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Kaminski HJ, Sikorski P, Coronel SI, Kusner LL. Myasthenia gravis: the future is here. J Clin Invest 2024; 134:e179742. [PMID: 39105625 DOI: 10.1172/jci179742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
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.
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Affiliation(s)
| | | | | | - Linda L Kusner
- Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA
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Djordjevic I, Garai N, Peric S, Karanovic J, Pesovic J, Brkusanin M, Lavrnic D, Apostolski S, Savic-Pavicevic D, Basta I. Association between Cytotoxic T-Lymphocyte-Associated Antigen 4 (CTLA-4) Locus and Early-Onset Anti-acetylcholine Receptor-Positive Myasthenia Gravis in Serbian Patients. Mol Neurobiol 2024:10.1007/s12035-024-04183-8. [PMID: 38652350 DOI: 10.1007/s12035-024-04183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Genome-wide association studies (GWAS) have provided strong evidence that early- and late-onset MG have different genetic backgrounds. Recent in silico analysis based on GWAS results revealed rs231735 and rs231770 variants within CTLA-4 locus as possible MG causative genetic factors. We aimed to explore the association of rs231735 and rs231770 with MG in a representative cohort of Serbian patients. We conducted an age-, sex-, and ethnicity-matched case-control study. Using TaqMan allele discrimination assays, the frequency of rs231735 and rs231770 genetic variants was examined in 447 AChR-MG patients and 447 matched controls. There was no significant association of rs231735 and rs231770 with the entire MG cohort (P > 0.05). Nevertheless, when stratifying patients into early-onset (n = 183) and late-onset MG (n = 264), we found early-onset patients had a significantly lower frequency of the rs231735 allele T compared to controls (OR = 0.734, 95% CI = 0.575-0.938, p10e6 permutation < 0.05), and rs231735 genotype TT and rs231770 genotype TT had a protective effect on early-onset MG (OR = 0.548, 95% CI = 0.339-0.888, and OR = 0.563, 95% CI = 0.314-1.011, p10e6 permutation < 0.05). Consequently, we found that individuals with the rs231735-rs231770 haplotype GC had a higher risk for developing early-onset MG (OR = 1.360, P = 0.027, p10e6 permutation < 0.05). Our results suggest that CTLA-4 rs231735 and rs231770 may be risk factors only for patients with early-onset MG in Serbian population.
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Affiliation(s)
- Ivana Djordjevic
- University Clinical Center of Serbia, Neurology Clinic, 6 Dr Subotića starijeg street, Belgrade, 11129, Serbia.
| | - Nemanja Garai
- University of Belgrade, Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Stojan Peric
- University Clinical Center of Serbia, Neurology Clinic, 6 Dr Subotića starijeg street, Belgrade, 11129, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Jelena Karanovic
- University of Belgrade, Institute of Molecular Genetics and Genetic Engineering, Laboratory for Molecular Biology, Belgrade, Serbia
| | - Jovan Pesovic
- University of Belgrade, Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Milos Brkusanin
- University of Belgrade, Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Dragana Lavrnic
- University Clinical Center of Serbia, Neurology Clinic, 6 Dr Subotića starijeg street, Belgrade, 11129, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | - Dusanka Savic-Pavicevic
- University of Belgrade, Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Ivana Basta
- University Clinical Center of Serbia, Neurology Clinic, 6 Dr Subotića starijeg street, Belgrade, 11129, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
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Bao C, Tan T, Wang S, Gao C, Lu C, Yang S, Diao Y, Jiang L, Jing D, Chen L, Lv H, Fang H. A cross-disease, pleiotropy-driven approach for therapeutic target prioritization and evaluation. CELL REPORTS METHODS 2024; 4:100757. [PMID: 38631345 PMCID: PMC11046034 DOI: 10.1016/j.crmeth.2024.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/08/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
Cross-disease genome-wide association studies (GWASs) unveil pleiotropic loci, mostly situated within the non-coding genome, each of which exerts pleiotropic effects across multiple diseases. However, the challenge "W-H-W" (namely, whether, how, and in which specific diseases pleiotropy can inform clinical therapeutics) calls for effective and integrative approaches and tools. We here introduce a pleiotropy-driven approach specifically designed for therapeutic target prioritization and evaluation from cross-disease GWAS summary data, with its validity demonstrated through applications to two systems of disorders (neuropsychiatric and inflammatory). We illustrate its improved performance in recovering clinical proof-of-concept therapeutic targets. Importantly, it identifies specific diseases where pleiotropy informs clinical therapeutics. Furthermore, we illustrate its versatility in accomplishing advanced tasks, including pathway crosstalk identification and downstream crosstalk-based analyses. To conclude, our integrated solution helps bridge the gap between pleiotropy studies and therapeutics discovery.
