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Akerele JM, Erameh C, Okomayin AA, Dongo A, Omosofe F, Ikponmonsa G, Osemobor KO, Akerele NN, Ngwu S. Myasthenia Gravis with Toxic Goiter: Challenges with Management in a Low-Resource Setting in Africa; Review of Literature and Case Report. Niger J Clin Pract 2024; 27:148-152. [PMID: 38317049 DOI: 10.4103/njcp.njcp_206_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
ABSTRACT Myasthenia gravis (MG) is an antibody-mediated autoimmune disease with the cardinal feature being exertional voluntary skeletal muscle weakness and fatigability. It can be an isolated finding or in association with other autoimmune conditions such as Hashimoto's thyroiditis, Graves' disease, systemic lupus erythematosus (SLE), or rheumatoid arthritis. Thymectomy is recommended for most patients with MG whose symptoms begin before the age of 60 years. Patients with thymoma or thymic hyperplasia do respond to thymectomy compared to those without thymoma or enlarged thymus. Those with enlarged goiter would benefit from thyroidectomy. The management of these patients requires a multidisciplinary approach as performed in a low-resource setting. We are reporting the case of a 24-year-old who presented with MG with toxic goiter and had good control on medication. A computed tomography scan of the chest showed a superior mediastinal mass and a soft tissue scan of the neck was done which showed a diffusely enlarged thyroid gland. She subsequently had thymectomy and subtotal thyroidectomy with a satisfactory outcome. We highlight this case to show that MG with thymoma and goiter could coexist. Reports of such findings are infrequently reported in our environment.
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Affiliation(s)
- J M Akerele
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - C Erameh
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - A A Okomayin
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - A Dongo
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - F Omosofe
- Department of Anasthesia, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - G Ikponmonsa
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - K O Osemobor
- Department of Surgery, University of Benin Teching Hospital, Benin, Edo State, Nigeria
| | - N N Akerele
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - S Ngwu
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
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Saghazadeh A, Rezaei N. MicroRNA expression profiles of peripheral blood and mononuclear cells in myasthenia gravis: A systematic review. Int Immunopharmacol 2022; 112:109205. [PMID: 36087508 DOI: 10.1016/j.intimp.2022.109205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies have described the role of microRNAs (miRNAs) in thymic function, along with directly observing the altered expression of miRNAs in thymuses of myasthenia gravis (MG) patients; so, miRNAs became a core component in the pathophysiology of MG. However, because the miRNA analysis results are contradictory, the identification of MG-related miRNAs is daunting. OBJECTIVE We did a systematic review of studies analyzing the miRNA expression profile of peripheral blood and mononuclear cells for patients with MG. METHODS We ran a database search in PubMed, Scopus, and Web of Science on August 17, 2021. Original articles that analyzed miRNA profiles in peripheral blood (serum, plasma, and whole blood) and peripheral blood mononuclear cells (PBMCs) for patients with MG in comparison with a non-MG or healthy control (HC) group were eligible. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). RESULTS 26 studies were included. The quality of studies was fair (median score, 5). Among 226 different miRNAs that were deregulated in at least one study (range, 1-87), ten miRNAs were significantly deregulated in three or more studies. Five miRNAs (50%) showed the same deregulation: miR-106b-3p and miR-21-5p were consistently upregulated, and miR-20b, miR-15b, and miR-16 were consistently downregulated. Also, there were five miRNAs that were mostly upregulated, miR-150-5p, miR-146a, miR-30e-5p, and miR-338-3p, or downregulated, miR-324-3p, across studies. CONCLUSION These miRNAs contribute to different pathways, importantly neural apoptosis and autophagy, inflammation, T regulatory cell development, and T helper cell balance. Prior to being used for diagnostic and therapeutic purposes, it is required to pursue molecular mechanisms these consistently and mostly dysregulated miRNAs specifically use in the context of MG.
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Affiliation(s)
- Amene Saghazadeh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Salari N, Fatahi B, Bartina Y, Kazeminia M, Fatahian R, Mohammadi P, Shohaimi S, Mohammadi M. Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: a systematic review and meta-analysis. J Transl Med 2021; 19:516. [PMID: 34930325 PMCID: PMC8686543 DOI: 10.1186/s12967-021-03185-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Myasthenia gravis is a neuromuscular autoimmune disorder characterized by weakness and disability in the voluntary muscles. There have been several preliminary studies on the epidemiology of myasthenia gravis in different parts of the world and the effectiveness of common drugs in its treatment, but there has been no comprehensive study of the efficacy of common drugs in the treatment of myasthenia gravis. Therefore, this study aimed to determine the epidemiology of myasthenia gravis globally and the effectiveness of common drugs in its treatment using systematic review and meta-analysis. METHODS Research studies were extracted from IranDoc, MagIran, IranMedex, SID, ScienceDirect, Web of Sciences (WoS), ProQuest, Medline (PubMed), Scopus and Google Scholar based on Cochran's seven-step guidelines using existing keywords extracted in MeSH browser. The I2 test was used to calculate the heterogeneity of studies, and Begg and Mazumdar rank correlation tests were used to assess publication bias. Data were analyzed using Comprehensive Meta-Analysis software (Version 2). RESULTS In the search for descriptive studies based on the research question, 7374 articles were found. After deleting articles unrelated to the research question, finally, 63 articles with a sample size of 1,206,961,907 people were included in the meta-analysis. The prevalence of MG worldwide was estimated to be 12.4 people (95% CI 10.6-14.5) per 100,000 population. For analytical studies on the effectiveness of common myasthenia gravis drugs, 4672 articles were found initially, and after removing articles unrelated to the research question, finally, 20 articles with a sample size of 643 people in the drug group and 619 people in the placebo group were included in the study. As a result of the combination of studies, the difference between the mean QMGS score index after taking Mycophenolate and Immunoglobulin or plasma exchange drugs in the group of patients showed a significant decrease of 1.4 ± 0.77 and 0.62 ± 0.28, respectively (P < 0.01). CONCLUSION The results of systematic review of drug evaluation in patients with myasthenia gravis showed that Mycophenolate and Immunoglobulin or plasma exchange drugs have positive effects in the treatment of MG. It also represents the positive effect of immunoglobulin or plasma exchange on reducing SFEMG index and QMGS index and the positive effect of Mycophenolate in reducing MG-ADL index, SFEMG and Anti-AChR antibodies index. In addition, based on a meta-analysis of the random-effect model, the overall prevalence of MG in the world is 12.4 people per 100,000 population, which indicates the urgent need for attention to this disease for prevention and treatment.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnaz Fatahi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Bartina
- Department of Translation Studies, Faculty of Literature, Istanbul University, Istanbul, Turkey
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fatahian
- Department of Neurosurgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Mohammadi
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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Liu C, Liu P, Ma M, Yang H, Qi G. Efficacy and safety of double-filtration plasmapheresis treatment of myasthenia gravis: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25622. [PMID: 33907116 PMCID: PMC8084046 DOI: 10.1097/md.0000000000025622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/09/2020] [Accepted: 04/03/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of double-filtration plasmapheresis (DFPP) treatment of myasthenia gravis (MG) through a systematic review and meta-analysis. METHODS PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang databases were searched for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on DFPP for MG from database establishment to June 2019. Two researchers independently screened the articles, extracted the data, and cross checked the results. RevMan 5.3 was used for statistical analyses. RESULTS Seven RCTs and 2 CCTs were found comprising 329 patients. The results showed that clinical MG remission rate after DFPP treatment was significantly higher (OR = 4.33; 95% confidence interval [CI], 1.97-9.53; P < .001) and the serum levels of antititin antibody was significantly decreased (standardized mean difference [SMD] = 9.30; 95% CI, 7.51-11.08; P < .001). In addition, the quantitative MG (QMG) score, hospital stay and time to remission of MG symptoms, and acetylcholine receptor antibody (AchRAb) decreased in the DFPP treatment group; however, these outcomes had high heterogeneity among the studies. Only one study has reported on the adverse effects, including hypotension and hematoma. CONCLUSION This meta-analysis suggests that DFPP can be recommended for the short-term mitigation of MG. Because our review was limited by the quantity and quality of the included studies, the above conclusions should be verified by additional high-quality studies.
