Microenvironment of thymic myoid cells in myasthenia gravis

Thymic expression of the main immunogenic region of titin in thymomatous myasthenia gravis

Antititin antibody occurs in the serum of myasthenia gravis (MG) patients with thymoma (MGT), and is a diagnostic marker for the disease. The mechanism that triggers MGT development is, however, unclear. This study evaluated the role of the main immunogenic region (MIR) of titin in MGT pathogenesis. Titin MIR antiserum (antibody titre 1:16) was obtained and an in situ immunohistochemical study of thymomatous tissue samples was performed. Strong immunostaining for titin MIR was observed on epithelial cell membranes in MGT patients, and the degree of immunostaining was directly proportional to the number of epithelial cells in thymomatous tissue. Serum antititin antibody levels were closely related to titin MIR levels in thymoma cells; however, titin MIR levels did not appear to be related to MG severity. Antititin antibody may be a good surrogate marker for thymoma but is probably not involved in the pathogenesis of MGT.

Granzyme B: evidence for a role in the origin of myasthenia gravis

PURPOSE OF RESEARCH

Although the pathogenesis of myasthenia gravis (MG) as an antibody mediated disorder of acetylcholine receptors (AChRs) at neuromuscular junctions is well understood, the origin of the autoimmune response is unclear. The thymus is intimately involved in initiation of the autoimmune response; the antigen, AChR, is present in the thymus, but how the autoimmune response is triggered is not known. Granzyme B (GrB), a proteolytic enzyme present in cytolytic T cells and natural killer (NK) cells, selectively cleaves many potential autoantigens (but few non-autoantigens), generating novel fragments that trigger autoreactive responses. This protease has been strongly implicated in the pathogenesis of several autoimmune diseases including lupus, rheumatoid arthritis, dermatomyositis, and others. In the studies described in this manuscript, we examined the ability of GrB to cleave the AChR subunits, and performed biochemical, immunohistochemical and molecular studies on thymus glands from myasthenic patients and controls to assess GrB expression.

MAIN RESULTS

GrB efficiently and specifically cleaves subunits of AChR, especially the epsilon subunit. GrB is present in thymus glands from myasthenia patients, but is absent in control thymuses.

CONCLUSIONS

Our results provide evidence supporting a potential role for GrB in the process of initiation of MG, and are consistent with the concept of an immunodominant epsilon epitope.

Reflections on the "intrathymic pathogenesis" of myasthenia gravis

The beneficial effects of thymectomy argue for a causal role of the thymus in myasthenia gravis (MG). The MG thymus contains acetylcholine receptor (AChR), which is expressed by myoid cells (whole AChR), and by medullary thymic epithelial cells (AChR subunits). The myoid cells are closely associated with antigen-presenting dendritic cells, helper T cells, and antibody-producing B cells in lymphoid follicles ("lymphofollicular hyperplasia"). Thus, all the cellular components required to initiate and maintain an autoimmune response to AChR are present in the MG thymus. It is unlikely that the cellular alterations in the thymus are secondary to an ongoing peripheral immune response, because they are absent in experimental autoimmune myasthenia gravis.

The cardiac isoform of α-actin in regenerating and atrophic skeletal muscle, myopathies and rhabdomyomatous tumors: an immunohistochemical study using monoclonal antibodies

The two sarcomeric isoforms of actins, cardiac and skeletal muscle alpha-actin, are highly homologous so that their immunohistochemical distinction is extremely difficult. Taking advantage of monoclonal antibodies distinguishing the two conservative amino acid exchanges near the aminoterminus, we have performed an extended immunohistochemical analysis of the cardiac alpha-actin (CAA) isoform in normal, regenerating, diseased and neoplastic human muscle tissues. Intense and uniform CAA staining is seen in fetal and adult myocardium and in fetal skeletal muscle while adult skeletal muscle is essentially negative, except for muscle spindle myocytes and a few scattered muscle fibres with overall reduced diameter. By contrast, CAA synthesis is markedly induced in regenerating skeletal muscle cells, in Duchenne muscular dystrophy and upon degenerative atrophy. CAA has also been detected in certain vascular and visceral smooth muscle cells. Among tumors, CAA has consistently been seen in rhabdomyosarcomas and rhabdomyomatous cells of nephroblastomas, whereas, smooth muscle tumors have shown only occasional staining. While the synthesis of this actin isoform is less restricted than previously thought, monoclonal antibodies against CAA provide a well-defined, reliable and sensitive diagnostic tool for the definition and detection of aberrant differentiation in diseased skeletal muscle and of striated muscle differentiation in rhabdomyosarcomas.

