Department of Immunology, Hellenic Pasteur Institute, Athens, Greece.
Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece.
Front Immunol. 2020 Feb 14;11:212. doi: 10.3389/fimmu.2020.00212. eCollection 2020.
Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatiguability of skeletal muscles. It is an antibody-mediated disease, caused by autoantibodies targeting neuromuscular junction proteins. In the majority of patients (~85%) antibodies against the muscle acetylcholine receptor (AChR) are detected, while in 6% antibodies against the muscle-specific kinase (MuSK) are detected. In ~10% of MG patients no autoantibodies can be found with the classical diagnostics for AChR and MuSK antibodies (seronegative MG, SN-MG), making the improvement of methods for the detection of known autoantibodies or the discovery of novel antigenic targets imperative. Over the past years, using cell-based assays or improved highly sensitive immunoprecipitation assays, it has been possible to detect autoantibodies in previously SN-MG patients, including the identification of the low-density lipoprotein receptor-related protein 4 (LRP4) as a third MG autoantigen, as well as AChR and MuSK antibodies undetectable by conventional methods. Furthermore, antibodies against other extracellular or intracellular targets, such as titin, the ryanodine receptor, agrin, collagen Q, K1.4 potassium channels and cortactin have been found in some MG patients, which can be useful biomarkers. In addition to the improvement of diagnosis, the identification of the patients' autoantibody specificity is important for their stratification into respective subgroups, which can differ in terms of clinical manifestations, prognosis and most importantly their response to therapies. The knowledge of the autoantibody profile of MG patients would allow for a therapeutic strategy tailored to their MG subgroup. This is becoming especially relevant as there is increasing progress toward the development of antigen-specific therapies, targeting only the specific autoantibodies or immune cells involved in the autoimmune response, such as antigen-specific immunoadsorption, which have shown promising results. We will herein review the advances made by us and others toward development of more sensitive detection methods and the identification of new antibody targets in MG, and discuss their significance in MG diagnosis and therapy. Overall, the development of novel autoantibody assays is aiding in the more accurate diagnosis and classification of MG patients, supporting the development of advanced therapeutics and ultimately the improvement of disease management and patient quality of life.
重症肌无力(MG)是一种以骨骼肌无力和易疲劳为特征的自身免疫性疾病。它是一种抗体介导的疾病,由针对神经肌肉接头蛋白的自身抗体引起。在大多数患者(约 85%)中,可检测到针对肌肉乙酰胆碱受体(AChR)的抗体,而在 6%的患者中,可检测到针对肌肉特异性激酶(MuSK)的抗体。在约 10%的 MG 患者中,无法使用针对 AChR 和 MuSK 抗体的经典诊断方法检测到自身抗体(血清阴性 MG,SN-MG),因此迫切需要改进检测已知自身抗体的方法或发现新的抗原性靶标。在过去的几年中,使用基于细胞的测定法或改进的高灵敏度免疫沉淀测定法,有可能在以前的 SN-MG 患者中检测到自身抗体,包括鉴定低密度脂蛋白受体相关蛋白 4(LRP4)作为第三种 MG 自身抗原,以及通过常规方法无法检测到的 AChR 和 MuSK 抗体。此外,在一些 MG 患者中还发现了针对其他细胞外或细胞内靶标的抗体,如titin、ryanodine 受体、agrin、胶原 Q、K1.4 钾通道和 cortactin,这些抗体可作为有用的生物标志物。除了改善诊断外,鉴定患者的自身抗体特异性对于将其分层为各自的亚组也很重要,这些亚组在临床表现、预后和最重要的是对治疗的反应方面可能有所不同。了解 MG 患者的自身抗体谱可以制定针对其 MG 亚组的治疗策略。随着针对参与自身免疫反应的特定自身抗体或免疫细胞的抗原特异性治疗方法的不断发展,这种策略变得越来越重要,例如抗原特异性免疫吸附,该方法已显示出可喜的结果。本文将综述我们和其他人在开发更敏感的检测方法和鉴定 MG 中的新抗体靶标方面取得的进展,并讨论它们在 MG 诊断和治疗中的意义。总之,新型自身抗体检测方法的发展有助于更准确地诊断和分类 MG 患者,支持先进治疗方法的发展,最终改善疾病管理和患者生活质量。