|
1
|
Shushtari A, Ashayeri H, Salmannezhad A, Seyedmirzaei H, Rezaei N. Pro-inflammatory cytokines in myasthenia gravis: a systematic review and meta-analysis. Neurol Sci 2025:10.1007/s10072-025-08218-3. [PMID: 40347402 DOI: 10.1007/s10072-025-08218-3] [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: 01/23/2025] [Accepted: 04/27/2025] [Indexed: 05/12/2025]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune neuromuscular disorder impacting muscle endplate components. Pro-inflammatory cytokines, particularly, might play pivotal roles in MG pathogenesis, influencing regulatory T cells and contributing to chronic inflammation. We did this systematic review and meta-analysis to address the conflicting results about pro-inflammatory cytokine profiles in MG. METHODS A thorough search was conducted in PubMed, Scopus, and Embase to find studies measuring interleukin (IL)-1 family (IL-1β, IL-18, IL-33, IL-36, IL-37), IL-6, and tumor necrosis factor-alpha (TNF-α) levels in MG patients' serum and controls. Selection criteria encompassed various MG types, including ocular and generalized, with and without thymoma, and acetylcholine receptor (AChR) antibody-positive and negative. RESULTS Of the 1843 identified studies, 16 met the inclusion criteria. The meta-analysis revealed a significant increase in serum TNF-α, IL-1β, and IL-33 level in MG patients compared to controls. The included studies also implied elevated levels of IL-18 in people with MG compared to controls and elevated levels of IL-18 and IL-33 in generalized MG compared to ocular MG. CONCLUSION Our study highlights the altered profiles of pro-inflammatory cytokines in MG.
Collapse
Affiliation(s)
- Ali Shushtari
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamidreza Ashayeri
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirhossein Salmannezhad
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Homa Seyedmirzaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Children's Medical Center Hospital, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran.
| |
Collapse
|
|
2
|
Jiang Y, Wang J, Su S, Zhang S, Wen Q, Wang Y, Li L, Han J, Xie N, Liu H, Sun Y, Lu Y, Di L, Wang M, Xu M, Chen H, Wang S, Wen X, Zhu W, Da Y. The Impact of COVID-19 Vaccination and Infection on the Exacerbation of Myasthenia Gravis. Vaccines (Basel) 2024; 12:1221. [PMID: 39591124 PMCID: PMC11598725 DOI: 10.3390/vaccines12111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/20/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
OBJECTIVES Myasthenia Gravis (MG) is an autoimmune disorder that can exacerbate for various reasons, including vaccination and infection. This study aimed to investigate the safety of COVID-19 vaccines for MG patients, factors influencing MG exacerbation after COVID-19 infection (MECI), the course and prognosis of MECI, and the impact of COVID-19 vaccine on infected MG patients. METHODS Patients were enrolled from the MG database in the Department of Neurology, Xuanwu Hospital, Capital Medical University. Two questionnaires were administered to collect data concerning COVID-19 vaccination (questionnaire 1, Q1) and infection (questionnaire 2, Q2) during two distinct periods. MG exacerbation was defined as an increase of at least two points in the MG activity of daily living (MG-ADL) score. COVID-19 severity was categorized as "hospitalization" or "home management"; Results: During the first data-collecting period, our database registered 1013 adult patients: 273 (26.9%) had received COVID-19 vaccinations and completed Q1, and 8 (2.9%) experienced MG exacerbation after vaccination. During the second data-collecting period, among the newly registered patients, 366 patients completed Q2. Of these, 244 were infected, with 39 (16.0%) experiencing MECI and 21 (8.6%) requiring hospitalization. Multivariate analysis showed that generalized myasthenia gravis was associated with MECI (OR 3.354, 95% CI: 1.423-7.908, p = 0.006). Among the 244 infected patients, 143 had received COVID-19 vaccinations, including 14 who received their booster dose within 6 months before COVID-19 and 129 who were vaccinated more than 6 months before COVID-19. The remaining 101 were unvaccinated. No significant associations were found between COVID-19 vaccination and COVID-19 severity (p = 0.292) or MECI incidence (p = 0.478); Conclusions: COVID-19 vaccines were found to be safe for MG patients in stable condition. Patients with gMG were more susceptible to experiencing MECI. No significant impact of the vaccine on COVID-19 severity or MECI incidence was observed.