Thymic myoid cells as a myasthenogenic antigen and antigen-presenting cells

We investigated immune property of a myoid cell line, established from Fisher rat thymus. Immunization of syngeneic rats with the myoid cells induced anti-rat acetylcholine receptor (AChR). Implantation of them into the thymus failed to induce typical thymic pathology of human myasthenia gravis (MG) or anti-AChR responses. We also demonstrated that the myoid cells were able to present exogenous antigens to T cells and induce antigen-specific T cell proliferation. These results suggest that myoid cells have the potential antigenicity to induce anti-AChR and the functions of antigen-presenting cells, but their expansion in the thymus may not directly cause MG.

Determinação imunohistoquímica da presença de células mióides em pacientes submetidos à timectomia

OBJETIVO: Detectar e quantificar células mióides em timos de pacientes com miastenia grave, estabelecendo possível correlação entre a quantidade de células mióides com variáveis demográficas e clínico-patológicas. MÉTODO: Foram analisados por meio de método imuno-histoquímico com anticorpo antidesmina (clone D33; marca Dako), timos de 22 pacientes (16 mulheres e seis homens, entre 12 e 61 anos) submetidos à timectomia, entre 1981 e 1995, no Serviço de Cirurgia Torácica do Hospital Heliópolis como parte do tratamento de miastenia grave. RESULTADOS: As maiores médias de células mióides foram encontrados em timos dos pacientes da raça negra (29,4:17,8), do sexo feminino (23,2:13,0) e com faixa etária entre 60 e 80 anos (média de 33,0). Pela classificação clínica da Fundação de Miastenia Grave da América (MGFA), a maior média de células mióides (26,7) encontra-se na classe IIIa, sendo do tipo histológico de hiperplasia verdadeira (média 42,0). As células mióides foram identificadas em 11 timos com hiperplasia linfóide, três hiperplasias verdadeiras e em quatro timos normais. Os timomas malignos (três) e um timo normal não apresentaram células mióides. CONCLUSÕES: As células mióides podem ser identificadas e quantificadas pelo método imuno-histoquímico com anticorpo antidesmina, porém não existe correlação entre a quantidade de células mióides e as variáveis demográficas, clínico-patológicas. Elas não foram identificadas no timoma fusocelular.

Immunoreactive POMC-derived peptides and cytokines in the chicken thymus and bursa of Fabricius microenvironments: age-related changes

Changes from hatching to the involutive stage in the thymus and bursa of Fabricius of Gallus domesticus were studied. Pro-opiomelanocortin (POMC)-derived peptides and cytokines were also tested by immunocytochemical procedures. Thymic histological modifications appeared at 3 months and involved an increase in connectival argyrophilic reticular fibres, a proliferation of non-epithelial cells in the reticulum network, the presence of mucous cells and small mucous cysts, and an increase in the number of eosinophilic and myoid cells. A clear distinction between the cortex and the medulla was lost. Immunoreactive POMC-related molecules and cytokines were demonstrated in thymic cells from 4-day-old chicken, and their number increased with ageing. These molecules were expressed in a few single epithelial cells and in interdigitating cells. With ageing, the number of immunoreactive interdigitating cells also increased, and these appeared in an activated phase. Histological modifications in the bursa of Fabricius appeared at 2 months and concerned a folding of the interfollicular surface epithelium covering the bursal plicae and a reduction in lymphoid follicle-associated epithelium. Fibrous tissue gradually increased, and large mucoid cysts were evident. The expression of POMC-derived peptide-and cytokine-like molecules differed during the development and involution phases of the organ. Cells of follicle associated epithelium and dendritic reticular cells of lymphoid follicles were immunoreactive to beta-endorphin between 4 days and 2 months, while ACTH-, alpha-MSH- and cytokine-like molecules were observed in follicles after 2 months. The findings indicate a physiological role of these molecules during the growth and involution of the two organs.

Do self-perpetuating B lymphocytes drive human autoimmune disease?

Normal immunological memory is thought to be underpinned by T lymphocytes. However, in rheumatoid arthritis there are indications that T-lymphocyte control has been subverted by self-perpetuating B lymphocytes. Potential mechanisms in other autoimmune states are less clear, but a number of observations suggest that misappropriation of immunological memory by B lymphocytes may be a common feature of human autoantibody-associated disease. Put simply, autoantibodies drive their own production. If so, the availability of safe B-lymphocyte-depleting agents provides a potential means for reversal of autoimmunity.

