Department of Neurology and Rehabilitation Medicine and.
Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA.
J Clin Invest. 2024 Jun 17;134(12):e179742. doi: 10.1172/JCI179742.
Myasthenia gravis (MG) stands as a prototypical antibody-mediated autoimmune disease: it is dependent on T cells and characterized by the presence of autoantibodies targeting proteins located on the postsynaptic surface of skeletal muscle, known as the neuromuscular junction. Patients with MG exhibit a spectrum of weakness, ranging from limited ocular muscle involvement to life-threatening respiratory failure. Recent decades have witnessed substantial progress in understanding the underlying pathophysiology, leading to the delineation of distinct subcategories within MG, including MG linked to AChR or MuSK antibodies as well as age-based distinction, thymoma-associated, and immune checkpoint inhibitor-induced MG. This heightened understanding has paved the way for the development of more precise and targeted therapeutic interventions. Notably, the FDA has recently approved therapeutic inhibitors of complement and the IgG receptor FcRn, a testament to our improved comprehension of autoantibody effector mechanisms in MG. In this Review, we delve into the various subgroups of MG, stratified by age, autoantibody type, and histology of the thymus with neoplasms. Furthermore, we explore both current and potential emerging therapeutic strategies, shedding light on the evolving landscape of MG treatment.
重症肌无力 (MG) 是一种典型的抗体介导的自身免疫性疾病:它依赖于 T 细胞,其特征是存在针对位于骨骼肌突触后表面的自身抗体,这些自身抗体称为神经肌肉接头。MG 患者表现出一系列的肌无力,从有限的眼肌受累到危及生命的呼吸衰竭不等。近几十年来,人们对其基础病理生理学的理解取得了实质性的进展,MG 被划分为不同的亚型,包括与 AChR 或 MuSK 抗体相关的 MG 以及基于年龄的区分、胸腺瘤相关和免疫检查点抑制剂诱导的 MG。这种更深入的理解为更精确和有针对性的治疗干预措施的发展铺平了道路。值得注意的是,FDA 最近批准了补体和 IgG 受体 FcRn 的治疗抑制剂,这证明了我们对 MG 中自身抗体效应机制的理解有所提高。在这篇综述中,我们深入探讨了 MG 的各种亚组,根据年龄、自身抗体类型和胸腺肿瘤的组织学进行分层。此外,我们还探讨了当前和潜在的新兴治疗策略,揭示了 MG 治疗的不断发展的格局。
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