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Lai et al. Imbalance of NK and B cell subsets in GMG exacerbation

RESULTS frequencies of Breg cells in GMG patients were not
significantly different between stages (6.93 ± 1.18;
Frequencies of Breg cells decreased in the 6.56 ± 1.32; P = 0.834) [Table 3; Figure 1].
peripheral blood of GMG patients
We have analyzed the frequencies of peripheral Breg Frequencies of NK cells correlate with clinical
cells in the MG patients. CD19 CD1d CD5 B cells are stages of GMG patients
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routinely regarded as Bregs. To characterize the Breg NK cells (CD3 CD19 CD56 ) are an important player
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cell subpopulation, we have determined their surface in the regulation of acquired immunity and the levels
expression of CD1d and CD5 with CD19 gating, the in the peripheral blood of MG patients have been
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2 markers that are believed to be co-expressed by analyzed. The percentage of CD3 CD19 CD56 NK
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“regulatory” B cells. The data revealed that the cells was increased to different degrees, especially
[38]
percentage of CD1d CD5 cells among the CD19 + in GMG patients in remission stage (20.69 ± 3.45)
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were significantly decreased in both the exacerbation compared to healthy controls (11.33 ± 0.95; P =
stage (6.93 ± 1.18) and remission stage (6.56 ± 1.32) 0.017). In the patients with OMG, who presented with
of GMG patients compared to healthy controls (15.97 mild symptoms, NK cells tended to increase compared
± 2.88; P = 0.001 and P = 0.002, respectively) and with those in the healthy controls (18.98 ± 3.81). Yet
topatients with OMG (16.08 ± 2.88; P = 0.001 and P the increase was less than that in GMG patients in
= 0.002, respectively). Bregs in the peripheral blood remission stage and there was no statistical difference.
of OMG patients did not show any decrease, instead The percentage of NK cells in the GMG patients at
a slight increase. But no significant difference was exacerbation stage also tended to increase, but the
found between those in the ocular MG patients and the difference was not significant when compared with
controls (P = 0.978). The imbalance of Bregs in GMG that in the healthy controls (12.32 ± 1.42). In order
was more obvious. Usually the patients with GMG to determine whether NK cell frequencies were
display different levels of severity, and a lot of patients associated with symptomatic exacerbation, the
may experience symptomatic fluctuation or develop percentages of NK cells were compared between the
myasthenic crisis. In order to clarify whether Breg cells two subgroups of GMG patients. The frequency of NK
play a key role during symptomatic exacerbations, cells in the patients in remission were significantly
we further compared the frequencies of these cells at increased compared to patients in exacerbation
different stages of GMG patients, and found that the (20.69 ± 3.45 vs. 12.32 ± 1.42, P = 0.017, Table 4,
Figure 2). The data suggest that NK cells are involved
Table 2: Factors leading to exacerbation in the pathogenesis of MG and mayplay a protective
Factor Number Ratio (%) role during development of the disease.
Infection 14 56
Inappropriate drug use 4 16 Frequency of lymphocyte subsets in patients
Unknown cause 4 16
Surgery 1 4 with exacerbation and infection
Exhaustion 1 4 It’s well known that various factors such as infections,
Stress 1 4 inappropriate drug use, or neuro-endocrine dysfunction

Table 3: Frequencies of Breg cells in the peripheral blood of MG patients (%)
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Group Number CD19 CD1d CD5 B cells P value a P value b P value c
Patients in exacerbation 25 6.93 ± 1.18 0.834 0.001 0.001
Patients in remission 18 6.56 ± 1.32 0.002 0.002
Ocular MG 11 16.08 ± 2.88 0.978
Healthy controls 10 15.97 ± 2.88
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a
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CD1d CD5 CD19 represent the Breg cells; the results represent the mean ± standard error; P value as compared between the patients in
b
c
exacerbation and patients in remission; P value as compared with ocular MG; P value as compared with healthy controls. MG: myasthenia
gravis
Table 4: Frequencies of NK cells in the peripheral blood of MG patients (%)
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Group Number CD3 CD19 CD56 NK cells P value a P value b P value c
Patients in exacerbation 25 12.32 ± 1.42 0.017 0.126 0.569
Patients in remission 18 20.69 ± 3.45 0.751 0.017
Ocular MG 11 18.98 ± 3.81 0.077
Healthy controls 10 11.33 ± 0.95
a
+
+
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CD3 CD19 CD56 cells represent the NK cells. The results represent the mean ± standard error; P value as compared between the
b
patients in exacerbation and ones in remission; P value as compared with ocular MG patients; P value as compared with the healthy
c
controls. NK: natural killer; MG: myasthenia gravis
182 Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ September 18, 2017