TCR-Vbeta usage in the thymus and blood of myasthenia gravis patients

In myasthenia gravis (MG) the muscle acetylcholine receptor (AChR) is the target of an autoimmune response. The anti-AChR response may originate in the thymus, which is abnormal in most MG patients and contains anti-AChR T and B cells. Microbial superantigens (sAg) may trigger autoimmune responses and in this study we sought clues as to whether sAg play a role in the pathogenesis of MG. We investigated the frequency of use of the different TCR Vbeta families by the thymus and blood T cells in MG patients and in control subjects, using a multi-primer PCR assay. Identical TCR-Vbeta usage was found in the thymi of MG patients and controls, except Vbeta2, which showed a small increase in MG patients' thymi. Blood T cells of MG patients used Vbeta4, Vbeta6, Vbeta15, Vbeta16 and Vbeta24 significantly more than those of the controls. Vbeta4 and Vbeta6 are the gene families most frequently used by anti-AChR CD4(+) cells in MG patients. Blood T cells from MG patients used Vbeta12, Vbeta14, Vbeta17 and Vbeta18 significantly less than controls. MG patients used Vbeta4 and Vbeta6 significantly more in the blood than in the thymus, while the opposite occurred for Vbeta7, Vbeta12 and Vbeta14. Controls used Vbeta17 more and Vbeta24 less in the blood than in the thymus. The preferential expansion of Vbeta4 and Vbeta6 in MG patients might reflect the immunodominance of certain AChR epitopes, or the action of a sAg outside the thymus. The minimal differences in the TCR-Vbeta usage in the blood and thymus of control subjects might be due to expansion of T cell clones specific for common antigens. Identical Vbeta usage in the thymi of MG patients and controls does not support an important role of the thymus as the location of anti-AChR sensitization when MG is clinically evident. The differences observed in the Vbeta usage in blood and thymi of MG patients are likely to be due to preferential Vbeta usage by the anti-AChR T cells in the blood.

The effect of thymectomy on autoreactive T- and B-lymphocytes in myasthenia gravis

Eleven patients with myasthenia gravis were followed for three years after thymectomy. Acetylcholine receptor-specific T-cell stimulation was found in 8/11 patients before operation as compared to 2/11 three years after thymectomy. Changes of T-cell antireceptor-reactivity were commonly paralleled by changes in disease severity. The numbers of cells secreting IL-2 upon stimulation with human acetylcholine receptor correlated with those secreting IFN-gamma. T-cell reactivity against a monoclonal acetylcholine receptor antibody did not decrease after thymectomy. Such reactivity could reflect a beneficial immune response counteracting anti-receptor reactivity. The frequency of autoantibody-secreting cells remained unchanged, while the serum concentration of acetylcholine receptor antibodies started to decrease one year after thymectomy. All examined thymus-cell suspensions contained autoreactive T- and B-lymphocytes. There was a preferential enrichment of autoreactive lymphocytes in the thymus in a few patients with recent onset of disease.

Exacerbation of myasthenia gravis after removal of thymomas

It appeared from this prospective and non-randomized study, that the removal of thymomas in myasthenia gravis (MG) patients resulted in rapid exacerbation of the clinical severity of the disease and of anti-acetylcholine receptor antibodies titres, which peaked after about 300 days and continued for up to 2 years. Long-term follow-up after thymomectomy (mean duration +/- SEM after surgery 5.5 +/- 0.8 years) showed that the immunological and clinical state observed prior to surgery was eventually restored, but long-term benefit attributable to surgery could not be demonstrated. Non-thymoma MG cases, however, exhibited post-operative amelioration in clinical course and decreasing antibodies titres, both of which were already significant one year after surgery, and additional improvement was observed at the time of long-term follow-up (mean 4.3 +/- 0.5 years). Furthermore, the prognosis for MG patients not operated on was also favourable. It is suggested that the occurrence of thymomas is linked to genetic factors and that neoplasia of the thymus may be part of immunoregulatory mechanisms with predominance of inhibition.