Collapse
Affiliation(s)
- Yuting Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Jingsi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shengyao Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shu Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Qi Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yaye Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Ling Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Tianjin 4th Centre Hospital, Tianjin 300140, China
| | - Jianxin Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing 102401, China
| | - Nairong Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Haoran Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yanan Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian 116001, China
| | - Yan Lu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Li Di
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Suobin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Xinmei Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Wenjia Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yuwei Da
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| |
Collapse
|
|
3
|
Xu Y, Li Q, Pan M, Jia X, Wang W, Guo Q, Luan L. Interpretable machine learning models for predicting short-term prognosis in AChR-Ab+ generalized myasthenia gravis using clinical features and systemic inflammation index. Front Neurol 2024; 15:1459555. [PMID: 39445190 PMCID: PMC11496189 DOI: 10.3389/fneur.2024.1459555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/18/2024] [Indexed: 10/25/2024] Open
Abstract
Background Myasthenia Gravis (MG) is an autoimmune disease that causes muscle weakness in 80% of patients, most of whom test positive for anti-acetylcholine receptor (AChR) antibodies (AChR-Abs). Predicting and improving treatment outcomes are necessary due to varying responses, ranging from complete relief to minimal improvement. Objective Our study aims to develop and validate an interpretable machine learning (ML) model that integrates systemic inflammation indices with traditional clinical indicators. The goal is to predict the short-term prognosis (after 6 months of treatment) of AChR-Ab+ generalized myasthenia gravis (GMG) patients to guide personalized treatment strategies. Methods We performed a retrospective analysis on 202 AChR-Ab+ GMG patients, dividing them into training and external validation cohorts. The primary outcome of this study was the Myasthenia Gravis Foundation of America (MGFA) post-intervention status assessed after 6 months of treatment initiation. Prognoses were classified as "unchanged or worse" for a poor outcome and "improved or better" for a good outcome. Accordingly, patients were categorized into "good outcome" or "poor outcome" groups. In the training cohort, we developed and internally validated various ML models using systemic inflammation indices, clinical indicators, or a combination of both. We then carried out external validation with the designated cohort. Additionally, we assessed the feature importance of our most effective model using the Shapley Additive Explanations (SHAP) method. Results In our study of 202 patients, 28.7% (58 individuals) experienced poor outcomes after 6 months of standard therapy. We identified 11 significant predictors, encompassing both systemic inflammation indexes and clinical metrics. The extreme gradient boosting (XGBoost) model demonstrated the best performance, achieving an area under the receiver operating characteristic (ROC) curve (AUC) of 0.944. This was higher than that achieved by logistic regression (Logit) (AUC: 0.882), random forest (RF) (AUC: 0.917), support vector machines (SVM) (AUC: 0.872). Further refinement through SHAP analysis highlighted five critical determinants-two clinical indicators and three inflammation indexes-as crucial for assessing short-term prognosis in AChR-Ab+ GMG patients. Conclusion Our analysis confirms that the XGBoost model, integrating clinical indicators with systemic inflammation indexes, effectively predicts short-term prognosis in AChR-Ab+ GMG patients. This approach enhances clinical decision-making and improves patient outcomes.
Collapse
Affiliation(s)
- Yanan Xu
- Department of Neurology, Nanjing Jiangbei Hospital, Nanjing, China
| | - Qi Li
- Department of Neurology, Nanjing Jiangbei Hospital, Nanjing, China
| | - Meng Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Jia
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenbin Wang
- Department of Neurology, Nanjing Jiangbei Hospital, Nanjing, China
| | - Qiqi Guo
- Department of Neurology, Nanjing Jiangbei Hospital, Nanjing, China
| | - Liqin Luan
- Department of Neurology, Nanjing Jiangbei Hospital, Nanjing, China
| |
Collapse
|
|
4
|
Theissen L, Schroeter CB, Huntemann N, Räuber S, Dobelmann V, Cengiz D, Herrmann A, Koch-Hölsken K, Gerdes N, Hu H, Mourikis P, Polzin A, Kelm M, Hartung HP, Meuth SG, Nelke C, Ruck T. Recombinant Acetylcholine Receptor Immunization Induces a Robust Model of Experimental Autoimmune Myasthenia Gravis in Mice. Cells 2024; 13:508. [PMID: 38534352 PMCID: PMC10969621 DOI: 10.3390/cells13060508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Myasthenia gravis (MG) is a prototypical autoimmune disease of the neuromuscular junction (NMJ). The study of the underlying pathophysiology has provided novel insights into the interplay of autoantibodies and complement-mediated tissue damage. Experimental autoimmune myasthenia gravis (EAMG) emerged as a valuable animal model, designed to gain further insight and to test novel therapeutic approaches for MG. However, the availability of native acetylcholine receptor (AChR) protein is limited favouring the use of recombinant proteins. To provide a simplified platform for the study of MG, we established a model of EAMG using a recombinant protein containing the immunogenic sequence of AChR in mice. This model recapitulates key features of EAMG, including fatigable muscle weakness, the presence of anti-AChR-antibodies, and engagement of the NMJ by complement and a reduced NMJ density. Further characterization of this model demonstrated a prominent B cell immunopathology supported by T follicular helper cells. Taken together, the herein-presented EAMG model may be a valuable tool for the study of MG pathophysiology and the pre-clinical testing of therapeutic applications.
Collapse
Affiliation(s)
- Lukas Theissen
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Christina B. Schroeter
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Vera Dobelmann
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Derya Cengiz
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Alexander Herrmann
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Kathrin Koch-Hölsken
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Norbert Gerdes
- Department of Cardiology, Pulmonolgy and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (N.G.); (H.H.); (P.M.); (A.P.); (M.K.)
| | - Hao Hu
- Department of Cardiology, Pulmonolgy and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (N.G.); (H.H.); (P.M.); (A.P.); (M.K.)
| | - Philipp Mourikis
- Department of Cardiology, Pulmonolgy and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (N.G.); (H.H.); (P.M.); (A.P.); (M.K.)
| | - Amin Polzin
- Department of Cardiology, Pulmonolgy and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (N.G.); (H.H.); (P.M.); (A.P.); (M.K.)
| | - Malte Kelm
- Department of Cardiology, Pulmonolgy and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (N.G.); (H.H.); (P.M.); (A.P.); (M.K.)