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Affiliation(s)
- Chaohui Bao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tingting Tan
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shan Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chenxu Gao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chang Lu
- MRC London Institute of Medical Sciences, Imperial College London, W12 0HS London, UK
| | - Siyue Yang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Faculty of Medical Laboratory Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yizhu Diao
- College of Finance and Statistics, Hunan University, Changsha, Hunan 410079, China
| | - Lulu Jiang
- Translational Health Sciences, University of Bristol, BS1 3NY Bristol, UK
| | - Duohui Jing
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Liye Chen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, OX3 7LD Oxford, UK.
| | - Haitao Lv
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; School of Chinese Medicine, State Key Laboratory of Environmental and Biological Analysis, Hong Kong Chinese Medicine Phenome Research Center, Hong Kong Baptist University, Hong Kong 999077, China.
| | - Hai Fang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Sun C, Ren Z, Miao X, Zheng Y, Zhang J, Qi X, Liu J, Qiu F. Clinical characteristics of late-onset myasthenia gravis. Heliyon 2024; 10:e28893. [PMID: 38596135 PMCID: PMC11002262 DOI: 10.1016/j.heliyon.2024.e28893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Late-onset myasthenia gravis (LOMG) often has comorbidities, and its initial symptoms may be ignored or misdiagnosed as other diseases. There were few large surveys on LOMG. Our study aimed to summarize clinical characteristics of LOMG to improve the rate of correct MG diagnosis. Methods A retrospective cohort study included 240 LOMG patients with onset age ≥65 years old who were treated at PLA General Hospital from January 1, 2003 to January 1, 2023. Results The male to female ratio was 1:1.2 (P = 0.699). MGFA clinical classification: Class I 31.3%, Class IIa 12.9%, Class IIb 51.3%, Class IIIa 0.8%, Class IIIb 0.8%, Class IV 0.4%, Class V2.5%. The onset symptom was ptosis in 78.8% and diplopia was in 18.8%. Swallowing dysfunction in the stage of LOMG was in 41.7%. The incidence of thymoma in LOMG was 14.2%. 85.4% of patients antibodies against the muscle acetylcholine receptor (AChR) are detected. The overall incidence of supramaximal repetitive nerve stimulation (Jolly test) was 57.1%, among which the highest positive rate (50.7%) was in the facial nerve. Jolly test of Class IIb was tested in the highest positive rate and Class I was in the lowest one (χ2 = 7.023, P = 0.030). Conclusion There was no significant difference in the incidence of LOMG between males and females. The clinical manifestations were mainly Class I and Class II, and severe MG was rare. The most common onset symptom was ptosis. The incidence of LOMG with thymoma was low. Supramaximal repetitive nerve stimulation (Jolly test) of the facial nerve was the easiest to detect and Jolly test of Class IIb was tested in the highest positive rate and Class I was in the lowest one.
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Affiliation(s)
- Chenjing Sun
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhuangzhuang Ren
- Navy Clinical College, the Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| | - Xiuling Miao
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yanxu Zheng
- Xiangya School of Medicine, Central South University, 87 Xiangya Road, Changsha, Hunan 410000, China
| | - Jun Zhang
- The Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Xiaokun Qi
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jianguo Liu
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Feng Qiu
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
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Bouchtout MN, Meçabih F, Boukadir C, Attal E, Daoudi S, Benkortbi H, Touil-Boukoffa C, Raache R, Attal N. Cytokines Single Nucleotide Polymorphisms (SNPs) Association With Myasthenia Gravis (MG) In Algerian Patients: A Case-Control Study On A Small Group. J Clin Neuromuscul Dis 2023; 25:18-26. [PMID: 37611266 DOI: 10.1097/cnd.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
ABSTRACT Myasthenia gravis (MG) is an autoimmune disease of multifactorial etiology in which genetic factors and cytokines seem to play an important role. The aim of this study was to investigate potential associations of cytokines single nucleotide polymorphisms (SNPs) and MG in Algerian patients. We performed a case-control study that included 27 patients and 74 healthy subjects. Cytokines SNPs genotyping was performed by the polymerase chain reaction sequence-specific primers (PCR-SSP) method. Our results showed that the TNF-α -308G/A (P < 0.005) and TGF-β1 +869T/T (P < 0.05) genotypes were more frequent among patients with MG compared with healthy individuals, whereas TNF-α -308G/G (P < 0.0001), TGF-β1 +869T/C (P < 0.05), and IFN-γ +874A/A (P < 0.05) were less frequent. Our results also showed that IL-10 and IL-6 SNPs did not show any significant difference in distribution between MG patients and healthy individuals. Our observations support the hypothesis that implicates genetic variants of certain cytokines in MG. However, ours results should be replicated with a larger sample size. In addition, the precise underlying processes remain to be clarified. HIGHLIGHTS TNF-α -308G/A and TGF-β1 +869T/C genotypes predispose to MG.IFN-γ +874A/A genotype protects against MG.IL-6 -174C/G SNP is not associated with MG.
