by chronic inflammatory processes, such as autoimmunity and infection, has indicated that lymphoid neogenesis might have a role in maintaining immune responses against persistent antigens. In this Review, we discuss recent progress in several aspects of lymphoid neogenesis, focusing on the similarities with lymphoid tissue development, the mechanisms of induction, functional competence and pathophysiological significance. As more information on these issues becomes available, a better understanding of the role of lymphoid neogenesis in promoting chronic inflammation might eventually lead to new strategies to target immunopathological processes.
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Affiliation(s)
- Francesca Aloisi
- Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità, Rome, Italy.
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11
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Nagane Y, Utsugisawa K, Obara D, Yamagata M, Tohgi H. Dendritic cells in hyperplastic thymuses from patients with myasthenia gravis. Muscle Nerve 2003; 27:582-9. [PMID: 12707978 DOI: 10.1002/mus.10362] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To investigate the role of dendritic cells (DCs) in the hyperplastic myasthenia gravis (MG) thymus, we studied the frequency and distribution of three mature DC phenotypes (CD83(+)CD11c(+), CD86(+)CD11c(+), and HLA-DR(+)CD11c(+)) in samples from patients with MG whose symptoms dramatically improved following thymectomy and in non-MG control thymuses. In hyperplastic MG thymuses, mature DCs were much more numerous in nonmedullary areas, such as the subcapsular/outer cortex; around the germinal centers; and in extralobular connective tissue, particularly around blood vessels. Mature DCs strongly coexpressed CD44 and appeared to be components of a CD44-highly positive (CD44(high)) cell population migrating from the vascular system. Furthermore, in the hyperplastic MG thymus, the expression of secondary lymphoid-tissue chemokine (SLC) markedly increased especially around extralobular blood vessels, where the CD44(high) cell population accumulated. These findings suggest that DCs may migrate into the hyperplastic thymus from the vascular system via mechanisms that involve CD44 and SLC. DCs may present self-antigens, thereby promoting the priming and/or boosting of potentially autoreactive T cells against the acetylcholine receptor.
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Affiliation(s)
- Yuriko Nagane
- Department of Neurology, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan
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Vincent A, Willcox N, Hill M, Curnow J, MacLennan C, Beeson D. Determinant spreading and immune responses to acetylcholine receptors in myasthenia gravis. Immunol Rev 1998; 164:157-68. [PMID: 9795773 DOI: 10.1111/j.1600-065x.1998.tb01217.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In myasthenia gravis (MG), antibodies to the muscle acetylcholine receptor (AChR) cause muscle weakness. Experimental autoimmune myasthenia gravis (EAMG) can be induced by immunisation against purified AChR; the main immunogenic region (MIR) is a conformation-dependent site that includes alpha 67-76. EAMG can also occur after immunisation against extracellular AChR sequences, but this probably involves intramolecular determinant spreading. In MG patients, thymic hyperplasia and germinal centres are found in about 50%, and thymoma in 10-15%. The heterogeneous, high affinity, IgG anti-AChR antibodies appear to be end-products of germinal centre responses, and react mainly with the MIR or a site on fetal AChR; the latter contains a gamma subunit and is mainly expressed on myoid cells in the thymic medulla. T cells cloned against recombinant AChR subunits recognise principally two naturally processed epitopes: epsilon 201-219 derived from adult AChR which is expressed in muscle, and sometimes in thymic epithelium, and alpha 146-160, common to fetal and adult AChR. Since AChR is not normally co-expressed with class II, it is unclear how CD4+ responses to AChR alpha and epsilon subunits are initiated, and how and where these spread to induce antibodies against fetal AChR. Various possibilities, including upregulation of class II on muscle/myoid cells and involvement of CD8+ responses to AChR and other muscle antigens, are discussed.
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Affiliation(s)
- A Vincent
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK.
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Murai H, Hara H, Hatae T, Kobayashi T, Watanabe T. Expression of CD23 in the germinal center of thymus from myasthenia gravis patients. J Neuroimmunol 1997; 76:61-9. [PMID: 9184633 DOI: 10.1016/s0165-5728(97)00030-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In order to investigate a pathogenic role of germinal centers which appear in the hyperplastic thymus of myasthenia gravis (MG) patients, we performed an immunohistochemical study using various monoclonal antibodies including CD23. In contrast with tonsilar germinal centers from non-MG individuals, CD23 was strongly and diffusely expressed in the whole area of germinal centers of MG thymi, including the outer zone. In addition, we measured the serum level of soluble CD23 (sCD23) in MG patients at various clinical stages. The high serum sCD23 levels, which were noted in the unthymectomized patients, fell to within normal range over 5 years after thymectomy, and the decline of serum sCD23 correlated well with clinical improvement. CD23 is thought to be responsible for preventing unselected germinal center B cells from entering apoptosis and, in turn, leads to the survival of auto-reactive B cell clones.
