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Peer-reviewedCC BY-NC-NDImmunity & ageing : I & A

Exaggerated thymic involution in late-onset myasthenia gravis: clinical and immunological evidence.

  • Yu-Xin Wang1
  • Tong Du1,2,3
  • Heng Li1,2,3
  • Peng-Xi Han4
  • Chang Liu1
  • Jia-Meng Lu5
  • Xiao-Li Li1,2,3
  • Bin Liu1
  • Yu-Yao Zhai1
  • Xin-Hua Zhao1
  • Guang-You Duan6
  • Rui-Sheng Duan7,8,9
1 more authors
  • Min Zhang10,11,12
12 affiliations
  1. 1Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China.
  2. 2Shandong Institute of Neuroimmunology, Jinan, 250014, People's Republic of China.
  3. 3Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan, 250014, People's Republic of China.
  4. 4Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China.
  5. 5Department of Medicine, Macau Special Administrative Region, Macau University of Science and Technology, Avenida Wai Long, Taipa, 999078, People's Republic of China.
  6. 6School of Life Sciences, Qilu Normal University, Jinan, 250200, China.
  7. 7Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China. [email protected].
  8. 8Shandong Institute of Neuroimmunology, Jinan, 250014, People's Republic of China. [email protected].
  9. 9Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan, 250014, People's Republic of China. [email protected].
  10. 10Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China. [email protected].
  11. 11Shandong Institute of Neuroimmunology, Jinan, 250014, People's Republic of China. [email protected].
  12. 12Shandong Provincial Medicine and Health Key Laboratory of Neuroimmunology, Jinan, 250014, People's Republic of China. [email protected].
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Abstract

Background

The thymus is critical in the pathogenesis of early-onset myasthenia gravis (EOMG), whereas its involvement in late-onset myasthenia gravis (LOMG) remains controversial. Herein, we systematically analyzed thymic computed tomography (CT) images and evaluated thymic output in patients with LOMG.Results

We retrospectively examined the chest CT images and clinical profiles of 59 patients with LOMG, 16 patients with EOMG, and 225 matched controls from our center. These data were acquired at the time of diagnosis and before any immunotherapy. The key CT features, thymic volume, surface area, and density (represented by gray value), were assessed quantitatively and compared between groups. In a separate flow-cytometry cohort, circulating naïve T cells and recent thymic emigrants (RTEs) were analyzed in 20 immunotherapy-naïve LOMG patients and 27 healthy matched controls. Patients with LOMG showed lower thymic gray value and larger thymic volume and surface area compared with controls. Thymic volume was positively correlated with BMI and LOMG patients with diabetes had larger thymus than those without. Multivariate Logistic regression analysis revealed that thymic volume, surface area, and gray value were associated with the risk of LOMG. In the independent flow-cytometry cohort, patients with LOMG also exhibited reduced circulating RTEs, suggesting impaired thymic output.Conclusions

Patients with LOMG showed exaggerated thymic involution and reduced thymic output, supporting thymic involvement in the pathophysiology of LOMG. These findings provide clues for future mechanistic and prospective studies.

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Cite

BibTeXRIS
BibTeX
@article{wang2026exaggerated,
  title = {{Exaggerated thymic involution in late-onset myasthenia gravis: clinical and immunological evidence.}},
  author = {Yu-Xin Wang and Tong Du and Heng Li and Peng-Xi Han and Chang Liu and Jia-Meng Lu and Xiao-Li Li and Bin Liu and Yu-Yao Zhai and Xin-Hua Zhao and Guang-You Duan and Rui-Sheng Duan and Min Zhang},
  journal = {Immunity \& ageing : I \& A},
  year = {2026},
  month = jul,
  doi = {10.1186/s12979-026-00589-1},
  url = {https://europepmc.org/article/MED/42958277},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Exaggerated thymic involution in late-onset myasthenia gravis: clinical and immunological evidence.
AU  - Yu-Xin Wang
AU  - Tong Du
AU  - Heng Li
AU  - Peng-Xi Han
AU  - Chang Liu
AU  - Jia-Meng Lu
AU  - Xiao-Li Li
AU  - Bin Liu
AU  - Yu-Yao Zhai
AU  - Xin-Hua Zhao
AU  - Guang-You Duan
AU  - Rui-Sheng Duan
AU  - Min Zhang
PY  - 2026
DA  - 2026/07/31
JO  - Immunity & ageing : I & A
DO  - 10.1186/s12979-026-00589-1
UR  - https://europepmc.org/article/MED/42958277
AB  - Background  The thymus is critical in the pathogenesis of early-onset myasthenia gravis (EOMG), whereas its involvement in late-onset myasthenia gravis (LOMG) remains controversial. Herein, we systematically analyzed thymic computed tomography (CT) images and evaluated thymic output in patients with LOMG.Results  We retrospectively examined the chest CT images and clinical profiles of 59 patients with LOMG, 16 patients with EOMG, and 225 matched controls from our center. These data were acquired at the time of diagnosis and before any immunotherapy. The key CT features, thymic volume, surface area, and density (represented by gray value), were assessed quantitatively and compared between groups. In a separate flow-cytometry cohort, circulating naïve T cells and recent thymic emigrants (RTEs) were analyzed in 20 immunotherapy-naïve LOMG patients and 27 healthy matched controls. Patients with LOMG showed lower thymic gray value and larger thymic volume and surface area compared with controls. Thymic volume was positively correlated with BMI and LOMG patients with diabetes had larger thymus than those without. Multivariate Logistic regression analysis revealed that thymic volume, surface area, and gray value were associated with the risk of LOMG. In the independent flow-cytometry cohort, patients with LOMG also exhibited reduced circulating RTEs, suggesting impaired thymic output.Conclusions  Patients with LOMG showed exaggerated thymic involution and reduced thymic output, supporting thymic involvement in the pathophysiology of LOMG. These findings provide clues for future mechanistic and prospective studies.
SN  - 1742-4933
ER  -