Tu Ting-Hao, Lu Jeng-Wei, Ho Yi-Jung, Lui Shan-Wen, Hsieh Ting-Yu, Wang Kuang-Yih, Liu Feng-Cheng
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
In Vivo. 2025 Jul-Aug;39(4):2186-2195. doi: 10.21873/invivo.14014.
BACKGROUND/AIM: Rheumatoid arthritis (RA) is a chronic autoimmune disease with systemic manifestations. Methotrexate (MTX) remains a cornerstone of RA treatment, offering significant therapeutic benefits; however, it is also associated with adverse effects, particularly myelosuppression. Molecular hydrogen, recognized for its anti-inflammatory and antioxidant properties, has demonstrated potential in mitigating oxidative stress and modulating immune responses in RA. This study aimed to evaluate the efficacy of molecular hydrogen therapy in alleviating MTX-induced myelosuppression while preserving its immunoregulatory effects in a patient with RA.
We present the case of a 66-year-old Taiwanese female diagnosed with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. The patient presented to the emergency department on August 30, 2024, with oral ulcers, sore throat, weakness, and diarrhea. Clinical assessment revealed hypotension, tachycardia, pancytopenia, hepatic insufficiency, and acute kidney injury. Outpatient medications were discontinued, and molecular hydrogen therapy was initiated. The patient exhibited marked clinical improvement, with normalization of laboratory parameters. Flow cytometry analysis demonstrated a progressive increase in the percentages of PD-1+ subsets of Th and Tc cells, as well as memory and activated regulatory T (Treg) cells. In contrast, B regulatory (Breg) cell levels remained unchanged. No adverse events were observed during the course of hydrogen therapy.
This is the first case report to highlight severe MTX-induced myelosuppression in an RA patient and to demonstrate the potential of molecular hydrogen therapy in modulating immune markers.
背景/目的：类风湿关节炎（RA）是一种具有全身表现的慢性自身免疫性疾病。甲氨蝶呤（MTX）仍然是RA治疗的基石，具有显著的治疗益处；然而，它也与不良反应相关，尤其是骨髓抑制。分子氢因其抗炎和抗氧化特性而闻名，已显示出在减轻RA氧化应激和调节免疫反应方面的潜力。本研究旨在评估分子氢疗法在减轻MTX诱导的骨髓抑制同时保留其对RA患者免疫调节作用的疗效。
我们报告一例66岁台湾女性患者，根据2010年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）标准诊断为RA。该患者于2024年8月30日因口腔溃疡、咽痛、乏力和腹泻就诊于急诊科。临床评估显示低血压、心动过速、全血细胞减少、肝功能不全和急性肾损伤。停用门诊药物，并开始分子氢治疗。患者临床症状明显改善，实验室指标恢复正常。流式细胞术分析显示，Th和Tc细胞的PD-1+亚群以及记忆和活化调节性T（Treg）细胞的百分比逐渐增加。相比之下，B调节（Breg）细胞水平保持不变。在氢治疗过程中未观察到不良事件。
这是首例强调RA患者中严重MTX诱导的骨髓抑制并证明分子氢疗法在调节免疫标志物方面潜力的病例报告。