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Affiliation(s)
- H Murai
- Department of Neurology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Yu GH, Salhany KE, Gokaslan ST, Cajulis RS, De Frias DV. Thymic epithelial cells as a diagnostic pitfall in the fine-needle aspiration diagnosis of primary mediastinal lymphoma. Diagn Cytopathol 1997; 16:460-5. [PMID: 9143851 DOI: 10.1002/(sici)1097-0339(199705)16:5<460::aid-dc15>3.0.co;2-h] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The cytologic diagnosis of primary mediastinal lesions is challenging due to the large number of lesions which may arise (i.e., lymphoma, thymoma, germ cell tumor), often with overlapping cytomorphologic features. We present an instructive case of primary mediastinal non-Hodgkin's large-cell lymphoma with sclerosis, entrapping thymic epithelium. Preoperative fine-needle aspiration yielded predominantly epithelial fragments and few lymphoid cells leading to the cytologic misdiagnosis of thymoma. The entity of primary mediastinal large-cell lymphoma (LCL) is discussed and correlated with the cytologic features seen. In addition, histologic sections from 15 additional cases of primary mediastinal LCL were evaluated to determine the frequency with which significant numbers of epithelial fragments may be observed.
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Affiliation(s)
- G H Yu
- Department of Pathology, Northwestern University Medical School, Chicago, Illinois, USA
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Iwami Y, Hashimoto Y, Iwanaga T. Production of a monoclonal antibody (59.4) against canine lymphocyte surface antigen and its immunohistochemical application. J Vet Med Sci 1997; 59:239-44. [PMID: 9152930 DOI: 10.1292/jvms.59.239] [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: 02/04/2023] Open
Abstract
A monoclonal antibody was produced by immunizing BALB/c mice with freshly prepared canine thymocytes and peripheral blood leukocytes. The antibody, designated 59.4, was of the IgG1 subclass type and mainly reacted with lymphocytes. In single-color flow cytometric analysis, lymphocytes from the peripheral blood, thymus and spleen were graded into three categories according to their fluorescence intensity labeling by antibody 59.4: weakly, moderately and intensely positive cells. Two-color analysis revealed that a major population of CD8-positive cells were intensely labeled by antibody 59.4, but less than 50% of CD4-positive cells were moderately reacted with antibody 59.4. Immunohistochemically, thymocytes in the medulla showed moderately intense immunoreactivity to 59.4, but most lymphocytes in the cortex were negative in reaction. Immunostaining using antibody 59.4 demonstrated characteristic aggregations of 59.4-positive lymphocytes in the reticulum cell-free region of the thymic medulla. In the spleen, scattered lymphocytes in the outer layer of the marginal zone and in the red pulp were intensely labeled by antibody 59.4, while lymphocytes gathering in the mantle zone and periarterial lymphatic sheath (PALS) were moderately stained. Antibody 59.4 appears to recognize an antigen which is expressed by a more-differentiated T cell-lineage but not by immature T cells in the thymic cortex.
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Affiliation(s)
- Y Iwami
- Department of Biomedical Science, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Onodera J, Nakamura S, Nagano I, tobita M, Yoshioka M, Takeda A, Oouchi M, Itoyama Y. Upregulation of Bcl-2 protein in the myasthenic thymus. Ann Neurol 1996; 39:521-8. [PMID: 8619530 DOI: 10.1002/ana.410390414] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We examined the expression of Fas antigen and Bcl-2 protein in thymic tissue surgically resected from 10 patients with myasthenia gravis, using immunocytochemical techniques. Histologically, thymic tissues from 7 myasthenia gravis patients showed hyperplasia, while 3 other patients had thymomas. In hyperplastic thymic tissue, immunoreactivity for Fas antigen was observed mainly in the network of medullary epithelial cells. In contrast, expression of Fas antigen was rare in the cortex. Fas antigen was also detected to some degree in thymoma tissue from 3 patients. Bcl-2 protein was highly expressed in the medullary thymocytes in the hyperplastic thymic tissue, whereas its staining was quite low in myasthenia gravis thymomas. The number of Bcl-2-positive thymocytes in the medulla was significantly greater in the hyperplastic myasthenia gravis thymic tissue than in the control thymic tissue. These findings suggest that Bcl-2 protein may be upregulated in the myasthenia gravis thymus and that this phenomenon may be related to impaired apoptotic cell death of autoreactive thymocytes in myasthenia gravis.
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Affiliation(s)
- J Onodera
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
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Lewis RA, Selwa JF, Lisak RP. Myasthenia gravis: immunological mechanisms and immunotherapy. Ann Neurol 1995; 37 Suppl 1:S51-62. [PMID: 8968217 DOI: 10.1002/ana.410370707] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review of the immunological aspects of myasthenia gravis and the immunotherapy of the disease emphasizes the current state of knowledge of the immunological events at the neuromuscular junction, and the immunoregulatory abnormalities noted in myasthenic patients. The treatment modalities available to the clinician are discussed in an attempt to provide information that will allow for a rational approach to therapy.
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Affiliation(s)
- R A Lewis
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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18
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Abstract
It appeared from this prospective and non-randomized study, that the removal of thymomas in myasthenia gravis (MG) patients resulted in rapid exacerbation of the clinical severity of the disease and of anti-acetylcholine receptor antibodies titres, which peaked after about 300 days and continued for up to 2 years. Long-term follow-up after thymomectomy (mean duration +/- SEM after surgery 5.5 +/- 0.8 years) showed that the immunological and clinical state observed prior to surgery was eventually restored, but long-term benefit attributable to surgery could not be demonstrated. Non-thymoma MG cases, however, exhibited post-operative amelioration in clinical course and decreasing antibodies titres, both of which were already significant one year after surgery, and additional improvement was observed at the time of long-term follow-up (mean 4.3 +/- 0.5 years). Furthermore, the prognosis for MG patients not operated on was also favourable. It is suggested that the occurrence of thymomas is linked to genetic factors and that neoplasia of the thymus may be part of immunoregulatory mechanisms with predominance of inhibition.
