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Vitamin B3-Based Biologically Active Compounds as Inhibitors of Human Cholinesterases. Int J Mol Sci 2020; 21:ijms21218088. [PMID: 33138280 PMCID: PMC7663184 DOI: 10.3390/ijms21218088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022] Open
Abstract
We evaluated the potential of nine vitamin B3 scaffold-based derivatives as acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitors, as a starting point for the development of novel drugs for treating disorders with cholinergic neurotransmission-linked pathology. As the results indicate, all compounds reversibly inhibited both enzymes in the micromolar range pointing to the preference of AChE over BChE for binding the tested derivatives. Molecular docking studies revealed the importance of interactions with AChE active site residues Tyr337 and Tyr124, which dictated most of the observed differences. The most potent inhibitor of both enzymes with Ki of 4 μM for AChE and 8 μM for BChE was the nicotinamide derivative 1-(4′-phenylphenacyl)-3-carbamoylpyridinium bromide. Such a result places it within the range of several currently studied novel cholinesterase inhibitors. Cytotoxicity profiling did not classify this compound as highly toxic, but the induced effects on cells should not be neglected in any future detailed studies and when considering this scaffold for drug development.
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102
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Katz NK, Barohn RJ. The history of acetylcholinesterase inhibitors in the treatment of myasthenia gravis. Neuropharmacology 2020; 182:108303. [PMID: 32918950 DOI: 10.1016/j.neuropharm.2020.108303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/22/2020] [Accepted: 09/08/2020] [Indexed: 12/22/2022]
Abstract
The beneficial effects of acetylcholinesterase inhibitors for the treatment of myasthenia gravis (MG) was a major discovery that came about through one young physician putting together a string of previous observations. To understand how this discovery came to light, we must first go back to earlier times when men hunted by bow-and-arrow to capture their prey. The substance used to poison the prey was eventually was identified as curare. Centuries later, a connection was made between the physiological effects of curare and a disease entity with no known pathological mechanism or treatment, myasthenia gravis. In 1935, house officer Dr. Mary Walker was the first physician to try physostigmine in the treatment of MG, which had previously been used to treat curare poisoning. What she saw was a dramatic improvement in the symptoms experienced in patients with MG, and thus became the first documented case of use of physostigmine, an acetylcholinesterase inhibitor, in the treatment of MG. This article is a summary of the history of the use of acetylcholinesterase inhibitors in the treatment of myasthenia gravis. This article is part of the special issue entitled 'Acetylcholinesterase Inhibitors: From Bench to Bedside to Battlefield'.
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Arnon R, Yahalomi T, Rozen-Knisbacher I, Pikkel J, Mostovoy D. Ocular Myasthenia Gravis with Severe Blepharitis and Ocular Surface Disease: A Case Report. Case Rep Ophthalmol 2020; 11:322-329. [PMID: 32884545 PMCID: PMC7443649 DOI: 10.1159/000508815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Ocular myasthenia gravis (OMG) is an autoimmune disease of the neuromuscular junction and commonly associated with other immune diseases. We describe a 16-year-old female who presented to our clinic with 1-month complaints of diplopia and strabismus, visual acuity deterioration, and ocular irritation. Her examination showed crossed diplopia and alternating exotropia of 25 prism diopters, severe blepharitis, conjunctival hyperemia, corneal pannus, epithelial irregularities, and subepithelial opacities. Workup included pediatric neurologic examination, laboratory tests, imaging, and electrophysiological tests. Diagnoses of OMG and blepharitis with ocular surface disease were made. Topical treatment included eyelid hygiene, tea tree oil scrubbing, topical steroids, and tacrolimus ointment. Systemic treatment included corticosteroids, pyridostigmine, azathioprine, intravenous immunoglobulins, amitriptyline, and doxycycline. Both diseases were refractory to intensive immunosuppressive treatment and had simultaneous relapses and an intertwined course. Our hypothesis is that a shared immune mechanism may be the cause of both OMG and ocular surface disease in our patient.