Specific tolerance to an acetylcholine receptor epitope induced in vitro in myasthenia gravis CD4+ lymphocytes by soluble major histocompatibility complex class II-peptide complexes

In autoimmune disorders, inactivation of pathogenic antigen-specific T cells, rather than global immunosuppression, would be highly desirable. One way to achieve this would be to deliver the first antigen-specific signal to the T cell in the absence of the second costimulatory signal. Myasthenia gravis (MG) is a well-characterized autoimmune disease in which T cell-dependent autoantibodies are directed against the acetylcholine receptor (A ChR) at the neuromuscular junction. AChR-specific T cells have been cloned from MG patients, and in this study, we have induced long-lasting tolerance in vitro in one particular clone (PM-A1) with a known peptide epitope (alpha 144-163) and MHC class II restriction (DR4 Dw14.2 or 4.2) by using soluble MHC-class II peptide complexes. Preincubation of PM-A1 T cells with such complexes induced death by apoptosis in < or = 40-50% of the AChR-specific cells. Surviving cells remained refractory to stimulation with AChR-derived synthetic peptides or recombinant polypeptides for < or = 38 d after complex treatment. These effects were highly specific, dose-dependent and required > 2 h preincubation. The T cells could be protected from the tolerizing effects of complex by coincubation with DR-matched or -mismatched antigen-presenting cells. This work shows that antigen-specific T cells can be selectively killed or anergized using soluble MHC class II: peptide complexes. Such an antigen-specific therapy offers a rational approach to the immunotherapy of autoimmune or allergic disease in vivo.

The role of the thymus in myasthenia gravis

The experimental work discussed here supports the hypothesis that in the pathogenesis of MG the initial and essential steps take place within the thymus. Most if not all thymuses of MG patients contain B cells capable of producing AChR specific autoantibody along with appropriate stroma elements. Hyperplastic thymuses characteristically contain germinal centers with cellular complexes of AChR-producing MC and surrounding interdigitating dendritic cells. In thymomas, the source of the myasthenogenic autoantigen is less obvious. There are data suggesting that thymoma epithelium expresses a protein sharing certain peptide epitopes with the AChR alpha chain, although there is no further molecular similarity. A unique type of 'molecular self-mimicry' cold be involved in the initiation of thymoma-associated MG.

Myasthenia gravis: an autoimmune response against the acetylcholine receptor

Myasthenia gravis (MG) is an organ-specific autoimmune disease caused by an antibody-mediated assault on the muscle nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Binding of antibodies to the AChR leads to loss of functional AChRs and impairs the neuromuscular signal transmission, resulting in muscular weakness. Although a great deal of information on the immunopathological mechanisms involved in AChR destruction exists due to well-characterized animal models, it is not known which etiological factors determine the susceptibility for the disease. This review gives an overview of the literature on the AChR, MG and experimental models for this autoimmune disease.

Transplantation of thymic autoimmune microenvironment to severe combined immunodeficiency mice. A new model of myasthenia gravis

To study the role of the thymus in the cellular pathogenesis of myasthenia gravis (MG) we transplanted thymus tissue fragments from MG thymuses beneath the kidney capsule of severe combined immunodeficiency (SCID) mice. Immunocytochemical studies documented that the human thymus tissues are accepted as long-term grafts in the host SCID mice, with human lymphocytes, thymic stroma, and thymic myoid cells demonstrable in transplanted thymus for at least 15 weeks after transplantation. Human anti-acetylcholine receptor antibodies became detectable 1 to 2 weeks after transplantation, and in most chimeras the titers increased over at least 11 weeks to reach levels typically found in severe human MG. Human Ig deposits were detected at skeletal muscle end-plates, demonstrating that the human (auto)antibodies bound to murine acetylcholine receptor. In contrast, transfers of dissociated thymus cells only lead to a transient increase of anti-acetylcholine receptor antibodies. Our data prove that myasthenia gravis thymus is able to induce and maintain autoantibody production in immunodeprived host animals, and that this tissue contains all cellular components required for autoantibody production. Transplantation of solid thymus tissue seems to transfer an autoimmune microenvironment, which will allow direct studies of the mechanism of autosensitization inside the thymus.

The thymus in seronegative myasthenia gravis patients

In 5-10% of all patients with typical generalised myasthenia gravis (MG), serum antibody to the acetylcholine receptor (AChR) is undetectable. To determine whether these represent a distinct subgroup, we have compared the thymuses of 14 seronegatives, 70 seropositives and 12 non-myasthenic controls. By quantitative immunohistology on coded sections, the 7 seronegative samples were clearly distinguishable from the controls by the pronounced lymph node-type T-cell areas in the medulla. While these closely resembled those in the seropositive cases, germinal centres were significantly sparser, and total in vitro IgG production was disproportionately low (per B cell) in the 12 cases tested. Furthermore, specific anti-AChR production was never detected in any of these cultures. The data support the view that the medullary T-cell areas are the most consistent abnormality in the MG thymus (though it may not be primary), and they strongly imply that seronegative and seropositive MG are distinct entities.