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Weng S, Fan Z, Qiu G, Liu F, Huang L, Li J, Jiang X, Song Z, Gao Y, Zhong Z, He L, Kang L, Wu Y, Chen B, Jiang Q. Therapeutic efficacy and immunoregulatory effect of Qiangji Jianli Capsule for patients with myasthenia gravis: Study protocol for a series of randomized, controlled N-of-1 trials. Medicine (Baltimore) 2020; 99:e23679. [PMID: 33371107 PMCID: PMC7748195 DOI: 10.1097/md.0000000000023679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Myasthenia gravis (MG) is an autoimmune disease in which antibodies directly target components of the neuromuscular junction, causing neuromuscular conduction damage that leads to muscle weakness. The current pharmaceutical treatment for MG is still not ideal to address the problems of disease progression, high recurrence rate, and drug side effects. Clinical observations suggest that traditional Chinese medicine (TCM) can strengthen immunity and improve symptoms of MG patients, delay the progression of the disease, reduce or even prevent the need for immunosuppressive therapy when used in combination with acetylcholinesterase inhibitors or low-dose prednisone, as well as improve the quality of life of patients. The Qiangji Jianli Capsule (QJC) is a combination of medicinal herbs which is used in traditional Chinese medicine. Since MG is a rare disorder, randomized controlled trials comparing large cohorts are difficult to conduct. Therefore, we proposed to aggregate data from a small series of N-of-1 trials to assess the effect of the Chinese medical prescription QJC, which strengthens the spleen and nourishes Qi, as an add-on treatment for MG with spleen and stomach Qi deficiency syndrome. METHODS AND ANALYSIS Single-center, randomized, double-blind, multiple crossover N-of-1 studies will compare QJC versus placebo in 5 adult MG patients with spleen and stomach Qi deficiency syndrome. Patients will undergo 3 cycles of two 4-week intervention periods. According to the treatment schedule, patients will continue to be treated with pyridine bromide tablets, prednisone acetate, tablets and/or tacrolimus capsules throughout the entire trial. Each period consisting of 4-week oral add-on treatment with QJC will be compared with 4-week add-on treatment with a placebo. The primary endpoints are quantitative myasthenia gravis (QMG) test; measurement of the amount of Treg cells and cytokines such as interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-17A (IL-17A), and transforming growth factor-β (TGF-β); and corticosteroid or immunosuppressive agent dosage. Secondary outcome measures: Clinical: Evaluation of the effect of TCM syndromes; MG-activities of daily living (MG-ADL) scales; adverse events. ETHICS AND DISSEMINATION This study was approved by The First Affiliated Hospital of Guangzhou University of Chinese Medicine (GZUCM), No. ZYYECK[2019]038. The results will be published in a peer-reviewed publication. Regulatory stakeholders will comment on the suitability of the trial for market authorization and reimbursement purposes. Trial registration: Chinese Clinical Trial Register, ID: ChiCTR2000033516. Registered on 3 June 2020, http://www.chictr.org.cn/showprojen.aspx?proj=54618.
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Affiliation(s)
- Senhui Weng
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Zhixin Fan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyu Qiu
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Fengbin Liu
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Linwen Huang
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Jinghao Li
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Xiaotao Jiang
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Zhixuan Song
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuxia Gao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhuotai Zhong
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Long He
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Liping Kang
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Yunlong Wu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Benshu Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qilong Jiang
- Department of Spleen-Stomach, First Affiliated Hospital of Guangzhou University of Chinese Medicine
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Amin S, Aung M, Gandhi FR, Pena Escobar JA, Gulraiz A, Malik BH. Myasthenia Gravis and its Association With Thyroid Diseases. Cureus 2020; 12:e10248. [PMID: 33042687 PMCID: PMC7536109 DOI: 10.7759/cureus.10248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Myasthenia gravis (MG) is a rare autoimmune neuromuscular junction disorder, and thyroid disorder is a disorder involving the thyroid receptor, of which Graves' disease (GD) is the most common autoimmune thyroid disorder, in which antibodies develop against thyroid receptors. Both may have similar clinical features. In myasthenia gravis, autoimmune antibodies develop against postsynaptic neuromuscular junction disrupting the neuromuscular transmission, resulting in fluctuating muscle weakness and fatigue. It is a disease of young women and older men. The two pathologies may coexist in a patient or can precede one another. Graves' disease (GD) among thyroid diseases is most often associated with MG. Similarities in clinical features lead to difficulty in distinguishing MG and GD. Despite the standard treatment of myasthenia gravis, including steroids, acetylcholinesterases, rituximab, immunosuppressants, and thymectomy, there is still an increased number of relapses and myasthenia crisis. Eculizumab and plasmapheresis are the two new treatment options for MG, with supporting evidence of marked improvement in recent studies. Myasthenia gravis and Graves' disease have a see-saw relationship. Treating one pathology may worsen the other, so physicians should always consider MG as a differential in patients of hyperthyroidism presenting with new symptoms of fatigue or respiratory failure or neuromuscular weakness. In this comprehensive review article, we tried to establish an association between myasthenia gravis and Graves' disease (GD) by exploring currently available literature from PubMed. However, more studies need to be done to establish an association between pathologies.
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Affiliation(s)
- Saba Amin
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Myat Aung
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fenil R Gandhi
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Julio A Pena Escobar
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azouba Gulraiz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Abstract
This study aimed to review studies focused on the affective comorbidities associated with myasthenia gravis and to determine the extent to which neuromuscular treatment modalities address non-somatic aspects of autoimmune myasthenia gravis. Depression, anxiety, and emotional hyperactivity can aggravate myasthenia gravis, hinder accurate diagnoses, and presumably influence overall health-related quality of life. Studies were identified using PubMed Medline and Web of Science to assess the effects of psychological factors on myasthenia gravis, encompassing 49 years of research worldwide. After analysis, approximately 6,060 patients from 32 studies worldwide between 1971 and 2020 were included. Standard-of-care approaches to diagnosis and treatment continue to under-appreciate the prevalence or impact of mood disorders in myasthenia gravis. The majority of studies evaluated demonstrated an association between myasthenia gravis and mood disorders. However, the initiative to detect and treat affective comorbidities probably remains suboptimal. Although treatments for the somatic effects of myasthenia gravis have evolved over the past century, the paradigm of clinical practice has yet to adequately address the management of psychological impacts on the disease. This review is hoped to raise the necessary awareness in this regard.