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Affiliation(s)
- Roee Arnon
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel
| | - Irit Rozen-Knisbacher
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel.,Ben Gurion University School of Medicine, Beer-Sheva, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel.,Ben Gurion University School of Medicine, Beer-Sheva, Israel
| | - Dina Mostovoy
- Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel.,Ben Gurion University School of Medicine, Beer-Sheva, Israel
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Amin S, Aung M, Gandhi FR, Pena Escobar JA, Gulraiz A, Malik BH. Myasthenia Gravis and its Association With Thyroid Diseases. Cureus 2020; 12:e10248. [PMID: 33042687 PMCID: PMC7536109 DOI: 10.7759/cureus.10248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Myasthenia gravis (MG) is a rare autoimmune neuromuscular junction disorder, and thyroid disorder is a disorder involving the thyroid receptor, of which Graves' disease (GD) is the most common autoimmune thyroid disorder, in which antibodies develop against thyroid receptors. Both may have similar clinical features. In myasthenia gravis, autoimmune antibodies develop against postsynaptic neuromuscular junction disrupting the neuromuscular transmission, resulting in fluctuating muscle weakness and fatigue. It is a disease of young women and older men. The two pathologies may coexist in a patient or can precede one another. Graves' disease (GD) among thyroid diseases is most often associated with MG. Similarities in clinical features lead to difficulty in distinguishing MG and GD. Despite the standard treatment of myasthenia gravis, including steroids, acetylcholinesterases, rituximab, immunosuppressants, and thymectomy, there is still an increased number of relapses and myasthenia crisis. Eculizumab and plasmapheresis are the two new treatment options for MG, with supporting evidence of marked improvement in recent studies. Myasthenia gravis and Graves' disease have a see-saw relationship. Treating one pathology may worsen the other, so physicians should always consider MG as a differential in patients of hyperthyroidism presenting with new symptoms of fatigue or respiratory failure or neuromuscular weakness. In this comprehensive review article, we tried to establish an association between myasthenia gravis and Graves' disease (GD) by exploring currently available literature from PubMed. However, more studies need to be done to establish an association between pathologies.
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Affiliation(s)
- Saba Amin
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Myat Aung
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fenil R Gandhi
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Julio A Pena Escobar
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azouba Gulraiz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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105
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Pohanka M. Diagnoses of Pathological States Based on Acetylcholinesterase and Butyrylcholinesterase. Curr Med Chem 2020; 27:2994-3011. [PMID: 30706778 DOI: 10.2174/0929867326666190130161202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
Two cholinesterases exist: Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). While AChE plays a crucial role in neurotransmissions, BChE has no specific function apart from the detoxification of some drugs and secondary metabolites from plants. Thus, both AChE and BChE can serve as biochemical markers of various pathologies. Poisoning by nerve agents like sarin, soman, tabun, VX, novichok and overdosing by drugs used in some neurodegenerative disorders like Alzheimer´s disease and myasthenia gravis, as well as poisoning by organophosphorus pesticides are relevant to this issue. But it appears that changes in these enzymes take place in other processes including oxidative stress, inflammation, some types of cancer and genetically conditioned diseases. In this review, the cholinesterases are introduced, the mechanism of inhibitors action is explained and the relations between the cholinesterases and pathologies are explained.
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Affiliation(s)
- Miroslav Pohanka
- Faculty of Military Health Sciences, University of Defence, Trebesska 1575, 50001 Hradec Kralove, Czech Republic
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106
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Lushchekina SV, Masson P. Slow-binding inhibitors of acetylcholinesterase of medical interest. Neuropharmacology 2020; 177:108236. [PMID: 32712274 DOI: 10.1016/j.neuropharm.2020.108236] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/11/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
Certain ligands slowly bind to acetylcholinesterase. As a result, there is a slow establishment of enzyme-inhibitor equilibrium characterized by a slow onset of inhibition prior reaching steady state. Three mechanisms account for slow-binding inhibition: a) slow binding rate constant kon, b) slow ligand induced-fit following a fast binding step, c) slow conformational selection of an enzyme form. The slow equilibrium may be followed by a chemical step. This later that can be irreversible has been observed with certain alkylating agents and substrate transition state analogs. Slow-binding inhibitors present long residence times on target. This results in prolonged pharmacological or toxicological action. Through several well-known molecules (e.g. huperzine) and new examples (tocopherol, trifluoroacetophenone and a 6-methyluracil alkylammonium derivative), we show that slow-binding inhibitors of acetylcholinesterase are promising drugs for treatment of neurological diseases such as Alzheimer disease and myasthenia gravis. Moreover, they may be of interest for neuroprotection (prophylaxis) against organophosphorus poisoning. This article is part of the special issue entitled 'Acetylcholinesterase Inhibitors: From Bench to Bedside to Battlefield'.
