Get access

Granulocyte macrophage colony-stimulating factor treatment of a patient in myasthenic crisis: Effects on regulatory T cells

Authors

  • Julie Rowin MD,

    Corresponding author
    1. Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    • Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    Search for more papers by this author
  • Muthusamy Thiruppathi PhD,

    1. Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    Search for more papers by this author
  • Ebinehita Arhebamen MD,

    1. Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    Search for more papers by this author
  • Jianrong Sheng PhD,

    1. Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    Search for more papers by this author
  • Bellur S. Prabhakar PhD,

    1. Department of Microbiology and Immunology, University of Illinois Medical Center, Chicago, Illinois, USA
    Search for more papers by this author
  • Matthew N. Meriggioli MD

    1. Department of Neurology and Rehabilitation, University of Illinois Medical Center, 912 South Wood Street, 855N, M/C 796, Chicago, Illinois 60612, USA
    Search for more papers by this author

  • Disclosure: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the UIC CCTS, MDA, or the NIH.

Abstract

Introduction: In this study we describe a patient with a prolonged myasthenic crisis refractory to conventional immunomodulatory therapy who was treated with GM-CSF (granulocyte macrophage colony-stimulating factor, sargramostim). Methods: T-regulatory cell (Treg) suppressive function and Foxp3 expression were evaluated before and after treatment with GM-CSF. Results: Treatment with GM-CSF was associated with clinical improvement, expansion in the circulating numbers of Foxp3+ cells, increase in Foxp3 expression levels in Tregs, early improvement in Treg suppressive capacity for AChR-α–induced T-cell proliferation, and subsequent enhancement in Treg suppression of polyclonal T-cell proliferation. Conclusion: Although definitive conclusions cannot be drawn from a single case, the correlation with similar findings in GM-CSF–treated animals with experimental autoimmune myasthenia gravis suggests further exploration of the effects of GM-CSF in myasthenia gravis should be studied in a clinical trial setting. Muscle Nerve 46: 449–453, 2012

Ancillary