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Affiliation(s)
- Christina Law
- Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Claire V Flaherty
- Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Madsen MB, Bergsten H, Norrby-Teglund A. Treatment of Necrotizing Soft Tissue Infections: IVIG. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1294:105-125. [DOI: 10.1007/978-3-030-57616-5_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Supakornnumporn S, Katirji B. Autoimmune Neuromuscular Diseases Induced by Immunomodulating Drugs. J Clin Neuromuscul Dis 2018; 20:28-34. [PMID: 30124557 DOI: 10.1097/cnd.0000000000000214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Immunomodulating drugs are widely used in autoimmune, transplant, and cancer patients. However, these drugs are associated with various autoimmune neuromuscular diseases such as demyelinating polyneuropathy, myasthenia gravis, and myositis. Early recognition of these complications and immediately terminating these drugs are very essential since some are life-threatening conditions. This review provides a general overview of drug-induced autoimmunity and autoimmune neuromuscular diseases associated with tumor necrosis factor alpha (TNF-α) antagonists, immune checkpoint inhibitors, and interferon (IFN) type 1 (IFN-β and IFN-α).
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Affiliation(s)
- Songkit Supakornnumporn
- Department of Neurology, Neuromuscular Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
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Li FJ, Liu Y, Yuan Y, Yang B, Liu ZM, Huang LQ. Molecular interaction studies of acetylcholinesterase with potential acetylcholinesterase inhibitors from the root of Rhodiola crenulata using molecular docking and isothermal titration calorimetry methods. Int J Biol Macromol 2017. [DOI: 10.1016/j.ijbiomac.2017.06.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang L, Zhang S, Xi J, Li W, Zhou L, Lu J, Lu J, Zhang T, Zhao C. Efficacy and safety of tacrolimus for myasthenia gravis: a systematic review and meta-analysis. J Neurol 2017; 264:2191-2200. [PMID: 28921038 DOI: 10.1007/s00415-017-8616-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
To evaluate the efficacy and safety of tacrolimus in patients with myasthenia gravis (MG), a systematic review and meta-analysis was performed. We searched PubMed and Embase for randomized controlled trials and clinical controlled trials in English language. Demographic and clinical characteristics of the MG patients were extracted. Differences in the current glucocorticoids (GC) dose in each included study were the primary outcome measure. The adverse events reported in each included study were used as safety evaluation. There were 5 trials included involving 683 patients. In this systematic review, we identified treatment with tacrolimus did not exhibit a statistically significant difference in the GC dose reduction at 6 months and 12 months compared with placebo. The standard mean differences in the GC dose reduction were -1.95 [(-4.20 to 0.30); p = 0.09] at 6 months and -1.72 [(-4.21 to 0.77); p = 0.18] at 12 months. But GC dose reduction from baseline in the tacrolimus group exceeded that in the controlled group. The weighted mean differences were -1.34 [(-2.46 to 0.23); p = 0.02] in the quantitative myasthenia gravis score and -1.10 [(-1.84 to -0.36); p = 0.004] in the myasthenia gravis activities of daily living score at 6 months. Adverse events were recorded in 80 of 347 patients (23%) treated with tacrolimus and most of them were mild. This meta-analysis proves that tacrolimus therapy is beneficial to improve clinical symptoms in MG patients. Tacrolimus may be a worthy therapy to relieve MG symptoms.
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Affiliation(s)
- Liang Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Suxian Zhang
- Department of Chinese Traditional Medicine, Jing'an District Centre Hospital of Shanghai, Shanghai, 200040, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenhui Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, 200040, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jun Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Tiansong Zhang
- Department of Chinese Traditional Medicine, Jing'an District Centre Hospital of Shanghai, Shanghai, 200040, China.
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China. .,Department of Neurology, Jing'an District Centre Hospital of Shanghai, Shanghai, 200040, China.
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Guoyan Q, Peng L, Shanshan G, Hongxia Y, Huimin D, Yinping X. Effect of Jianpiyiqi granule on ocular myasthenia gravis in children prepared with a formula from Traditional Chinese Medicine. J TRADIT CHIN MED 2017. [DOI: 10.1016/s0254-6272(17)30162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soukup O, Winder M, Killi UK, Wsol V, Jun D, Kuca K, Tobin G. Acetylcholinesterase Inhibitors and Drugs Acting on Muscarinic Receptors- Potential Crosstalk of Cholinergic Mechanisms During Pharmacological Treatment. Curr Neuropharmacol 2017; 15:637-653. [PMID: 27281175 PMCID: PMC5543679 DOI: 10.2174/1570159x14666160607212615] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pharmaceuticals with targets in the cholinergic transmission have been used for decades and are still fundamental treatments in many diseases and conditions today. Both the transmission and the effects of the somatomotoric and the parasympathetic nervous systems may be targeted by such treatments. Irrespective of the knowledge that the effects of neuronal signalling in the nervous systems may include a number of different receptor subtypes of both the nicotinic and the muscarinic receptors, this complexity is generally overlooked when assessing the mechanisms of action of pharmaceuticals. METHODS We have search of bibliographic databases for peer-reviewed research literature focused on the cholinergic system. Also, we have taken advantage of our expertise in this field to deduce the conclusions of this study. RESULTS Presently, the life cycle of acetylcholine, muscarinic receptors and their effects are reviewed in the major organ systems of the body. Neuronal and non-neuronal sources of acetylcholine are elucidated. Examples of pharmaceuticals, in particular cholinesterase inhibitors, affecting these systems are discussed. The review focuses on salivary glands, the respiratory tract and the lower urinary tract, since the complexity of the interplay of different muscarinic receptor subtypes is of significance for physiological, pharmacological and toxicological effects in these organs. CONCLUSION Most pharmaceuticals targeting muscarinic receptors are employed at such large doses that no selectivity can be expected. However, some differences in the adverse effect profile of muscarinic antagonists may still be explained by the variation of expression of muscarinic receptor subtypes in different organs. However, a complex pattern of interactions between muscarinic receptor subtypes occurs and needs to be considered when searching for selective pharmaceuticals. In the development of new entities for the treatment of for instance pesticide intoxication, the muscarinic receptor selectivity needs to be considered. Reactivators generally have a muscarinic M2 receptor acting profile. Such a blockade may engrave the situation since it may enlarge the effect of the muscarinic M3 receptor effect. This may explain why respiratory arrest is the major cause for deaths by esterase blocking.
