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Anutraungkool T, Padungkiatsagul T, Jindahra P, Vanikieti K. Prevalences of Other Non-Thyroid Autoimmune Diseases and Factor Associated with Their Presence in Ocular Myasthenia Gravis. Clin Ophthalmol 2024; 18:1125-1132. [PMID: 38686013 PMCID: PMC11057627 DOI: 10.2147/opth.s458979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose To report the prevalences of other non-thyroid autoimmune diseases and identify factors associated with their presence in ocular myasthenia gravis (OMG) subjects. Subjects and Methods A total of 208 subjects with OMG diagnosis were included. Demographic data, clinical characteristics, the ice-pack test, the acetylcholine receptor (AChR) antibody test, electrophysiology tests (single-fiber electromyography and repetitive nerve stimulation), the presence of thymoma, generalized myasthenia gravis conversion, and the presence of other non-thyroid autoimmune diseases (defined as the presence of at least one other non-thyroid autoimmune disease) were retrospectively reviewed. Factors associated with the presence of other non-thyroid autoimmune diseases were analyzed by univariate and multivariate logistic regression. Results Of the total 208 subjects, 21 (10.10%) exhibited the presence of other non-thyroid autoimmune diseases (19 subjects (9.14%) and 2 subjects (0.96%) had one and two other non-thyroid autoimmune diseases, respectively), and systemic lupus erythematosus (SLE) was diagnosed in 9 subjects, followed by Sjogren's syndrome (7 subjects), rheumatoid arthritis (6 subjects), and ankylosing spondylitis (1 subject). Therefore, the prevalences of SLE, Sjogren's syndrome, rheumatoid arthritis, and ankylosing spondylitis in OMG subjects were estimated to be 4.33% (95% confidence interval (CI): 2.29-8.02%), 3.37% (95% CI: 1.64-6.79%), 2.88% (95% CI: 1.33-6.14%), and 0.48% (95% CI: 0.08-2.67%), respectively. Positivity of the AChR antibody was the only significant factor associated with the presence of other non-thyroid autoimmune diseases (odds ratio 4.10, 95% CI: 1.11-15.21, p = 0.035). Conclusions The presence of other non-thyroid autoimmune diseases was found in approximately 10% of OMG patients, with SLE displaying the highest prevalence. We recommend screening and monitoring for other non-thyroid autoimmune diseases in OMG patients, particularly those with positivity of the AChR antibody.
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Affiliation(s)
- Thanathon Anutraungkool
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Yasumizu Y, Takeuchi D, Morimoto R, Takeshima Y, Okuno T, Kinoshita M, Morita T, Kato Y, Wang M, Motooka D, Okuzaki D, Nakamura Y, Mikami N, Arai M, Zhang X, Kumanogoh A, Mochizuki H, Ohkura N, Sakaguchi S. Single-cell transcriptome landscape of circulating CD4 + T cell populations in autoimmune diseases. CELL GENOMICS 2024; 4:100473. [PMID: 38359792 PMCID: PMC10879034 DOI: 10.1016/j.xgen.2023.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024]
Abstract
CD4+ T cells are key mediators of various autoimmune diseases; however, their role in disease progression remains unclear due to cellular heterogeneity. Here, we evaluated CD4+ T cell subpopulations using decomposition-based transcriptome characterization and canonical clustering strategies. This approach identified 12 independent gene programs governing whole CD4+ T cell heterogeneity, which can explain the ambiguity of canonical clustering. In addition, we performed a meta-analysis using public single-cell datasets of over 1.8 million peripheral CD4+ T cells from 953 individuals by projecting cells onto the reference and cataloging cell frequency and qualitative alterations of the populations in 20 diseases. The analyses revealed that the 12 transcriptional programs were useful in characterizing each autoimmune disease and predicting its clinical status. Moreover, genetic variants associated with autoimmune diseases showed disease-specific enrichment within the 12 gene programs. The results collectively provide a landscape of single-cell transcriptomes of CD4+ T cell subpopulations involved in autoimmune disease.
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Affiliation(s)
- Yoshiaki Yasumizu
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan; Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan
| | - Daiki Takeuchi
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan; Faculty of Medicine, Osaka University, Osaka, Japan
| | - Reo Morimoto
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Yusuke Takeshima
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Tatsusada Okuno
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Kinoshita
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Kato
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Immunopathology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Min Wang
- Clinical Immunology Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daisuke Motooka
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan; Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Daisuke Okuzaki
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan; Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Yamami Nakamura
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Norihisa Mikami
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Masaya Arai
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Xuan Zhang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Atsushi Kumanogoh
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan; Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Immunopathology, Immunology Frontier Research Center, Osaka University, Osaka, Japan; Center for Infectious Diseases for Education and Research, Osaka University, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan
| | - Naganari Ohkura
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan; Department of Frontier Research in Tumor Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Shimon Sakaguchi
- Department of Experimental Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan; Department of Experimental Immunology, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan.
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Chung HY, Shin HY, Choi Y, Park HJ, Lee JG, Lee CY, Park BJ, Kim GJ, Kim SW. Germinal centers are associated with postthymectomy myasthenia gravis in patients with thymoma. Eur J Neurol 2024; 31:e16119. [PMID: 37909803 PMCID: PMC11235914 DOI: 10.1111/ene.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE Germinal centers (GCs) can be observed in the thymic tissues of patients with thymoma-associated myasthenia gravis (MG). Although an association between thymic GCs and MG has been suggested, it is unknown whether the presence of GCs could predict the development of MG after the resection of thymoma, known as postthymectomy MG. METHODS We conducted a retrospective analysis of previously nonmyasthenic patients who underwent surgical removal of the thymoma. All available thymic tissue slides were rereviewed by a pathologist to assess for GCs. Patients were classified into GC-positive and GC-negative groups based on the presence of GCs. The incidence of postthymectomy MG was compared between the two groups, and the risk factors for postthymectomy MG were assessed. RESULTS Of the 196 previously nonmyasthenic patients who underwent thymoma resection, 21 were GC-positive, whereas 175 were GC-negative. Postthymectomy MG developed in 11 (5.6%) patients and showed a higher incidence in the GC-positive group than in the GC-negative group (33.3% vs. 2.3%, p < 0.001). No postoperative radiotherapy and the presence of GCs were risk factors for postthymectomy MG in the univariate analysis. In multivariate analysis, invasive thymoma (hazard ratio [HR] = 9.835, 95% confidence interval [CI] = 1.358-105.372), postoperative radiotherapy (HR = 0.160, 95% CI = 0.029-0.893), and presence of GCs (HR = 15.834, 95% CI = 3.742-67.000) were significantly associated with postthymectomy MG. CONCLUSIONS Thymic GCs may be a significant risk factor for postthymectomy MG. Even in patients with thymoma who do not show clinical symptoms of MG, postthymectomy MG should be considered, especially if thymic GCs are observed.