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Affiliation(s)
- Sofya V Lushchekina
- Laboratory of Computer Modeling of Biomolecular Systems and Nanomaterials, Emanuel Institute of Biochemical Physics of RAS, 4 Kosygina St., Moscow, 119334, Russia.
| | - Patrick Masson
- Laboratory of Neuropharmacology, Kazan Federal University, 18 Kremlyovskaya St., Kazan, 420008, Russia.
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Yang H, Liu D, Hong X, Sun H, Zheng Y, Yang B, Wang W. Effectiveness and safety of thymectomy plus prednisone compares with prednisone monotherapy for the treatment of non-thymomatous Myasthenia Gravis: Protocol for a systematic review. Medicine (Baltimore) 2020; 99:e20832. [PMID: 32569233 PMCID: PMC7310738 DOI: 10.1097/md.0000000000020832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The pathogenesis of myasthenia gravis (MG) has strong connection with thymic abnormalities. Thymic hyperplasia or thymoma can be found with most patients. Thymectomy is currently one of the regular treatment in clinic, which is, however, still controversial for non-thymomatous MG. This research will assess the effectiveness and safety of thymectomy plus prednisone compared to prednisone monotherapy for the treatment of non-thymomatous MG systematically. METHODS According to eligibility and ineligibility criteria, 8 databases, including PubMed, EMBASE, the Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan-fang Database, Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (CSTJ), will be searched to gather the up-to-standard articles from September 2000 to September 2025. Inclusion criteria are as follows: randomized controlled trials of thymectomy plus prednisone for the treatment of non-thymomatous MG. The quantitative myasthenia gravis score (QMG) and the dose of prednisone required will be accepted as the main outcomes. Data synthesis, subgroup analysis, sensitivity analysis, and meta-regression analysis will be conducted using RevMan 5.3 software. We will use Egger or Begg test to evaluate symmetry on a funnel plot which is made to assess reporting bias, and use trial sequential analysis (TSA) to exclude the probability of false positives. RESULTS This systematic review will measure the QMG and the dose of prednisone required, the myasthenia gravis activities of daily living scale scores (MG-ADL), treatment-associated complications, incidence of myasthenic crisis and other aspects to comprehensively assess the clinical benefits of thymectomy plus prednisone for MG patients without thymoma. CONCLUSION The conclusion of this study will achieve convincing evidence to evaluate the effectiveness and safety of thymectomy plus prednisone for the treatment of non-thymomatous MG. PROSPERO REGISTRATION NUMBER CRD 42020167735.
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Affiliation(s)
- Huili Yang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine
- Department of Graduate School, Guangzhou University of Chinese Medicine
| | - Dandan Liu
- Department of Graduate School, Guangzhou University of Chinese Medicine
- General Hospital of Southern Theater Command of PLA, Guangzhou
| | - Xinxin Hong
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen
| | - Haonan Sun
- Traditional Chinese Medicine Hospital, Xinjiang Medical University, Urumqi, China
| | - Yu Zheng
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine
| | - Biying Yang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine
| | - Wanshun Wang
- Department of Graduate School, Guangzhou University of Chinese Medicine
- General Hospital of Southern Theater Command of PLA, Guangzhou
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108
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Vemuri D, Garuda BR, Gopi S, Kumar TS, Kumari UA. Disease Severity Assessment and Short-Term Outcome in Patients with Myasthenia Gravis. Ann Indian Acad Neurol 2020; 23:215-219. [PMID: 32189865 PMCID: PMC7061515 DOI: 10.4103/aian.aian_243_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 11/04/2022] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disorder with a chronic fluctuating course. The outcome measures encapsulate disease severity, functional impact at diagnosis, and objective evaluation of clinical benefit from therapeutic interventions. Aims and Objective To assess the disease severity, correlation between various outcome measures, and to evaluate the short-term outcome at 3 months and 6 months in a cohort of MG patients. Materials and Methods Quantitative myasthenia gravis (QMG) score, myasthenia gravis composite (MGC) score, and myasthenia gravis quality of life-15 (MG-QoL-15) score were applied to 54 patients at first visit, 3 months and 6 months follow-up. Results Mean quality of life-15 (QoL-15) score at base line was 15.241. Mean QMG and MGC scores at baseline were 14.63 ± 8.37 and 15.87 ± 9.14, respectively. QMG score showed a strong positive correlation with both MGC and MG-QoL-15 scores. QMG and MGC scores showed a moderate correlation with acetylcholine receptor antibody (AChR Ab) titers. Mean QMG at follow-up was 9.95 ± 5.49 at 3 months and 6.74 ± 4.74 at 6 months. Mean MGC at follow-up was 10.75 ± 5.58 at 3 months and 6.51 ± 4.36 at 6 months. Conclusion The combination of physician-evaluated and patient-reported outcome measures provided a more discerning picture of patient status and response to treatment. Incorporating MG outcome measures into clinical practice would aid in modulating therapies.
