Clinical Significance Of Interleukin-36 In Myasthenia Gravis

ObjectiveMyasthenia gravis is an autoimmune disease of the neuromuscular junction,in which auto-antibodies cause morphological and functional alterations of the postsynaptic membrane,resulting in neuromuscular transmission impairment and fatigable skeletal muscle weakness.And this autoimmune disease is cellular immune dependent and complement-activating.Interleukin 36(IL-36),a novel member of Interleukin 1(IL-1)cytokine family.It has activity on specific immune cells inducing cellular activation and secretion of cytokines and chemokines.This study is intended to investigate the the role and mechanisms of IL-36 in Myasthenia gravis.MethodsForty-nine patients with acute MG who were hospitalized in our department of neurology from December 2016 to December 2018 were selected as patient groups and divided into several subgroups in subsequent studies.The healthy person control group was from the physical examination center of our hospital,and the sex ratio and average age matched the patient group.Collect and record the material such as the age,gender,age of onset,clinical symptoms of the study subjects,Myasthenia Gravis Foundation of America(MGFA)classification,and thymus-related conditions such as computed tomography(CT)And Magnetic Resonance Imaging(MRI),treatment plan,Quantitative MG score(QMG).The acetylcholine receptor(ACh R)antibody was qualitatively measured by cell based assay(CBA),and the level of IL-36 in the serum was measured by Enzyme-Linked Immunosorbent Assay(ELISA).The changes of IL-36 levels before and after treatment and the correlation with some clinical indicators were analyzed.Results:1.The serum level of IL-36γ(1422.030 ± 2824.692)pg/ml in MG patients before treatment was significantly higher than that in healthy controls(291.425 ± 403.348)pg/ml,the difference was statistically significant(P = 0.047).Serum levels of IL-36β were higher in OMG patients(1185.998 ± 258.092)pg/ml than in healthy controls(P = 0.009),and the serum level of IL-36γ in OMG(1084.031 ± 270.630)pg/ml and GMG(1601.592 ± 3495.807)pg/ml was higher than that in healthy controls,and the difference was statistically significant(P = 0.043,P < 0.001).2.In the MG patients who received immunosuppression treatment in the acute phase,the serum level IL-36α(141.847 ± 171.942)pg/ml and IL-36γ(806.742 ± 2774.373)pg/ml were compared with those before treatment.IL-36α(211.525 ± 237.690)pg/ml and IL-36γ(1601.592 ± 3495.807)pg/ml were significantly decreased after treatment,and the difference was statistically significant(P = 0.002,P < 0.001).3.The serum levels of IL-36 between ACh R antibody positive and negative subgroup were not significantly different(P = 0.822,P = 0.635,P = 0.608).4.There was a correlation between serum IL-36γ level and QMG score before treatment,and it was positively correlated(r = 0.35,P = 0.014).Conclusion1.The serum levels of IL-36γ in MG patients before treatment were significantly higher than those in healthy controls.The serum levels of IL-36β in OMG patients and the serum levels of IL-36γ in both OMG and GMG patients were higher than those in healthy controls.It’s suggested that IL-36β and IL-36γ play an important role in the pathogenesis of MG inflammatory immunity and may be an indicators for predicting inflammatory activity of MG.2.In patients with MG who received high-dose hormonal shock in the acute phase,the levels of IL-36α and IL-36γ in the serum were lower than those before treatment.There was a correlation between serum IL-36γ level and QMG score,and it was positively correlated.It indicates that the levels of IL-36α and IL-36γ may have a certain predictive effect on the activity and therapeutic effect of the disease,and IL-36γ may predict the severity and prognosis of MG patients.