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Affiliation(s)
- Hye Yoon Chung
- Department of NeurologyYonsei University College of MedicineSeoulKorea
- Department of NeurologyYongin Severance Hospital, Yonsei University Health SystemYonginKorea
| | - Ha Young Shin
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Young‐Chul Choi
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Hyung Jun Park
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Gi Jeong Kim
- Department of PathologyYonsei University College of MedicineSeoulKorea
| | - Seung Woo Kim
- Department of NeurologyYonsei University College of MedicineSeoulKorea
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Cebi M, Cakar A, Erdogdu E, Durmus-Tekce H, Yegen G, Ozkan B, Parman Y, Saruhan-Direskeneli G. Thymoma patients with or without myasthenia gravis have increased Th17 cells, IL-17 production and ICOS expression. J Neuroimmunol 2023; 381:578129. [PMID: 37329662 DOI: 10.1016/j.jneuroim.2023.578129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/19/2023]
Abstract
Thymoma associated myasthenia gravis (TAMG) is a small disease subgroup with autoantibodies against the acetylcholine receptor. The aim of this study was to assess the role of T helper (Th) cells in TAMG compared to thymoma patients without MG (TOMA) and healthy controls (HC). Peripheral blood cells were used for intracellular cytokine measurements and phenotyping of CD4+ Th cells. IL-21 and IL-4 productions and peripheral Th cells were higher in TAMG compared to TOMA patients and HC. Increases of ICOS and Th17 population were detected both in TAMG and TOMA groups. Higher IL-10 and Th1 population have been observed related to thymectomy. ICOS expression and Th17 induced by thymoma may contribute to the development of TAMG.
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Affiliation(s)
- Merve Cebi
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey; Department of Immunology, Institute of Health Sciences, Istanbul University, Turkey
| | - Arman Cakar
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Eren Erdogdu
- Department of Thoracic Surgery, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Hacer Durmus-Tekce
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Gulcin Yegen
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Berker Ozkan
- Department of Thoracic Surgery, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Yesim Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
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Sezen CB, Dogru MV, Tanrikulu G, Erduhan S, Sonmezoglu Y, Erdogu V, Metin M. Evaluation of Early Results Video-Assisted Thoracoscopic Surgery with Multi-Joint Wristed Instruments in Lung Cancer Surgery. J Laparoendosc Adv Surg Tech A 2023. [PMID: 36989517 DOI: 10.1089/lap.2022.0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background: Our objective in this study is to compare the early outcomes of patients who underwent technical resection of non-small cell lung cancer (NSCLC) with video-assisted thoracoscopic surgery (VATS) with multi-joint wristed instruments, also known as surgeon-powered robotic surgery (SpRS) and conventional VATS. Methods: One hundred twenty-two thoracoscopic lung resections were performed in our hospital for NSCLC between March 2021 and March 2022. Of these resections, 95 were performed with VATS, while 27 patients underwent the SpRS technique. Results: Lobectomy was performed in 112 patients (91.8%), and segmentectomy was performed in 10 patients (8.2%). The median duration of hospitalization was 5 days in patients who underwent VATS, while the median duration of hospitalization was 4 days in patients who underwent the SpRS technique. No significant difference was found between the groups when demographic characteristics were compared with surgical techniques. The median drainage was 125 mL in the SpRS technique, while 150 mL of drainage occurred in patients who underwent resection by VATS (0.165). While an average of 12 lymph nodes was dissected in the VATS group, an average of 14 lymph nodes was dissected in the SpRS group (0.602). Complications occurred in 17 patients (13.9%). Complications were observed at a rate of 16.8% in the VATS group, while complications were observed at a rate of 3.7% in the SpRS group (P = .116). Conclusion: As a result, our study shows that it is an effective and reliable method with early results similar to thoracoscopic surgery. Registration Number: 2022-194.
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Affiliation(s)
- Celal Bugra Sezen
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Vedat Dogru
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gamze Tanrikulu
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Erduhan
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yasar Sonmezoglu
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Volkan Erdogu
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Álvarez-Velasco R, Dols-Icardo O, El Bounasri S, López-Vilaró L, Trujillo JC, Reyes-Leiva D, Suárez-Calvet X, Cortés-Vicente E, Illa I, Gallardo E. Reduced Number of Thymoma CTLA4-Positive Cells Is Associated With a Higher Probability of Developing Myasthenia Gravis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/2/e200085. [PMID: 36697230 PMCID: PMC9879278 DOI: 10.1212/nxi.0000000000200085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) is an autoimmune disease associated with comorbid thymoma in 10%-15% of cases. Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) expressed by T cells downregulates T-cell-mediated immune response. Polymorphisms in the CTLA4 gene have been associated with the development of MG. In this context, we aimed to determine whether CTLA4 expression in the thymoma differs between patients with and without MG and whether CTLA4 gene polymorphisms are associated with these differences. METHODS This is a retrospective study of all patients, with and without MG, surgically treated at our institution for thymoma between January 2010 and December 2020. Ten samples were obtained from normal thymuses as controls. The number of CTLA4-positive cells in paraffin-embedded thymoma samples was determined by immunohistochemistry. The presence of follicular-center and regulatory T-cell lymphocytes was determined by immunohistochemistry (B-cell lymphoma [BCL]-6 expression) and double immunofluorescence-based staining of CD4-FOXP3, respectively. We evaluated the association between thymic expression of CTLA4 and the development of MG. We also determined the association between CTLA4 expression and various clinical and prognostic characteristics of MG. We sequenced the CTLA4 gene and evaluated possible associations between CTLA4 polymorphisms and thymic CTLA4 expression. Finally, we assessed the potential association between these polymorphisms and the risk of MG. RESULTS Forty-one patients with thymoma were included. Of them, 23 had comorbid MG (56.1%). On average, patients with MG had fewer CTLA4-positive cells in the thymoma than non-MG patients: 69.3 cells/mm2 (95% CIs: 39.6-99.1) vs 674.4 (276.0-1,024.0) cells/mm2; p = 0.001 and vs controls (200.74 [57.9-343.6] cells/mm2; p = 0.02). No between-group differences (MG vs non-MG) were observed in the number of cells positive for BCL6 or CD4-FOXP3. CTLA4 expression was not associated with differences in MG outcome or treatment refractoriness. Two polymorphisms were detected in the CTLA4 gene, rs231770 (n = 30 patients) and rs231775 (n = 17). MG was present in a similar proportion of patients for all genotypes. However, a nonsignificant trend toward a lower CTLA4-positive cell count was observed among carriers of the rs231775 polymorphism vs noncarriers: 77.9 cells/mm2 (95% CI: -51.5 to 207.5) vs 343.3 cells/mm2 (95% CI: 126.2-560.4). DISCUSSION Reduced CTLA4 expression in thymoma may predispose to a higher risk of developing MG.
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Affiliation(s)
- Rodrigo Álvarez-Velasco
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Oriol Dols-Icardo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Shaima El Bounasri
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Laura López-Vilaró
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Juan Carlos Trujillo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - David Reyes-Leiva
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Xavier Suárez-Calvet
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Elena Cortés-Vicente
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Isabel Illa
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Eduard Gallardo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid.