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Affiliation(s)
- Deepthi Vemuri
- Department of Neurology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Butchi Raju Garuda
- Department of Neurology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - S Gopi
- Department of Neurology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - T Sateesh Kumar
- Department of Neurology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - U Aruna Kumari
- Department of Neurology, Andhra Medical College/King George Hospital, Visakhapatnam, Andhra Pradesh, India
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Pasnoor M, Heim AJ, Herbelin L, Statland J, Dimachkie MM, Becker M, Barohn RJ. Methotrexate Polyglutamation in a Myasthenia Gravis Clinical Trial. Kans J Med 2020; 13:10-13. [PMID: 32256969 PMCID: PMC7106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Methotrexate (MTX) is an immunosuppressive and anti-inflammatory drug used to treat rheumatoid arthritis (RA) and other autoimmune conditions. MTX is transported into cells, where glutamate moieties are added and is retained as methotrexate polyglutamates (MTXPGs). In the RA literature, it has been reported that the degree of polyglutamation correlates with the anti-inflammatory effect of MTX in RA. There are no prior studies evaluating the relationship between MTXPGs and myasthenia gravis (MG) outcome measures. The objective of this study was to assess the correlation between methotrexate (MTX) polyglutamates (MTXPGs) with Myasthenia Gravis (MG) outcome measures. METHODS An analysis was done of blood drawn from patients enrolled in the 12-month randomized, placebo-controlled study of MTX in MG study. Red blood cell MTXPGs were measured via ultra-performance liquid chromatography and tandem mass spectrometry. MTXPG was correlated to MG outcome measures using Spearman Correlation Coefficient. A two-group t-test was used to determine the difference in MTXPG based on clinical outcome responder definitions. RESULTS Twenty-one polyglutamate samples were analyzed of subjects on MTX while eight samples were analyzed from subjects on placebo. Pentaglutamate had the strongest correlation with the MG-ADL (0.99), while tetraglutamate had the strongest correlation with the QMG (0.54). Triglutamate had the strongest correlation with MGC (0.76). CONCLUSION There were variable correlations between MTXPG1-5 and MG outcomes (rho range: 0.08 to 0.99). There are strong correlations between MTXPG and the MG-ADL, QMG, and MGC. Long chain methotrexate polyglutamates correlate better with MG outcomes.
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Affiliation(s)
- Mamatha Pasnoor
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
| | - Andrew J. Heim
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
| | - Laura Herbelin
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
| | - Jeffrey Statland
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
| | - Mazen M. Dimachkie
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
| | - Mara Becker
- Duke University School of Medicine, Division of Rheumatology, Durham, NC
| | - Richard J. Barohn
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS
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Zhang Y, Yang J, Chen Y, Lv J, Zhang J, Zhang Y, Zhao X, Fang H, Liu C, Zhang Q, Cui X, Wang X, Gao F. iTRAQ-Based Proteomics Analysis of Plasma of Myasthenia Gravis Patients Treated with Jia Wei Bu Zhong Yi Qi Decoction. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:9147072. [PMID: 31915455 PMCID: PMC6930785 DOI: 10.1155/2019/9147072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/04/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease. A proportion of MG patients did not get satisfactory results after treatment with pyridostigmine and prednisone. Jia Wei Bu Zhong Yi Qi (Jia Wei BZYQ) decoction, a water extract from multiple herbs, has been demonstrated to be effective in the treatment of multiple "Qi deficiency type" diseases including MG in China. In this text, we investigated protein alterations in the plasma from healthy volunteers (C), MG patients without any treatment (T1), MG patients with routine western medical treatment (T2), and MG patients with combined treatments of Jia Wei BZYQ decoction and routine western medicines (T3) and identified some potential proteins involved in the pathogenesis and treatment of MG. iTRAQ (isobaric tags for relative and absolute quantitation) and 2D-LC-MS/MS (two-dimensional liquid chromatography-tandem mass spectrometry technologies) were employed to screen differentially expressed proteins. The identification, quantification, functional annotation, and interaction of proteins were analyzed by matching software and databases. In our project, 618 proteins were identified, among which 447 proteins had quantitative data. The number of differentially expressed proteins was 110, 117, 143, 115, 86, and 158 in T1 vs. C, T2 vs. C, T2 vs. T1, T3 vs. C, T3 vs. T1, and T3 vs. T2 groups, respectively. Functional annotation results showed that many differentially expressed proteins were closely associated with immune responses. For instance, some key proteins such as C-reactive protein, apolipoprotein C-III, apolipoprotein A-II, alpha-actinin-1, and thrombospondin-1 have been found to be abnormally expressed in T3 group compared to T1 group or T2 group. Interaction network analyses also provided some potential biomarkers or targets for MG management.