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Affiliation(s)
- F E Somnier
- Department of Neurology, National Hospital (Rigshospitalet), Hellerup, Denmark
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19
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Abstract
IgG-class anticardiolipin antibodies (IgG-ACA) were found in 25% of patients with myasthenia gravis. The prevalence and the level distribution were significantly different from those of a normal donor population (p < 0.001). In myastenic patients, IgG-ACA bound negatively charged, but not zwitterionic, phospholipids. They were significantly associated with the thymic abnormalities, thymoma and thymic hyperplasia, but not with various factors such as age, sex, antinuclear antibodies, severity of the disease and clinical thrombosis. The IgG-ACA levels did not correlate with titers of anti-acetylcholine receptor antibodies. Thus in Myasthenia Gravis, asymptomatic IgG-ACA could reflect an immune dysregulation under the influence of thymic alterations.
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Affiliation(s)
- M Sanmarco
- Laboratoire d'Immunologie, Faculté de Médecine, Marseille, France
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20
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Fujii Y, Hayakawa M, Nakahara K. Thymus cells in myasthenia gravis: a two-colour flow cytometric analysis of lymphocytes in the thymus and thymoma. J Neurol 1992; 239:82-8. [PMID: 1552308 DOI: 10.1007/bf00862978] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The thymus in patients with myasthenia gravis has germinal centres and the thymic lymphocytes spontaneously produce anti-acetylcholine receptor antibody in vitro. This suggests indirectly that the myasthenic thymus contains mature T and B cells that are autoreactive. We report a two colour flow cytometric analysis of the surface antigen phenotype of lymphocytes in the thymus and in thymoma in 24 patients and in 14 normal thymuses. The results show a decline in the proportion of double positive immature thymocytes with age. This process seems to be partially disrupted in patients with myasthenia gravis. In addition titres of anti-acetylcholine receptor antibody were positively correlated with the proportion of mature single positive T cells and non-T DR positive cells.
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Affiliation(s)
- Y Fujii
- First Department of Surgery, Osaka University Medical School, Japan
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21
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Abstract
Neoplastic epithelial cells of thymoma apparently retain the function of the cortical epithelial cells of normal thymus because a large number of nonneoplastic T cells in thymomas are often CD4+8+. However, the lack of medullary structure suggests that thymomas may lack some of the function of the normal thymus, especially the function of the medullary interdigitating cells to induce tolerance to self-antigens on T cells. Thymoma is often associated with autoimmune diseases, most frequently, myasthenia gravis. This suggests that the microenvironment of a thymoma may not be able to induce T cell tolerance to self-antigens. We addressed this question by testing the lymphocytes in thymomas for proliferative responses to mitogens and allogeneic or autologous stimulator cells. The lymphocytes in thymomas proliferated consistently in response to PHA and to allogeneic cells even when the response to OKT3 was undetectable. However, neither the thymoma lymphocytes nor the peripheral blood lymphocytes in these patients proliferated in response to autologous cells.
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Affiliation(s)
- Y Fujii
- First Department of Surgery, Osaka University Medical School, Japan
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22
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Durelli L, Maggi G, Casadio C, Ferri R, Rendine S, Bergamini L. Actuarial analysis of the occurrence of remissions following thymectomy for myasthenia gravis in 400 patients. J Neurol Neurosurg Psychiatry 1991; 54:406-11. [PMID: 1865202 PMCID: PMC488538 DOI: 10.1136/jnnp.54.5.406] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The role of thymectomy in the treatment of myasthenia gravis (MG) was analysed in 400 patients affected with generalised MG operated on between 1974-83, and prospectively followed up for five years after surgery. The occurrence of stable remission (SR) (that is, complete clinical drug-free remission that remains stable for all the subsequent follow up) was the endpoint of survival analyses and the distribution of SR time (SRT, that is, the interval from thymectomy to the occurrence of SR) was assessed by actuarial and Cox multivariate analyses. SRT distribution after surgery showed a slow progressive increase of cumulative SR rate that could both be ascribed to a delayed effect of thymectomy as well as reflect the natural history of MG, itself characterised by an increasing probability of spontaneous remission with time. SRT distribution was similar after stratification for all variables studied except when patients without thymoma were stratified for the need for immunosuppressive treatment in addition to thymectomy. Patients without thymoma who did not require additional immunosuppressive therapy (n = 130) had the highest SR rate occurring in the two years after thymectomy, and differed from patients treated with immunosuppressive drugs who showed the highest SR rate five years after surgery. Actuarial analysis has therefore identified a subgroup of patients where SR, occurring in the first years after surgery, is more likely to be ascribed to thymectomy than merely reflect the natural course of the disease.