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Supawongwattana M, Vanikieti K, Jindahra P, Padungkiatsagul T. Significance of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization and Presence of Thyroid Autoimmune Antibodies and Thymoma. Clin Ophthalmol 2023; 17:649-656. [PMID: 36875532 PMCID: PMC9983331 DOI: 10.2147/opth.s402181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Objective To evaluate the association in acetylcholine receptor (AChR) antibody-positive ocular myasthenia gravis (OMG) subjects between AChR antibody titers and conversion to generalized myasthenia gravis (GMG), the presence of thyroid autoimmune antibodies, and the presence of thymoma. Subjects and Methods A total of 118 subjects with AChR antibody-positive OMG were included. Demographic data, clinical characteristics, serology tests, presence of thymoma, treatment, and conversion to GMG were retrospectively reviewed. The presence of thyroid autoimmune antibodies was defined as the presence of at least one of the following: (1) thyroid peroxidase antibody; (2) thyroglobulin antibody; (3) thyroid-stimulating hormone receptor antibody. Univariate and multivariate logistic regression analyses were used as methods of evaluating association. Results AChR antibody titers were determined in all subjects with a median of 3.33 (0.46-141.09) nmol/L. The median follow-up period was 14.5 (3-113) months. At the final follow-up time-point, 99 subjects (83.90%) remained with a diagnosis of pure OMG, while 19 subjects (16.10%) had converted to GMG. An AChR antibody titer ≥8.11 nmol/L was associated with the conversion to GMG (odds ratio (OR) 3.66, 95% CI: 1.19-11.26; p = 0.023). Of the 79 subjects with available thyroid autoimmune antibodies data, 26 subjects (32.91%) displayed the presence of thyroid autoimmune antibodies. An AChR antibody titer ≥2.81 nmol/L was associated with the presence of thyroid autoimmune antibodies (OR 6.16, 95% CI: 1.79-21.22; p = 0.004). Finally, of the 106 subjects with available thoracic computed tomography (CT) data, only 9 subjects (8.49%) demonstrated the presence of thymoma. An AChR antibody titer ≥15.12 nmol/L was associated with the presence of thymoma (OR 4.97, 95% CI: 1.10-22.48; p = 0.037). Conclusion AChR antibody titers should be considered in AChR antibody-positive OMG patients. Those with AChR antibody titers ≥8.11 nmol/L, who are at a greater risk of conversion to GMG, should be closely monitored and encouraged to be aware of early clinical signs of life-threatening GMG. In addition, serum thyroid autoimmune antibodies and thoracic CT screening for thymoma should be performed in AChR antibody-positive OMG patients, particularly in those with AChR antibody titers ≥2.81 nmol/L and ≥15.12 nmol/L, respectively.
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Affiliation(s)
- Montana Supawongwattana
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Huda R. Inflammation and autoimmune myasthenia gravis. Front Immunol 2023; 14:1110499. [PMID: 36793733 PMCID: PMC9923104 DOI: 10.3389/fimmu.2023.1110499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
Myasthenia gravis (MG) is a neuromuscular autoimmune disorder characterized by chronic but intermittent fatigue of the eye- and general body muscles. Muscle weakness is caused primarily by the binding of an autoantibody to the acetylcholine receptors, resulting in blockage of normal neuromuscular signal transmission. Studies revealed substantial contributions of different proinflammatory or inflammatory mediators in the pathogenesis of MG. Despite these findings, compared to therapeutic approaches that target autoantibody and complements, only a few therapeutics against key inflammatory molecules have been designed or tested in MG clinical trials. Recent research focuses largely on identifying unknown molecular pathways and novel targets involved in inflammation associated with MG. A well-designed combination or adjunct treatment utilizing one or more selective and validated promising biomarkers of inflammation as a component of targeted therapy may yield better treatment outcomes. This review briefly discusses some preclinical and clinical findings of inflammation associated with MG and current therapy approaches and suggest the potential of targeting important inflammatory marker(s) along with current monoclonal antibody or antibody fragment based targeted therapies directed to a variety of cell surface receptors.
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Yasumizu Y, Ohkura N, Murata H, Kinoshita M, Funaki S, Nojima S, Kido K, Kohara M, Motooka D, Okuzaki D, Suganami S, Takeuchi E, Nakamura Y, Takeshima Y, Arai M, Tada S, Okumura M, Morii E, Shintani Y, Sakaguchi S, Okuno T, Mochizuki H. Myasthenia gravis-specific aberrant neuromuscular gene expression by medullary thymic epithelial cells in thymoma. Nat Commun 2022; 13:4230. [PMID: 35869073 PMCID: PMC9305039 DOI: 10.1038/s41467-022-31951-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractMyasthenia gravis (MG) is a neurological disease caused by autoantibodies against neuromuscular-associated proteins. While MG frequently develops in thymoma patients, the etiologic factors for MG are not well understood. Here, by constructing a comprehensive atlas of thymoma using bulk and single-cell RNA-sequencing, we identify ectopic expression of neuromuscular molecules in MG-type thymoma. These molecules are found within a distinct subpopulation of medullary thymic epithelial cells (mTECs), which we name neuromuscular mTECs (nmTECs). MG-thymoma also exhibits microenvironments dedicated to autoantibody production, including ectopic germinal center formation, T follicular helper cell accumulation, and type 2 conventional dendritic cell migration. Cell–cell interaction analysis also predicts the interaction between nmTECs and T/B cells via CXCL12-CXCR4. The enrichment of nmTECs presenting neuromuscular molecules within MG-thymoma is further confirmed immunohistochemically and by cellular composition estimation from the MG-thymoma transcriptome. Altogether, this study suggests that nmTECs have a significant function in MG pathogenesis via ectopic expression of neuromuscular molecules.
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Zhu H, Zou J, Zeng B, Yang L, Xiao J, Zhang X, Feng Y, Su C. Expression of Programmed Cell Death 1 Ligand 2 in Patients With Thymoma and Thymomatous Myasthenia Gravis. Am J Clin Pathol 2022; 158:646-654. [PMID: 36208149 DOI: 10.1093/ajcp/aqac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to examine the expression of programmed cell death 1 ligand 2 (PD-L2) in thymoma and thymomatous myasthenia gravis (MG). METHODS The records of 70 patients with thymoma receiving surgical resection between January 2017 and December 2018 were retrospectively reviewed. Thymoma PD-L2 expression was evaluated by immunohistochemistry staining. Associations between PD-L2 expression and clinicopathologic features were examined. RESULTS PD-L2 expression was positive in 41 patients (58.6%) and negative in 29 patients (41.4%). Of them, 33 had thymomatous MG. Patients with MG were more likely to be 50 years of age or younger (69.70% vs 35.14%); have more World Health Organization (WHO) type B thymomas (84.85% vs 64.86%); have tumors of smaller size (4.09 ± 2.33 cm vs 6.47 ± 2.42 cm); have positive PD-L2 expression (78.79% vs 40.54%); and have a higher percentage of PD-L2-positive cells, higher PD-L2 expression intensity, and score (all P < .05). Positive PD-L2 expression was associated with more type B thymomas, higher Masaoka-Koga stage, smaller tumor size, ectopic thymus, and MG (all P < .05). Factors significantly associated with MG were age under 50 years, tumor size less than 5 cm, and positive PD-L2 expression (all P < .05). CONCLUSIONS Thymoma PD-L2 expression is significantly associated with thymomatous MG and WHO histologic types B2 and B3.
