Effect of Follicular T helper and T helper 17 cells-related Molecules on Disease Severity in Patients with Myasthenia Gravis.

Contribution of T helper 1 and 2 cells-related cytokines to pathogenesis of myasthenia gravis (MG) is well known. Recently, the contribution of follicular T helper (Tfh) and T helper 17 cells-related molecules to the pathogenesis has gained importance. In this study, we aimed to evaluate the changes in Tfh and Th17-related molecules before and after rescue therapy in patients with myasthenic crisis (cMG) and to reveal the molecular differences between stable MG and myasthenic crisis patients. Patients with stable generalized MG (gMG) and cMG were classified according to Myasthenia Gravis Foundation of America (MGFA) classification. Serum samples were collected from cMG patients both before) and after rescue therapy (plasmapheresis or IVIg). Serum levels of Tfh and selected Th17-related molecules (IL-22, IL-17A, CXCL13, sPD-L1, sICOSLG and sCD40L) were analyzed by commercial ELISA kits. Twelve cMG (6 for IVIg, 6 for plasmapheresis) and ten gMG patients were included in the study. A decrease in serum sPDL1 and CXCL13 levels was observed in cMG patients after treatment, regardless of the treatment modality (p<0.05). In contrast, serum sICOSLG levels decreased only in patients treated with IVIg (p<0.05) and serum IL22 levels increased in patients receiving plasmapheresis (p<0.05). cMG patients had higher serum IL-17A levels compared to stable patients (p<0.001) and its level was positively correlated with disease severity (r=0.678, p=0.001). Our results confirm the contribution of Tfh and Th17-related cell pathways to MG pathogenesis. Both IVIg and plasmapheresis appear to be effective in reducing Tfh and Th17-related cytokine/molecule levels in myasthenic crisis patients. Increased serum IL-17A levels may contribute to disease severity.

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