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Affiliation(s)
- Yunke Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou City, Henan Province 450008, China
| | - Junhong Yang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, No. 19, Renmin Road, Zhengzhou City, Henan Province 450000, China
| | - Yingzhe Chen
- Department of Neurology, Pingdingshan Traditional Chinese Medicine Hospital, Henan No. 4 Courtyard, North Section of Zhongxing Road, Pingdingshan City 467000, China
| | - Jie Lv
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
| | - Jing Zhang
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
| | - Yingna Zhang
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
| | - Xue Zhao
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
| | - Hua Fang
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
| | - Chongchong Liu
- Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing 100029, China
| | - Qingyong Zhang
- Myasthenia Gravis Comprehensive Diagnosis and Treatment Center, Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province 450003, China
| | - Xinzheng Cui
- Myasthenia Gravis Comprehensive Diagnosis and Treatment Center, Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province 450003, China
| | - Xiaohan Wang
- Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou City, Henan Province 450008, China
| | - Feng Gao
- Department of Neuroimmunology Research, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Henan, No. 40, University Road, Zhengzhou City, Henan Province 450052, China
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Gummi RR, Kukulka NA, Deroche CB, Govindarajan R. Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve 2019; 60:693-699. [DOI: 10.1002/mus.26689] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Chelsea B. Deroche
- Health Management and InformaticsUniversity of Missouri School of Medicine Columbia Missouri
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112
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Myasthenia Gravis: Pathogenic Effects of Autoantibodies on Neuromuscular Architecture. Cells 2019; 8:cells8070671. [PMID: 31269763 PMCID: PMC6678492 DOI: 10.3390/cells8070671] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction (NMJ). Autoantibodies target key molecules at the NMJ, such as the nicotinic acetylcholine receptor (AChR), muscle-specific kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (Lrp4), that lead by a range of different pathogenic mechanisms to altered tissue architecture and reduced densities or functionality of AChRs, reduced neuromuscular transmission, and therefore a severe fatigable skeletal muscle weakness. In this review, we give an overview of the history and clinical aspects of MG, with a focus on the structure and function of myasthenic autoantigens at the NMJ and how they are affected by the autoantibodies' pathogenic mechanisms. Furthermore, we give a short overview of the cells that are implicated in the production of the autoantibodies and briefly discuss diagnostic challenges and treatment strategies.
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113
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Mi W, Silvestri NJ, Wolfe GI. A Neurologist's Perspective on Thymectomy for Myasthenia Gravis: Current Perspective and Future Trials. Thorac Surg Clin 2019; 29:143-150. [PMID: 30927995 DOI: 10.1016/j.thorsurg.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The first randomized blinded study of thymectomy in nonthymomatous myasthenia gravis was designed to answer 3 questions: does the combination of prednisone and removal of the thymus gland via extended transsternal thymectomy after 3 years compared with an identical dosing protocol of prednisone alone (1) lead to better disease status for generalized MG patients with antiacetylcholine receptor antibodies, (2) reduce their prednisone requirements, and/or (3) reduce the side-effect burden from medications used to treat the disease? The study demonstrated that thymectomy confers these benefits for patients and sets the stage for inquiries into the benefits of less-invasive approaches to thymic resection.
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Affiliation(s)
- Wentao Mi
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, 1010 Main Street, 2nd Floor, Buffalo, NY 14202, USA
| | - Nicholas J Silvestri
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, 1010 Main Street, 2nd Floor, Buffalo, NY 14202, USA
| | - Gil I Wolfe
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, 1010 Main Street, 2nd Floor, Buffalo, NY 14202, USA.
