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Double filtration plasmapheresis benefits myasthenia gravis patients through an immunomodulatory action
Lei Zhang1, Junfeng Liu1, Hongna Wang1
1Department of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
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(+)CD25(high)Foxp3(+) (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.
Insights
Double filtration plasmapheresis (DFPP) combined with methylprednisolone improves myasthenia gravis (MG) by lowering anti-titin antibodies and increasing regulatory T cells (Tregs). This immunomodulatory action enhances clinical remission rates in MG patients.
Area of Science:
- Immunology
- Neurology
- Medical treatment
Background:
- Myasthenia gravis (MG) is often treated with double filtration plasmapheresis (DFPP), but its precise mechanism remains unclear.
- Investigating the immunomodulatory effects of DFPP is crucial for understanding its efficacy in MG treatment.
Purpose of the Study:
- To determine if double filtration plasmapheresis (DFPP) improves myasthenia gravis (MG) through immunomodulation.
- To compare the efficacy of DFPP combined with methylprednisolone versus methylprednisolone alone in treating MG.
Main Methods:
- Thirty-five MG patients were randomized into two groups: DFPP plus methylprednisolone (Group A) and methylprednisolone alone (Group B).
- Evaluated outcomes included antibody levels, clinical scores, cytokine profiles, soluble intercellular adhesion molecule-1 (sICAM-1), and regulatory T cell (Treg) percentages.
Main Results:
- Group A showed significantly lower anti-titin antibody levels and a higher clinical remission rate compared to Group B.
- DFPP treatment led to a significant reduction in sICAM-1 levels and a greater increase in Treg cell percentages.
- Cytokine level changes did not significantly differ between groups, suggesting a targeted immunomodulatory effect beyond broad cytokine modulation.
Conclusions:
- DFPP combined with methylprednisolone offers superior clinical benefits for MG patients compared to methylprednisolone alone.
- DFPP exerts its therapeutic effect in MG by reducing specific antibodies, decreasing sICAM-1, and enhancing regulatory T cell function.
- The findings support DFPP as an effective immunomodulatory therapy for myasthenia gravis.
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