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Nelke C, Schroeter CB, Barman S, Stascheit F, Masanneck L, Theissen L, Huntemann N, Walli S, Cengiz D, Dobelmann V, Vogelsang A, Pawlitzki M, Räuber S, Konen FF, Skripuletz T, Hartung HP, König S, Roos A, Meisel A, Meuth SG, Ruck T. Identification of disease phenotypes in acetylcholine receptor-antibody myasthenia gravis using proteomics-based consensus clustering. EBioMedicine 2024; 105:105231. [PMID: 38959848 PMCID: PMC11269806 DOI: 10.1016/j.ebiom.2024.105231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The clinical heterogeneity of myasthenia gravis (MG), an autoimmune disease defined by antibodies (Ab) directed against the postsynaptic membrane, constitutes a challenge for patient stratification and treatment decision making. Novel strategies are needed to classify patients based on their biological phenotypes aiming to improve patient selection and treatment outcomes. METHODS For this purpose, we assessed the serum proteome of a cohort of 140 patients with anti-acetylcholine receptor-Ab-positive MG and utilised consensus clustering as an unsupervised tool to assign patients to biological profiles. For in-depth analysis, we used immunogenomic sequencing to study the B cell repertoire of a subgroup of patients and an in vitro assay using primary human muscle cells to interrogate serum-induced complement formation. FINDINGS This strategy identified four distinct patient phenotypes based on their proteomic patterns in their serum. Notably, one patient phenotype, here named PS3, was characterised by high disease severity and complement activation as defining features. Assessing a subgroup of patients, hyperexpanded antibody clones were present in the B cell repertoire of the PS3 group and effectively activated complement as compared to other patients. In line with their disease phenotype, PS3 patients were more likely to benefit from complement-inhibiting therapies. These findings were validated in a prospective cohort of 18 patients using a cell-based assay. INTERPRETATION Collectively, this study suggests proteomics-based clustering as a gateway to assign patients to a biological signature likely to benefit from complement inhibition and provides a stratification strategy for clinical practice. FUNDING CN and CBS were supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf. CN was supported by the Else Kröner-Fresenius-Stiftung (EKEA.38). CBS was supported by the Deutsche Forschungsgemeinschaft (DFG-German Research Foundation) with a Walter Benjamin fellowship (project 539363086). The project was supported by the Ministry of Culture and Science of North Rhine-Westphalia (MODS, "Profilbildung 2020" [grant no. PROFILNRW-2020-107-A]).
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Affiliation(s)
- Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Sumanta Barman
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Frauke Stascheit
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Masanneck
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Lukas Theissen
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Sara Walli
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Derya Cengiz
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Vera Dobelmann
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Anna Vogelsang
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Saskia Räuber
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Felix F Konen
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany; Brain and Mind Center, University of Sydney, Sydney NSW, Australia; Department of Neurology, Palacky University Olomouc, Olomouc, Czech Republic
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Münster, Germany
| | - Andreas Roos
- Department of Neuropaediatrics, Neuromuscular Centre, Universitätsmedizin Essen, Essen, Germany
| | - Andreas Meisel
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
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Petersson M, Feresiadou A, Jons D, Ilinca A, Lundin F, Johansson R, Budzianowska A, Roos AK, Kågström V, Gunnarsson M, Sundström P, Piehl F, Brauner S. Patient-Reported Symptom Severity in a Nationwide Myasthenia Gravis Cohort: Cross-sectional Analysis of the Swedish GEMG Study. Neurology 2021; 97:e1382-e1391. [PMID: 34376512 PMCID: PMC8520390 DOI: 10.1212/wnl.0000000000012604] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe myasthenia gravis activities of daily living (MG-ADL) in relation to clinical characteristics in a large Swedish nationwide cohort. METHODS In a cross-sectional prevalence cohort study, the Genes and Environment in Myasthenia Gravis study, performed from November 2018 through August 2019, patients with myasthenia gravis (MG) were invited to submit an extensive 106-item life environment questionnaire, including the MG-ADL score. Patients were classified into early-onset MG (EOMG, <50 years), late-onset MG (LOMG, ≥50 years), or thymoma-associated MG (TAMG). Comparisons of disease-specific characteristics were made between subgroups, sexes, and different MG-ADL scores. RESULTS A total of 1,077 patients were included, yielding a 74% response rate: 505 (47%) were classified as EOMG, 520 (48%) LOMG, and 45 (4%) TAMG. Mean age at inclusion was 64.3 years (SD 15.7) and mean disease duration was 14.6 years (SD 14.0). Complete MG-ADL scores (n = 1,035) ranged from 0p to 18p, where 26% reported a score of 0p. Higher MG-ADL scores were associated with female sex, obesity, and diagnostic delay (odds ratio [OR] 1.62, 1.72, and 1.69; p adj = 0.017, 0.013, and 0.008) and inversely correlated with high educational attainment (OR 0.59; p adj = 0.02), but not with age at inclusion, disease subtype, or disease duration. Almost half of the population (47%) reported MG-ADL ≥3p, corresponding to an unsatisfactory symptom state. DISCUSSION In this nationwide study, comprising more than 40% of the prevalent MG population in Sweden, almost half of the patients reported current disease symptoms associated with an unsatisfactory symptom state, indicating the need for improved treatment options.
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Affiliation(s)
- Malin Petersson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Amalia Feresiadou
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Jons
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Andreea Ilinca
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Lundin
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Rune Johansson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna Budzianowska
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Roos
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Kågström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Martin Gunnarsson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Peter Sundström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Brauner
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden.
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