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Affiliation(s)
- Ondrej Soukup
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- National Institute of Mental Health, Klecany, Hradec Kralove, Czech Republic
| | - Michael Winder
- Institute of Neuroscience and Physiology, Department of Pharmacology, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Uday Kumar Killi
- Department of Biochemical Sciences, Faculty of Pharmacy, Charles University, Hradec Kralove, Czech Republic
| | - Vladimir Wsol
- Department of Biochemical Sciences, Faculty of Pharmacy, Charles University, Hradec Kralove, Czech Republic
| | - Daniel Jun
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Gunnar Tobin
- Institute of Neuroscience and Physiology, Department of Pharmacology, the Sahlgrenska Academy at the University of Gothenburg, Sweden
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Gupta A, Goyal V, Srivastava AK, Shukla G, Behari M. Remission And relapse of myasthenia gravis on long-term azathioprine: An ambispective study. Muscle Nerve 2016; 54:405-12. [DOI: 10.1002/mus.25052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Anirban Gupta
- Department of Neurology, Cardiothoracic and Neurosciences Centre, Room 706; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Vinay Goyal
- Department of Neurology, Cardiothoracic and Neurosciences Centre, Room 706; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Achal Kumar Srivastava
- Department of Neurology, Cardiothoracic and Neurosciences Centre, Room 706; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Garima Shukla
- Department of Neurology, Cardiothoracic and Neurosciences Centre, Room 706; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Madhuri Behari
- Department of Neurology, Cardiothoracic and Neurosciences Centre, Room 706; All India Institute of Medical Sciences; New Delhi 110029 India
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Effect of Polygoni Cuspidati Rhizoma et Radix and Its Ingredient Resveratrol on Experimental Autoimmune Myasthenia Gravis by Suppressing Immune Response. CHINESE HERBAL MEDICINES 2016. [DOI: 10.1016/s1674-6384(16)60047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Draczkowski P, Tomaszuk A, Halczuk P, Strzemski M, Matosiuk D, Jozwiak K. Determination of affinity and efficacy of acetylcholinesterase inhibitors using isothermal titration calorimetry. Biochim Biophys Acta Gen Subj 2016; 1860:967-974. [DOI: 10.1016/j.bbagen.2015.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/23/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
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Yang ZX, Xu KL, Xiong H. Clinical characteristics and therapeutic evaluation of childhood myasthenia gravis. Exp Ther Med 2015; 9:1363-1368. [PMID: 25780436 PMCID: PMC4353784 DOI: 10.3892/etm.2015.2256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 12/05/2014] [Indexed: 11/28/2022] Open
Abstract
This study aimed to analyze the clinical characteristics, classification and treatment of childhood myasthenia gravis (MG) and address the prognosis through follow-up. The clinical data of 135 children with MG were grouped according to clinical type and therapeutic drugs, retrospectively analyzed and prospectively monitored. Of the 135 MG patients, 85.2% had type I (ocular type), with only 4.2% progressing to systemic MG; 13.4% had type II (general type); and 1.5% had type III (fulminating type). Relapse occurred in 46.1% of the 102 patients that were followed up. The positive rate for the primary acetylcholine receptor antibody was 40.19%, without significant differences among clinical subtypes. The positive rate of the repetitive nerve stimulation frequency test by electromyography was 37.97%. Decreased expression of CD4+, CD8+, or CD3+ was present in 71% of the patients. Thymic hyperplasia was present in 5.93% of the patients, while 1.48% had thymoma. Steroid treatment was effective in the majority of the patients. Ocular type MG was common in this cohort of patients. The incidence and mortality of myasthenia crisis were low, the presence of concurrent thymoma was rare and only a limited number of children developed neurological sequelae.
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Affiliation(s)
- Zhi-Xiao Yang
- Department of Neurology, Children's Hospital of Zhengzhou, Zhengzhou, Henan 450053, P.R. China
| | - Kai-Li Xu
- Department of Neurology, Children's Hospital of Zhengzhou, Zhengzhou, Henan 450053, P.R. China
| | - Hui Xiong
- Department of Paediatrics, Peking University First Hospital, Beijing 100034, P.R. China
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Liu GC, Gao BL, Yang HQ, Qi GY, Liu P. The clinical absolute and relative scoring system-a quantitative scale measuring myasthenia gravis severity and outcome used in the traditional Chinese medicine. Complement Ther Med 2014; 22:877-86. [PMID: 25440379 DOI: 10.1016/j.ctim.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 06/30/2014] [Accepted: 08/05/2014] [Indexed: 12/24/2022] Open
Abstract
Myasthenia gravis (MG) is a chronic autoimmune disease caused by autoantigen against the nicotine acetylcholine receptor at the neuromuscular junction. With modern treatment facilities, the treatment effect and outcome for MG has been greatly improved with MG and non-MG patients enjoying the same life expectancy. Many classifications of disease distribution and severity have been set up and tested all over the world, mainly in the western world. However, the absolute and relative scoring system for evaluating the severity and treatment effect of MG in China where traditional Chinese medicine (TCM) has been practiced for thousands of years has not been introduced worldwide. The TCM has achieved a great success in the treatment of MG in the country with a huge population. This article serves to introduce this scoring system to the world.
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Affiliation(s)
- Guo-Chao Liu
- Shijiazhuang First Hospital, Hebei Medical University, China
| | - Bu-Lang Gao
- Shijiazhuang First Hospital, Hebei Medical University, China.
| | - Hong-Qi Yang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou University, China
| | - Guo-Yan Qi
- Shijiazhuang First Hospital, Hebei Medical University, China
| | - Peng Liu
- Shijiazhuang First Hospital, Hebei Medical University, China
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Janbaz KH, Arif J, Saqib F, Imran I, Ashraf M, Zia-Ul-Haq M, Jaafar HZE, De Feo V. In-vitro and in-vivo validation of ethnopharmacological uses of methanol extract of Isodon rugosus Wall. ex Benth. (Lamiaceae). BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:71. [PMID: 24559094 PMCID: PMC3974051 DOI: 10.1186/1472-6882-14-71] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/17/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Isodon rugosus is used in folk Pakistan traditional practices to cure ailments related to gastrointestinal, respiratory and cardiovascular problems. Present study was undertaken to validate these folkloric uses. METHODS A crude methanol extract of the aerial parts of Isodon rugosus (Ir.Cr.) was used for both in vitro and in vivo experiments. The plant extract was tested on isolated rabbit jejunum preparations for possible presence of spasmolytic activity. Moreover, isolated rabbit tracheal and aorta preparations were used to ascertain the relaxant effects of the extract. Acetylcholinesterase and butyrylcholinesterase inhibitory activities of Ir.Cr were also determined as well as its antioxidant activity. The in vivo antiemetic activity of the extract was evaluated by using the chick emesis model, while the analgesic and antipyretic activities were conducted on albino mice. RESULTS The application of the crude extract of I. rugosus to isolated rabbit jejunum preparations exhibited relaxant effect (0.01-0.3 mg/ml). The Ir.Cr also relaxed K+(80 m M)-induced spastic contractions in isolated rabbit jejunum preparations and shifted the Ca+2 concentration response curves towards right (0.01-0.3 mg/ml). Similarly, the extract, when applied to the isolated rabbit tracheal preparations relaxed the carbachol (1 μM)--as well as K+ (80 mM)-induced contractions in a concentration range of 0.01-1.0 mg/ml. Moreover, it also relaxed (0.01-3.0 mg/ml) the phenylephrine (1 μM)- and K+ (80 mM)-induced contractions in isolated rabbit aorta preparations. The Ir.Cr (80 mg/kg) demonstrated antipyretic activity on pyrogen-induced pyrexia in rabbits as compared to aspirin as standard drug. The Ir.Cr also exhibited anti-oxidant as well as inhibitory effect on acetyl- and butyryl-cholinesterase and lipoxygenase (0.5 mg/ml). CONCLUSIONS The observed relaxant effect on isolated rabbit jejunum, trachea and aorta preparations caused by Ir.Cr is possibly to be mediated through Ca+2 channel blockade and therefore may provided scientific basis to validate the folkloric uses of the plant in the management of gastrointestinal, respiratory and cardiovascular ailments. The observed antioxidant activity as well as the lipoxygenase inhibitory activity may validate its traditional use in pain and inflammations.