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Affiliation(s)
- Haoshuai Zhu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianyong Zou
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zeng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Yang
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiefei Xiao
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanfen Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chunhua Su
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Huijbers MG, Marx A, Plomp JJ, Le Panse R, Phillips WD. Advances in the understanding of disease mechanisms of autoimmune neuromuscular junction disorders. Lancet Neurol 2022; 21:163-175. [DOI: 10.1016/s1474-4422(21)00357-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 01/19/2023]
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Yamamoto Y, Matsui N, Uzawa A, Ozawa Y, Kanai T, Oda F, Kondo H, Ohigashi I, Takizawa H, Kondo K, Sugano M, Kitaichi T, Hata H, Kaji R, Kuwabara S, Yamamura T, Izumi Y. Intrathymic Plasmablasts Are Affected in Patients With Myasthenia Gravis With Active Disease. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1087. [PMID: 34561276 PMCID: PMC8474506 DOI: 10.1212/nxi.0000000000001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 08/04/2021] [Indexed: 12/31/2022]
Abstract
Background and Objectives To investigate intrathymic B lymphopoiesis in patients with myasthenia gravis (MG) and explore thymus pathology associated with clinical impact. Methods Thymic lymphocytes from 15 young patients without MG, 22 adult patients without MG, 14 patients with MG without thymoma, and 11 patients with MG with thymoma were subjected to flow cytometry analysis of T follicular helper (Tfh), naive B, memory B, plasmablasts, CD19+B220high thymic B cells, B-cell activating factor receptor, and C-X-C chemokine receptor 5 (CXCR5). Peripheral blood mononuclear cells of 16 healthy subjects and 21 untreated patients with MG were also analyzed. Immunologic values were compared, and correlations between relevant values and clinical parameters were evaluated. Results The frequencies of circulating and intrathymic plasmablasts were significantly higher in patients with MG than controls. On the other hand, the frequency of CD19+B220high thymic B cells was not increased in MG thymus. We observed a significant increase in CXCR5 expression on plasmablasts in MG thymus and an increased frequency of intrathymic plasmablasts that was correlated with preoperative disease activity. The frequency of intrathymic Tfh cells was significantly lower in patients who received immunosuppressive (IS) therapy than those without IS therapy. However, there was no significant difference in the frequency of intrathymic plasmablasts irrespective of IS therapy. Discussion Our findings confirmed a correlation between increased frequency of intrathymic plasmablasts and disease activity before thymectomy. We postulate that activated intrathymic plasmablasts endow pathogenic capacity in MG.
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Affiliation(s)
- Yohei Yamamoto
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Naoko Matsui
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.
| | - Akiyuki Uzawa
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yukiko Ozawa
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Tetsuya Kanai
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Fumiko Oda
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hiroyuki Kondo
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Izumi Ohigashi
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hiromitsu Takizawa
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Kazuya Kondo
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Mikio Sugano
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Takashi Kitaichi
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hiroki Hata
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Ryuji Kaji
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Satoshi Kuwabara
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Takashi Yamamura
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yuishin Izumi
- From the Department of Neurology (Y.Y., N.M., Y.I.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (A.U., Y.O., T. Kanai, F.O., S.K.), Graduate School of Medicine, Chiba University; Division of Experimental Immunology (H.K., I.O.), Institute of Advanced Medical Sciences, Tokushima University; Department of Thoracic, Endocrine Surgery and Oncology (H.T.), Tokushima University Graduate School of Biomedical Sciences; Department of Oncological Medical Services (K.K.), Tokushima University Graduate School of Biomedical Sciences; Department of Cardiovascular Surgery (M.S., T. Kitaichi, H.H.), Tokushima University Graduate School of Biomedical Sciences; Department of Neurology (R.K.), National Hospital Organization Utano Hospital, Kyoto; and Department of Immunology (T.Y.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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Nabe Y, Hashimoto T, Tanaka K, Fujita Y, Yoshimatsu K, Nemoto Y, Oyama R, Matsumiya H, Mori M, Kanayama M, Taira A, Shinohara S, Kuwata T, Takenaka M, Tashima Y, Kuroda K, Tanaka F. Relationship between anti-acetylcholine receptor antibodies and the development of post-thymectomy myasthenia gravis in patients with thymoma: a single-center experience. Gland Surg 2021; 10:2408-2413. [PMID: 34527552 DOI: 10.21037/gs-21-287] [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: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022]
Abstract
Background Approximately 15-29.6% of patients with thymoma have myasthenia gravis (MG). Some of these patients develop MG after thymectomy despite having no history of MG or related symptoms. Few previous studies have examined the risk factors for the development of post-thymectomy MG in patients with thymoma. Herein, we retrospectively reviewed our institutional experience with patients with thymoma who developed MG after thymectomy. Methods Twenty-six patients with thymoma but without MG, who were tested preoperatively for anti-acetylcholine receptor antibody (anti-AChR-Ab) levels, underwent surgical resection at our hospital between 2013 and 2020. Patients with thymic carcinoma were excluded from the study. We evaluated the association of outcomes with preoperative anti-AChR-Ab levels and post-thymectomy MG. We performed a χ2 test for bivariate analysis of categorical data. Differences were considered significant at P<0.05. Results The characteristics of the 26 patients (median age: 62 years; 8 men, 18 women) were as follows: World Health Organization (WHO) classifications AB (n=8), B1 (n=9), B2 (n=6), B3 (n=1), and others (n=2) and Masaoka stage I (n=12), II (n=9), III (n=3), and IVa (n=2). Among the 26 patients, only five had high (>0.3 nmol/L) preoperative anti-AChR-Ab levels. Post-thymectomy MG occurred in two of the five patients (40%) with high preoperative anti-AChR-Ab levels. A high preoperative serum anti-AChR-Ab titer was significantly associated with post-thymectomy MG (P=0.0267). The anti-AChR-Ab titer was also measured postoperatively in four of the five (80%) patients with high preoperative levels. The anti-AChR-Ab titer decreased in two of these four patients, and neither developed postoperative MG. Conclusions Preoperative and postoperative anti-AChR-Ab positivity might be associated with post-thymectomy MG. Therefore, regular measurement of anti-AChR-Ab levels after thymectomy is required.