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
- Brain and Mind Center, University of Sidney, Sidney NSW 2050, Australia
- Department of Neurology, Palacky University Olomouc, 77146 Olomouc, Czech Republic
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Christopher Nelke
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| | - Tobias Ruck
- Department of Neurology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany; (L.T.); (C.B.S.); (N.H.); (S.R.); (V.D.); (D.C.); (A.H.); (K.K.-H.); (H.-P.H.); (S.G.M.)
| |
Collapse
|
|
5
|
Huang X, An X, Gao X, Wang N, Liu J, Zhang Y, Qi G, Zhang C. Serum amyloid A facilitates expansion of CD4 + T cell and CD19 + B cell subsets implicated in the severity of myasthenia gravis patients. J Neurochem 2024; 168:224-237. [PMID: 38214332 DOI: 10.1111/jnc.16047] [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: 11/05/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024]
Abstract
Serum amyloid A (SAA) is a clinically useful inflammatory marker involved in the pathogenesis of autoimmune diseases. This study aimed to explore the SAA levels in a cohort of patients with myasthenia gravis (MG) in relation to disease-related clinical parameters and myasthenic crisis (MC) and elucidate the effects of SAA on immune response. A total of 82 MG patients including 50 new-onset MG patients and 32 MC patients were enrolled in this study. Baseline data and laboratory parameters of all enrolled MG patients were routinely recorded through electronic medical systems. SAA levels were measured by enzyme-linked immunosorbent assay (ELISA) kit. CD4+ T and CD19+ B cell subsets were analyzed by flow cytometry. In vitro, human recombinant SAA (Apo-SAA) was applied to stimulate peripheral blood mononuclear cells (PBMCs) from MG patients to observe the effect on T and B cell differentiation. Our results indicated that SAA levels in new-onset MG patients were higher than those in controls and were positively correlated with QMG score, MGFA classification, plasmablast cells, IL-6, and IL-17 levels. Subgroup analysis revealed that SAA levels were increased in generalized MG (GMG) patients than in ocular MG (OMG), as well as elevated in late-onset MG (LOMG) than in early-onset MG (EOMG) and higher in MGFA III/IV compared with MGFA I/II. The ROC curve demonstrated that SAA showed good diagnostic value for MC, especially when combined with NLR. In vitro, Apo-SAA promoted the Th1 cells, Th17 cells, plasmablast cells, and plasma cells differentiation in MG PBMCs. The present findings suggested that SAA was increased in MG patients and promoted expansion of CD4+ T cell and CD19+ B cell subsets, which implicated in the severity of MG patients.
Collapse
Affiliation(s)
- Xiaoyu Huang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xueting An
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xue Gao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ningning Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guoyan Qi
- Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - Chao Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
|
6
|
Peng Y, Yang H, Chen Q, Jin H, Xue YH, Du MQ, Liu S, Yao SY. An angel or a devil? Current view on the role of CD8 + T cells in the pathogenesis of myasthenia gravis. J Transl Med 2024; 22:183. [PMID: 38378668 PMCID: PMC10877804 DOI: 10.1186/s12967-024-04965-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Myasthenia gravis (MG) and the experimental autoimmune MG (EAMG) animal model are characterized by T-cell-induced and B-cell-dominated autoimmune diseases that affect the neuromuscular junction. Several subtypes of CD4+ T cells, including T helper (Th) 17 cells, follicular Th cells, and regulatory T cells (Tregs), contribute to the pathogenesis of MG. However, increasing evidence suggests that CD8+ T cells also play a critical role in the pathogenesis and treatment of MG. MAIN BODY Herein, we review the literature on CD8+ T cells in MG, focusing on their potential effector and regulatory roles, as well as on relevant evidence (peripheral, in situ, cerebrospinal fluid, and under different treatments), T-cell receptor usage, cytokine and chemokine expression, cell marker expression, and Treg, Tc17, CD3+CD8+CD20+ T, and CXCR5+ CD8+ T cells. CONCLUSIONS Further studies on CD8+ T cells in MG are necessary to determine, among others, the real pattern of the Vβ gene usage of autoantigen-specific CD8+ cells in patients with MG, real images of the physiology and function of autoantigen-specific CD8+ cells from MG/EAMG, and the subset of autoantigen-specific CD8+ cells (Tc1, Tc17, and IL-17+IFN-γ+CD8+ T cells). There are many reports of CD20-expressing T (or CD20 + T) and CXCR5+ CD8 T cells on autoimmune diseases, especially on multiple sclerosis and rheumatoid arthritis. Unfortunately, up to now, there has been no report on these T cells on MG, which might be a good direction for future studies.
Collapse
Affiliation(s)
- Yong Peng
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China.
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China.
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Quan Chen
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| | - Hong Jin
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| | - Ya-Hui Xue
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| | - Miao-Qiao Du
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| | - Shu Liu
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| | - Shun-Yu Yao
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, 412000, Hunan, China
- Department of Neurology, The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, 412000, Hunan, China
| |
Collapse
|
|
7
|
Wei SL, Yang CL, Si WY, Dong J, Zhao XL, Zhang P, Li H, Wang CC, Zhang M, Li XL, Duan RS. Altered serum levels of cytokines in patients with myasthenia gravis. Heliyon 2024; 10:e23745. [PMID: 38192761 PMCID: PMC10772159 DOI: 10.1016/j.heliyon.2023.e23745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/12/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disease characterized by generalized skeletal muscle contraction weakness due to autoantibodies targeting neural-muscular junctions. Here, we investigated the relationship between key cytokines and MG type, disease course, antibodies, and comorbidities. Method Cytokine levels in serum samples collected from MG (n = 45) and healthy control (HC, n = 38) patients from January 2020 to June 2022 were quantified via flow cytometry. Results Levels of IL-6 were higher in the MG group versus healthy individuals (p = 0.026) and in patients with generalized versus ocular MG (p = 0.019). IL-6 levels were positively correlated with QMG score. In patients with MG with both AChR and Titin antibodies, serum levels of sFas and granulysin were higher than in those with AChR alone (p = 0.036, and p = 0.028, respectively). LOMG had a reduction in serum levels of IL-2 compared to EOMG (p = 0.036). LOMG patients with diabetes had lower serum levels of IL-2, IL-4, and IFN-γ (p = 0.044, p = 0.038, and p = 0.047, respectively) versus those without diabetes. sFas in the MG with Abnormal thymus were reduced compared to those in MG with Normal thymus (p = 0.008). Conclusions This study revealed a positive correlation between IL-6 level and MG status. Serum cytokine levels of the AChR + Titin MG group differed from those of the AChR group. LOMG had a lower IL-2 level. Comorbidities affect some cytokines in peripheral blood in MG serum.
