Acetylcholine receptors in cultured human muscle cells

Identification of disease phenotypes in acetylcholine receptor-antibody myasthenia gravis using proteomics-based consensus clustering

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]).

A human skeletal muscle cell line obtained from an adult donor

A cell line (RCMH) in permanent culture was established from surgically removed adult normal human skeletal muscle by exposure to conditioned media obtained from thyroid cells. Cells proliferated indefinitely but displayed density inhibition of growth while maintaining some differentiated markers. Under certain incubation conditions, cells fused into myotube-like structures, with a concomitant increase in muscle specific proteins, such as human myoglobin, skeletal muscle myosin, desmin and dystrophin, as identified using immunocytochemical procedures. In addition, RCMH cells displayed high affinity receptors for alpha-bungarotoxin (Bmax = 0.7 pmol/mg protein, Kd = 1.5 nM) and dihydropyridines (Bmax = 0.3 pmol/mg protein, Kd = 0.5 nM for [3H]PN200-110); these values are comparable to those reported for muscle cells in primary culture. Patch-clamp studies showed the presence of 42 pS carbachol gated channels and of 5 pS calcium channels (current carried by barium); chloride and potassium channels were also seen. This new cell line appears to be a convenient model system to study skeletal muscle function.

Properties of acetylcholine-receptor activation in human Duchenne muscular dystrophy myotubes

In human myotubes cultured from biopsies of normal subjects and dystrophic patients we investigated, with the patch-clamp technique, the activation properties of the nicotinic acetylcholine receptor (AChoR) in the presence of acetylcholine and suberyldicholine. The single-channel conductance and the lifetime of the openings were not found to differ. In contrast, the average frequency of openings was about four times higher in Duchenne muscular dystrophy (DMD) myotubes in the presence of equal amounts of acetylcholine, but not of suberyldicholine. The most reasonable conclusion from this observation is that the behaviour of the AChoR is not altered in DMD cells but that there is a greater average concentration of ACho molecules present around AChoRs. This leads to the tentative conclusion that the activity of the enzyme acetylcholinesterase (AChoE) is impaired by some unknown mechanism in the dystrophic myotube.

Skeletal muscle neural cell adhesion molecule (N-CAM): changes in protein and mRNA species during myogenesis of muscle cell lines

Qualitative and quantitative changes in neural cell adhesion molecule (N-CAM) protein and mRNA forms were measured during myogenesis in G8-1 and C2 cell lines. Indirect immunofluorescence assay showed that N-CAM was constitutively expressed by myoblasts in culture and that myotubes appeared to be stained more strongly. These changes were quantified using a dot blot assay. N-CAM levels increased almost 4-fold in G8-1 cells and 15-fold in C2 cells during myogenesis. The kinetics of accumulation of N-CAM were not coordinate with other muscle markers such as creatine kinase or acetylcholine receptor levels, since N-CAM accumulated significantly ahead of these markers. Immunoblotting showed that myogenesis was not associated with changes in the extent of sialylation of N-CAM. However, distinct changes in desialo forms were observed after neuraminidase treatment. Myogenesis was accompanied by increases in 125- and 155-kD desialo forms with minor changes in 120- and 145-kD forms. Biosynthetic labeling studies showed that myoblasts specifically expressed a transmembrane isoform of 145 kD that was phosphorylated and was down-regulated in myotubes. Pulse-chase analysis of myotubes showed that the 120-kD isoform and an isoform of 145 kD that co-migrated with, but was distinct from, the 145 kD transmembrane isoform of myoblasts were precursors of the 125- and 155-kD isoforms, respectively, that accumulated in myotubes. The 125- and 155-kD isoforms in myotubes are linked to the cell membrane via phosphatidylinositol linkage and can be released by phospholipase C. Indirect immunofluorescence analysis showed that phosphatidylinositol specific phospholipase C specifically released N-CAM from the myotube membrane generating N-CAM-free myotubes, while myoblasts were unaffected by this treatment. Three N-CAM mRNA species were observed in mouse muscle cell lines. Myoblasts were characterized by their expression of 6.7- and 5.2-kb transcripts while myotubes express 5.2- and 2.9-kb transcripts. Thus, myogenesis is qualitatively associated with a down regulation of the 6.7-kb transcript and an up regulation of the 5.2- and 2.9-kb transcript.

