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    Glucose metabolism pattern of peripheral blood immune cells in myasthenia gravis patients. Li Zhibin,Peng Yuyao,Li Yi,Zhou Ran,Chen Di,Jin Wanlin,Xu Qiu,Xu Liqun,Luo Zhaohui,Yang Huan Annals of translational medicine Background:We investigated the correlation between glucose metabolism patterns of different immune cells and the metabolic regulatory signaling pathways in myasthenia gravis (MG) and aimed to identify therapeutic targets for MG. Methods:We isolated peripheral blood mononuclear cells (PBMCs) and sorted CD19B cells, dendritic cells (DCs), CD4 T cells, CD8 T cells, CD4CD25 regulatory T cells (Tregs), CD4CD25T cells, and T helper (Th) cells such as Th1, Th2, and Th17 cells. Then, we detected the expression levels of PI3K/AKT/mTOR-HIF-1α, GLUT1, hexokinase (HK), phosphofructokinase (PFK), and pyruvate kinase (PK) by RT-PCR, measured the oxygen consumption rate and extracellular acidification rate of freshly sorted cells using the Seahorse XF96 Analyzer. In addition, we compared the glycolysis levels using these cells from the same MG patients. By performing experiments, we measured, the mRNA expression levels of mTOR, HIF-1α, B cell activating factor receptor (BAFF-R), GLUT1, HK, PFK, and PK, in addition to ECAR profiles, frequency of CD80 and CD86, and IgG levels from the culture supernatant of B cells (isolated from MG patients) treated with rapamycin and PX-478 (selective mTOR and HIF-1α inhibitor, respectively) from. Results:Except PBMCs, Th2 and CD8 T cells, the expression levels of the key enzymes involved in glycolysis and HIF-1α were significantly higher in B cells, DCs, Tregs, CD4CD25T cells, and Th1 and Th17 cells in MG patients, and the measurement of ECAR and OCR confirmed the metabolic status. In MG patients, B cells and DCs showed significantly higher levels of glycolysis and glycolytic capacity than CD8 T cells, CD4 T cells and its subsets. , except IgG levels, the increased glycolysis levels, expression of key glycolytic enzymes, BAFF-R and frequency of CD80 and CD86 of B cells, could be inhibited by rapamycin and PX-478. Conclusions:Different subtypes of immune cells in MG exhibit different glucose metabolism patterns. The mTOR-HIF-1α signaling pathway might be the immunometabolism reprogramming checkpoint of glycolysis-dependent activated B cells in MG. 10.21037/atm-20-918