Collapse
Affiliation(s)
- Shu-Li Wei
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Chun-Lin Yang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| | - Wei-Yue Si
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, PR China
| | - Jing Dong
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
| | - Xue-Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
| | - Peng Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| | - Heng Li
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| | - Cong-Cong Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| | - Min Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| | - Xiao-Li Li
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, 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 and Shandong Provincial Qianfoshan Hospital, Jinan 250014, PR China
- Shandong Institute of Neuroimmunology, Jinan 250014, PR China
- Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan 250014, PR China
| |
Collapse
|
|
8
|
Paardekooper LM, Fillié-Grijpma YE, van der Sluijs-Gelling AJ, Zlei M, van Doorn R, Vermeer MH, Paunovic M, Titulaer MJ, van der Maarel SM, van Dongen JJM, Verschuuren JJ, Huijbers MG. Autoantibody subclass predominance is not driven by aberrant class switching or impaired B cell development. Clin Immunol 2023; 257:109817. [PMID: 37925120 DOI: 10.1016/j.clim.2023.109817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
A subset of autoimmune diseases is characterized by predominant pathogenic IgG4 autoantibodies (IgG4-AID). Why IgG4 predominates in these disorders is unknown. We hypothesized that dysregulated B cell maturation or aberrant class switching causes overrepresentation of IgG4+ B cells and plasma cells. Therefore, we compared the B cell compartment of patients from four different IgG4-AID with two IgG1-3-AID and healthy donors, using flow cytometry. Relative subset abundance at all maturation stages was normal, except for a, possibly treatment-related, reduction in immature and naïve CD5+ cells. IgG4+ B cell and plasma cell numbers were normal in IgG4-AID patients, however they had a (sub)class-independent 8-fold increase in circulating CD20-CD138+ cells. No autoreactivity was found in this subset. These results argue against aberrant B cell development and rather suggest the autoantibody subclass predominance to be antigen-driven. The similarities between IgG4-AID suggest that, despite displaying variable clinical phenotypes, they share a similar underlying immune profile.
Collapse
Affiliation(s)
| | | | | | - Mihaela Zlei
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Manuela Paunovic
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jacques J M van Dongen
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands; Centro de Investigación del Cáncer-Instituto de Biología Molecular y Celular del Cáncer (CIC-IBMCC, USAL-CSIC-FICUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Jan J Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje G Huijbers
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
|
9
|
Weng S, Huang L, Cai B, He L, Wen S, Li J, Zhong Z, Zhang H, Huang C, Yang Y, Jiang Q, Liu F. Astragaloside IV ameliorates experimental autoimmune myasthenia gravis by regulating CD4 + T cells and altering gut microbiota. Chin Med 2023; 18:97. [PMID: 37542273 PMCID: PMC10403896 DOI: 10.1186/s13020-023-00798-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is an antibody-mediated autoimmune disease and its pathogenesis is closely related to CD4 + T cells. In recent years, gut microbiota is considered to play an important role in the pathogenesis of MG. Astragaloside IV (AS-IV) is one of the main active components extracted from Astragalus membranaceus and has immunomodulatory effects. To study the immunomodulatory effect of AS-IV and the changes of gut microbiota on experimental autoimmune myasthenia gravis (EAMG) mice, we explore the possible mechanism of AS-IV in improving MG. METHODS In this study, network pharmacology was utilized to screen the crucial targets of AS-IV in the treatment of MG. Subsequently, a Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was performed to identify potential pathways through which AS-IV acts against MG. Furthermore, experimental investigations were conducted to validate the underlying mechanism of AS-IV in MG treatment. Before modeling, 5 mice were randomly selected as the control group (CFA group), and the other 10 were induced to EAMG model. These mice were randomly divided into EAMG group and EAMG + AS-IV group, n = 5/group. In EAMG + AS-IV group, AS-IV was administered by gavage. CFA and EAMG groups were given the same volume of PBS. Body weight, grip strength and clinical symptoms were assessed and recorded weekly. At the last administration, the feces were collected for 16S RNA microbiota analysis. The levels of Treg, Th1 and Th17 cells in spleen and Th1 and Th17 cells in thymus were detected by flow cytometry. The levels of IFN-γ, IL-17 and TGF-β in serum were measured by ELISA. Furthermore, fecal microbial transplantation (FMT) experiments were performed for exploring the influence of changed intestinal flora on EAMG. After EAMG model was induced, the mice were treated with antibiotics daily for 4 weeks to germ-free. Then germ-free EAMG mice were randomly divided into two groups: FMT EAMG group, FMT AS-IV group, n = 3/group. Fecal extractions from EAMG and EAMG + AS-IV groups as gathered above were used to administered daily to the respective groups for 4 weeks. Body weight, grip strength and clinical symptoms were assessed and recorded weekly. The levels of Treg, Th1 and Th17 cells in spleen and Th1 and Th17 cells in thymus were detected at the last administration. The levels of IFN-γ, IL-17 and TGF-β in serum were measured by ELISA. RESULTS The network pharmacology and KEGG pathway analysis revealed that AS-IV regulates T cell pathways, including T cell receptor signaling pathway and Th17 cell differentiation, suggesting its potential in improving MG. Further experimental verification demonstrated that AS-IV administration improved muscle strength and body weight, reduced the level of Th1 and Th17 cells, enhanced the level of Treg cells, and resulted in alterations of the gut microbiota, including changes in beta diversity, the Firmicutes/Bacteroidetes (F/B) ratio, and the abundance of Clostridia in EAMG mice. We further conducted FMT tests and demonstrated that the EAMG Abx-treated mice which were transplanted the feces of mice treated with AS-IV significantly alleviated myasthenia symptoms, reduced Th1 and Th17 cells levels, and increased Treg cell levels. CONCLUSION This study speculated that AS-IV ameliorates EAMG by regulating CD4 + T cells and altering the structure and species of gut microbiota of EAMG.