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Affiliation(s)
- Mohamed Nadji Bouchtout
- Laboratory of Cellular and Molecular Biology, Cytokine and NO Synthase Team, University of Science and Technology Houari Boumediene (USTHB), Algiers, Algeria
| | - Fethi Meçabih
- Immunology Department, Pasteur Institute of Algeria, Algiers, Algeria
| | - Chahrazad Boukadir
- Neurology department, Sidi Belloua Unit, University Hospital Center of Tizi Ouzou, Tizi Ouzou, Algeria
| | - Elias Attal
- Male unit of neurology, Ait Idir neurosurgery hospital, Algiers, Algeria
| | - Smail Daoudi
- Neurology department, Sidi Belloua Unit, University Hospital Center of Tizi Ouzou, Tizi Ouzou, Algeria
| | - Halla Benkortbi
- Immunology Department, Pasteur Institute of Algeria, Algiers, Algeria
| | - Chafia Touil-Boukoffa
- Laboratory of Cellular and Molecular Biology, Cytokine and NO Synthase Team, University of Science and Technology Houari Boumediene (USTHB), Algiers, Algeria
| | - Rachida Raache
- Laboratory of Cellular and Molecular Biology, Cytokine and NO Synthase Team, University of Science and Technology Houari Boumediene (USTHB), Algiers, Algeria
| | - Nabila Attal
- Immunology Department, Pasteur Institute of Algeria, Algiers, Algeria
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Álvarez-Velasco R, Dols-Icardo O, El Bounasri S, López-Vilaró L, Trujillo JC, Reyes-Leiva D, Suárez-Calvet X, Cortés-Vicente E, Illa I, Gallardo E. Reduced Number of Thymoma CTLA4-Positive Cells Is Associated With a Higher Probability of Developing Myasthenia Gravis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/2/e200085. [PMID: 36697230 PMCID: PMC9879278 DOI: 10.1212/nxi.0000000000200085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) is an autoimmune disease associated with comorbid thymoma in 10%-15% of cases. Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) expressed by T cells downregulates T-cell-mediated immune response. Polymorphisms in the CTLA4 gene have been associated with the development of MG. In this context, we aimed to determine whether CTLA4 expression in the thymoma differs between patients with and without MG and whether CTLA4 gene polymorphisms are associated with these differences. METHODS This is a retrospective study of all patients, with and without MG, surgically treated at our institution for thymoma between January 2010 and December 2020. Ten samples were obtained from normal thymuses as controls. The number of CTLA4-positive cells in paraffin-embedded thymoma samples was determined by immunohistochemistry. The presence of follicular-center and regulatory T-cell lymphocytes was determined by immunohistochemistry (B-cell lymphoma [BCL]-6 expression) and double immunofluorescence-based staining of CD4-FOXP3, respectively. We evaluated the association between thymic expression of CTLA4 and the development of MG. We also determined the association between CTLA4 expression and various clinical and prognostic characteristics of MG. We sequenced the CTLA4 gene and evaluated possible associations between CTLA4 polymorphisms and thymic CTLA4 expression. Finally, we assessed the potential association between these polymorphisms and the risk of MG. RESULTS Forty-one patients with thymoma were included. Of them, 23 had comorbid MG (56.1%). On average, patients with MG had fewer CTLA4-positive cells in the thymoma than non-MG patients: 69.3 cells/mm2 (95% CIs: 39.6-99.1) vs 674.4 (276.0-1,024.0) cells/mm2; p = 0.001 and vs controls (200.74 [57.9-343.6] cells/mm2; p = 0.02). No between-group differences (MG vs non-MG) were observed in the number of cells positive for BCL6 or CD4-FOXP3. CTLA4 expression was not associated with differences in MG outcome or treatment refractoriness. Two polymorphisms were detected in the CTLA4 gene, rs231770 (n = 30 patients) and rs231775 (n = 17). MG was present in a similar proportion of patients for all genotypes. However, a nonsignificant trend toward a lower CTLA4-positive cell count was observed among carriers of the rs231775 polymorphism vs noncarriers: 77.9 cells/mm2 (95% CI: -51.5 to 207.5) vs 343.3 cells/mm2 (95% CI: 126.2-560.4). DISCUSSION Reduced CTLA4 expression in thymoma may predispose to a higher risk of developing MG.