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Affiliation(s)
- L Durelli
- Clinica Neurologica, Faculty of Medicine, University of Turin, Italy
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23
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Davis RE, Dorfman RF, Warnke RA. Primary large-cell lymphoma of the thymus: a diffuse B-cell neoplasm presenting as primary mediastinal lymphoma. Hum Pathol 1990; 21:1262-8. [PMID: 2249839 DOI: 10.1016/s0046-8177(06)80040-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary mediastinal nonlymphoblastic non-Hodgkin's lymphoma (NLNHL) has distinct clinical, histologic (diffuse large-cell morphology, often with sclerosis and clear cytoplasm), and immunohistochemical features (predominantly B-cell lineage, usually immunoglobulin-negative), which suggest origin from a unique B-cell population. The thymus has a resident population of B cells with a unique immunophenotype, and can be involved by primary mediastinal NLNHL, in some cases selectively. Fifteen cases of NLNHL involving the thymus were studied by paraffin-section immunohistochemistry using antibodies to formalin-resistant epitopes of B cells (4KB5 [CD45RA] and L26 [CD20]) and T cells (L60 [CD43] and UCHL1 [CD45RO]). All were diffuse large-cell or immunoblastic lymphomas with sclerosis, and were also similar to primary mediastinal NLNHL in clinical features. Neoplastic cells stained with L26 in all but one case, which stained with 4KB5 and an antibody to a leukocyte-common antigen (PD7/26 [CD45RB]), and were uniformly nonreactive with L60 (with one exception) and UCHL1. Intermingled small lymphocytes were uniformly L26-negative and positive for T-cell markers, even in one case with atypia suggesting a lymphoma of mixed morphology. These findings demonstrate that primary thymic and primary mediastinal NLNHL are similar B-lineage neoplasms, and support previous suggestions that both may originate in thymic B cells.
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Affiliation(s)
- R E Davis
- Department of Pathology, Stanford University Medical Center, CA 94305
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24
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Sommer N, Willcox N, Harcourt GC, Newsom-Davis J. Myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor-reactive T cells. Ann Neurol 1990; 28:312-9. [PMID: 2241114 DOI: 10.1002/ana.410280303] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We compared T-cell proliferative responses to acetylcholine receptor (AChR) and to purified protein derivative (PPD) (of tuberculin) of hyperplastic thymus, thymoma, and blood cells from patients with myasthenia gravis (MG). Hyperplastic MG thymus cells gave significantly higher and more consistent responses to AChR than parallel cultures of autologous blood cells, whereas responses to PPD showed an opposite trend. Thus there was a preferential localization of AChR-reactive T cells in the hyperplastic MG thymus. Furthermore, there was a strong correlation between blood and thymus cell responses to PPD (but not to AChR), arguing that the hyperplastic MG thymus contains a sample of sensitized peripheral T cells. By contrast, both AChR- and PPD-responsive T cells were almost undetectable in thymus from nonmyasthenic patients, which is evidently much less receptive to circulating T cells. Cells from MG thymomas showed the highest stimulations by AChR but did not consistently react to PPD. However, the uninvolved thymus adjacent to these thymomas behaved almost identically to the hyperplastic samples described above. Our interpretation is that AChR-specific T cells are initially sensitized in the MG thymoma but are selectively trapped in the hyperplastic thymus after being primed elsewhere.
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Affiliation(s)
- N Sommer
- Department of Neurological Science, Royal Free Hospital, London, United Kingdom
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25
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Durelli L, Massazza U, Poccardi G, Ferrio MF, Cavallo R, Maggi G, Casadio C, Di Summa M, Bergamini L. Increased thymocyte differentiation in myasthenia gravis: a dual-color immunofluorescence phenotypic analysis. Ann Neurol 1990; 27:174-80. [PMID: 2317013 DOI: 10.1002/ana.410270213] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thymocytes express multiple, different surface antigens according to their stage of maturation. Surface differentiation antigens have been studied with the technique of simultaneous dual-color, direct immunofluorescence in the thymuses of 20 patients with myasthenia gravis (MG) and 10 control subjects with cardiac diseases. Fluorescein isothiocyanate-conjugated and phycoerythrin-conjugated monoclonal antibodies were used to stain thymic cell suspensions. A significant decrease in the percentage of immature and common thymocyte phenotypes (CD1+,3+ and CD4+,8+) and a significant increase in the percentage of mature thymocyte phenotypes (CD1-,3+; CD4+,8-; and CD4-,8+) and of B cells (CD20+) were found in MG thymuses compared with controls. These data, indicating an increased availability of mature, fully immunocompetent T and B cells, indirectly suggest the occurrence of an active immune response in MG thymus.
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Affiliation(s)
- L Durelli
- Clinica Neurologica, Facoltà di Medicina, Università di Torino, Italy
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26
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Matsui M, Fukuyama H, Akiguchi I, Kameyama M. Circulating CD4+CD8+ cells in myasthenia gravis: supplementary immunological parameter for long-term prognosis. J Neurol 1989; 236:329-35. [PMID: 2571681 DOI: 10.1007/bf00314374] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty patients with myasthenia gravis (MG) were studied prospectively for up to 5 years after thymectomy, in order to clarify the relationships between disease severity, anti-acetylcholine receptor antibody (anti-AChR) titres, proportions of circulating CD4+CD8+ cells (CD4+CD8+ cell level) and major lymphocyte subsets. The CD4+CD8+ cell levels were closely related to the clinical change within 1 year after surgery in 8 patients who showed a preoperative elevation in the cell levels. This group of patients consisted of six thymomatous and two non-thymomatous patients; the latter were both negative for anti-AChR. The anti-AChR titres generally changed in parallel with the clinical state in 9 of the 16 patients who were followed up for more than a year after thymectomy, and the CD4+CD8+ cell levels were useful in predicting the clinical course in 6 of the above 9 patients and 3 other patients, including antibody-negative cases. The present study suggests that the CD4+CD8+ cell levels may serve as an indicator for long-term prognosis of MG.