Collapse
Affiliation(s)
- Senhui Weng
- Department of Spleen and Stomach Diseases, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Linwen Huang
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Bingxing Cai
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Long He
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
- Department of Spleen and Stomach Diseases, First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Shuting Wen
- Department of Spleen and Stomach Diseases, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Jinghao Li
- Department of Traditional Chinese Medicine of the Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, China
| | - Zhuotai Zhong
- Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Haiyan Zhang
- Department of Spleen and Stomach Diseases, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China
| | - Chongyang Huang
- Department of Spleen and Stomach Diseases, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China
| | - Yunying Yang
- Department of Spleen and Stomach Diseases, First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, 510422, China
| | - Qilong Jiang
- Department of Spleen and Stomach Diseases, First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, 510422, China.
| | - Fengbin Liu
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, No.12 Airport Road, Baiyun District, Guangzhou, 510422, China.
- Department of Spleen and Stomach Diseases, First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, 510422, China.
- Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 2, Helongqi Road, Renhe Town, Baiyun District, Guangzhou, 510000, China.
| |
Collapse
|
|
10
|
Bi Z, Zhan J, Zhang Q, Gao H, Yang M, Ge H, Gui M, Lin J, Bu B. Clinical and immune-related factors associated with exacerbation in adults with well-controlled generalized myasthenia gravis. Front Immunol 2023; 14:1177249. [PMID: 37266422 PMCID: PMC10230065 DOI: 10.3389/fimmu.2023.1177249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives To describe the clinical predictors and immune-related factors for exacerbation in adults with well-controlled generalized myasthenia gravis (GMG). Methods We conducted a retrospective analysis of 585 adults with well-controlled GMG from our institution to explore the risk factors for exacerbation. Furthermore, propensity score matching (PSM) was used to compare the proportions of lymphocyte subsets, and the levels of immunoglobulin, complement, and anti-acetylcholine receptor antibody (AChR-ab) in the peripheral blood of 111 patients with exacerbations and 72 patients without exacerbations. Results A total of 404 patients (69.1%) experienced at least one exacerbation, and the median (interquartile range) time to the first exacerbation was 1.5 years (0.8-3.1 years). Multivariable Cox regression analysis showed that age at onset, disease duration before enrollment, Myasthenia Gravis Foundation of America classification (MGFA) class III vs. class II, MGFA class IV-V vs. class II, AChR-ab levels, anti-muscle specific kinase antibody levels, thymus hyperplasia, prednisone plus immunosuppressants vs. prednisone treatment, and thymectomy were independent predictors for exacerbations [hazard ratio (HR) = 1.011, 1.031, 1.580, 1.429, 2.007, 2.033, 1.461, 0.798, and 0.651, respectively]. Propensity-matched analysis compared 51 patient pairs. After PSM, the peripheral blood proportions of CD3-CD19+ B cells, ratios of CD3+CD4+/CD3+CD8+ T cells, and AChR-ab levels were significantly increased, and the peripheral blood proportions of CD3+CD8+ T and CD4+CD25+CD127low+ regulatory T cells (Tregs) were significantly lower in patients with exacerbation than in those without exacerbation (all p < 0.05). Conclusion Myasthenia gravis (MG) exacerbations were more frequent in those patients with older onset age, longer disease duration, more severe MGFA classification, positive AChR-ab, and lack of combined immunotherapy or thymectomy treatment. On the other hand, CD3-CD19+ B cells, CD3+CD8+ T cells, Tregs, and AChR-ab in peripheral blood may be involved in the course of GMG exacerbation.
Collapse
|
|
11
|
Immunological Aspects of Von Hippel-Lindau Disease: A Focus on Neuro-Oncology and Myasthenia Gravis. Diagnostics (Basel) 2023; 13:diagnostics13010144. [PMID: 36611440 PMCID: PMC9818211 DOI: 10.3390/diagnostics13010144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant condition that predisposes affected individuals to a variety of malignant and benign neoplasms. The pathogenetic turning point of this illness is the accumulation of hypoxia-inducible factor (HIF)-1α, a transcription factor of several genes involved in oncogenesis, angiogenesis, tissue regeneration, metabolic regulation, hematopoiesis, and inflammatory responses. From an oncological perspective, increased awareness of the molecular pathways underlying this disease is bringing us closer to the development of specific and targeted therapies. Meanwhile, on the surgical side, improved understanding can help to better identify the patients to be treated and the surgical timing. Overall, pathogenesis research is crucial for developing patient-tailored therapies. One of the actual key topics of interest is the link between the VHL/HIF axis and inflammation. The present study aims to outline the fundamental mechanisms that link VHL disease and immune disorders, as well as to explore the details of the overlap between VHL disease and myasthenia gravis (MG) pathogenetic pathways. As a result, MG becomes a paradigm for autoimmune disorders that might be related with VHL disease.