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Affiliation(s)
- Khalid Hussain Janbaz
- Department of Biochemistry and Biotechnology, Islamia University, Bahawalpur, Pakistan
| | - Javeria Arif
- Department of Biochemistry and Biotechnology, Islamia University, Bahawalpur, Pakistan
| | - Fatima Saqib
- Department of Biochemistry and Biotechnology, Islamia University, Bahawalpur, Pakistan
| | - Imran Imran
- Department of Biochemistry and Biotechnology, Islamia University, Bahawalpur, Pakistan
| | - Muhammad Ashraf
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Hawa ZE Jaafar
- Department of Crop Science, Faculty of Agriculture, 43400 UPM Serdang, Selangor, Pakistan
| | - Vincenzo De Feo
- Department of Pharmacy, Salerno University, Fisciano, Salerno, Pakistan
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Clinical Study of Effects of Jian Ji Ning, a Chinese Herbal Medicine Compound Preparation, in Treating Patients with Myasthenia Gravis via the Regulation of Differential MicroRNAs Expression in Serum. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:518942. [PMID: 24734107 PMCID: PMC3956408 DOI: 10.1155/2014/518942] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/09/2013] [Accepted: 10/22/2013] [Indexed: 02/07/2023]
Abstract
Myasthenia gravis (MG) is an autoimmune disease, of which the pathogenesis has remained unclear. At present, MG does not have any effective treatment with minor side effects. Jian Ji Ning (JJN), a traditional Chinese medicine formula consisting of 11 medicinal plants, has been used in the treatment of MG for many years. The present study aims to determine if the Chinese herbal medicine JJN could lighten the clinical symptoms of patients with MG via the regulation of differential microRNAs (miRNAs) expression in serum. JJN should be orally administered twice a day for 6 months. In the efficacy evaluation adopting the Quantitative Myasthenia Gravis Score (QMG), we found that JJN could improve the clinical symptoms of patients with MG more effectively. Besides, we found that JJN could regulate differential miRNAs expression in serum of patients with MG. Accordingly, we speculate that the effects of JJN on improving clinical symptoms and blood test indicators of patients with MG may be due to its inhibition of apoptotic pathways of some immune cells and its connection with the regulation of serum miRNAs of some patients. In conclusion, we believe that JJN has a reliable curative effect on patients with MG-induced neuropathologic changes.
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Mechanisms associated with the pathogenicity of antibodies against muscle-specific kinase in myasthenia gravis. Autoimmun Rev 2013; 12:912-7. [DOI: 10.1016/j.autrev.2013.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 12/27/2022]
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22
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Tüzün E, Christadoss P. Complement associated pathogenic mechanisms in myasthenia gravis. Autoimmun Rev 2013; 12:904-11. [DOI: 10.1016/j.autrev.2013.03.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 12/26/2022]
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23
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Howard JF, Barohn RJ, Cutter GR, Freimer M, Juel VC, Mozaffar T, Mellion ML, Benatar MG, Farrugia ME, Wang JJ, Malhotra SS, Kissel JT. A randomized, double-blind, placebo-controlled phase II study of eculizumab in patients with refractory generalized myasthenia gravis. Muscle Nerve 2013; 48:76-84. [PMID: 23512355 DOI: 10.1002/mus.23839] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Complement activation at the neuromuscular junction is a primary cause of acetylcholine receptor loss and failure of neuromuscular transmission in myasthenia gravis (MG). Eculizumab, a humanized monoclonal antibody, blocks the formation of terminal complement complex by specifically preventing the enzymatic cleavage of complement 5 (C5). METHODS This study was a randomized, double-blind, placebo-controlled, crossover trial involving 14 patients with severe, refractory generalized MG (gMG). RESULTS Six of 7 patients treated with eculizumab for 16 weeks (86%) achieved the primary endpoint of a 3-point reduction in the quantitative myasthenia gravis (QMG) score. Examining both treatment periods, the overall change in mean QMG total score was significantly different between eculizumab and placebo (P = 0.0144). After assessing data obtained from all visits, the overall change in mean QMG total score from baseline was found to be significantly different between eculizumab and placebo (P < 0.0001). Eculizumab was well tolerated. CONCLUSION The data suggest that eculizumab may have a role in treating severe, refractory MG.
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Affiliation(s)
- James F Howard
- Department of Neurology, University of North Carolina, 2200 Physicians Office Building, CB 7025, 170 Manning Drive, Chapel Hill, North Carolina, 27599-7025, USA.
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Evoli A, Padua L. Diagnosis and therapy of myasthenia gravis with antibodies to muscle-specific kinase. Autoimmun Rev 2013; 12:931-5. [PMID: 23535158 DOI: 10.1016/j.autrev.2013.03.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 01/01/2023]
Abstract
Myasthenia gravis (MG) with antibodies to the muscle-specific receptor tyrosine kinase (MuSK-MG) is a rare disease which covers 5-8% of all MG patients. Symptoms are nearly always generalized, though more focal than in MG with anti-acetylcholine receptor antibodies, with predominant involvement of cranial, bulbar and axial muscles; early respiratory crises are frequent. Focal atrophy, mostly of facial, masseter and tongue muscles, occurs in a proportion of patients. Diagnosis is often challenging on account of atypical presentation with little or no symptom fluctuations, lack of response to acetylcholinesterase inhibitors in a high proportion of patients and negative results of electrodiagnostic studies when performed on limb muscles. Immunosuppression is the mainstay of treatment, since the response to acetylcholinesterase inhibitors is generally unsatisfactory and thymectomy does not appear to improve the course of the disease. Although corticosteroids result in marked improvement, disease flares are frequent during prednisone dosage tapering and most patients remain dependent on treatment. Since treatment with rituximab, in uncontrolled studies, induced sustained benefit in patients with refractory disease, B cell depletion is an attractive option for MuSK-MG patients unresponsive to conventional immunosuppressants.
