Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context
Summary: Background: Autoimmune diseases comprise a spectrum of illnesses stemming from a common etiology: the loss of self-tolerance. The organ crucial for the establishment and maintenance of central and peripheral tolerance, namely the thymus, has rarely been explored across these diseases. Meth...
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2025-07-01
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| author | Haoxiao Chang Junqiang Yan Anxin Wang Ningning Wang Peng Liu Yemin Shi Xin Zhao Jinqiao Zhu Yuan Cai Xue Xia Yunyi Hao Shiyi Yin Jing Wang Xinli Wang Lina Sun Jia Ma Xiaoyu Huang Haonan Guan De-Cai Tian Kaibin Shi Ganqin Du Wenhao Huang Guoyan Qi Hao Li Yongjun Wang Fu-Dong Shi Zhang Zhang Wei-Na Jin |
| author_facet | Haoxiao Chang Junqiang Yan Anxin Wang Ningning Wang Peng Liu Yemin Shi Xin Zhao Jinqiao Zhu Yuan Cai Xue Xia Yunyi Hao Shiyi Yin Jing Wang Xinli Wang Lina Sun Jia Ma Xiaoyu Huang Haonan Guan De-Cai Tian Kaibin Shi Ganqin Du Wenhao Huang Guoyan Qi Hao Li Yongjun Wang Fu-Dong Shi Zhang Zhang Wei-Na Jin |
| author_sort | Haoxiao Chang |
| collection | DOAJ |
| description | Summary: Background: Autoimmune diseases comprise a spectrum of illnesses stemming from a common etiology: the loss of self-tolerance. The organ crucial for the establishment and maintenance of central and peripheral tolerance, namely the thymus, has rarely been explored across these diseases. Methods: In a multicentre radiological case–control study, we characterized the thymus in 16 prevalent autoimmune diseases using chest computed tomography (CT) images from patients and age- and sex-1:1 matched healthy controls. Participants underwent a routine CT examination, and baseline information on demographic, clinical, and potential risk factors was gathered at the time of enrollment. A semi-automatic algorithm was developed and employed for the analysis of thymic radiological characteristics, encompassing structural features and density. Thymic fatty replacement was evaluated using a four-point visual scoring scale (0–3). This study is registered with the Chinese Clinical Trial Registry (ChiCTR2300078417). Findings: After matching, 2441 participants in each group were included in case–control study. As individuals age, the thymus undergoes involution, leading to marked changes in thymic features over time, yet the degree of thymic feature alterations varies among groups. Compared to healthy controls, multiple characteristics of the thymus were distinct in the autoimmune disease patients, featuring higher trapezoidal proportions (68.21% vs 46.29%; p < 0.0001), larger bilobed size, and reduced density (−9.50; 95% CI, −10.95 to −8.04; p < 0.0001). In addition, the autoimmune disease patients displayed a greater proportion of fatty replacement (score 0, score 1, and score 2, 94.23% vs 87.83%, p < 0.0001). This consistent trend of thymic characteristic alternations, was observed across the 16 diseases (albeit varying in degree) and in newly diagnosed as early-stage patients. Notably, the subgroup for female patients of childbearing age (≤49 years) exhibited an especially prominent difference in thymic density (−16.23; 95% CI, −19.19 to −13.26; p < 0.0001 in all comparisons) and in the proportion of fatty replacement (85.37% vs 71.68%; p < 0.0001). Interpretation: Radiological assessments reveal a consistent pattern of exacerbated age-dependent thymic involution across 16 autoimmune diseases, suggesting a common underlying mechanism in the development of these diseases. This mechanism may involve the compromise of self-tolerance due to thymic involution. Funding: The National Key R&D Program of China, the National Science Foundation of China, and the Tianjin Key Medical Discipline (Specialty) Construction Project. |
| format | Article |
| id | doaj-art-48bb08b9f73d45a7a6ab94a29b1ef1a2 |
| institution | OA Journals |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-48bb08b9f73d45a7a6ab94a29b1ef1a22025-08-20T02:38:41ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-07-016010161510.1016/j.lanwpc.2025.101615Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in contextHaoxiao Chang0Junqiang Yan1Anxin Wang2Ningning Wang3Peng Liu4Yemin Shi5Xin Zhao6Jinqiao Zhu7Yuan Cai8Xue Xia9Yunyi Hao10Shiyi Yin11Jing Wang12Xinli Wang13Lina Sun14Jia Ma15Xiaoyu Huang16Haonan Guan17De-Cai Tian18Kaibin Shi19Ganqin Du20Wenhao Huang21Guoyan Qi22Hao Li23Yongjun Wang24Fu-Dong Shi25Zhang Zhang26Wei-Na Jin27Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Neuromolecular Biology, Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaCenter of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang, ChinaBeijing Academy of Artificial Intelligence, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Key Laboratory of Neuromolecular Biology, Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDivision of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region of ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Neuromolecular Biology, Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Radiology, Tianjin Key Lab of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Beijing Shunyi Hospital, Beijing Shunyi Teaching Hospital of Capital Medical University, Beijing, ChinaDepartment of Neurology, Tianjin Medical University General Hospital, Tianjin, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; The Third Afliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Neuromolecular Biology, Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, ChinaBeijing Academy of Artificial Intelligence, Beijing, ChinaCenter of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Radiology, Tianjin Key Lab of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, ChinaDepartment of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Corresponding author.Summary: Background: Autoimmune diseases comprise a spectrum of illnesses stemming from a common etiology: the loss of self-tolerance. The organ crucial for the establishment and maintenance of central and peripheral tolerance, namely the thymus, has rarely been explored across these diseases. Methods: In a multicentre radiological case–control study, we characterized the thymus in 16 prevalent autoimmune diseases using chest computed tomography (CT) images from patients and age- and sex-1:1 matched healthy controls. Participants underwent a routine CT examination, and baseline information on demographic, clinical, and potential risk factors was gathered at the time of enrollment. A semi-automatic algorithm was developed and employed for the analysis of thymic radiological characteristics, encompassing structural features and density. Thymic fatty replacement was evaluated using a four-point visual scoring scale (0–3). This study is registered with the Chinese Clinical Trial Registry (ChiCTR2300078417). Findings: After matching, 2441 participants in each group were included in case–control study. As individuals age, the thymus undergoes involution, leading to marked changes in thymic features over time, yet the degree of thymic feature alterations varies among groups. Compared to healthy controls, multiple characteristics of the thymus were distinct in the autoimmune disease patients, featuring higher trapezoidal proportions (68.21% vs 46.29%; p < 0.0001), larger bilobed size, and reduced density (−9.50; 95% CI, −10.95 to −8.04; p < 0.0001). In addition, the autoimmune disease patients displayed a greater proportion of fatty replacement (score 0, score 1, and score 2, 94.23% vs 87.83%, p < 0.0001). This consistent trend of thymic characteristic alternations, was observed across the 16 diseases (albeit varying in degree) and in newly diagnosed as early-stage patients. Notably, the subgroup for female patients of childbearing age (≤49 years) exhibited an especially prominent difference in thymic density (−16.23; 95% CI, −19.19 to −13.26; p < 0.0001 in all comparisons) and in the proportion of fatty replacement (85.37% vs 71.68%; p < 0.0001). Interpretation: Radiological assessments reveal a consistent pattern of exacerbated age-dependent thymic involution across 16 autoimmune diseases, suggesting a common underlying mechanism in the development of these diseases. This mechanism may involve the compromise of self-tolerance due to thymic involution. Funding: The National Key R&D Program of China, the National Science Foundation of China, and the Tianjin Key Medical Discipline (Specialty) Construction Project.http://www.sciencedirect.com/science/article/pii/S266660652500152XAutoimmune diseasesThymusThymic involutionSelf-toleranceCT |
| spellingShingle | Haoxiao Chang Junqiang Yan Anxin Wang Ningning Wang Peng Liu Yemin Shi Xin Zhao Jinqiao Zhu Yuan Cai Xue Xia Yunyi Hao Shiyi Yin Jing Wang Xinli Wang Lina Sun Jia Ma Xiaoyu Huang Haonan Guan De-Cai Tian Kaibin Shi Ganqin Du Wenhao Huang Guoyan Qi Hao Li Yongjun Wang Fu-Dong Shi Zhang Zhang Wei-Na Jin Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context The Lancet Regional Health. Western Pacific Autoimmune diseases Thymus Thymic involution Self-tolerance CT |
| title | Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context |
| title_full | Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context |
| title_fullStr | Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context |
| title_full_unstemmed | Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context |
| title_short | Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational studyResearch in context |
| title_sort | thymic characteristics in patients with autoimmune diseases a multicentre radiological observational studyresearch in context |
| topic | Autoimmune diseases Thymus Thymic involution Self-tolerance CT |
| url | http://www.sciencedirect.com/science/article/pii/S266660652500152X |
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