Collapse
|
|
12
|
Fan R, Que W, Liu Z, Zheng W, Guo X, Liu L, Xiao F. Single-cell mapping reveals dysregulation of immune cell populations and VISTA+ monocytes in myasthenia gravis. Clin Immunol 2022; 245:109184. [DOI: 10.1016/j.clim.2022.109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
|
|
13
|
Huang X, Xu M, Wang Y, Zhang Z, Li F, Chen X, Zhang Y. The systemic inflammation markers as possible indices for predicting respiratory failure and outcome in patients with myasthenia gravis. Ann Clin Transl Neurol 2022; 10:98-110. [PMID: 36453129 PMCID: PMC9852395 DOI: 10.1002/acn3.51706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to explore the relationship between systemic inflammation markers and clinical activity, respiratory failure, and prognosis in patients with myasthenia gravis (MG). METHODS One hundred and seventeen MG patients and 120 controls were enrolled in this study. Differences in the four immune-related markers of two groups based on blood cell counts: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and systemic immune-inflammation index (SII) were measured. The stability of the associations between systemic inflammation markers and respiratory failure in MG patients was confirmed by adjusted logistic regression analysis. Moreover, Kaplan-Meier curve and multivariate COX regression models were applied to assess the factors affecting the outcome of MG. RESULTS NLR, PLR, and SII were higher in MG patients than those in controls and were positively associated with MGFA classification, but not LMR. Adjusted logistic regression analysis showed that PLR was an independent predictor of MG with respiratory failure. The ROC curve demonstrated that PLR showed good sensitivity and specificity for the diagnosis of MG with respiratory failure. Kaplan-Meier curve showed that GMG, positive AchR-Ab, respiratory failure, high NLR, PLR, SII, and IVIg exposure correlated with the risk for poor outcomes in MG patients. The multivariate COX regression models indicated that GMG and high SII was a risk factor for poor outcome of MG. INTERPRETATION The systemic inflammation markers expressed abnormally in MG patients, in which PLR may be an independent predictor of respiratory failure, and high SII and GMG were predictive risk factors for poor outcomes in MG patients.
Collapse
Affiliation(s)
- Xiaoyu Huang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina,Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
| | - Mingming Xu
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Yingying Wang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Zhouao Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Fengzhan Li
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Xiao Chen
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Yong Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| |
Collapse
|
|
14
|
Li T, Li Y, Li JW, Qin YH, Zhai H, Feng B, Li H, Zhang NN, Yang CS. Expression of TRAF6 in peripheral blood B cells of patients with myasthenia gravis. BMC Neurol 2022; 22:302. [PMID: 35978310 PMCID: PMC9382794 DOI: 10.1186/s12883-022-02833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Tumor necrosis factor receptor-associated factor 6 (TRAF6) can regulate the activation of inflammatory signaling pathways by acting as an E3 ubiquitin ligase, which enhances B cell activation. This study aimed to evaluate the expression of TRAF6 in the peripheral blood B cells of myasthenia gravis (MG) patients and analyze the relationships between TRAF6 expression and clinical characteristics. Method In our study, the expression level of TRAF6 in peripheral blood B cells of 89 patients was measured by flow cytometry compared with that of healthy subjects. The effects of disease severity, MG classification and immunotherapy on TRAF6 expression level were also analyzed. Results In our study, TRAF6 expression was elevated in CD19+ B cells and CD19+CD27+ memory B cells in generalized MG (GMG) patients compared with ocular MG (OMG) patients (p = 0.03 and p = 0.03, respectively). There was a significant positive correlation between the TRAF6 expression level and disease severity in both OMG patients and GMG patients (CD19+ B cells: OMG: p < 0.001, r = 0.89; GMG: p = 0.001, r = 0.59; CD29+CD27+ B cells: OMG: p = 0.001, r = 0.80; GMG: p = 0.048, r = 0.38). TRAF6 expression was significantly elevated in CD19+ B cells and CD19+CD27+ memory B cells in GMG with acute aggravation compared with GMG in MMS (p = 0.009 and p = 0.028, respectively). In the eleven MG patients who were followed, TRAF6 expression in B cells and memory B cells was significantly decreased after treatment (p = 0.03 and p < 0.01, respectively). Conclusion TRAF6 is potentially a useful biomarker of inflammation in patients with MG, and might be used to evaluate the effectiveness of treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02833-9.
Collapse
Affiliation(s)
- Ting Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.
| | - Yue Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jia-Wen Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Ying-Hui Qin
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Hui Zhai
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Bin Feng
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - He Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ning-Nannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, School of Medical Imaging, Tianjin Medical University General Hospital, Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Chun-Sheng Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.