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Affiliation(s)
- Amelia Evoli
- Institute of Neurology, Catholic University, Largo F. Vito 1, 00168 Roma, Italy.
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25
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Wang C, Lu Y, Chen Z, Liu X, Lin H, Zhao H, Chen J, Kwan Y, Ngai S. Serum proteomic, peptidomic and metabolomic profiles in myasthenia gravis patients during treatment with Qiangji Jianli Fang. Chin Med 2012; 7:16. [PMID: 22838635 PMCID: PMC3464942 DOI: 10.1186/1749-8546-7-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/18/2012] [Indexed: 11/23/2022] Open
Abstract
Background Qiangji Jianli Fang (QJF) has been used for treatment of myasthenia gravis (MG) in China. However, our understanding of the effects of QJF against MG at the molecular level is limited. This study aims to investigate the effects of QJF treatment of MG patients on the protein, peptide and metabolite levels in serum. Methods High-throughput proteomic, peptidomic and metabolomic techniques were applied to investigate serum samples from 21 healthy individuals and 47 MG patients before and after QJF treatment via two-dimensional gel electrophoresis, matrix-assisted laser desorption/ionization time of flight mass spectrometry and liquid chromatography Fourier transform mass spectrometry, respectively. Results After QJF treatment, the expression levels of peptides m/z 1865.019, 2021.128 and 1211.668 of complement C3f increased (P = 0.004, P = 0.001 and P = 0.043, respectively), while that of peptide m/z 1739.931 of component C4b decreased (P = 0.043), in the serum of MG patients. The levels of γ-aminobutyric acid (P = 0.000) and coenzyme Q4 (P = 0.000) resumed their normal states. Conclusion QJF could inhibit the activity of the complement system and restore the normal levels of metabolites.
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Affiliation(s)
- Chunmei Wang
- School of Life Sciences, The Chinese University of Hong Kong, Shatin, N,T, Hong Kong SAR, China.
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Bilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression. Gen Thorac Cardiovasc Surg 2012; 60:595-8. [PMID: 22580971 DOI: 10.1007/s11748-012-0053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 10/31/2011] [Indexed: 10/28/2022]
Abstract
Buffalo chest refers to the pleuro-pleural communication that results in a single pleural cavity. Iatrogenic buffalo chest can occur following heart or heart-lung transplantation and other major thoracic surgeries. We present the case of malignant pleural mesothelioma in which iatrogenic buffalo chest after extended thymectomy caused bilateral pneumothoraces and contralateral dissemination of the disease. The free communication between bilateral pleural cavities had facilitated the rapid progression of tumor and the consequent bilateral malignant pleural effusions had made the management of disease much more difficult, leading to the early fatal outcome. To our knowledge, this is the first case of buffalo chest that was associated with bilateral malignant pleural effusions.
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Malla RK, Bandyopadhyay S, Spilling CD, Dutta S, Dupureur CM. The first total synthesis of (±)-cyclophostin and (±)-cyclipostin P: inhibitors of the serine hydrolases acetyl cholinesterase and hormone sensitive lipase. Org Lett 2011; 13:3094-7. [PMID: 21591624 DOI: 10.1021/ol200991x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cyclophostin, a structurally unique and potent naturally occurring acetyl cholinesterase (AChE) inhibitor, and its unnatural diastereomer were prepared in 6 steps and 15% overall yield from hydroxymethyl butyrolactone. The unnatural diastereomer of cyclophostin was converted into cyclipostin P, a potent naturally occurring hormone sensitive lipase (HSL) inhibitor, using a one pot dealkylation-alkylation process. The inhibition [IC(50)] of human AChE by cyclophostin and its diastereomer are reported, as well as constituent binding (K(I)) and reactivity (k(2)) constants.
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Affiliation(s)
- Raj K Malla
- Department of Chemistry and Biochemistry, University of Missouri-St. Louis, One University Boulevard, St. Louis, Missouri 63121, USA
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Khorzad R, Whelan M, Sisson A, Shelton GD. Myasthenia gravis in dogs with an emphasis on treatment and critical care management. J Vet Emerg Crit Care (San Antonio) 2011; 21:193-208. [PMID: 21631705 DOI: 10.1111/j.1476-4431.2011.00636.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the human and veterinary literature on the pathophysiology of myasthenia gravis (MG) and describe treatment options for clinical use in people and animals. DATA SOURCES Human and veterinary clinical reports, studies and reviews, textbooks, and recent research findings in MG from 1996 present, with a focus on treatment and patient management. HUMAN DATA SYNTHESIS MG is a well-described condition in people with new research and treatment options available. Many of the newest therapeutic options available in veterinary medicine for MG are based on current strategies used in people with this condition. Seronegative MG is well described in people and provides insight to clinical cases encountered in veterinary medicine when the index of suspicion is high though serologic tests are negative. VETERINARY DATA SYNTHESIS Previous studies in veterinary medicine focused on the use of acetylcholinesterase inhibitors as the main form of treatment in canine MG. Recent studies, mainly case series and case reports, emphasize the use of immunomodulatory treatments as an alternative for long-term treatment. However, there are no randomized, controlled studies on treatment with immunomodulatory therapy for MG in dogs available to assess the efficacy of this treatment strategy. CONCLUSIONS Although early recognition of clinical signs is most important in the outcome of patients with MG, further understanding the pathophysiology of MG may lead to earlier diagnosis and novel treatment strategies. The discovery of additional autoantibodies against striated muscle proteins in dogs, should enhance our understanding of diseases affecting the neuromuscular junction. In addition, clinical data for canine MG could be applied to other autoimmune disorders.
