Double filtration plasmapheresis benefits myasthenia gravis patients through an immunomodulatory action |
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| Affiliation: | 1. Department of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China;2. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China;1. Paediatric Department, College of Medicine, Queen Elizabeth Central Hospital, Box 360, Blantyre, Malawi;2. Department of Pediatric Medicine, Neonatology, Texas Children''s Hospital, Houston, TX, USA;1. Department of Urology, Health Services Research Group, Los Angeles, California;2. Jonsson Comprehensive Cancer Center, Los Angeles, California;3. David Geffen School of Medicine at UCLA, Los Angeles, California;4. University of California, Riverside School of Medicine, Riverside, California;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;2. Clinical Medical Examination, The Sixth People Hospital of Jinan, Shandong, China;3. School of Public Health and Family Medicine, Capital Medical University, Beijing, China;4. Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China;1. Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA;2. Department of Neurosurgery, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA;3. Department of Radiology, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA;4. Department of Neurosurgery, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA;5. Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA |
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| Abstract: | Double filtration plasmapheresis (DFPP) is used to treat myasthenia gravis (MG). However, the definite mechanism is unclear. This study investigated whether DFPP improves MG through an immunomodulatory action. Thirty-five MG patients were randomly divided into two treatment groups: Group A (DFPP combined with oral methylprednisolone) and Group B (oral methylprednisolone alone). Their antibody levels, clinical scores, cytokine levels, and CD4+CD25highFoxp3+ (regulatory T cell [Treg]) levels were then determined. Anti-titin antibody levels were significantly lower in Group A compared with Group B after treatment. The clinical remission rate in Group A was significantly higher than in Group B. The changes in cytokine levels (interleukin [IL]-2, IL-4, IL-10, and interferon-γ) in sera and the peripheral blood mononuclear cell culture supernatants did not significantly differ before and after the treatments in both groups (p < 0.05). The soluble intercellular adhesion molecule-1 (sICAM-1) levels were lower in Group A than in Group B (p < 0.05). MG patients exhibited a lower percentage of Treg cells than normal patients. DFPP combined with methylprednisolone treatment increased the Treg cell percentage more than treatment with methylprednisolone alone (p < 0.05). DFPP treatment more effectively lowers sICAM-1 and increases Treg cell expression, consequently benefiting MG patients. |
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| Keywords: | Cytokines Double-filtration plasmapheresis Myasthenia gravis Regulatory T cells Titin-antibody |
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