| |
Collapse
|
|
15
|
Rao J, Li S, Wang Q, Cheng Q, Ji Y, Fu W, Huang H, Shi L, Wu X. Comparison of Peripheral Blood Regulatory T Cells and Functional Subsets Between Ocular and Generalized Myasthenia Gravis. Front Med (Lausanne) 2022; 9:851808. [PMID: 35755064 PMCID: PMC9218215 DOI: 10.3389/fmed.2022.851808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aims to discuss the function mechanism of regulatory T cells and its subsets in the pathogenic process of myasthenia gravis by contracting the activation levels of those cells in peripheral blood among healthy people, patients with ocular myasthenia gravis (oMG) and patients with generalized myasthenia gravis (gMG). Method Healthy people, newly diagnosed oMG patients, and gMG patients were enrolled in this study. The percentage of the CD3+CD4+CD25+ Treg cells, CD3+CD4+CD25+Foxp3+ Treg cells, CD3+CD4+CD25+Foxp3hi CD45RA–aTreg cells, CD3+CD4+CD25+Foxp3loCD45RA–n-sTreg cells, and CD3+CD4+CD25+ Foxp3loCD45RA+rTreg cells in the peripheral blood were examined by flow cytometry. And then analyzed the differences of Treg cells and its subsets among the study members. Results The percentage of the CD4+CD25+Treg cells in the peripheral blood of oMG patients and gMG patients were both lower than that of healthy people (p < 0.05), the percentage of patients with oMG had no distinct difference with that of patients with gMG (p = 0.475), however. Also, the percentage of CD3+CD4+CD25+Foxp3+Treg cells in the oMG and gMG patients’ group were both lower than that of healthy group. And the percentage of CD25+Foxp3+Treg cells in the peripheral blood of patients with oMG and healthy people were both higher than that of patients with gMG (p < 0.05). The percentage of rTreg in the CD3+CD4+CD25+Treg of the peripheral blood for both gMG and oMG patients’ group were lower than healthy group (p < 0.05), but there was no statistical significance between the oMG and gMG patients’ group (p = 0.232). The percentage of the aTreg cells in the CD3+CD4+CD25+Treg cells of the peripheral blood for the oMG patients was higher than that of gMG patients (p < 0.05), but both of them were lower than healthy group (p < 0.05). The percentage of n-sTreg cells in the peripheral blood descended among the gMG patients’ group, oMG patients’ group, and healthy group (p < 0.05). Conclusion The changes in the number and function of Treg cells and its subsets can cause the impairment of negative immune regulation, which may mediate the triggering of oMG and its progression to gMG.
Collapse
Affiliation(s)
- Jie Rao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Siyu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiyu Wang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qi Cheng
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Ji
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenwen Fu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ling Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaorong Wu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
|
16
|
Song J, Zhao R, Yan C, Luo S, Xi J, Ding P, Li L, Hu W, Zhao C. A Targeted Complement Inhibitor CRIg/FH Protects Against Experimental Autoimmune Myasthenia Gravis in Rats via Immune Modulation. Front Immunol 2022; 13:746068. [PMID: 35154091 PMCID: PMC8825366 DOI: 10.3389/fimmu.2022.746068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Antibody-induced complement activation may cause injury of the neuromuscular junction (NMJ) and is thus considered as a primary pathogenic factor in human myasthenia gravis (MG) and animal models of experimental autoimmune myasthenia gravis (EAMG). In this study, we tested whether CRIg/FH, a targeted complement inhibitor, could attenuate NMJ injury in rat MG models. We first demonstrated that CRIg/FH could inhibit complement-dependent cytotoxicity on human rhabdomyosarcoma TE671 cells induced by MG patient-derived IgG in vitro. Furthermore, we investigated the therapeutic effect of CRIg/FH in a passive and an active EAMG rodent model. In both models, administration of CRIg/FH could significantly reduce the complement-mediated end-plate damage and suppress the development of EAMG. In the active EAMG model, we also found that CRIg/FH treatment remarkably reduced the serum concentration of autoantibodies and of the cytokines including IFN-γ, IL-2, IL-6, and IL-17, and upregulated the percentage of Treg cells in the spleen, which was further verified in vitro. Therefore, our findings indicate that CRIg/FH may hold the potential for the treatment of MG via immune modulation.
Collapse
Affiliation(s)
- Jie Song
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Rui Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Chong Yan
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Peipei Ding
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ling Li
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiguo Hu
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| |
Collapse
|
|
17
|
Chen P, Tang X. Gut Microbiota as Regulators of Th17/Treg Balance in Patients With Myasthenia Gravis. Front Immunol 2022; 12:803101. [PMID: 35003133 PMCID: PMC8732367 DOI: 10.3389/fimmu.2021.803101] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Myasthenia gravis (MG) is an acquired neurological autoimmune disorder characterized by dysfunctional transmission at the neuromuscular junction, with its etiology associated with genetic and environmental factors. Anti-inflammatory regulatory T cells (Tregs) and pro-inflammatory T helper 17 (Th17) cells functionally antagonize each other, and the immune imbalance between them contributes to the pathogenesis of MG. Among the numerous factors influencing the balance of Th17/Treg cells, the gut microbiota have received attention from scholars. Gut microbial dysbiosis and altered microbial metabolites have been seen in patients with MG. Therefore, correcting Th17/Treg imbalances may be a novel therapeutic approach to MG by modifying the gut microbiota. In this review, we initially review the association between Treg/Th17 and the occurrence of MG and subsequently focus on recent findings on alterations of gut microbiota and microbial metabolites in patients with MG. We also explore the effects of gut microbiota on Th17/Treg balance in patients with MG, which may provide a new direction for the prevention and treatment of this disease.
Collapse
Affiliation(s)
- Pan Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
|
18
|
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: 13] [Impact Index Per Article: 3.3] [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.