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114
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A Neurologist's Perspective on Understanding Myasthenia Gravis: Clinical Perspectives of Etiologic Factors, Diagnosis, and Preoperative Treatment. Thorac Surg Clin 2019; 29:133-141. [PMID: 30927994 DOI: 10.1016/j.thorsurg.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myasthenia gravis (MG) is a disease of neuromuscular transmission caused by antibodies directed toward proteins concentrated at the neuromuscular junction. Mild to life-threatening weakness varies in severity over time and with level of activity. Therefore, clinical diagnosis is often challenging. MG may be categorized by autoantibody type, thymic pathologic condition, and age of onset. Treatments are tailored for each group. A key management concern is severe exacerbation of weakness resulting from infections or exposure to certain medications, including antibiotics, which may be severe enough to produce respiratory decompensation. The article reviews key diagnostic issues and treatment options.
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Ravulizumab (ALXN1210) vs eculizumab in C5-inhibitor-experienced adult patients with PNH: the 302 study. Blood 2018; 133:540-549. [PMID: 30510079 DOI: 10.1182/blood-2018-09-876805] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/18/2018] [Indexed: 12/13/2022] Open
Abstract
Ravulizumab, a new complement component C5 inhibitor administered every 8 weeks, was noninferior to eculizumab administered every 2 weeks in complement-inhibitor-naive patients with paroxysmal nocturnal hemoglobinuria (PNH). This study assessed noninferiority of ravulizumab to eculizumab in clinically stable PNH patients during previous eculizumab therapy. In this phase 3, open-label, multicenter study, 195 PNH patients on labeled-dose (900 mg every 2 weeks) eculizumab for >6 months were randomly assigned 1:1 to switch to ravulizumab (n = 97) or continue eculizumab (n = 98). Primary efficacy end point was percentage change in lactate dehydrogenase (LDH) from baseline to day 183. Key secondary end points included proportion of patients with breakthrough hemolysis, change in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score, transfusion avoidance, and stabilized hemoglobin. In 191 patients completing 183 days of treatment, ravulizumab was noninferior to eculizumab (P inf < .0006 for all end points), including percentage change in LDH (difference, 9.21% [95% confidence interval (CI), -0.42 to 18.84], P = .058 for superiority), breakthrough hemolysis (difference, 5.1 [95% CI, -8.89 to 18.99]), change in FACIT-Fatigue score (difference, 1.47 [95% CI, -0.21 to 3.15]), transfusion avoidance (difference, 5.5 [95% CI, -4.27 to 15.68]), and stabilized hemoglobin (difference, 1.4 [95% CI, -10.41 to 13.31]). The most frequently reported adverse event was headache (26.8%, ravulizumab; 17.3%, eculizumab). No meningococcal infections or discontinuations due to adverse events occurred. Patients with PNH may be safely and effectively switched from labeled-dose eculizumab administered every 2 weeks to ravulizumab administered every 8 weeks. This trial was funded by Alexion Pharmaceuticals, Inc., and is registered at www.clinicaltrials.gov as #NCT03056040.
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Zhang L, Fedorov Y, Adams D, Lin F. Identification of complement inhibitory activities of two chemotherapeutic agents using a high-throughput cell imaging-based screening assay. Mol Immunol 2018; 101:86-91. [PMID: 29909366 DOI: 10.1016/j.molimm.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
Excessive complement activation contributes significantly to the pathogeneses of various diseases. Currently, significant developmental research efforts aim to identify complement inhibitors with therapeutic uses have led to the approval of one inhibitor for clinical use. However, most existing complement inhibitors are based on monoclonal antibodies, which have many drawbacks such as high costs and limited administration options. With this report, we establish an inexpensive, cell imaging-based high-throughput assay for the large-scale screening of potential small molecule complement inhibitors. Using this assay, we screened a library containing 3115 bioactive chemical compounds and identified cisplatin and pyridostatin as two new complement inhibitors in addition to nafamostat mesylate, a compound with known complement inhibitory activity. We further demonstrated that cisplatin and pyridostatin inhibit C5 convertases in the classical pathway of complement activation but have no effects on the alternative pathway of complement activation. In summary, this work has established a simple, large-scale, high-throughput assay for screening novel complement inhibitors and discovered previously unknown complement activation inhibitory activities for cisplatin and pyridostatin.
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Affiliation(s)
- Lingjun Zhang
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Yuriy Fedorov
- Small Molecules Drug Development Core Facility, Office of Research Administration, Case Western Reserve University, Cleveland, OH, United States
| | - Drew Adams
- Department of Genetics, Case Western Reserve University, Cleveland, OH, United States
| | - Feng Lin
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
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