A Decrease in the Percentage of CD3⁺ Cells Is Correlated With Clinical Improvement During Plasmapheresis in Patients With Myasthenia Gravis

Abstract

Plasmapheresis not only removes circulating antibodies but also modulates cellular immunity, including lymphocyte subsets. To investigate the effect of double-filtration plasmapheresis (DFPP) on the ratio of lymphocyte subsets in patients with myasthenia gravis (MG), we examined the percentages of B-cells, T-cells, T helper (Th) cells, T suppressor (Ts) cells, natural killer (NK) cells, NKT cells, and Th/Ts ratio before and after a single DFPP session and after a course of DFPP. A total of 26 patients were recruited; their peripheral blood lymphocyte subsets were assayed using flow cytometry. After a single session of DFPP treatment, the percentages of T-cells (P = 0.0200), Th cells (P = 0.0178), and the Th/Ts ratio (P = 0.0309) decreased significantly, whereas the percentage of NK cells (P = 0.0007) increased significantly. More importantly, after one course of DFPP treatment, the reduced clinical quantitative MG (QMG) score was correlated with the decrease of the percentage of T-cells (r = 0.5005, P = 0.0092). Fourteen thymectomized MG patients had decreased percentages of T-cells (P = 0.0304) and Th cells (P = 0.0444), whereas they had increased NK cells (P = 0.0197) after a single DFPP session. Here, transiently decreased percentages of T-cells after the full DFPP course could enhance the effectiveness of plasmapheresis for MG patients.

Desensitization for solid organ and hematopoietic stem cell transplantation

“…120 observed a significant decrease in the percentage of CD3 + T cells and a concomitant decrease in the T-helper/T-suppressor ratio, but there was a significant increase in the percentage of NK cells. Interestingly, after three treatments, all the T-cell subsets had returned to base line levels perhaps due to homeostatic proliferation.…”

Lymphoplasma Exchange Improves Myasthenia Gravis Exacerbations: A Retrospective Study in a Chinese Center

“…Chien et al. also showed that PE had an excellent short effect, and it could adjust the ratio of T helper cells to T suppressor cells after a single session ( 22 ). In 2016, Guptill et al.…”

Peripheral NK and B regulatory cell frequencies are altered with symptomatic exacerbation in generalized myasthenia gravis patients

“…Changes in peripheral lymphocyte subsets were reported in patients with MG as well as patients with other autoimmune diseases, including systemic lupus erythematosus, [12] rheumatoid arthritis [13] and Sjogren's syndrome, [14,15] suggesting that these abnormal distributions of lymphocyte subsets may be involved in the pathogenesis of autoimmune diseases. [16][17][18][19] CD4 + T helper cells have an important role in an experimental animal model of myasthenia gravis (EAMG) and MG patients as they influence autoreactive B cell production of anti-AChR antibodies. [20] Th1, Th2, Th17 and regulatory T (Treg) cells, which were differentiated from Naïve CD4 + T cells, have been shown to be involved in the pathogenesis of MG. [21] B cells, because of the key contribution to humoral immune responses involving the secretion of antibodies, are generally considered to be pathogenic in the majority of autoimmune diseases.…”

“…[27][28][29] Interestingly, the number of NK cells was increased significantly after plasmapheresis in patients with MG, indicating that they may become an important marker for monitoring clinical activation in MG patients. [16] Traditionally, B cells have been thought to contribute to the antigen (Ag)-specific autoantibody production. Nonetheless, the role of B cells extends beyond the production of antibodies in autoimmune diseases.…”