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Affiliation(s)
- M Matsui
- Department of Neurology, Faculty of Medicine, Kyoto University, Japan
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27
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Abstract
A small subpopulation of human thymic medullary cells was found to express B cell-restricted and -associated antigens in various combinations. The cells were detected in fetal, juvenile, and adult thymi using indirect immunoenzymatic methods and monoclonal antibodies (MoAbs). Morphologically, they could be subdivided into small, round lymphoid cells, accounting for less than 1% of medullary lymphoid cells, and into a larger variant, even more infrequent in number and asteroid in shape because of short cytoplasmic processes. Immunophenotype (CD19+, CD20+, CD22+, CD37+, IgM+, IgD+) and morphology of the first cell type led to the conclusion that the lymphoid cells were B lymphocytes. The second, asteroid cell type constantly expressed CD20 and inconstantly expressed IgM, CD19, CD22, and CD37; they were often found to form rosettes with non-B lymphocytes. It can be concluded that a small number of B cells and asteroid cells of still uncertain origin, but expressing B cell-restricted antigens, are constitutive elements of the fetal and adult thymic medulla. It can be hypothesized that the asteroid cell might represent a novel type of thymic accessory cell and that the rosetting of non-B lymphocytes around this asteroid cell might simulate or in fact be the earliest B cell interaction of maturing T cells.
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Affiliation(s)
- W J Hofmann
- Institute of Pathology, University of Heidelberg, FRG
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28
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Schluep M, Willcox N, Ritter MA, Newsom-Davis J, Larché M, Brown AN. Myasthenia gravis thymus: clinical, histological and culture correlations. J Autoimmun 1988; 1:445-67. [PMID: 3254184 DOI: 10.1016/0896-8411(88)90067-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper attempts to quantitate immunohistological changes in the myasthenia gravis (MG) thymus and to correlate them with clinical and culture parameters in 40 untreated young onset patients covering a wide range of durations and serum anti-acetylcholine receptor (AChR) antibody titers. Total cellularities of both the thymic cortex and the medulla declined significantly with age. There was some hyperplasia of subcapsular and of medullary epithelial cells, often at the expense of cortex. A combined index of all hyperplastic changes correlated significantly with serum anti-AChR titre. Otherwise histological indices, e.g. of germinal centres (GC) were largely unrelated to any clinical parameters, especially duration of symptoms. Specific anti-AChR synthesis in culture (very closely related to serum titer) correlated better with the medullary lymph node-type T-cell areas; these were more widely prevalent and MG-specific. In contrast, basal and mitogen-stimulated total IgG productivity followed the GC indices more closely. We propose that the variability of GC is due to their dependence on extraneous immune complexes, and we discuss whether they or the T-cell areas are primary or secondary abnormalities. Finally, we conclude that autosensitization in MG with thymic hyperplasia and neoplasia probably arises through separate mechanisms.
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Affiliation(s)
- M Schluep
- Department of Neurological Science, Royal Free Hospital School of Medicine, London
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29
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Hofmann WJ, Momburg F, Möller P, Otto HF. Intra- and extrathymic B cells in physiologic and pathologic conditions. Immunohistochemical study on normal thymus and lymphofollicular hyperplasia of the thymus. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1988; 412:431-42. [PMID: 2451873 DOI: 10.1007/bf00750577] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Normal thymuses and thymuses with lymphofollicular hyperplasia have been examined immunohistologically using immunoenzymatic single and double labelling methods and a panel of monoclonal antibodies against B lymphocyte differentiation antigens (CD19-, CD20-, CD21-, CD22-, CD23- and CD37ag) and human immunoglobulins (IgM, IgD) for the presence and localisation of B lymphocytes and cells expressing B cell differentiation antigens. The numerous hyperplastic lymph follicles which occur in the pathological condition of lymphofollicular hyperplasia of the thymus were found to originate in the extrathymic compartment of the interlobular septal space. This area was found to be blown up by the growing lymph follicles with exactly the same cellular composition as their counterparts in the peripheral lymphatic tissue. Some of the B lymphocytes expressing the immunophenotype of follicular mantle zone lymphocytes which were detected in the thymic medulla probably infiltrated through discontinuities of the border between the perivascular space and the thymic medulla. Apart from this primarily extrathymic B cell compartment, B lymphocytes and cells expressing B cell antigens were found within the thymus medulla of normal control thymuses of different ages from fetal to adult life. These cells were detected as a small subpopulation in normal fetal, juvenile and adult thymuses. Morphologically they could be subdivided into small, round lymphoid cells accounting for less than 1% of medullary lymphoid cells, and into a larger variant, asteroidally shaped because of short cytoplasmic processes. These asteroid cells were even more infrequent than the lymphoid variant. Immunophenotype (CD19ag+, CD20ag+, CD22ag+, CD37ag+, IgM+, IgD+) and morphology of the first cell type led to the conclusion that the lymphoid cells were in fact B lymphocytes. They were scattered throughout the medulla of fetal and juvenile and adult thymuses alike. The second, the asteroid cell type, constantly expressed CD20ag and inconstantly IgM, CD22ag and CD37ag; furthermore, CD23ag was detected in a subset of the asteroid cells either restricted to the perinuclear zone or expressed in the entire cytoplasma and on the plasma membrane. The asteroid cells were located in the corticomedullary region of the fetal thymuses but were randomly distributed with a tendency to Hassall's corpuscles in juvenile and adult thymuses. They often formed rosettes with non-B lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- W J Hofmann