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Affiliation(s)
- Roxanna Khorzad
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, MA 02130, USA
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Conejo-García A, Pisani L, del Carmen Núñez M, Catto M, Nicolotti O, Leonetti F, Campos JM, Gallo MA, Espinosa A, Carotti A. Homodimeric Bis-Quaternary Heterocyclic Ammonium Salts as Potent Acetyl- and Butyrylcholinesterase Inhibitors: A Systematic Investigation of the Influence of Linker and Cationic Heads over Affinity and Selectivity. J Med Chem 2011; 54:2627-45. [DOI: 10.1021/jm101299d] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ana Conejo-García
- Departamento de Química Farmacéutica y Orgánica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain
| | - Leonardo Pisani
- Dipartimento Farmacochimico, Università degli Studi di Bari “Aldo Moro”, Via E. Orabona, 4, 70125 Bari, Italy
| | - Maria del Carmen Núñez
- Departamento de Química Farmacéutica y Orgánica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain
| | - Marco Catto
- Dipartimento Farmacochimico, Università degli Studi di Bari “Aldo Moro”, Via E. Orabona, 4, 70125 Bari, Italy
| | - Orazio Nicolotti
- Dipartimento Farmacochimico, Università degli Studi di Bari “Aldo Moro”, Via E. Orabona, 4, 70125 Bari, Italy
| | - Francesco Leonetti
- Dipartimento Farmacochimico, Università degli Studi di Bari “Aldo Moro”, Via E. Orabona, 4, 70125 Bari, Italy
| | - Joaquín M. Campos
- Departamento de Química Farmacéutica y Orgánica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain
| | - Miguel A. Gallo
- Departamento de Química Farmacéutica y Orgánica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain
| | - Antonio Espinosa
- Departamento de Química Farmacéutica y Orgánica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain
| | - Angelo Carotti
- Dipartimento Farmacochimico, Università degli Studi di Bari “Aldo Moro”, Via E. Orabona, 4, 70125 Bari, Italy
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Musilek K, Pavlikova R, Marek J, Komloova M, Holas O, Hrabinova M, Pohanka M, Dohnal V, Dolezal M, Gunn-Moore F, Kuca K. The preparation, in vitro screening and molecular docking of symmetrical bisquaternary cholinesterase inhibitors containing a but-(2E)-en-1,4-diyl connecting linkage. J Enzyme Inhib Med Chem 2011; 26:245-53. [DOI: 10.3109/14756366.2010.496362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kamil Musilek
- University of Defence, Faculty of Military Health Sciences, Department of Toxicology, Trebesska 1575, Hradec Kralove, Czech Republic
- University of Jan Evangelista Purkynje, Faculty of Science, Department of Chemistry, Ceske mladeze 8, Usti nad Labem, Czech Republic
| | - Ruzena Pavlikova
- University of Defence, Faculty of Military Health Sciences, Department of Toxicology, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Jan Marek
- University of Defence, Faculty of Military Health Sciences, Department of Toxicology, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Marketa Komloova
- Charles University, Faculty of Pharmacy, Department of Pharmaceutical Chemistry and Drug Control, Heyrovskeho 1203, Hradec Kralove, Czech Republic
| | - Ondrej Holas
- Charles University, Faculty of Pharmacy, Department of Pharmaceutical Chemistry and Drug Control, Heyrovskeho 1203, Hradec Kralove, Czech Republic
| | - Martina Hrabinova
- University of Defence, Faculty of Military Health Sciences, Centre of Advanced Studies, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Miroslav Pohanka
- University of Defence, Faculty of Military Health Sciences, Centre of Advanced Studies, Trebesska 1575, Hradec Kralove, Czech Republic
| | - Vlastimil Dohnal
- University of Jan Evangelista Purkynje, Faculty of Science, Department of Chemistry, Ceske mladeze 8, Usti nad Labem, Czech Republic
| | - Martin Dolezal
- Charles University, Faculty of Pharmacy, Department of Pharmaceutical Chemistry and Drug Control, Heyrovskeho 1203, Hradec Kralove, Czech Republic
| | - Frank Gunn-Moore
- University of St. Andrews, School of Biology, Bute Building, St. Andrews, Fife, UK
| | - Kamil Kuca
- University of Defence, Faculty of Military Health Sciences, Centre of Advanced Studies, Trebesska 1575, Hradec Kralove, Czech Republic
- University of Jan Evangelista Purkynje, Faculty of Science, Department of Chemistry, Ceske mladeze 8, Usti nad Labem, Czech Republic
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32
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Psychosocial aspects in myasthenic patients treated by plasmapheresis. J Neurol 2011; 258:1240-6. [DOI: 10.1007/s00415-011-5913-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 11/29/2022]
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Keefe D, Parng C, Lundberg D, Ray S, Martineau-Bosco J, Leng C, Tzartos S, Powell J, Concino M, Heartlein M, Lamsa J, Josiah S. In vitrocharacterization of an acetylcholine receptor–transferrin fusion protein for the treatment of myasthenia gravis. Autoimmunity 2010; 43:628-39. [DOI: 10.3109/08916931003599070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Tanaka S, Nakajima K, Hirano T, Oka K, Saito T, Wakata N. Suppressive potencies of calcineurin inhibitors against the mitogen-induced blastogenesis of peripheral-blood mononuclear cells of myasthenia gravis patients. J Pharm Pharmacol 2010. [DOI: 10.1211/jpp.60.10.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
The calcineurin inhibitors, tacrolimus and ciclosporin, are two useful immunosuppressive drugs for the treatment of myasthenia gravis (MG), for patients who have low responses to glucocorticoids. We have studied the suppressive potencies of tacrolimus and ciclosporin on concanavalin A-induced blastogenesis of peripheral-blood mononuclear cells (PBMCs) obtained from 38 MG patients and 26 healthy volunteers. Differences in the IC50 values of the two calcineurin inhibitors between the patients and the healthy subjects were evaluated. The median (range) IC50 values for tacrolimus and ciclosporin on the blastogenesis of PBMCs of MG patients were 0.06 (0.001–100) and 0.41 (0.09–83.0) ng mL−1, respectively. In contrast, the median (range) IC50 values of tacrolimus and ciclosporin on healthy PBMCs were 0.16 (0.001–0.33) and 5.59 (1.4–31.3), respectively, and thus ciclosporin potencies against PBMCs of MG patients were significantly higher than those against PBMCs of healthy subjects (P < 0.0001). The differences in tacrolimus IC50 values between the patients and healthy subjects were not significant. There was a correlation between ciclosporin IC50 values against the blastogenesis of PBMCs of MG patients and the duration of the disease (r = 0.35, P = 0.049). A significant correlation between the IC50 values of ciclosporin and those of prednisolone against the blastogenesis of PBMCs of MG patients was also observed (r = 0.56, P = 0.003). Furthermore, the ciclosporin IC50 values significantly correlated with the periods of glucocorticoid administration for MG treatment (r = 0.42, P = 0.038). Such correlations were not observed with the tacrolimus IC50 values. These results suggested that glucocorticoid administration had an influence on PBMC response to the suppressive efficacy of ciclosporin in MG.
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Affiliation(s)
- Sachiko Tanaka
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Kanako Nakajima
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Kitaro Oka
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Toyokazu Saito
- Department of Neurology, Kitasato University East Hospital, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan
| | - Nobuo Wakata
- Fourth Department of Internal Medicine, Toho University School of Medicine, 2-17-6 Oohashi, Meguro-ku, Tokyo 153-8515, Japan
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Musilek K, Komloova M, Zavadova V, Holas O, Hrabinova M, Pohanka M, Dohnal V, Nachon F, Dolezal M, Kuca K, Jung YS. Preparation and in vitro screening of symmetrical bispyridinium cholinesterase inhibitors bearing different connecting linkage-initial study for Myasthenia gravis implications. Bioorg Med Chem Lett 2010; 20:1763-6. [PMID: 20138518 DOI: 10.1016/j.bmcl.2010.01.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 01/04/2010] [Accepted: 01/06/2010] [Indexed: 11/25/2022]
Abstract
Reversible inhibitors (e.g., pyridostigmine bromide, neostigmine bromide) of carbamate origin are used in the early treatment of Myasthenia gravis (MG) to block acetylcholinesterase (AChE) native function and conserve efficient amount of acetylcholine for decreasing number of nicotinic receptors. Carbamate inhibitors are known for many undesirable side effects related to the reversible inhibition of AChE. In contrast, this paper describes 20 newly prepared bispyridinium inhibitors of potential concern for MG. Although some compounds from this series have been known before, they were not assayed for cholinesterase inhibition yet. The newly prepared compounds were evaluated in vitro on human erythrocyte AChE and human plasmatic butyrylcholinesterase (BChE). Their inhibitory ability was expressed as IC(50) and compared to standard carbamate drugs. Three compounds presented promising inhibition (in muM range) of both enzymes in vitro similar to the used standards. The novel inhibitors did not present selectivity between AChE and BChE. Two newly prepared compounds were chosen for docking studies and confirmed apparent pi-pi or pi-cationic interactions aside enzyme's catalytic sites. The kinetics assay confirmed non-competitive inhibition of AChE by two best newly prepared compounds.