Human myasthenia gravis thymic myoid cells: de novo immunohistochemical and intracellular electrophysiological studies

Thymic myoid cells from myasthenia gravis (MG) patients and controls were successfully grown in explant cultures: we have compared them with skeletal muscle cells cultured from biopsies in morphological, immunohistochemical and electrophysiological studies. Some mononucleate cells in thymus cultures were myoglobin- or desmin-positive, but they were much rarer than the otherwise similar fusing myoblasts in muscle cultures. Frequencies of cultured myoglobin-positive cells showed no difference between MG and control and male or female, but were lower in samples of malignant thymoma, in younger cases and in those with less severe MG. Electrophysiologically the resting membrane potentials of cultured thymic multinucleate cells were significantly less than those of cultured skeletal muscle cells, and action potentials by electrical stimulation were rarely observed. In thymus cultures from only one case with malignant thymoma, desmin-positive myotubes had spontaneous irregular contractions followed by electrical firings. It is concluded that there are myoid cells in MG and control thymuses which have the potential to become skeletal muscle fibers morphologically and electrophysiologically, although their frequency and proliferation in culture are quite low.

Absence of the Epstein-Barr virus genome in the normal thymus, thymic epithelial tumors, thymic lymphoid hyperplasia in a European population

It has previously been shown that the Epstein-Barr virus (EBV) genome may be detected in some thymic tumors. We have investigated specimens of normal thymus, thymitis with lymphoid hyperplasia and a large spectrum of thymic epithelial tumors obtained from european patients for the presence of EBV genome by in situ hybridization and DNA-blotting methods. Cell lines established from seven of the thymic tumors were also tested for EBV. No EBV genome was demonstrated in any of the tumors examined, which included various types of thymoma and thymic carcinomas, nor in the non-neoplastic thymic specimens. However, unlike previous reports, no examples of lymphoepithelial-like thymic carcinoma, nor specimen from Asian patients were included in this study. We suggest that EBV is linked to a specific epithelial tumor type, namely the lymphoepithelial-like carcinoma, regardless of its site, and not to thymic tumors in general.

Myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor-reactive T cells

We compared T-cell proliferative responses to acetylcholine receptor (AChR) and to purified protein derivative (PPD) (of tuberculin) of hyperplastic thymus, thymoma, and blood cells from patients with myasthenia gravis (MG). Hyperplastic MG thymus cells gave significantly higher and more consistent responses to AChR than parallel cultures of autologous blood cells, whereas responses to PPD showed an opposite trend. Thus there was a preferential localization of AChR-reactive T cells in the hyperplastic MG thymus. Furthermore, there was a strong correlation between blood and thymus cell responses to PPD (but not to AChR), arguing that the hyperplastic MG thymus contains a sample of sensitized peripheral T cells. By contrast, both AChR- and PPD-responsive T cells were almost undetectable in thymus from nonmyasthenic patients, which is evidently much less receptive to circulating T cells. Cells from MG thymomas showed the highest stimulations by AChR but did not consistently react to PPD. However, the uninvolved thymus adjacent to these thymomas behaved almost identically to the hyperplastic samples described above. Our interpretation is that AChR-specific T cells are initially sensitized in the MG thymoma but are selectively trapped in the hyperplastic thymus after being primed elsewhere.

Myoid cells in the human thymus and thymoma revealed by three different immunohistochemical markers for striated muscle

Specimens of human thymus and thymoma obtained from 81 patients including 22 with myasthenia gravis (MG), ranging in age from 10 weeks of gestation to 75 years were examine by the indirect immunoperoxidase technique using three different striated muscle markers: myoglobin, CPK-mm and beta-enolase. Myoid cells ovoid or elongated in shape were distributed in the medulla and showed positive immunoreactions for myoglobin, CPK-mm and beta-enolase by light and electron microscopy. The antigens were first detectable immunohistochemically in the fetus at the 10th week of gestation and showed a relative increase in number and varying distribution patterns with age involution in non-myasthenic thymuses. In MG cases, the number of myoid cells was smaller than in non-myasthenic cases, especially in markedly involuted thymuses. Myoid cells were occasionally observed within thymomas in areas showing medullary differentiation. Small numbers of cells showing a positive immunoreaction for beta-enolase but not for myoglobin and CPK-mm were scattered in the area predominantly composed of epithelial cells. These cells were occasionally positive for keratin and showed desmosome-like structures but no apparent myofilaments, suggesting that muscle-like differentiation of epithelial cells might occur in the neoplastic process of thymoma.