- Pathologisches Institut, Universität Heidelberg, FRG
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30
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Lisak RP, Levinson AI, Zweiman B, Kornstein MJ. In vitro synthesis of IgG and antibodies to AChR by peripheral and thymic lymphocytes. Ann N Y Acad Sci 1987; 505:39-49. [PMID: 3500667 DOI: 10.1111/j.1749-6632.1987.tb51281.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- R P Lisak
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104
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31
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DALAKAS MARINOSC. The Role of Thymosin ? 4and Interdigitating Cells in the Thymic Involvement of Myasthenia Gravis. Ann N Y Acad Sci 1987. [DOI: 10.1111/j.1749-6632.1987.tb51377.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Berrih-Aknin S, Morel E, Raimond F, Safar D, Gaud C, Binet JP, Levasseur P, Bach JF. The role of the thymus in myasthenia gravis: immunohistological and immunological studies in 115 cases. Ann N Y Acad Sci 1987; 505:50-70. [PMID: 3318621 DOI: 10.1111/j.1749-6632.1987.tb51282.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S Berrih-Aknin
- CNRS UA-1159, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
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33
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Newsom-Davis J, Willcox N, Schluep M, Harcourt G, Vincent A, Mossman S, Wray D, Burges J. Immunological heterogeneity and cellular mechanisms in myasthenia gravis. Ann N Y Acad Sci 1987; 505:12-26. [PMID: 2825574 DOI: 10.1111/j.1749-6632.1987.tb51279.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J Newsom-Davis
- Department of Neurological Science, Royal Free Hospital School of Medicine, London, England
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34
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Levinson AI, Zweiman B, Lisak RP. Immunopathogenesis and treatment of myasthenia gravis. J Clin Immunol 1987; 7:187-97. [PMID: 3036906 DOI: 10.1007/bf00915723] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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35
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Hofmann WJ, Möller P, Otto HF. Thymic hyperplasia. II. Lymphofollicular hyperplasia of the thymus. An immunohistologic study. KLINISCHE WOCHENSCHRIFT 1987; 65:53-60. [PMID: 2435953 DOI: 10.1007/bf01745473] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The so-called lymphofollicular hyperplasia, which is caused by the occurrence of hyperplastic lymph follicles within the organ, is constantly associated with autoimmune diseases (e.g., myasthenia gravis) and in rare instances with malignant tumors. The architecture of lymphofollicular hyperplasia was studied immunohistochemically using antibodies against epithelial, vascular, lymphocytic, and histiocytic antigens. There is evidence, that the configuration, microtopography, cellular composition, and immunohistological findings of the lymph follicles with germinal centers in the myasthenic thymus are essentially the same as in those occurring in lymph nodes and in other lymphatic tissue. Furthermore it could be shown that the follicles originate in the interlobular septal space and displace the thymic parenchyma by extension.
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36
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Kirchner T, Schalke B, Melms A, von Kügelgen T, Müller-Hermelink HK. Immunohistological patterns of non-neoplastic changes in the thymus in Myasthenia gravis. VIRCHOWS ARCHIV. B, CELL PATHOLOGY INCLUDING MOLECULAR PATHOLOGY 1986; 52:237-57. [PMID: 2879380 DOI: 10.1007/bf02889966] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Non-neoplastic thymuses from 20 patients with myasthenia gravis (MG) have been studied by routine stains on paraffin sections and by immunohistological methods on frozen sections using a panel of monoclonal antibodies against thymic epithelial cells, macrophages/reticulum cells, lymphoid cells and myoid cells. Three types of thymic histology in MG were distinguished: (1) thymitis with lymphoid follicular hyperplasia (11 cases), (2) thymitis with diffuse B-cell infiltration (5 cases) and (3) thymic atrophy (4 cases). Thymitis was more common in younger females and thymic atrophy in older patients. Both types of thymitis were associated with conspicuous structural disturbance of the thymic perivascular space (PVS) and medulla, characterized by a distinct enlargement of the PVS and disruption of the epithelium and reticulin fibre network at the medullary boundary, leading to fusion of the two compartments. The PVS and medulla contained a striking B-cell infiltration. Large well-developed germinal centers (GCs), showing the same cellular organization as in the peripheral lymphatic system, occurred in thymitis with lymphoid follicular hyperplasia, whereas thymitis with diffuse B-cell infiltration merely exhibited a few tiny lymphoid follicles, which could be demonstrated only by immunostaining of dendritic reticulum cells. In thymic atrophy a diffuse B-cell infiltration of the PVS and the medulla was also observed, but only minor alterations of the epithelial framework were seen. There was an increased number of interdigitating reticulum cells with variable expression of the T-6 antigen in all the thymuses examined, indicating an immune stimulation of the intrathymic T-cells. Myoid cells, the supposed target of the intrathymic immune reaction in MG, were found to be less frequent in thymic atrophy than in thymitis. This variable number of myoid cells may explain the different grades of immune stimulation and different types of histology seen in the thymus in MG.
