Thymectomy and myasthenia gravis

Lisak, Robert P.; Richman, David P.

doi:10.1073/pnas.2022901117

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…Because accumulative evidence suggests that the different clinical subtypes of MG mentioned above are not related to thymic tissue histopathology [ 1 , 2 , 5 , 18 ], the removal of the thymus in whatever subtype of MG patients should have satisfactory clinical outcomes. However, the clinical benefits of a thymectomy cannot be expected in a short time after a thymectomy, as such benefits have usually required at least 2 years to manifest after the operation in the existing clinical studies [ 13 , 14 , 24 ]. It is believed that the delayed clinical benefit is because of the persistence of thymic T cells or circulating antibodies produced by these cells in the serum of MG patients before and a long time after a thymectomy [ 13 , 14 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the clinical benefits of a thymectomy cannot be expected in a short time after a thymectomy, as such benefits have usually required at least 2 years to manifest after the operation in the existing clinical studies [ 13 , 14 , 24 ]. It is believed that the delayed clinical benefit is because of the persistence of thymic T cells or circulating antibodies produced by these cells in the serum of MG patients before and a long time after a thymectomy [ 13 , 14 , 21 ]. For this reason, during the first few post-thymectomy years, despite the extensive surgical removal of the thymus, symptomatic drug, or one or more immunosuppressants are required to control the MG symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it has been known that the thymus of MG patients acts as the primary source of auto-antibody production regardless of thymic histopathology, i.e., either thymoma (Th) or non-thymoma (non-Th). Therefore, early thymectomy is advocated, although obvious clinical benefits may require several years after thymectomy [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Additionally, a number of studies have suggested that early thymectomy was superior to conservative treatment in terms of MG clinical remission, regardless of the thymic tissue histopathology [ 7 , 8 , 9 , 10 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients

Wiboonpong

Setthawatcharawanich

Korathanakhun

et al. 2023

IJERPH

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(1) Background: Early thymectomy is suggested in all clinically indicated myasthenia gravis (MG) patients. However, short-term clinical response after thymectomy in MG patients has been limitedly described in the literature. This study aimed to compare the 5-year post-thymectomy outcomes between thymoma (Th) and non-thymoma (non-Th) MG patients. (2) Methods: MG patients aged ≥18 years who underwent transsternal thymectomy and had tissue histopathology reports in Songklanagarind Hospital between 2002 and 2020 were enrolled in a retrospective review. The differences in the baseline demographics and clinical characteristics between ThMG and non-Th MG patients were studied. We compared the time-weighted averages (TWAs) of daily required dosages of pyridostigmine, prednisolone or azathioprine to efficiently maintain daily living activities and earnings between the MG patient groups during 5 consecutive years following thymectomy. Post-thymectomy clinical status, exacerbations or crises were followed. Descriptive statistics were used for analysis with statistical significance set at p < 0.05. (3) Results: ThMG patients had significantly older ages of onset and shorter times from the MG diagnosis to thymectomy. Male gender was the only significant factor associated with ThMG. TWAs of the daily MG treatment drug dosages required showed no differences between the groups. Additionally, the rates of exacerbations and crises were not different, but decremental trends were shown in both groups after the thymectomies. (4) Conclusions: The daily dosage requirements of MG treatment drugs were not different. There was a trend of decreasing adverse event rates despite no statistically significant differences during the first 5 years after thymectomy in ThMG and non-ThMG patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients

Wiboonpong

Setthawatcharawanich

Korathanakhun

et al. 2023

IJERPH

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“…We demonstrated that the patients in the refractory group were more often treated with thymectomy but did not achieve symptom remission. The ineffectiveness of thymectomy can be attributed to circulating plasma cells that are often long-lived and can secrete antibodies in the absence of T cells ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Polymorphisms in drug metabolism genes predict the risk of refractory myasthenia gravis

Zhang¹,

Ge²,

Gui³

et al. 2022

Ann Transl Med

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Background: Nearly 10% to 20% of myasthenia gravis (MG) patients are refractory to conventional treatment for unclear reasons. The study aimed to explore the relationship between drug metabolism gene polymorphisms and refractory MG.Methods: One hundred and thirty-one MG patients (33 in the refractory group; 98 in the non-refractory group) admitted to Tongji Hospital were included in this retrospective study. Improved multiplex ligation detection reaction (iMLDR) was used to genotype 13 polymorphisms (

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“…Furthermore, we have demonstrated decreased THY ASC expression of CD69 with age ( 37 ) which may facilitate their thymic egress and subsequent localization into more optimal survival niches. This could partially explain why thymectomy is not always a successful treatment in individuals with MG ( 30 , 32 ). While this regulatory loop remains to be tested, it provides an example of how defining THY ASC phenotypes and nodes of regulation in health may lead to key breakthroughs in understanding the etiology of autoimmune diseases that possess a significant THY B cell/ASC component.…”

Section: Looking Towards the Future: Insights Into Autoimmunity?mentioning

confidence: 99%

Thymus antibody-secreting cells: once forgotten but not lost

Pioli

2023

Front. Immunol.

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Antibody-secreting cells are essential contributors to the humoral response. This is due to multiple factors which include: 1) the ability to secrete thousands of antibodies per second, 2) the ability to regulate the immune response and 3) the potential to be long-lived. Not surprisingly, these cells can be found in numerous sites within the body which include organs that directly interface with potential pathogens (e.g., gut) and others that provide long-term survival niches (e.g., bone marrow). Even though antibody-secreting cells were first identified in the thymus of both humans and rodents in the 1960s, if not earlier, only recently has this population begun to be extensively investigated. In this article, we provide an update regarding the current breath of knowledge pertaining to thymus antibody-secreting cells and discuss the potential roles of these cells and their impact on health.

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Thymectomy and myasthenia gravis

Cited by 9 publications

References 21 publications

Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients

Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients

Polymorphisms in drug metabolism genes predict the risk of refractory myasthenia gravis

Thymus antibody-secreting cells: once forgotten but not lost

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