{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:02:28Z","timestamp":1779667348853,"version":"3.53.1"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":128,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371365"],"award-info":[{"award-number":["82371365"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Immunology Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to systematically investigate the dynamics changes in membrane\u2010bound B7\u2010H4 (mB7\u2010H4) expression and soluble B7\u2010H4 (sB7\u2010H4) levels in the peripheral blood of patients with acetylcholine receptor antibodies (AchR\u2010Ab)\u2010positive myasthenia gravis (MG) across different disease phases, and to explore their clinical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AchR\u2010Ab\u2010positive MG patients at baseline, relapse, and remission stages, along with age\u2010 and sex\u2010matched healthy controls (HCs), were enrolled. Peripheral blood was obtained from all participants. mB7\u2010H4 expression on circulating immune cell subsets was determined by flow cytometry, while plasma sB7\u2010H4 concentration was quantified using enzyme\u2010linked immunosorbent assay (ELISA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared to HC, patients with relapsing MG exhibited significantly increased mB7\u2010H4 expression on CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cells and CD14\n                      <jats:sup>+<\/jats:sup>\n                      monocytes (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). In contrast, plasma sB7\u2010H4 levels were markedly decreased in relapsing\u2010MG patients relative to HC (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Among MG subgroups, mB7\u2010H4 expression on CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cells was significantly higher in relapsing\u2010MG patients than in those at baseline or in remission (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Conversely, plasma sB7\u2010H4 levels were significantly lower in both relapsing and remitting patients compared with the baseline\u2010MG group (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Within the relapsing\u2010MG patients, patients with abnormal thymic pathology exhibited significantly lower sB7\u2010H4 levels than those with a normal thymus (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Correlation analyses demonstrated that mB7\u2010H4 expression on CD14\n                      <jats:sup>+<\/jats:sup>\n                      monocytes was positively correlated with quantitative MG scores (QMGs;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.544,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.020), whereas sB7\u2010H4 levels were negatively correlated with QMGs (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.417,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.016). Immunosuppressive treatment did not significantly affect sB7\u2010H4 levels compared with pre\u2010treatment values (\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). Univariate analysis identified elevated mB7\u2010H4 expression on CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cells as a potential risk factor for MG relapse. However, this association did not remain significant after multivariate adjustment for confounders variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      During MG relapse, inflammatory activation may engage the B7\u2010H4 pathway, characterized by increased mB7\u2010H4 and decreased sB7\u2010H4 levels, which may cooperatively contribute to immune suppression and serve as a compensatory protective mechanism. B7\u2010H4 expression appears to be associated with disease severity. Thymic abnormalities may contribute to the downregulation of sB7\u2010H4, whereas immunosuppressive treatment may not significantly modify its circulating levels. Although increased CD4\n                      <jats:sup>+<\/jats:sup>\n                      B7\u2010H4 expression is associated with relapse, it does not represent an independent predictor of relapse risk.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jimr\/2743928","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T23:06:52Z","timestamp":1778368012000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Significance of B7\u2010H4 in Peripheral Blood of Patients With Myasthenia Gravis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6922-1245","authenticated-orcid":false,"given":"Xiaoling","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5479-1680","authenticated-orcid":false,"given":"Yunfei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Gui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanzheng","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifeng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentong","family":"Ju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7243-1633","authenticated-orcid":false,"given":"Jingluan","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7324-7982","authenticated-orcid":false,"given":"Qun","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"crossref","first-page":"2570","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia Gravis","volume":"375","author":"Gilhus N. 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