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Affiliation(s)
- Rodrigo Álvarez-Velasco
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Oriol Dols-Icardo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Shaima El Bounasri
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Laura López-Vilaró
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Juan Carlos Trujillo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - David Reyes-Leiva
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Xavier Suárez-Calvet
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Elena Cortés-Vicente
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Isabel Illa
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid
| | - Eduard Gallardo
- From the Neuromuscular Diseases Unit (R.Á.-V., D.R.-L., E.C.-V., I.I.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona; Department of Medicine (R.Á.-V., D.R.-L.), Universitat Autónoma de Barcelona; Memory Unit (O.D.-I., S.E.B.), Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) (O.D.-I., S.E.B.), Madrid; Departments of Pathology (L.L.-V.) and Thoracic Surgery (J.C.T.), Hospital de la Santa Creu i Sant Pau, Barcelona; Neuromuscular Diseases Group (X.S.-C., E.G.), Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (E.G.), Instituto de Salud Carlos III, Madrid.
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7
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Abstract
PURPOSE OF REVIEW This review summarizes recent insights into the immunopathogenesis of autoimmune myasthenia gravis (MG). Mechanistic understanding is presented according to MG disease subtypes and by leveraging the knowledge gained through the use of immunomodulating biological therapeutics. RECENT FINDINGS The past two years of research on MG have led to a more accurate definition of the mechanisms through which muscle-specific tyrosine kinase (MuSK) autoantibodies induce pathology. Novel insights have also emerged from the collection of stronger evidence on the pathogenic capacity of low-density lipoprotein receptor-related protein 4 autoantibodies. Clinical observations have revealed a new MG phenotype triggered by cancer immunotherapy, but the underlying immunobiology remains undetermined. From a therapeutic perspective, MG patients can now benefit from a wider spectrum of treatment options. Such therapies have uncovered profound differences in clinical responses between and within the acetylcholine receptor and MuSK MG subtypes. Diverse mechanisms of immunopathology between the two subtypes, as well as qualitative nuances in the autoantibody repertoire of each patient, likely underpin the variability in therapeutic outcomes. Although predictive biomarkers of clinical response are lacking, these observations have ignited the development of assays that might assist clinicians in the choice of specific therapeutic strategies. SUMMARY Recent advances in the understanding of autoantibody functionalities are bringing neuroimmunologists closer to a more detailed appreciation of the mechanisms that govern MG pathology. Future investigations on the immunological heterogeneity among MG patients will be key to developing effective, individually tailored therapies.
