No correlation between acetylcholine receptor antibody concentration and individual clinical symptoms of myasthenia gravis: A systematic retrospective study involving 67 patients

Wang, Lulu; Wang, Shumin; Yang, Haonan; Han, Jiaojiao; Zhao, Xue; Han, Sensen; Zhang, Yingna; Lv, Jie; Zhang, Jing; Li, Mingqiang; Ji, Ying; Zhou, Shuxian; He, Xiaoxiao; Fang, Hua; Yang, Jing; Zhang, Yunke; Zhang, Qingyong; Gao, Pei-yang; Gao, Feng

doi:10.1002/brb3.2203

Cited by 11 publications

(6 citation statements)

References 39 publications

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“…Furthermore, we found no difference in the circulating levels of the three DCs subsets among patients with different MGFA classifications. Being consistent with the previous report [34], no association between levels of IgG anti-AChR antibodies and frequency of pDCs, CD1c + DCs, or CD141 + DCs in seropositive patients was observed by our study. The pathogenesis of MG is a multifactorial and dynamic process, which is a consequence of interactions among a series of pro-inflammatory and tolerogenic immune cells, as well as the various genetic and environmental risk factors.…”

Section: Discussionsupporting

confidence: 94%

Aberrant Dendritic Cell Subsets in Patients with Myasthenia Gravis and Related Clinical Features

Yan

Xing

et al. 2023

Neuroimmunomodulation

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Introduction: Dendritic cells (DCs) play critical roles in the pathogenesis of myasthenia gravis (MG), and a series of DC-based experimental strategies for MG have recently been developed. However, the definite roles of different DC subsets in the mechanism of MG have scarcely been covered by previous studies. The present study aimed to investigate the levels of three main DC subsets, plasmacytoid DCs (pDCs) (CD303 positive) and two distinct subsets of conventional DCs (cDCs), namely CD1c+ cDCs and CD141+ cDCs, in MG patients and analyze related clinical features. Methods: From January 2016 to December 2020, 160 newly diagnosed MG patients and matched healthy controls (n = 160) were included in the study, and their clinical data were collected. The blood samples from MG patients before treatment and controls were collected for flow cytometry analysis. A total of 14 MG thymomas, 24 control thymomas, and 3 thymic cysts were used to immunostain the DC subsets. Results: The flow cytometry analysis showed a significantly higher frequency of circulating pDCs, CD1c+ cDCs, and CD141+ cDCs in MG patients than in healthy controls (p < 0.001 for all). Patients with early-onset MG (˂50 years old) had a lower frequency of circulating pDCs but a higher frequency of circulating CD1c+ cDCs than those with late-onset MG (≥50 years old) (p = 0.014 and p = 0.025, respectively). The frequency of circulating pDCs was positively associated with the clinical severity of late-onset MG patients (r = 0.613, p ˂ 0.001). 64.3% (9/14) of MG thymoma is of type B2 under the World Health Organization classification, which is higher than that in control thymoma (33.3%, 8/24) (p = 0.019). For type B2 thymoma, there were significantly more pDCs but fewer CD1c+ cDCs in MG thymoma than in the controls. Discussion/Conclusion: The distribution of aberrant pDCs, CD1c+ cDCs, and CD141+ cDCs in MG patients displayed age- and thymoma-related differences, which may contribute to the impaired immune tolerance and lead to the onset of MG.

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Section: Discussionsupporting

confidence: 94%

Aberrant Dendritic Cell Subsets in Patients with Myasthenia Gravis and Related Clinical Features

Yan

Xing

et al. 2023

Neuroimmunomodulation

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“…The reason for this association may be the immune cross ‐ reaction against autoantigens or epitopes shared by ocular muscles and the thyroid gland 29 . Some studies have shown a positive association between AChR‐Ab titers and the clinical severity of MG, 30,31 while others have not 32,33 . Whether the lower AChR‐Ab titers in the TAb positive group are associated with mild clinical expression of MG is an interesting issue for future exploration.…”