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37
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Penn AS, Schotland DL, Lamme S. Antimuscle and antiacetylcholine receptor antibodies in myasthenia gravis. Muscle Nerve 1986; 9:407-15. [PMID: 3724787 DOI: 10.1002/mus.880090505] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The sera of 134 patients were examined for antimuscle antibodies by immunofluorescence (IF). These derived from 77 myasthenics, 30 myasthenics with thymoma, 6 patients with thymoma and no clinical evidence of myasthenia, and 21 patients with other autoimmune or neuromuscular diseases. Three separate patterns of antimuscle antibodies could be identified in the myasthenic sera by examination of the relaxed glycerinated myofibrils by both IF and phase-contrast optics: A-band (9 with thymoma, 1 without), I-band (11 with thymoma, 17 without), and a mixed A plus I pattern (5 with thymoma, 3 without). Seventy-seven myasthenic serum samples (24 with thymoma, 53 without) were available for evaluation of antibodies to acetylcholine receptor (anti-AChR) by radioimmunoassay. Ninety-one percent reacted with crude human receptor extract and 80% with receptor extracted from denervated rat muscle. There was no correlation between the titers of anti-AChR and the presence or staining patterns of antimuscle antibodies, but patients without anti-AChR did not have antimuscle antibodies. Myasthenics with thymoma had the highest prevalence of anti-AChR (23/24) and of antimuscle antibodies (25/30), and 15 of the 20 positives stained A-bands alone or with I-band, as compared to 4 of 21 positive reactions in those without tumor. Immunoabsorption, which removed or significantly reduced anti-AChR, did not alter antimuscle reactivity. The discrepancies between anti-AChR levels and the presence and types of antimuscle antibodies suggest that these are independent autoantibodies. Current theories of immunopathogenesis implicate altered thymic antigens or a major breakdown in immune regulation, either of which could explain their production.
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38
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Chilosi M, Iannucci A, Fiore-Donati L, Tridente G, Pampanin M, Pizzolo G, Ritter M, Bofill M, Janossy G. Myasthenia gravis: immunohistological heterogeneity in microenvironmental organization of hyperplastic and neoplastic thymuses suggesting different mechanisms of tolerance breakdown. J Neuroimmunol 1986; 11:191-204. [PMID: 3514666 DOI: 10.1016/0165-5728(86)90003-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Four samples of thymoma obtained from patients affected by myasthenia gravis have been immunohistologically analysed on cryostat sections using a panel of antisera and monoclonal antibodies specific for antigens which define different stages of intrathymic lymphocyte differentiation and antigens specific for different types of thymic epithelial cells (cortical, medullary). When the thymoma samples were compared to age-matched normal thymuses and hyperplastic thymuses obtained from patients with myasthenia gravis some evident microenvironmental differences could be demonstrated using these reagents. In all the thymoma samples in fact the neoplastic lobules appeared as grossly enlarged cortical-type areas, formed by accumulations of T lymphocytes exhibiting the cortical immature phenotype (TdT+, T6+, etc.) within a network of putatively neoplastic epithelial cells characterized by cortical phenotype as defined by reactivity with various monoclonal antibodies (RFD4-, MR3+). These 'cortical' epithelia showed some abnormal features such as lack or irregular distribution of HLA-DR and enhanced keratin expression. Small areas of 'medullary' differentiation could be observed in 3/4 thymoma samples. In thymic hyperplasia, on the other hand, the cortical areas appeared somewhat compressed (but comparable to those observed in normal age-matched samples) by enlarged medullary areas. The expansion of medullary areas was due to the infiltration of 'peripheral' lymphoid tissue intruding through the extraparenchymal zone and forming organized B and T areas. These observations are discussed in the light of the clinical heterogeneity observed in myasthenia gravis.
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Gilhus NE, Matre R, Aarli JA, Hofstad H, Thunold S. Thymic lymphoepitheliomas and skeletal muscle expressing common antigen(s). Acta Neurol Scand 1986; 73:428-33. [PMID: 2425540 DOI: 10.1111/j.1600-0404.1986.tb03300.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rabbit antiserum to a citric acid extract of human skeletal muscle (CA) stained epithelial thymoma cells as well as skeletal muscle. Thymomas from two myasthenia gravis (MG) patients showing no circulating anti-CA antibodies prior to thymectomy were also stained by the antiserum. Thus, in these patients as well, the thymoma and skeletal muscle possess common antigens. The rabbit and the human antibodies most probably reacted with different antigens, apparently located close to each other in the cell membrane. The reason why anti-CA antibodies cannot be detected in serum from a few MG patients with a thymoma may be that the thymoma-associated antigen is not present in vivo in these cases, or that an inhibiting factor blocks the antibody synthesis. Both patients developed anti-CA antibodies post-operatively, which favours the latter explanation.
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Addis BJ, Isaacson PG. Large cell lymphoma of the mediastinum: a B-cell tumour of probable thymic origin. Histopathology 1986; 10:379-90. [PMID: 2423430 DOI: 10.1111/j.1365-2559.1986.tb02491.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifteen cases of non-Hodgkin's lymphoma of the anterior mediastinum are reported. In the first group of four, fresh tissue was available and immunohistochemical studies demonstrated their B-cell origin, with monotypic immunoglobulin production in two. Only fixed tissue was available in the second group of 11 patients. All stained with antibody to leucocyte common antigen (PD7/26) and three showed monotypic immunoglobulin production. If the two groups are combined seven of the 15 tumours were clearly of B-cell origin. Classification on morphological grounds was difficult, with most tumours showing mixtures of centroblasts and large centrocytes, and the original diagnoses had included Hodgkin's disease (three), thymoma (one) and undifferentiated carcinoma (two). None of the patients had evidence of extra-thoracic disease at presentation and when this developed the organs involved were liver (one), kidney (two) and thyroid (one). Direct extension within the chest led to infiltration of chest wall, sternum, lung, superior vena cava and other structures. The site of origin, lack of nodal involvement and, in one case, presence of residual thymus around the tumour indicate an origin in thymic B-cells.