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Affiliation(s)
- Kamil Musilek
- Department of Toxicology, Faculty of Military Health Sciences, Trebesska 1575, 500 01 Hradec Kralove, Czech Republic.
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Musilek K, Komloova M, Holas O, Pohanka M, Opletalova V, Dolezal M, Kuca K. Small quaternary AChE inhibitors—Implication for pretreatment of OP poisoning or MG treatment. Toxicol Lett 2009. [DOI: 10.1016/j.toxlet.2009.06.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bodack MI. Ptosis and cranial nerve IV palsy reveal juvenile myasthenia gravis. OPTOMETRY (ST. LOUIS, MO.) 2009; 80:342-349. [PMID: 19545846 DOI: 10.1016/j.optm.2008.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 02/19/2008] [Accepted: 03/04/2008] [Indexed: 05/28/2023]
Abstract
BACKGROUND Ptosis and strabismus are 2 common presenting complaints of preschool-age patients. In both cases, these conditions can be benign and require no further workup. However, sudden onset of these findings can indicate a more serious neurologic problem. If a patient presents with multiple neurologic signs, a sudden onset eye turn, or ptosis, the patient must undergo a workup to rule out a pathologic etiology, specifically a brain tumor. The workup should include neuroimaging. If the results of the neuroimaging are normal, and the findings are variable, myasthenia gravis should be considered, and additional testing should be ordered to assist in the diagnosis. CASE REPORT This case report presents a 3-year-old boy who presented with a sudden onset of ptosis and hypertropia. Diagnosis of myasthenia gravis was made based on clinical presentation and response to ice pack testing. The patient was treated with pyridostigmine (Mestinon; Valent Pharmaceuticals, Costa Mesa, California) and has shown improvement in his clinical signs. CONCLUSIONS Although rare, myasthenia should be considered a diagnosis in children who present with variable ptosis or strabismus. Patients can be successfully treated with medication.
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Affiliation(s)
- Marie I Bodack
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Methylacridinium and its Cholinergic Properties. Neurotox Res 2009; 16:372-7. [DOI: 10.1007/s12640-009-9071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 03/06/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
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Luther C, Adamopoulou E, Stoeckle C, Brucklacher-Waldert V, Rosenkranz D, Stoltze L, Lauer S, Poeschel S, Melms A, Tolosa E. Prednisolone treatment induces tolerogenic dendritic cells and a regulatory milieu in myasthenia gravis patients. THE JOURNAL OF IMMUNOLOGY 2009; 183:841-8. [PMID: 19542375 DOI: 10.4049/jimmunol.0802046] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
FOXP3-expressing naturally occurring CD4(+)CD25(high) T regulatory cells (Treg) are relevant in the control of autoimmunity, and a defect in this cell population has been observed in several human autoimmune diseases. We hypothesized that altered functions of peripheral Treg cells might play a role in the immunopathogenesis of myasthenia gravis, a T cell-dependent autoimmune disease characterized by the presence of pathogenic autoantibodies specific for the nicotinic acetylcholine receptor. We report in this study a significant decrease in the in vitro suppressive function of peripheral Treg cells isolated from myasthenia patients in comparison to those from healthy donors. Interestingly, Treg cells from prednisolone-treated myasthenia gravis patients showed an improved suppressive function compared with untreated patients, suggesting that prednisolone may play a role in the control of the peripheral regulatory network. Indeed, prednisolone treatment prevents LPS-induced maturation of monocyte-derived dendritic cells by hampering the up-regulation of costimulatory molecules and by limiting secretion of IL-12 and IL-23, and enhancing IL-10. In addition, CD4(+) T cells cultured in the presence of such tolerogenic dendritic cells are hyporesponsive and can suppress autologous CD4(+) T cell proliferation. The results shown in this study indicate that prednisolone treatment promotes an environment that favors immune regulation rather than inflammation.
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Affiliation(s)
- Claudia Luther
- Department of General Neurology and Neurodegenerative Disorders, Hertie Institute for Clinical Brain Research, Tübingen University Hospital, Germany.
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Cereda E, Beltramolli D, Pedrolli C, Costa A. Refractory myasthenia gravis, dysphagia and malnutrition: a case report to suggest disease-specific nutritional issues. Nutrition 2009; 25:1067-72. [PMID: 19457639 DOI: 10.1016/j.nut.2008.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 10/30/2008] [Accepted: 12/14/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition. METHODS A 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition. RESULTS The first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic poussés. CONCLUSIONS Current guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia.
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Affiliation(s)
- Emanuele Cereda
- International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy.
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Bandyopadhyay S, Dutta S, Spilling CD, Dupureur CM, Rath NP. Synthesis and biological evaluation of a phosphonate analog of the natural acetyl cholinesterase inhibitor cyclophostin. J Org Chem 2008; 73:8386-91. [PMID: 18821801 DOI: 10.1021/jo801453v] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two diastereomers of a phosphonate analog 6 of the AChE inhibitor cyclophostin were synthesized. The substitution reaction of phosphono allylic carbonate 10a with methyl acetoacetate gave the vinyl phosphonate 9a. Attempted hydrogenation/debenzylation gave an unexpected enolether lactone. Alternatively, selective hydrogenation, demethylation, cyclization and debenzylation gave the phosphonate analog of cyclophostin as a separable mixture of diastereomers 6. The trans phosphonate isomer was more active than the cis isomer against AChE from two sources.
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Affiliation(s)
- Saibal Bandyopadhyay
- Department of Chemistry and Biochemistry, University of Missouri-St. Louis, 1 University Boulevard, St. Louis, Missouri 63121, USA
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Janssen SP, Phernambucq M, Martinez-Martinez P, De Baets MH, Losen M. Immunosuppression of experimental autoimmune myasthenia gravis by mycophenolate mofetil. J Neuroimmunol 2008; 201-202:111-20. [DOI: 10.1016/j.jneuroim.2008.05.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 05/13/2008] [Accepted: 05/13/2008] [Indexed: 11/30/2022]
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Affiliation(s)
- Diana Lindquist
- Imaging Research Center , Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229, USA.
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