Collapse
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.
| |
Collapse
|
|
19
|
Li Y, Quan C, Xing W, Wang P, Gao J, Zhang Z, Jiang X, Ma C, Carr MJ, He Q, Gao L, Bi Y, Tang H, Shi W. Rapid humoral immune responses are required for recovery from haemorrhagic fever with renal syndrome patients. Emerg Microbes Infect 2021; 9:2303-2314. [PMID: 32990499 PMCID: PMC8284976 DOI: 10.1080/22221751.2020.1830717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Haemorrhagic fever with renal syndrome (HFRS) following Hantaan virus (HTNV) infection displays variable clinical signs. Humoral responses elicited during HTNV infections are considered important, however, this process remains poorly understood. Herein, we have investigated the phenotype, temporal dynamics, and characteristics of B-cell receptor (BCR) repertoire in an HFRS cohort. The serological profiles were characterized by a lowered expression level of nucleoprotein (NP)-specific antibody in severe cases. Importantly, B-cell subsets were activated and proliferated within the first two weeks of symptom onset and moderate cases reacted more rapidly. BCR analysis in the recovery phase revealed a dramatic increase in the immunoglobulin gene diversity which was more significantly progressed in moderate infections. In severe cases, B-cell-related transcription was lower with inflammatory sets overactivated. Taken together, these data suggest the clinical signs and disease recovery in HFRS patients were positively impacted by rapid and efficacious humoral responses.
Collapse
Affiliation(s)
- Yaoni Li
- Baoji Center Hospital, Baoji, People's Republic of China
| | - Chuansong Quan
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Weijia Xing
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Peihan Wang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Jiming Gao
- Institute of Immunology, Shandong First Medical University& Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Zhenjie Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Xiaolin Jiang
- Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China
| | - Chuanmin Ma
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Michael J Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin, Ireland.,Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Kita-ku, Japan
| | - Qian He
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Lei Gao
- School of Life Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Yuhai Bi
- Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early Warning, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Hua Tang
- Institute of Immunology, Shandong First Medical University& Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Weifeng Shi
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| |
Collapse
|
|
20
|
Xiang W, Xie C, Guan Y. The identification, development and therapeutic potential of IL-10-producing regulatory B cells in multiple sclerosis. J Neuroimmunol 2021; 354:577520. [PMID: 33684831 DOI: 10.1016/j.jneuroim.2021.577520] [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: 09/13/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
Regulatory B cells are a rare B-cell subset widely known to exert their immunosuppressive function via the production of interleukin-10 (IL-10) and other mechanisms. B10 cells are a special subset of regulatory B cells with immunoregulatory function that is fully attributed to IL-10. Their unique roles in the animal model of multiple sclerosis (MS) have been described, as well as their relevance in MS patients. This review specifically focuses on the identification and development of B10 cells, the signals that promote IL-10 production in B cells, the roles of B10 cells in MS, and the potential and major challenges of the application of B10-based therapies for MS.
Collapse
Affiliation(s)
- Weiwei Xiang
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Rd, Shanghai 200127, China
| | - Chong Xie
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Rd, Shanghai 200127, China
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Rd, Shanghai 200127, China.
| |
Collapse
|
|
21
|
Howlett-Prieto Q, Langer C, Rezania K, Soliven B. Modulation of immune responses by bile acid receptor agonists in myasthenia gravis. J Neuroimmunol 2020; 349:577397. [PMID: 32979707 DOI: 10.1016/j.jneuroim.2020.577397] [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: 07/22/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/13/2023]
Abstract
Bile acids bind to multiple receptors, including Takeda G protein-coupled receptor 5 (TGR5) and farnesoid-X-receptors alpha (FXRα). We compared the response of PBMCs to the activation of these receptors in healthy controls and myasthenic patients. We found that TGR5 is a more potent negative regulator of T cell cytokine response than FXRα in both groups. In contrast, TGR5 and FXRα agonists elicit distinct B cell responses in myasthenia compared to controls, specifically on the frequency of IL-6+ B cells and regulatory B cells, as well as IL-10 secretion from PBMCs. We propose that TGR5 is a potential therapeutic target in myasthenia.
Collapse
Affiliation(s)
- Quentin Howlett-Prieto
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States of America
| | - Collin Langer
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States of America
| | - Kourosh Rezania
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States of America
| | - Betty Soliven
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States of America.
| |
Collapse
|
|
22
|
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: 85] [Impact Index Per Article: 17.0] [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.
Collapse
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
| |
Collapse
|
|
23
|
Miyazaki Y, Niino M. Regulatory B cells in neuroimmunological diseases. CLINICAL AND EXPERIMENTAL NEUROIMMUNOLOGY 2020; 11:156-162. [DOI: 10.1111/cen3.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 01/03/2025]
Abstract
AbstractThe idea that B cells participate in immune regulation was initially postulated from observations in animals in the 1970s. It is now established that certain B‐cell populations, known as regulatory B cells, regulate immune reactions in various animal models of autoimmunity, chiefly through the production of interleukin‐10. Subsequent to these findings in animals, several B‐cell subsets have been identified in human blood that are capable of producing interleukin‐10 when stimulated ex vivo. Although we still do not have direct evidence showing that these interleukin‐10‐producing B cells regulate autoimmunity in humans, their functional and phenotypic homology to regulatory B cells in animals, their abnormalities reported in various autoimmune diseases and their alterations in response to treatments all suggest their regulatory role in humans. In this review, the role of regulatory B cells in three neuroimmunological diseases – multiple sclerosis, neuromyelitis optica spectrum disorder and myasthenia gravis – are discussed.
Collapse
Affiliation(s)
- Yusei Miyazaki
- Department of Clinical Research National Hospital Organization Hokkaido Medical Center Sapporo Japan
- Department of Neurology National Hospital Organization Hokkaido Medical Center Sapporo Japan
| | - Masaaki Niino
- Department of Clinical Research National Hospital Organization Hokkaido Medical Center Sapporo Japan
| |
Collapse
|