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Affiliation(s)
- Yusuke Nabe
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Teppei Hashimoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kanji Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhiro Fujita
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Katsuma Yoshimatsu
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukiko Nemoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rintaro Oyama
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroki Matsumiya
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masataka Mori
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masatoshi Kanayama
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiro Taira
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinji Shinohara
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taiji Kuwata
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuko Tashima
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Kuroda
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Yang X, Peng J, Huang X, Liu P, Li J, Pan J, Wei Z, Liu J, Chen M, Liu H. Association of Circulating Follicular Helper T Cells and Serum CXCL13 With Neuromyelitis Optica Spectrum Disorders. Front Immunol 2021; 12:677190. [PMID: 34335576 PMCID: PMC8316915 DOI: 10.3389/fimmu.2021.677190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorders (NMOSDs) are severe inflammatory diseases mediated mainly by humoral and cellular immunity. Circulating follicular helper T (Tfh) cells are thought to be involved in the pathogenesis of NMOSD, and serum C-X-C motif ligand 13 (CXCL13) levels reflect the effects of Tfh cells on B-cell-mediated humoral immunity. Immune cell and cytokine changes during the dynamic relapsing and remitting processes in NMOSD require further exploration. Patients and methods Blood samples were collected from 36 patients in acute and recovery phases of NMOSD, 20 patients with other noninflammatory neurological diseases (ONND) and 20 age- and sex-matched healthy volunteers. CD4+CXCR5+PD-1+ Tfh cells were detected by flow cytometry, and serum CXCL13 levels were assessed by enzyme-linked immunosorbent assay (ELISA). Results The percentage of CD4+CXCR5+PD-1+ Tfh cells was significantly higher during the acute phase than during the recovery phase, and serum CXCL13 levels were significantly higher in patients in the acute and recovery phases of NMOSD than in the ONND and control groups. The Tfh cell percentage was positively correlated with CXCL13 levels, and both were positively correlated with Expanded Disability Status Scale (EDSS) scores and cerebrospinal fluid protein levels in patients with acute NMOSD. Conclusion Circulating Tfh cells level has the potential to be a biomarker of disease severity.
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Affiliation(s)
- Xiaoyan Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Peng
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoxi Huang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peidong Liu
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiali Pan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhihua Wei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ju Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Min Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongbo Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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15
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Liu RT, Li W, Guo D, Yang CL, Ding J, Xu JX, Duan RS. Natural killer cells promote the differentiation of follicular helper T cells instead of inducing apoptosis in myasthenia gravis. Int Immunopharmacol 2021; 98:107880. [PMID: 34174703 DOI: 10.1016/j.intimp.2021.107880] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
Recent evidence has shown that natural killer (NK) cells have an immunoregulatory function in the pathogenesis of myasthenia gravis (MG). In this study, the phenotype and function of NK cell subsets in peripheral blood of new-onset MG (N-MG) and stable MG (S-MG) patients were explored. Circulating CD56dim and CD56bright NK cells were increased and decreased, respectively, in patients with N-MG and S-MG compared with healthy control (HC). Moreover, all circulating NK cell subsets from N-MG patients showed significantly lower expression of activating receptor NKG2D and production of Interferon (IFN) -γ than that from HC. The killing effects of NK cells on CD4+ T cells and Tfh cells were impaired in MG patients, whereas, they promoted the differentiation and activation of Tfh cells. These data indicated that the immune-regulation of NK cells on CD4+ T cells and Tfh cells in MG patients was abnormal, which may contribute to the immune-pathological mechanism of MG.
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Affiliation(s)
- Rui-Ting Liu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, PR China; Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, PR China
| | - Wei Li
- The Neurosurgical Department, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, PR China
| | - Dong Guo
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, PR China
| | - Chun-Lin Yang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Jie Ding
- Central Laboratory of Liaocheng People's Hospital, Liaocheng, Shandong 252000, PR China
| | - Jian-Xin Xu
- Department of Neurology, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, PR China
| | - Rui-Sheng Duan
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, PR China; Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, PR China; Shandong Institute of Neuroimmunology, Jinan 250014, PR China.
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16
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Ingelfinger F, Krishnarajah S, Kramer M, Utz SG, Galli E, Lutz M, Zwicky P, Akarca AU, Jurado NP, Ulutekin C, Bamert D, Widmer CC, Piccoli L, Sallusto F, Núñez NG, Marafioti T, Schneiter D, Opitz I, Lanzavecchia A, Jung HH, De Feo D, Mundt S, Schreiner B, Becher B. Single-cell profiling of myasthenia gravis identifies a pathogenic T cell signature. Acta Neuropathol 2021; 141:901-915. [PMID: 33774709 PMCID: PMC8113175 DOI: 10.1007/s00401-021-02299-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
Myasthenia gravis (MG) is an autoimmune disease characterized by impaired neuromuscular signaling due to autoantibodies targeting the acetylcholine receptor. Although its auto-antigens and effector mechanisms are well defined, the cellular and molecular drivers underpinning MG remain elusive. Here, we employed high-dimensional single-cell mass and spectral cytometry of blood and thymus samples from MG patients in combination with supervised and unsupervised machine-learning tools to gain insight into the immune dysregulation underlying MG. By creating a comprehensive immune map, we identified two dysregulated subsets of inflammatory circulating memory T helper (Th) cells. These signature ThCD103 and ThGM cells populated the diseased thymus, were reduced in the blood of MG patients, and were inversely correlated with disease severity. Both signature Th subsets rebounded in the blood of MG patients after surgical thymus removal, indicative of their role as cellular markers of disease activity. Together, this in-depth analysis of the immune landscape of MG provides valuable insight into disease pathogenesis, suggests novel biomarkers and identifies new potential therapeutic targets for treatment.
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Affiliation(s)
- Florian Ingelfinger
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Michael Kramer
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Sebastian G Utz
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Edoardo Galli
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Mirjam Lutz
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Pascale Zwicky
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Ayse U Akarca
- Department of Cellular Pathology, University College London Hospital, London, UK
| | | | - Can Ulutekin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - David Bamert
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Corinne C Widmer
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luca Piccoli
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Federica Sallusto
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland
| | - Nicolás G Núñez
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, UK
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Lanzavecchia
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Donatella De Feo
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Sarah Mundt
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Bettina Schreiner
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.
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17
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Ashida S, Ochi H, Hamatani M, Fujii C, Kimura K, Okada Y, Hashi Y, Kawamura K, Ueno H, Takahashi R, Mizuno T, Kondo T. Immune Skew of Circulating Follicular Helper T Cells Associates With Myasthenia Gravis Severity. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e945. [PMID: 33436376 PMCID: PMC8105905 DOI: 10.1212/nxi.0000000000000945] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To clarify functional alterations of follicular helper T cells (Tfh) in myasthenia gravis (MG) because Tfh play important roles in helping B cells generate antibody-producing cells. METHODS A total of 24 immunotherapy-naive patients with anti-acetylcholine receptor (AchR) antibody-positive MG and 18 age-matched healthy subjects (HS) were enrolled. Samples from 6 patients were available for posttreatment analysis. Subsets of circulating Tfh (cTfh) and B cells were identified by flow cytometry analysis of surface molecules. Cytokine production by isolated cTfh subsets from 5 patients with MG and 5 HS was measured in vitro. Analysis was performed to examine the correlation between the frequency of cTfh subsets and that of plasmablasts and between cTfh subsets and the quantitative MG score. RESULTS cTfh increased with elevated expression of inducible T-cell costimulator (ICOS) in patients with MG. cTfh shifted to Th2 and Th17 over Th1 in MG. ICOShighcTfh produced significantly higher levels of interleukin (IL)-21, IL-4, and IL-17A than ICOSlow cTfh only in patients with MG. The frequency of cTfh within CD4 T cells was more closely associated with disease severity than the serum anti-AchR antibody titer and frequency of plasmablasts within B cells. Abnormalities of cTfh were improved after immunotherapy in parallel with clinical improvement. CONCLUSIONS Alternation of cTfh is a key feature in the development of MG and may become a biomarker for disease severity and therapeutic efficacy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the level of cTfh is associated with disease severity in patients with MG.
