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This study aimed to explore the SAA levels in a cohort of patients with myasthenia gravis (MG) in relation to disease\u2010related clinical parameters and myasthenic crisis (MC) and elucidate the effects of SAA on immune response. A total of 82 MG patients including 50 new\u2010onset MG patients and 32 MC patients were enrolled in this study. Baseline data and laboratory parameters of all enrolled MG patients were routinely recorded through electronic medical systems. SAA levels were measured by enzyme\u2010linked immunosorbent assay (ELISA) kit. CD4<jats:sup>+<\/jats:sup> T and CD19<jats:sup>+<\/jats:sup> B cell subsets were analyzed by flow cytometry. In\u00a0vitro, human recombinant SAA (Apo\u2010SAA) was applied to stimulate peripheral blood mononuclear cells (PBMCs) from MG patients to observe the effect on T and B cell differentiation. Our results indicated that SAA levels in new\u2010onset MG patients were higher than those in controls and were positively correlated with QMG score, MGFA classification, plasmablast cells, IL\u20106, and IL\u201017 levels. Subgroup analysis revealed that SAA levels were increased in generalized MG (GMG) patients than in ocular MG (OMG), as well as elevated in late\u2010onset MG (LOMG) than in early\u2010onset MG (EOMG) and higher in MGFA III\/IV compared with MGFA I\/II. The ROC curve demonstrated that SAA showed good diagnostic value for MC, especially when combined with NLR. In\u00a0vitro, Apo\u2010SAA promoted the Th1 cells, Th17 cells, plasmablast cells, and plasma cells differentiation in MG PBMCs. The present findings suggested that SAA was increased in MG patients and promoted expansion of CD4<jats:sup>+<\/jats:sup> T cell and CD19<jats:sup>+<\/jats:sup> B cell subsets, which implicated in the severity of MG patients.<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/jnc16047-fig-0007-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p>","DOI":"10.1111\/jnc.16047","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T10:54:29Z","timestamp":1705056869000},"page":"224-237","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Serum amyloid A facilitates expansion of <scp>CD4<\/scp><sup>+<\/sup> T cell and <scp>CD19<\/scp><sup>+<\/sup> B cell subsets implicated in the severity of myasthenia gravis patients"],"prefix":"10.1111","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0993-6994","authenticated-orcid":false,"given":"Xiaoyu","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology Tianjin Neurological Institute, Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueting","family":"An","sequence":"additional","affiliation":[{"name":"Department of Neurology Tianjin Neurological Institute, Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurology Tianjin Neurological Institute, Tianjin Medical University General Hospital  Tianjin 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