HLA in myasthenia gravis: From superficial correlation to underlying mechanism
Publication date: Available online 16 July 2019Source: Autoimmunity ReviewsAuthor(s): Huahua Zhong, Chongbo Zhao, Sushan LuoAbstractMyasthenia gravis (MG) is a rare autoimmune disease characterized by muscle weakness and abnormal fatigability. Like many other autoimmune diseases, genetic contribution to MG has been studied where the HLA system appears to play the most vital role. Although many correlations have been revealed in these studies, the underlying mechanism for them is still in the veil. Based on current evidence, we propose two synergetic mechanisms underlying the MG predisposition via HLA. In brief, the first advocates specific MHC II-peptide patterns that influence the efficacy of antigen presentation, and the second emphasizes the role of classical MHC alleles in shaping the TCR repertoire for MG predisposition. Besides, possible explanations for unresolved or controversial MG-related epidemiological phenomenon or clinical problems are addressed as well. Then, we discuss three factors influencing the effect of HLA on MG: gender discrepancy, inflammatory microenvironment, and epigenetic regulation. Lastly, from a provisional angle, we introduce several precautious treatments for people highly predisposed to MG. Although this is a review focusing on MG, the underlying mechanisms might be applicable in other autoimmune diseases as well.
Here we describe a 79 years old man admitted to our unit for worsening diplopia and fatigue, started a few weeks after an episode of bronchitis and flu vaccination. Past medical history included myasthenia gravis well controlled by Pyridostigmine, Azathioprine and Prednisone. During the first days, the patient developed progressive ocular movement abnormalities up to complete external ophthalmoplegia, severe limb and gait ataxia and mild dysarthria. Deep tendon reflexes were absent in lower limbs. Since not all the symptoms were explainable with the previous diagnosis of myasthenia gravis, other etiologies were investiga...
Publication date: Available online 9 August 2019Source: Autoimmunity ReviewsAuthor(s): Adrian W. Zuercher, Rolf Spirig, Adriana Baz Morelli, Tony Rowe, Fabian KäsermannAbstractIn recent years, there has been a surge in the research and development of novel molecules as potential therapeutic alternatives to traditional treatments (such as intravenous immunoglobulins) for autoimmune disorders. The aim of this review is to describe different drug development strategies and evaluate how various molecules have performed in clinical trials to date. Broadly, three main approaches have been pursued. Recombinant fragment cryst...
Conclusion: Existing research provides evidence revealing a spectrum of antibodies linked to the development and progression of neurological diseases. However, further antibody testing and studies should be performed to validate the relationship between conditions and antibodies. PMID: 31380113 [PubMed]
Conclusions: Overexpression of sBTLA, CCR7, TNFRSF25 and ANKRD55 was identified and validated by RT-qPCR, which could partly explain the underlying pathogenesis in TAMG. PMID: 31372268 [PubMed]
This report offers the possibility of a simple, non-pharmacological treatment of MG-related ptosis and potentially MG symptoms as a whole, with potential application toward other autoimmune disorders. PMID: 31370037 [PubMed - in process]
ConclusionIn patients presenting to the clinic with seropositive MG, metabolomic profiling is capable of distinguishing patients with disease from those without. These results provide an important first step towards a potential biomarker for improving MG identification.
Myasthenia gravis (MG) is an autoimmune disease, mediated by antibodies to a number of well characterized autoantigens.  However, current knowledge on the involved autoantigens does not provide conclusive answers for the large heterogeneity that is observed in distribution of muscle weakness and the shifts in this distribution within individual MG patients. The most frequently involved autoantigen is the acetylcholine receptor (AChR), against which antibodies are present in about 85% of MG patients.
Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage. PMID: 31311172 [PubMed - in process]
The chronic autoimmune disease myasthenia gravis (MG) is characterized with fluctuating muscle weakness which can lead to a large amount of stress in the patient. The current investigation plans to assess the risk of depressive disorders in MG patients. A retrospective cohort study of patients ageing from 20 year and older and also newly diagnosed with MG between January 1st, 2000 and December 31st, 2008 was conducted from the National Health Insurance Research Database (NHIRD) in Taiwan. Observations of all 349 MG patients and 1,396 control individuals were made until diagnosed with a depressive disorder by a psychiatrist...
We report the case of 48 year-old woman, in whom initial presentation of MG with predominance of bulbar symptoms was mistaken for thyroid disease complications. Subsequently, correct diagnosis and optimal management resulted on significant improvement of her functional state. We discuss the importance of considering MG as one of the potential differential diagnoses among cases of new onset or recurrent unexplained bulbar symptoms. PMID: 31260558 [PubMed - in process]