Serum metabolomics of treatment response in myasthenia gravis

Authors

Patricia Sikorski, Department of Neurology & Rehabilitation Medicine, George Washington University, Washington, DC, United States of America.
Yaoxiang Li, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States of America.
Mehar Cheema, Department of Neurology & Rehabilitation Medicine, George Washington University, Washington, DC, United States of America.
Gil I. Wolfe, Department of Neurology, University at Buffalo/SUNY, Buffalo, New York, United States of America.
Linda L. Kusner, Department of Pharmacology & Physiology, George Washington University, Washington, DC, United States of America.
Inmaculada Aban, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
Henry J. Kaminski, Department of Neurology & Rehabilitation Medicine, George Washington University, Washington, DC, United States of America.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

PloS one

Volume

18

Issue

10

DOI

10.1371/journal.pone.0287654

Abstract

OBJECTIVE: High-dose prednisone use, lasting several months or longer, is the primary initial therapy for myasthenia gravis (MG). Upwards of a third of patients do not respond to treatment. Currently no biomarkers can predict clinical responsiveness to corticosteroid treatment. We conducted a discovery-based study to identify treatment responsive biomarkers in MG using sera obtained at study entry to the thymectomy clinical trial (MGTX), an NIH-sponsored randomized, controlled study of thymectomy plus prednisone versus prednisone alone. METHODS: We applied ultra-performance liquid chromatography coupled with electro-spray quadrupole time of flight mass spectrometry to obtain comparative serum metabolomic and lipidomic profiles at study entry to correlate with treatment response at 6 months. Treatment response was assessed using validated outcome measures of minimal manifestation status (MMS), MG-Activities of Daily Living (MG-ADL), Quantitative MG (QMG) score, or a strictly defined composite measure of response. RESULTS: Increased serum levels of phospholipids were associated with treatment response as assessed by QMG, MMS, and the Responders classification, but all measures showed limited overlap in metabolomic profiles, in particular the MG-ADL. A panel including histidine, free fatty acid (13:0), γ-cholestenol and guanosine was highly predictive of the strictly defined treatment response measure. The AUC in Responders' prediction for these markers was 0.90 irrespective of gender, age, thymectomy or baseline prednisone use. Pathway analysis suggests that xenobiotic metabolism could play a major role in treatment resistance. There was no association with outcome and gender, age, thymectomy or baseline prednisone use. INTERPRETATION: We have defined a metabolomic and lipidomic profile that can now undergo validation as a treatment predictive marker for MG patients undergoing corticosteroid therapy. Metabolomic profiles of outcome measures had limited overlap consistent with their assessing distinct aspects of treatment response and supporting unique biological underpinning for each outcome measure. Interindividual variation in prednisone metabolism may be a determinate of how well patients respond to treatment.

APA Citation

Sikorski, Patricia; Li, Yaoxiang; Cheema, Mehar; Wolfe, Gil I.; Kusner, Linda L.; Aban, Inmaculada; and Kaminski, Henry J., "Serum metabolomics of treatment response in myasthenia gravis" (2023). GW Authored Works. Paper 3620.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3620

Department

Neurology