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重症肌无力:未来已来。

Myasthenia gravis: the future is here.

机构信息

Department of Neurology and Rehabilitation Medicine and.

Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA.

出版信息

J Clin Invest. 2024 Jun 17;134(12):e179742. doi: 10.1172/JCI179742.


DOI:10.1172/JCI179742
PMID:39105625
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11178544/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/313b7f660da2/jci-134-179742-g150.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/c6504c5605ad/jci-134-179742-g147.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/bbc6dbcb1e24/jci-134-179742-g148.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/f5fd86763aad/jci-134-179742-g149.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/313b7f660da2/jci-134-179742-g150.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/c6504c5605ad/jci-134-179742-g147.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/bbc6dbcb1e24/jci-134-179742-g148.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/f5fd86763aad/jci-134-179742-g149.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/203b/11178544/313b7f660da2/jci-134-179742-g150.jpg

相似文献

[1]
Myasthenia gravis: the future is here.

J Clin Invest. 2024-6-17

[2]
Thymus histology and concomitant autoimmune diseases in Japanese patients with muscle-specific receptor tyrosine kinase-antibody-positive myasthenia gravis.

Eur J Neurol. 2013-5-17

[3]
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Curr Opin Neurol. 2005-10

[4]
Antibody effector mechanisms in myasthenia gravis-pathogenesis at the neuromuscular junction.

Autoimmunity. 2010-8

[5]
Muscle-Specific Receptor Tyrosine Kinase (MuSK) Myasthenia Gravis.

Curr Neurol Neurosci Rep. 2016-7

[6]
Autoantibody Specificities in Myasthenia Gravis; Implications for Improved Diagnostics and Therapeutics.

Front Immunol. 2020

[7]
[Myasthenia gravis induced by autoantibodies against MuSK].

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[8]
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[9]
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Curr Opin Neurol. 2013-10

[10]
Mechanisms associated with the pathogenicity of antibodies against muscle-specific kinase in myasthenia gravis.

Autoimmun Rev. 2013-3-26

引用本文的文献

[1]
Efgartigimod following plasma exchange in the treatment of subjects with generalised myasthenia gravis: study protocol for a multicentre, three-arm, open-label study.

BMJ Neurol Open. 2025-8-3

[2]
CAR T-cells meet autoimmune neurological diseases: a new dawn for therapy.

Front Immunol. 2025-7-18

[3]
Improvement in Patient-Reported Symptoms of Generalised Myasthenia Gravis With Rozanolixizumab in the Randomised Phase 3 MycarinG Study Using the MG Symptoms PRO.

Eur J Neurol. 2025-8

[4]
Loss of Ufsp1 does not cause major changes at the neuromuscular junction.

PLoS One. 2025-8-1

[5]
Unknown Immunoregulatory Effects of FcRn Inhibition by Efgartigimod in Myasthenia Gravis: A New Mechanism of Action Beyond IgG Reduction.

Neurol Neuroimmunol Neuroinflamm. 2025-9

[6]
Beyond the Surface: Investigating the Potential Mechanisms of Non-Motor Symptoms in Myasthenia Gravis.

Eur J Neurol. 2025-8

[7]
Thymic hyperplasia in myasthenia gravis: a narrative review.

Mediastinum. 2025-6-25

[8]
Wearable Bioelectronics for Home-Based Monitoring and Treatment of Muscle Atrophy.

Adv Sci (Weinh). 2025-9

[9]
Perspectives on the Parathyroid-Thymus Interconnection-A Literature Review.

Int J Mol Sci. 2025-6-23

[10]
Circadian rhythm genes and immune cell infiltration in myasthenia gravis: A comprehensive analysis.

PLoS One. 2025-7-7

本文引用的文献

[1]
Does Surgical Removal of the Thymus Have Deleterious Consequences?

Neurology. 2024-6-25

[2]
Functional Signature of LRP4 Antibodies in Myasthenia Gravis.

Neurol Neuroimmunol Neuroinflamm. 2024-5

[3]
Terminal Complement Inhibitor Ravulizumab in Generalized Myasthenia Gravis.

NEJM Evid. 2022-5

[4]
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Brain Nerve. 2024-1

[5]
The Role of Thymoma and Thymic Hyperplasia as Prognostic Risk Factors for Secondary Generalisation in Adults with Ocular Myasthenia Gravis: A Systematic Narrative Review.

Br Ir Orthopt J. 2023-11-30

[6]
Efficacy and safety of iscalimab, a novel anti-CD40 monoclonal antibody, in moderate-to-severe myasthenia gravis: A phase 2 randomized study.

J Clin Neurosci. 2024-1

[7]
Serum metabolomics of treatment response in myasthenia gravis.

PLoS One. 2023

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Environmental factors affecting the risk of generalization for ocular-onset myasthenia gravis: a nationwide cohort study.

QJM. 2024-2-26

[9]
Zilucoplan, a macrocyclic peptide inhibitor of human complement component 5, uses a dual mode of action to prevent terminal complement pathway activation.

Front Immunol. 2023

[10]
Healthcare resource utilization and costs associated with generalized myasthenia gravis: a retrospective matched cohort study using the National Health Insurance Research Database in Taiwan.

Front Neurol. 2023-7-26

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