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Wekerle H, Müller-Hermelink HK. The thymus in myasthenia gravis. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1986; 75:179-206. [PMID: 3514159 DOI: 10.1007/978-3-642-82480-7_6] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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42
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Janossy G, Bofill M, Trejdosiewicz LK, Willcox HN, Chilosi M. Cellular differentiation of lymphoid subpopulations and their microenvironments in the human thymus. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1986; 75:89-125. [PMID: 3514162 DOI: 10.1007/978-3-642-82480-7_3] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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43
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Abstract
Receptors for the Fc part of IgG (Fc gamma R) and HLA-DR antigens were detected in thymus tissue from patients with myasthenia gravis (MG) using monoclonal antibodies (B1D6 and OKIa1) in indirect immunofluorescence. The amount of Fc gamma R and HLA-DR antigens was increased on epithelial reticular cells and on interdigitating reticular cells in hyperplastic thymus as compared to normal thymus. In thymomas from MG patients the neoplastic epithelial cells expressed Fc gamma R, whereas only a few cells had HLA-DR antigens. Neither thymocytes nor B lymphocytes in the hyperplastic thymuses and in the thymomas were stained by B1D6.
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Levinson AI, Lisak RP, Zweiman B, Kornstein M. Phenotypic and functional analysis of lymphocytes in myasthenia gravis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1985; 8:209-33. [PMID: 3901367 DOI: 10.1007/bf00197297] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Willcox N. The cellular immunology of myasthenia gravis. LA RICERCA IN CLINICA E IN LABORATORIO 1985; 15:199-204. [PMID: 3878566 DOI: 10.1007/bf03029191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The possible role of the thymus in autosensitization to the acetylcholine receptor (AChR) in myasthenia gravis is briefly discussed, and work on autoantibody synthesis in vitro is reviewed. Whereas blood lymphocytes sometimes make anti-AChR in response to mitogens, spontaneous production is more regularly observed in cells from lymph nodes, bone marrow and, above all, thymus, where it is selectively activated. Cell separation studies imply a dominant contribution by the germinal centre cells and plasma cells there, many of which are autonomous (i.e. no longer require T cell help). The need for germinal centre-directed immunosuppressive regimes is discussed.
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Schumm F, Wiethölter H, Fateh-Moghadam A, Dichgans J. Thymectomy in myasthenia with pure ocular symptoms. J Neurol Neurosurg Psychiatry 1985; 48:332-7. [PMID: 3998738 PMCID: PMC1028297 DOI: 10.1136/jnnp.48.4.332] [Citation(s) in RCA: 107] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eighteen patients with exclusively ocular symptoms of myasthenia were thymectomised. Suspected thymoma, resistance to pyridostigmine therapy or relapse following immunosuppressive therapy were taken as indications for surgery. The mean preoperative observation period before operation was 40 months, and after operation was 26 months. There was no operative or postoperative morbidity or mortality. Histological thymic abnormalities were found in all patients (in one case, thymoma; in four, persistent thymus; in 13, thymic hyperplasia). The histological abnormalities were identical to those found in generalised myasthenia. This included the distribution of T-cell subtypes as identified by use of monoclonal antibodies. The severity of ocular symptoms was rated using a score developed for this purpose. The score progressively declined after surgery to an average of 70% of its initial amount in 80% of patients. Full remission occurred in three cases. No patient developed generalized myasthenia. Antibody titres against acetylcholine receptors if elevated preoperatively also dropped following surgery, with one exception. Clear criteria for the expected therapeutic success of thymectomy could not be identified. Based on our results, and on the assumed significance of the thymus gland for pathogenesis, thymectomy should be considered in patients with pure ocular symptoms.
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Janossy G, Bofill M. Changes of lymphoid microenvironments in human diseases--a short review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1985; 186:879-87. [PMID: 3901695 DOI: 10.1007/978-1-4613-2463-8_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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48
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Willcox N, Schluep M, Bofill M, Newsom-Davis J. Isolation of germinal centre (GC) cells is greatly improved by using the protease dispase to prepare cell suspensions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1985; 186:979-84. [PMID: 3901697 DOI: 10.1007/978-1-4613-2463-8_118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Wechter WJ, Loughman BE. Immunology in drug research. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1984; 28:233-72. [PMID: 6091176 DOI: 10.1007/978-3-0348-7118-1_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Oosterhuis HJ. Thymectomy in myasthenia gravis. A review. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1983; 4:399-407. [PMID: 6370908 DOI: 10.1007/bf02125618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The role of thymectomy in the management of myasthenia gravis is reviewed in the light of the published data and of a personal series. The patients in whom the operation is most successful are non thymomatous patients aged between 10 and 40 years with an MG history of less than 3 years. There is no sex prevalence. Lasting improvement may be expected. There are no proven correlations between biological indices like the germinal centers in the thymus and/or AChR antibody titers and the postoperative course of the disease. Complete removal of the thymus seems to be crucial and hence the transsternal approach is preferred. The operation, less effective in patients with thymoma than in those with an active thymus, is nonetheless necessary to in these patients prevent putative damage to surrounding organs from thymoma infiltration. Why thymectomy should be effective in patients with an active thymus and not in those with a thymoma may be revealed by in vitro studies of the interactions between thymic cells and peripheral B cells, now in progress.
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