Tissue culture studies of muscle disorders: Part 2. Biochemical studies, nerve-muscle culture, metabolic myopathies, and animal models

This review continues with studies of protein, lipid, and purine metabolism of Duchenne muscular dystrophy (DMD) cells in vitro and of muscle cells in combined culture with nerve cells. In vitro studies of human metabolic myopathies are tabulated. Results using the hamster, chicken, and mouse (dy25, dy, mdg, and mdx) myopathies are discussed. Interesting findings include suggestions of altered collagen synthesis by DMD cells. Analysis of cell proteins by two-dimensional gel electrophoresis and the use of combined nerve-muscle cultures remain important areas of development. It is disappointing that so few attempts have been made to repeat significant findings in this field, and when a number of laboratories have examined the same phenomenon, the results are often contradictory. It remains to be shown how these various abnormalities found in cells in vitro are related to each other and to those pathologic features of diseased muscle observed in vivo.

Tissue culture studies of muscle disorders: Part 1. Techniques, cell growth, morphology, cell surface

Tissue culture has been used extensively in studies of human inherited disorders, and its application in the field of the neuromuscular disorders has increased rapidly in recent years. This review, covering the period 1977 to 1984, deals with tissue culture studies of both human and animal muscle disorders, although Duchenne muscular dystrophy (DMD) figures prominently because of the overwhelming interest in that disorder. The review is in two parts. In the first part, I discuss technical innovations in the field, the morphology and growth of cells, and a variety of studies related to the cell surface. Important findings in relation to DMD include reports of abnormal growth rates and reduced lifespan of DMD cells, hypersensitivity to DNA-damaging agents, abnormal cell-to-cell and cell-to-substratum adhesion, and a more "fluid" cell membrane. However, these findings are controversial or have so far been reported only by single laboratories.

New approaches to the study of human dystrophic muscle cells in culture

Tissue culture provides a system for studying the growth and differentiation of muscle cells in a controlled environment. Several studies have been carried out on diseased muscle cells in culture in attempts to elucidate the aetiology of Duchenne muscular dystrophy (DMD) but the results were equivocal. Work in our laboratory in recent years has yielded an improved method for preparing primary muscle cell cultures from dissociated biopsies which permits the morphological and biochemical evaluation of these cultures at all stages of growth and development. Our results have shown abnormalities in cell behaviour, ultrastructure and creatine kinase synthesis. The background to these studies is reviewed. Recently we have developed a cell cloning procedure that allows the accumulation of a large number of cells from a single selected cell. We can with this technique monitor quantitative and qualitative cellular and cytochemical differences between individual cell types without the ambiguities inherent in the use of mixed cell populations. The results obtained with 4 different clonal preparations derived from dystrophic muscle have shown that a number of specific features were expressed by each of the 4 clones with respect to their growth pattern, ultrastructure, synthesis of muscle specific protein and cell surface antigen. These findings clearly illustrate the potential of these cloning procedures for studying the genetic expression of homogeneous cell populations derived from normal adult human muscle and patients with X-linked muscle disease.

Human--rat muscle somatic cell hybrids form myotubes and express human muscle gene products

Somatic cell hybrids have been prepared at high frequency between the rat muscle cell line L6 and human fetal muscle cells. The hybrid cells express several human gene products including an antigen, 12E7, controlled by the human X chromosome, Thy-1, and several human isoenzymes. In addition, one clone (37-11) expresses a human muscle-specific surface antigen (5.1 H11) and, under appropriate conditions, can be induced to form myotubes. Upon myotube formation, this clone switches on the production of the human muscle-specific creatine kinase (ATP:creatine N-phosphotransferase, EC 2.7.3.2) M subunit. This is an example of developmental regulation of human muscle-specific genes in somatic cell hybrids.

Growth of adult human cells in culture at clonal densities

The effect of varying medium concentrations of fetal calf serum (FCS), horse serum (HS) and chicken embryo extract (EE) on the growth capacity of adult human cells cultured at clonal densities was investigated. The best growth was consistently obtained with medium containing 20 parts FCS and 2 parts heat-treated commercial EE. The growth potential of human muscle cells was not related to the age of the patient from which the biopsy was taken, but was dependent on the microenvironment of the culture and the cell density.