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Affiliation(s)
- Shinji Ashida
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Hirofumi Ochi
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Mio Hamatani
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Chihiro Fujii
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Kimitoshi Kimura
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Yoichiro Okada
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Yuichiro Hashi
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Kazuyuki Kawamura
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Hideki Ueno
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Ryosuke Takahashi
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Toshiki Mizuno
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
| | - Takayuki Kondo
- From the Department of Neurology (S.A., C.F., T.M.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Geriatric Medicine and Neurology (H.O.), Ehime University Graduate School of Medicine, Toon; Department of Neurology (M.H., R.T.), Kyoto University Graduate School of Medicine; Department of Neurology (M.H., Y.O., Y.H., T.K.), Kansai Medical University Medical Center, Osaka, Japan; Brigham and Women's Hospital (K. Kimura), Harvard Medical School, Boston, MA; Department of Neurology (K. Kawamura), National Hospital Organization Minami Kyoto Hospital; and Department of Immunology (H.U.), Kyoto University Graduate School of Medicine, Japan
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18
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Uzawa A, Kuwabara S, Suzuki S, Imai T, Murai H, Ozawa Y, Yasuda M, Nagane Y, Utsugisawa K. Roles of cytokines and T cells in the pathogenesis of myasthenia gravis. Clin Exp Immunol 2020; 203:366-374. [PMID: 33184844 DOI: 10.1111/cei.13546] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
Myasthenia gravis (MG) is characterized by muscle weakness and fatigue caused by the presence of autoantibodies against the acetylcholine receptor (AChR) or the muscle-specific tyrosine kinase (MuSK). Activated T, B and plasma cells, as well as cytokines, play important roles in the production of pathogenic autoantibodies and the induction of inflammation at the neuromuscular junction in MG. Many studies have focused on the role of cytokines and lymphocytes in anti-AChR antibody-positive MG. Chronic inflammation mediated by T helper type 17 (Th17) cells, the promotion of autoantibody production from B cells and plasma cells by follicular Th (Tfh) cells and the activation of the immune response by dysfunction of regulatory T (Treg ) cells may contribute to the exacerbation of the MG pathogenesis. In fact, an increased number of Th17 cells and Tfh cells and dysfunction of Treg cells have been reported in patients with anti-AChR antibody-positive MG; moreover, the number of these cells was correlated with clinical parameters in patients with MG. Regarding cytokines, interleukin (IL)-17; a Th17-related cytokine, IL-21 (a Tfh-related cytokine), the B-cell-activating factor (BAFF; a B cell-related cytokine) and a proliferation-inducing ligand (APRIL; a B cell-related cytokine) have been reported to be up-regulated and associated with clinical parameters of MG. This review focuses on the current understanding of the involvement of cytokines and lymphocytes in the immunological pathogenesis of MG, which may lead to the development of novel therapies for this disease in the near future.
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Affiliation(s)
- A Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - T Imai
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - H Murai
- Department of Neurology, International University of Health and Welfare, Narita, Japan
| | - Y Ozawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
| | - K Utsugisawa
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
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19
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Lin W, Lin A, Li Z, Zhou C, Chen C, Chen B, Lyu Q, Zhang J, Luo P. Potential predictive value of SCN4A mutation status for immune checkpoint inhibitors in melanoma. Biomed Pharmacother 2020; 131:110633. [PMID: 32892029 DOI: 10.1016/j.biopha.2020.110633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022] Open
Abstract
Melanoma refers to a pigmented nevus with malignant changes. The preferred treatment for primary melanoma is surgical excision and postoperative radiotherapy, but the prognosis is poor. Immune checkpoint inhibitors (ICIs) have been remarkably successful in different types of cancers, but not all cancer patients can benefit from it. Therefore, it is essential to find predictable biomarkers and improve the accuracy of treatment. In this study, we used survival analysis, gene panorama analysis, immune cell enrichment analysis, TMB analysis, and GSEA to demonstrate that SCN4A gene mutations may be used as one of the indicators to predict the prognosis of melanoma patients undergoing ICI treatment. The research further indicates that SCN4A gene mutations improve the prognosis of ICI treatment. It is hoped that the effect of SCN4A on immunogenicity and tumor immunity can be demonstrated to further suggest the effect of this gene on the efficacy of ICIs.
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Affiliation(s)
- Weiyin Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Anqi Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhefu Li
- Central Sterile Supply Department, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Chaozheng Zhou
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Chufeng Chen
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Boliang Chen
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Qingwen Lyu
- Department of Information, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Guangdong Fusion Application Engineering Center of Medical Big Data, Guangzhou, Guangdong, People's Republic of China.
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
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Zhang XM, Liu CY, Shao ZH. Advances in the role of helper T cells in autoimmune diseases. Chin Med J (Engl) 2020; 133:968-974. [PMID: 32187054 PMCID: PMC7176439 DOI: 10.1097/cm9.0000000000000748] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 02/06/2023] Open
Abstract
Autoimmune diseases are primary immune diseases in which autoreactive antibodies or sensitized lymphocytes destroy and damage tissue and cellular components, resulting in tissue damage and organ dysfunction. Helper T cells may be involved in the pathogenesis of autoimmune diseases under certain conditions. This review summarizes recent research on the role of helper T cells in autoimmune diseases from two aspects, helper T cell-mediated production of autoantibodies by B cells and helper T cell-induced activation of abnormal lymphocytes, and provides ideas for the treatment of autoimmune diseases. The abnormal expression of helper T cells promotes the differentiation of B cells that produce autoantibodies, which leads to the development of different diseases. Among them, abnormal expression of Th2 cells and T follicular helper cells is more likely to cause antibody-mediated autoimmune diseases. In addition, abnormal activation of helper T cells also mediates autoimmune diseases through the production of abnormal cytokines and chemokines. Helper T cells play an essential role in the pathogenesis of autoimmune diseases, and a full understanding of their role in autoimmune diseases is helpful for providing ideas for the treatment of autoimmune diseases.
