Soluble adhesion molecules and cytokines in patients with myasthenia gravis treated by plasma exchange

Plasma exchange (PE) is an effective therapeutic method used in patients wi th myasthenia gravis (MG) refractory to common therapy and/or with life-thr eatening respiratory complications. Except for acetylcholine receptor antib odies (AChRAbs), some other inflammatory mediators possibly activated in MG may also be removed during PE. Serum levels of soluble adhesion molecules (sICAM-1 and sVCAM-1), IL-6 and soluble receptors for IL-2 (slL-2R), IL-6 ( sIL-6R) and TNF alpha (sTNF-R II) were measured in 20 WIG patients assigned to treatment with PE. On the basis of the serum levels of AChRAb the patie nts were subdivided into 2 groups (8 patients with low AChRAb, 12 patients with high AChRAb). Soluble adhesion molecules and cytokines were measured b efore the first and last PE, at the end of the first PE and in the samp res of plasma filtrate obtained during the first PE. Before the first PE patie nts with MG had higher serum levels of sICAM-1, sVCAM-1, slL-2R and sTNF-R II than controls. Both after the first PE and during the course of PE, a su bstantial decrease in serum levels of AChRAb, sICAM-1 and sVCAM-1 was recor ded. However, serum levels of slL-2R and sTNF-R II were not significantly i nfluenced by either a single treatment or during the course of PE. There we re high levels of AChRAb, soluble adhesion molecules and soluble cytokine r eceptors in plasma filtrates too. Patients with high circulating AChRAb had higher serum levels of sICAM-1 and sVCAM-1 than patients with low AChRAb. Increased serum levels of soluble adhesion molecules and soluble cytokine r eceptors in patients with MG suggest some systemic activation of the immune response which is more pronounced in patients with high circulating AChRAb . PE led to the decrease in serum AChRAb and soluble adhesion molecules due to their effective filtration but, on the other hand, serum levels of solu ble cytokine receptors were not influenced by PE, in spite of their effecti ve filtration which is probably counteracted by their increased production, possibly stimulated by the contact of the blood with the synthetic membran e. Copyright (C) 2000 S. Karger AG, Basel.