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Khirurgii

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Year 2021 Vol. 29 No 4

GENERAL & SPECIAL SURGERY

O.M. KLIMOVA 1, V.V. BOYKO 1, L.A. DROZDOVA 1, O.V. LAVINSKA 1, D.V. MINUKHIN 2, A.N. KUDREVICH 3

PROGNOSTIC MARKERS IN PATIENTS WITH THYMUS-INDEPENDENT AND THYMUS-DEPENDENT MYASTHENIA GRAVIS

Kharkiv National Medical University 2,
V. N. Karazin Kharkov National University 3, Kharkov,
Ukraine

Objective. To assess the presence of specific markers in patients with thymus-independent and thymus-dependent myasthenia gravis for choosing treatment tactics.
Methods. The presence of specific markers was assessed in 138 patients with thymus-independent (M – myasthenia gravis without thymus changes) and thymus-dependent (MH – myasthenia gravis with thymus hyperplasia, MT – myasthenia gravis with thymoma). The method ELISA (the content of antibodies to subunits 1 and 7 nAChR in blood serum, to 7 nAChR subunit in thymocyte mitochondria, a detectable level of antinuclear antibody (ANA), immunofluorescence (ANA glow) and flow cytometry (expression of CD14+CD11c+and CD14 + HLA-DR +) has been used.
Results. The relationship between the clinical phenotypes of myasthenia gravis and the variants of HLA diplotypes was revealed: in young patients with thymus-independent myasthenia gravis (M), a high heterogeneity of the genotypic markers HLA-DR (DR1, DR2, DR3, DR5, DR7) was detected. Patients with thymus-dependent myasthenia (MT) had only the HLA DR2 and HLA DR7 diplo- and haplotypes. The presence of HLA DR2 and HLA DR7 haplotypes in some young patients with progressive thymus-independent myasthenia gravis (M) led to the development of myasthenia gravis with thymoma (MT) in the elderly people. The pathogenic role also belongs to infection (ÑMV, EBV, HBV, HCV, HSV-1, HSV-2, HHV-6, mycoplasma) and food intolerance (IgE and IgG4) in the development and progression of myasthenia gravis. A four-fold prevalence of α7 subunit nicotinic acetylcholine receptors on the thymocyte mitochondria as an additional targets of autoimmune aggression in myasthenia gravis was determined. Specific antinuclear antibodies to centromere chromosome proteins were visualized in the elderly people with thymoma.
Conclusion. The prognosis of the myasthenia gravis progression and the development of remission can be made using genomic (the presence of certain HLA-DR haplotypes) and molecular (ANA antibodies to centromere chromosome proteins, expression of CD20+, CD14+CD11c+, CD14+HLA-DR+) biomarkers, that can be used for the choice of treatment tactics.

Keywords: myasthenia gravis, thymus hyperplasia, thymoma, antinuclear antibodies, differentiation cluster
p. 426-433 of the original issue
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Address for correspondence:
61103, Ukraine,
Kharkov, Balakireva vyizd, 1,
V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine,
Diagnostic Laboratory,
Tel. +38(057)3494115,
E-mail: klimovalena53@gmail.com,
Klimova Olena M.
Information about the authors:
Klimova Olena MD (Biol.), Professor, Head of the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-4007-6806
Boyko Valery V., Corresponding Member of National Academy of Medical Sciences of Ukraine, MD, Professor, Director of V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine. https://orcid.org/0000-0003-4771-9699
Drozdova Larisa À., Candidate of Biological Sciences, Senior Researcher, the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-9678-4046
Lavinska Olena V., PhD(Biol.), Researcher, the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5813-3656
Minukhin Dmitriy V., PhD, Associate Professor Of The Surgery Department No1, V.N. Karazin Kharkiv National Medical University, Kharkov, Ukraine https://orcid.org/0000-0003-3371-1178
Kudrevych Oleksandr M., PhD, Associate Professor, Head of the Department of Surgical Diseases, Operative Surgery and Topographical Anatomy, V.N. Karazin Kharkiv National Medical University, Kharkov, Ukraine
https://orcid.org/0000-0002-2086-8822
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