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Affiliation(s)
- Xiao-Mei Zhang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, China
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21
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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]
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Beecher G, Putko BN, Wagner AN, Siddiqi ZA. Therapies Directed Against B-Cells and Downstream Effectors in Generalized Autoimmune Myasthenia Gravis: Current Status. Drugs 2019; 79:353-364. [PMID: 30762205 DOI: 10.1007/s40265-019-1065-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Myasthenia gravis is a rare, heterogeneous, classical autoimmune disease characterized by fatigable skeletal muscle weakness, which is directly mediated by autoantibodies targeting various components of the neuromuscular junction, including the acetylcholine receptor, muscle specific tyrosine kinase, and lipoprotein-related protein 4. Subgrouping of myasthenia gravis is dependent on the age of onset, pattern of clinical weakness, autoantibody detected, type of thymic pathology, and response to immunotherapy. Generalized immunosuppressive therapies are effective in all subgroups of myasthenia gravis; however, approximately 15% remain refractory and more effective treatments with improved safety profiles are needed. In recent years, successful utilization of targeted B-cell therapies in this disease has triggered renewed focus in unraveling the underlying immunopathology in attempts to identify newer therapeutic targets. While myasthenia gravis is predominantly B-cell mediated, T cells, T cell-B cell interactions, and B-cell-related factors are increasingly recognized to play key roles in its immunopathology, particularly in autoantibody production, and novel therapies have focused on targeting these specific immune system components. This overview describes the current understanding of myasthenia gravis immunopathology before discussing B-cell-related therapies, their therapeutic targets, and the rationale and evidence for their use. Several prospective studies demonstrated efficacy of rituximab in various myasthenia gravis subtypes, particularly that characterized by antibodies against muscle-specific tyrosine kinase. However, a recent randomized control trial in patients with acetylcholine receptor antibodies was negative. Eculizumab, a complement inhibitor, has recently gained regulatory approval for myasthenia gravis based on a phase III trial that narrowly missed its primary endpoint while achieving robust results in all secondary endpoints. Zilucoplan is a subcutaneously administered terminal complement inhibitor that recently demonstrated significant improvements in functional outcome measures in a phase II trial. Rozanolixizumab, CFZ533, belimumab, and bortezomib are B-cell-related therapies that are in the early stages of evaluation in treating myasthenia gravis. The rarity of myasthenia gravis, heterogeneity in its clinical manifestations, and variability in immunosuppressive regimens are challenges to conducting successful trials. Nonetheless, these are promising times for myasthenia gravis, as renewed research efforts provide novel insights into its immunopathology, allowing for development of targeted therapies with increased efficacy and safety.
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Affiliation(s)
- Grayson Beecher
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 7-112 Clinical Sciences Building, 11350-83 Ave, Edmonton, AB, T6G 2G3, Canada
| | - Brendan Nicholas Putko
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 7-112 Clinical Sciences Building, 11350-83 Ave, Edmonton, AB, T6G 2G3, Canada
| | - Amanda Nicole Wagner
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 7-112 Clinical Sciences Building, 11350-83 Ave, Edmonton, AB, T6G 2G3, Canada
| | - Zaeem Azfer Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 7-112 Clinical Sciences Building, 11350-83 Ave, Edmonton, AB, T6G 2G3, Canada.
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23
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Myasthenia Gravis: Pathogenic Effects of Autoantibodies on Neuromuscular Architecture. Cells 2019; 8:cells8070671. [PMID: 31269763 PMCID: PMC6678492 DOI: 10.3390/cells8070671] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction (NMJ). Autoantibodies target key molecules at the NMJ, such as the nicotinic acetylcholine receptor (AChR), muscle-specific kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (Lrp4), that lead by a range of different pathogenic mechanisms to altered tissue architecture and reduced densities or functionality of AChRs, reduced neuromuscular transmission, and therefore a severe fatigable skeletal muscle weakness. In this review, we give an overview of the history and clinical aspects of MG, with a focus on the structure and function of myasthenic autoantigens at the NMJ and how they are affected by the autoantibodies' pathogenic mechanisms. Furthermore, we give a short overview of the cells that are implicated in the production of the autoantibodies and briefly discuss diagnostic challenges and treatment strategies.
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24
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Xi J, Wang L, Yan C, Song J, Song Y, Chen J, Zhu Y, Chen Z, Jin C, Ding J, Zhao C. The Cancer Genome Atlas dataset-based analysis of aberrantly expressed genes by GeneAnalytics in thymoma associated myasthenia gravis: focusing on T cells. J Thorac Dis 2019; 11:2315-2323. [PMID: 31372268 DOI: 10.21037/jtd.2019.06.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Myasthenia gravis (MG) is a group of autoimmune disease which could be accompanied by thymoma. Many differences have been observed between thymoma-associated MG (TAMG) and non-MG thymoma (NMG). However, the molecular difference between them remained unknown. This study aimed to explore the differentially expressed genes (DEGs) between the two categories and to elucidate the possible pathogenesis of TAMG further. Methods DEGs were calculated using the RNA-Sequencing data from 11 TAMG and 10 NMG in The Cancer Genome Atlas (TCGA) database. GeneAnalytics was performed to characterize the associations between DEGs and tissues and cells, diseases, gene ontology (GO) terms, pathways, phenotypes, and drug/compounds, respectively. Genes related to T cells were sorted out using LifeMapDiscovery Cells and Tissues Database. Genes directly related to the phenotype of autoimmune diseases that were identified by VarElect were validated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results The expression level of 169 genes showed a significant difference between the two groups, with 94 up-regulated and 75 down-regulated. Overexpression of six genes (ATM, SFTPB, ANKRD55, BTLA, CCR7, TNFRSF25), which are expressed in T cells and directly related to autoimmune disease through VarElect, was identified. The overexpression of soluble BTLA (sBTLA) (P=0.027), CCR7 (P=0.0018), TNFRSF25 (P=0.0013) and ANKRD55 (P=0.0026) was validated by RT-qPCR in thymoma tissues from our center. Conclusions Overexpression of sBTLA, CCR7, TNFRSF25 and ANKRD55 was identified and validated by RT-qPCR, which could partly explain the underlying pathogenesis in TAMG.
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Affiliation(s)
- Jianying Xi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Liang Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chong Yan
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jie Song
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yang Song
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ji Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yongjun Zhu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhiming Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chun Jin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China.,Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai 200040, China
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25
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Ujiie H, Gregor A, Yasufuku K. Minimally invasive surgical approaches for lung cancer. Expert Rev Respir Med 2019; 13:571-578. [DOI: 10.1080/17476348.2019.1610399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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26
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Zhao S, Ding J, Wang S, Li C, Guo P, Zhang M, Li Z. Decreased expression of circulating Aire and increased Tfh/Tfr cells in myasthenia gravis patients. Biosci Rep 2018; 38:BSR20180096. [PMID: 29773681 PMCID: PMC6239276 DOI: 10.1042/bsr20180096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/05/2018] [Accepted: 05/17/2018] [Indexed: 01/27/2023] Open
Abstract
Myasthenia gravis (MG) is a rare prototypical autoimmune disorder caused by antibodies (Ab) against postsynaptic membrane proteins. Most reports have investigated the role of autoimmune regulator gene (Aire) in thymic tissue in machianism of MG initiation. So far, the expression of Aire in human peripheral blood cells (we call it circulating Aire expression in the following passage) has not been reported. Herein, we explore the expression of Aire in peripharal blood, circulating T-follicular helper (cTfh) and T-follicular regulatory (cTfr) cells in MG patients. In our research, we found that the acetylcholine receptor (AChR) Ab level is higher in generalized MG (GMG) than that in ocular MG (OMG). Compared with the control group (CG), lower expression of Aire was found in MG patients, especially in GMG. The ratio of Tfh/Tfr was higher in GMG patients, and then in the OMG patients, and lowest in CG. All these differences above were statistically significant. Negative relation was discovered between expression of Aire in circulating blood and ratio of Tfh/Tfr, so did it exist between Aire expression and the severity of MG. Meanwhile, positive relation was discovered between ratio of Tfh/Tfr and the severity of MG. However, no significant relation was manifested in our study between the subset age of MG and Aire level. Overall, these findings imply circulating Aire might play a role in the imbalance of cTfh and cTfr cells and participate in the pathogenesis of MG.