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Affiliation(s)
- Gianvito Masi
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511 USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511 USA
| | - Kevin C. O’Connor
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511 USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511 USA
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8
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Huan X, Zhao R, Song J, Zhong H, Su M, Yan C, Wang Y, Chen S, Zhou Z, Lu J, Xi J, Luo S, Zhao C. Increased serum IL-2, IL-4, IL-5 and IL-12p70 levels in AChR subtype generalized myasthenia gravis. BMC Immunol 2022; 23:26. [PMID: 35624411 PMCID: PMC9145157 DOI: 10.1186/s12865-022-00501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions. Cytokines play important roles in facilitating the immune response and augmenting the pathogenic antibody production. The current study aims to sensitively characterize the serum levels of cytokines with very low concentration in generalized MG (gMG). Methods Using ultrasensitive single-molecule arrays (SIMOA), we measured serum IL-2, IL-4, IL-5 and IL-12p70 in 228 participants including 152 immunotherapy-naïve anti-acetylcholine receptor (AChR) subtype gMG from Huashan MG registry and 76 age-matched healthy controls. Subgroup analysis was then performed by stratifying patients according to the onset ages, MGFA classification, disease duration at baseline. Results Serum IL-2, IL-4, IL-5 and IL-12p70 levels were significantly elevated in gMG compared to controls (0.179 pg/mL versus 0.011 pg/mL, P < 0.0001; 0.029 pg/mL versus 0.018 pg/mL, P = 0.0259; 0.215 pg/mL versus 0.143 pg/mL, P = 0.0007; 0.132 pg/mL versus 0.118 pg/mL, P = 0.0401). Subgroup analysis revealed that IL-2 levels were slightly elevated in gMG with MGFA II compared to MGFA III/IV (0.195 pg/mL versus 0.160 pg/mL, P = 0.022), as well as elevated levels of IL-2 (0.220 pg/mL versus 0.159 pg/mL, P = 0.0002) and IL-5 (0.251 pg/mL versus 0.181 pg/mL, P = 0.004) in late-onset gMG compared with the early-onset gMG. gMG patients with a long duration had a significant increased serum IL-12p70 than those with a short duration (0.163 pg/mL versus 0.120 pg/mL, P = 0.011). Conclusion Serum IL-2, IL-4, IL-5 and IL-12p70 levels were increased in AChR subtype gMG using ultrasensitive measurement. Serum cytokines with very low concentrations may provide as potential biomarkers in stratifying gMG patients in future prospective cohort studies.
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Affiliation(s)
- Xiao Huan
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Rui Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Jie Song
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Huahua Zhong
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Manqiqige Su
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Chong Yan
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Ying Wang
- Department of Pharmacy, Huashan Hospital Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahong Lu
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Jianying Xi
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.,National Center for Neurological Disorders, Shanghai, China
| | - Sushan Luo
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China. .,National Center for Neurological Disorders, Shanghai, China.
| | - Chongbo Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China. .,National Center for Neurological Disorders, Shanghai, China.
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9
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Vakrakou A, Chatzistamatiou T, Koros C, Karathanasis D, Tentolouris-Piperas V, Tzanetakos D, Stathopoulos P, Koutsis G, Spyropoulou-Vlachou M, Evangelopoulos ME, Stefanis L, Stavropoulos-Giokas C, Anagnostouli M. HLA-genotyping by Next-Generation-Sequencing reveals shared and unique HLA alleles in two patients with coexisting neuromyelitis optica spectrum disorder and thymectomized myasthenia gravis: immunological implications for mutual aetiopathogenesis? Mult Scler Relat Disord 2022; 63:103858. [DOI: 10.1016/j.msard.2022.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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10
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Vanoli F, Mantegazza R. Antibody Therapies in Autoimmune Neuromuscular Junction Disorders: Approach to Myasthenic Crisis and Chronic Management. Neurotherapeutics 2022; 19:897-910. [PMID: 35165857 PMCID: PMC9294078 DOI: 10.1007/s13311-022-01181-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 02/06/2023] Open
Abstract
Myasthenia gravis (MG) is a neurological autoimmune disorder characterized by muscle weakness and fatigue. It is a B cell-mediated disease caused by pathogenic antibodies directed against various components of the neuromuscular junction (NMJ). Despite the wide range of adverse effects, current treatment is still based on non-specific immunosuppression, particularly on long-term steroid usage. The increasing knowledge regarding the pathogenic mechanisms of MG has however allowed to create more target-specific therapies. A very attractive therapeutic approach is currently offered by monoclonal antibodies (mAbs), given their ability to specifically and effectively target different immunopathological pathways, such as the complement cascade, B cell-related cluster of differentiation (CD) proteins, and the human neonatal Fc receptor (FcRn). Up to now, eculizumab, a C5-directed mAb, has been approved for the treatment of generalized MG (gMG) and efgartigimod, a FcRn inhibitor, has just been approved by the U.S. Food and Drug Administration for the treatment of anti-acetylcholine receptor (AChR) antibody positive gMG. Other mAbs are currently under investigation with encouraging preliminary results, further enriching the new range of therapeutic possibilities for MG. This review article provides an overview of the present status of mAb-based therapies for MG, which offer an exciting promise for better outcomes by setting the basis of a precision medicine approach.