Section: Discussionmentioning

confidence: 96%

“…29 Some studies have shown a positive association between AChR-Ab titers and the clinical severity of MG, 30,31 while others have not. 32,33 Whether the lower AChR-Ab titers in the TAb positive group are associated with mild clinical expression of MG is an interesting issue for future exploration.…”

Section: Discussionmentioning

confidence: 99%

Differences in immunophenotypes between myasthenia gravis patients with and without thyroid antibodies

Zhang

Yang

et al. 2022

Muscle and Nerve

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Introduction/Aims Immunophenotypes are related to the therapeutic efficacy of specific immunomodulating agents in patients with myasthenia gravis (MG), but the relationship of immunophenotype to the presence or absence of thyroid antibodies is unknown. This study aims to evaluate differences in the immunophenotypes between MG patients with and without thyroid antibody (TAb) positivity to provide insight for future targeted immunotherapies. Methods This retrospective observational study included 48 MG patients with acetylcholine receptor antibody (AchR‐Ab), of which 15 (31.25%) were TAb positive. Ocular MG (OMG) was defined as ocular‐only manifestations for the duration for which records were available. Peripheral lymphocyte subpopulations were measured by flow cytometry. Results TAb positive patients appeared to have a higher prevalence of OMG than TAb negative patients (53.33% vs. 24.24%, p = .048). Percentages of B cells (mean difference (MD) = 6.16, 95% confidence interval (CI): 1.91–10.40, p = .007) and CD8 + CD28+ cells (MD = 15.14, 95%CI: 5.17–25.11, p = .013) were higher in TAb positive patients than those in TAb negative patients, while AChR‐Ab titers (MD = −6.49 nmol/L, 95%CI: −9.29 to −3.70, p < .001), percentages of T cells (MD = −6.43, 95%CI: −11.92 to −0.94, p = .023), CD3 + HLA‐DR+ cells (MD = −6.47, 95%CI: −12.31 to −0.63, p = .031) and CD8+ T cells (MD = −6.60, 95%CI: −9.86 to −3.34, p < .001) were lower. Discussion The immunophenotypes of MG patients with and without TAb positivity were significantly different, suggesting that their sensitivity to immunotherapy may be different. Further studies focused on differences between TAb positive and TAb negative MG patients in their responses to specific immunotherapies are needed to support our exploratory findings.

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“…The activity of MG is difficult to define. Although a correlation was found between AChR antibody level and severity at group level in Meisel et al's report [1], inconsistent trends of AChR antibody level and severity were found in a certain proportion of individual patients, either at a time-point or over an interval [4].…”

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confidence: 89%

Autoantibody levels as biomarkers of disease activity in the management of myasthenia gravis

Gao

Chen

2023

Euro J of Neurology

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We appreciate Meisel et al. [1] for exploring the correlation between antibody level and activity of myasthenia gravis (MG). However, some concerns are raised here.The correlation between titin antibody level and MG severity was found to be different in various patients with different thymus pathology and related to different therapeutic mechanisms. In Chen et al.'s study [2], the cross-sectional correlation was much higher in MG patients with thymoma than in those with hyperplastic and normal thymus, and prevalence of titin antibody was associated with different thymomatous pathology. The higher correlation between antibody level and severity was presumed to be as a result of a complex mechanism of thymoma instead of a direct effect by titin antibody. In Liu et al.'s study [3], thymomatous patients constituted a major proportion in all three treatment groups. The decrease of titin

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No correlation between acetylcholine receptor antibody concentration and individual clinical symptoms of myasthenia gravis: A systematic retrospective study involving 67 patients

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 11 publications

References 39 publications

Aberrant Dendritic Cell Subsets in Patients with Myasthenia Gravis and Related Clinical Features

Aberrant Dendritic Cell Subsets in Patients with Myasthenia Gravis and Related Clinical Features

Differences in immunophenotypes between myasthenia gravis patients with and without thyroid antibodies

Autoantibody levels as biomarkers of disease activity in the management of myasthenia gravis

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