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Affiliation(s)
- Sijia Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
| | - Jiaqi Ding
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
| | - Shengyuan Wang
- Department of Hyperbaric Oxygen, Navy General Hospital of Chinese People's Liberation Army, Beijing 100048, China
| | - Chuan Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
| | - Peng Guo
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
| | - Min Zhang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, China
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Zhang H, Zhang P, Yu TL. Comparative study of computed tomography of normal and lymphoid follicular hyperplasia thymus in myasthenia gravis patients. Exp Ther Med 2018; 17:512-518. [PMID: 30651830 DOI: 10.3892/etm.2018.6948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/18/2018] [Indexed: 01/10/2023] Open
Abstract
The aim of the present study was to evaluate the thymuses of non-thymomatous myasthenia gravis (MG) patients by computed tomography (CT) for differentiating lymphoid follicular hyperplasia (LFH) thymus from normal/involuted thymus in order to assist surgeons in determining whether a non-thymomatous MG patient requires an operation. In the present retrospective review over 10 years, 80 patients who received CT scan and thymectomy at the Affiliated General Hospital of Tianjin Medial University (Tianjin, China) were included. According to the pathological records, 54 of the cases initially detected on CT were confirmed as LFH thymus. Thymic measurements, including anteroposterior and transverse dimensions, width (the longest axis of the lobe on a transverse scan) and thickness (the largest dimension perpendicular to the long axis of the lobe) and CT attenuation of the thymus region, adipose tissue and chest wall musculature in each CT slice were included to assess differences between the LFH group and the normal/involuted thymus group. Although a negative association between patient age and the CT attenuation of the thymus region was identified (r=-0.779, P<0.05, Pearson's correlation test), the LFH thymus group featured nodular changes on CT, while no such changes were observed in the normal/involuted thymus group. The mean age of disease onset in the LFH thymus group was significantly lower than that in the normal thymus group (40.2±17.3 vs. 59.2±9.3 years). Furthermore, significant differences in CT attenuation were identified between the LFH group and the normal/involuted thymus group [-41.21±54.42 vs. -108.23±8.72 Hounsfield units (HU) on unenhanced CT; -25.57±58.65 vs.-117.40±6.22 HU on contrast-enhanced CT]. In the LFH group, the difference in mean CT attenuation between the thymus region and adipose tissue was significant, while no significant difference was observed in the normal/involuted thymus group. In conclusion, CT may be used to distinguish LFH thymus from normal/involuted thymus in MG patients.
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Affiliation(s)
- Hui Zhang
- Department of Cardiac and Thoracic Surgery, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Peng Zhang
- Department of Cardiac and Thoracic Surgery, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Tie-Lian Yu
- Department of Radiology, Affiliated General Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
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28
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Tabata R, Tabata C, Yamamoto N, Shibuya S, Yasumizu R, Kojima M. Progressive peripheral CD8+ T lymphocytosis complicated by pure red cell aplasia following immunosuppressive therapy for thymoma-associated myasthenia gravis. Int Immunopharmacol 2018; 63:14-18. [DOI: 10.1016/j.intimp.2018.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Gensous N, Charrier M, Duluc D, Contin-Bordes C, Truchetet ME, Lazaro E, Duffau P, Blanco P, Richez C. T Follicular Helper Cells in Autoimmune Disorders. Front Immunol 2018; 9:1637. [PMID: 30065726 PMCID: PMC6056609 DOI: 10.3389/fimmu.2018.01637] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
T follicular helper (Tfh) cells are a distinct subset of CD4+ T lymphocytes, specialized in B cell help and in regulation of antibody responses. They are required for the generation of germinal center reactions, where selection of high affinity antibody producing B cells and development of memory B cells occur. Owing to the fundamental role of Tfh cells in adaptive immunity, the stringent control of their production and function is critically important, both for the induction of an optimal humoral response against thymus-dependent antigens but also for the prevention of self-reactivity. Indeed, deregulation of Tfh activities can contribute to a pathogenic autoantibody production and can play an important role in the promotion of autoimmune diseases. In the present review, we briefly introduce the molecular factors involved in Tfh cell formation in the context of a normal immune response, as well as markers associated with their identification (transcription factor, surface marker expression, and cytokine production). We then consider in detail the role of Tfh cells in the pathogenesis of a broad range of autoimmune diseases, with a special focus on systemic lupus erythematosus and rheumatoid arthritis, as well as on the other autoimmune/inflammatory disorders. We summarize the observed alterations in Tfh numbers, activation state, and circulating subset distribution during autoimmune and some other inflammatory disorders. In addition, central role of interleukin-21, major cytokine produced by Tfh cells, is discussed, as well as the involvement of follicular regulatory T cells, which share characteristics with both Tfh and regulatory T cells.
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Affiliation(s)
- Noémie Gensous
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Manon Charrier
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Dorothée Duluc
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | | | | | - Estibaliz Lazaro
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Pierre Duffau
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Patrick Blanco
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Christophe Richez
- ImmunoConcept, UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
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30
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Yi JS, Guptill JT, Stathopoulos P, Nowak RJ, O'Connor KC. B cells in the pathophysiology of myasthenia gravis. Muscle Nerve 2017; 57:172-184. [PMID: 28940642 DOI: 10.1002/mus.25973] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 12/21/2022]
Abstract
Myasthenia gravis (MG) is an archetypal autoimmune disease. The pathology is characterized by autoantibodies to the acetylcholine receptor (AChR) in most patients or to muscle-specific tyrosine kinase (MuSK) in others and to a growing number of other postsynaptic proteins in smaller subsets. A decrease in the number of functional AChRs or functional interruption of the AChR within the muscle end plate of the neuromuscular junction is caused by pathogenic autoantibodies. Although the molecular immunology underpinning the pathology is well understood, much remains to be learned about the cellular immunology contributing to the production of autoantibodies. This Review documents research concerning the immunopathology of MG, bringing together evidence principally from human studies with an emphasis on the role of adaptive immunity and B cells in particular. Proposed mechanisms for autoimmunity, which take into account that different types of MG may incorporate divergent immunopathology, are offered. Muscle Nerve 57: 172-184, 2018.
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Affiliation(s)
- John S Yi
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey T Guptill
- Department of Neurology, Neuromuscular Section, Duke University Medical Center, Durham, North Carolina, USA
| | - Panos Stathopoulos
- Department of Neurology, Yale School of Medicine, Room 353J, 300 George Street, New Haven, Connecticut, 06511, USA
| | - Richard J Nowak
- Department of Neurology, Yale School of Medicine, Room 353J, 300 George Street, New Haven, Connecticut, 06511, USA
| | - Kevin C O'Connor
- Department of Neurology, Yale School of Medicine, Room 353J, 300 George Street, New Haven, Connecticut, 06511, USA
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