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Affiliation(s)
- Fiammetta Vanoli
- Neuroimmunology and Neuromuscular Disease Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Disease Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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11
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Fang H, Knight JC. Priority index: database of genetic targets in immune-mediated disease. Nucleic Acids Res 2022; 50:D1358-D1367. [PMID: 34751399 PMCID: PMC8728240 DOI: 10.1093/nar/gkab994] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022] Open
Abstract
We describe a comprehensive and unique database 'Priority index' (Pi; http://pi.well.ox.ac.uk) of prioritized genes encoding potential therapeutic targets that encompasses all major immune-mediated diseases. We provide targets at the gene level, each receiving a 5-star rating supported by: genomic evidence arising from disease genome-wide associations and functional immunogenomics, annotation evidence using ontologies restricted to genes with genomic evidence, and network evidence from protein interactions. Target genes often act together in related molecular pathways. The underlying Pi approach is unique in identifying a network of highly rated genes that mediate pathway crosstalk. In the Pi website, disease-centric pages are specially designed to enable the users to browse a complete list of prioritized genes and also a manageable list of nodal genes at the pathway crosstalk level; both switchable by clicks. Moreover, target genes are cross-referenced and supported using additional information, particularly regarding tractability, including druggable pockets viewed in 3D within protein structures. Target genes highly rated across diseases suggest drug repurposing opportunity, while genes in a particular disease reveal disease-specific targeting potential. To facilitate the ease of such utility, cross-disease comparisons involving multiple diseases are also supported. This facility, together with the faceted search, enhances integrative mining of the Pi resource to accelerate early-stage therapeutic target identification and validation leveraging human genetics.
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Affiliation(s)
- Hai Fang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Julian C Knight
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
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12
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Zhong H, Jiao K, Huan X, Zhao R, Su M, Goh LY, Zheng X, Zhou Z, Luo S, Zhao C. Herpesvirus entry mediator on T cells as a protective factor for myasthenia gravis: A Mendelian randomization study. Front Immunol 2022; 13:931821. [PMID: 35979348 PMCID: PMC9376372 DOI: 10.3389/fimmu.2022.931821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Myasthenia gravis (MG) is a T cell-driven, autoantibody-mediated disorder affecting transmission in neuromuscular junctions. The associations between the peripheral T cells and MG have been extensively studied. However, they are mainly of observational nature, thus limiting our understanding of the effect of inflammatory biomarkers on MG risk. With large data sets now available, we used Mendelian randomization (MR) analysis to investigate whether the biomarkers on T cells are causally associated with MG and further validate the relationships. Methods We performed a two-sample MR analysis using genetic data from one genome-wide association study (GWAS) for 210 extensive T-cell traits in 3,757 general population individuals and the largest GWAS for MG currently available (1,873 patients versus 36,370 age/gender-matched controls) from US and Italy. Then the biomarkers of interest were validated separately in two GWASs for MG in FIN biobank (232 patients versus 217,056 controls) and UK biobank (152 patients versus 386,631 controls). Results In the first analysis, three T-cell traits were identified to be causally protective for MG risk: 1) CD8 on terminally differentiated CD8+ T cells (OR [95% CI] = 0.71 [0.59, 0.86], P = 5.62e-04, adjusted P =2.81e-02); 2) CD4+ regulatory T proportion in T cells (OR [95% CI] = 0.44 [0.26, 0.72], P = 1.30e-03, adjusted P =2.81e-02); 3) HVEM expression on total T cells (OR [95% CI] = 0.67 [0.52, 0.86], P = 1.61e-03, adjusted P =2.81e-02) and other eight T-cell subtypes (e.g., naïve CD4+ T cells). In particular, HVEM is a novel immune checkpoint on T cells that has never been linked to MG before. The SNPs on the TNFRSF14 per se further support a more direct link between the HVEM and MG. The validation analysis replicated these results in both FIN and UK biobanks. Both datasets showed a concordant protective trend supporting the findings, albeit not significant. Conclusion This study highlighted the role of HVEM on T cells as a novel molecular-modified factor for MG risk and validated the causality between T cells and MG. These findings may advance our understanding of MG's immunopathology and facilitate the future development of predictive disease-relevant biomarkers.
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Affiliation(s)
- Huahua Zhong
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Kexin Jiao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Xiao Huan
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Rui Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Manqiqige Su
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Li-Ying Goh
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Sushan Luo
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Chongbo Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
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