1
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CD4+ Cytotoxic T Cells Involved in the Development of EBV-Associated Diseases. Pathogens 2022; 11:pathogens11080831. [PMID: 35894054 PMCID: PMC9330826 DOI: 10.3390/pathogens11080831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Activated cytotoxic CD4 T cells (HLA-DR+) play an important role in the control of EBV infection, especially in cells with latency I (EBNA-1). One of the evasion mechanisms of these latency cells is generated by gp42, which, via peripherally binding to the β1 domain of the β chain of MHC class II (HLA-DQ, -DR, and -DP) of the infected B lymphocyte, can block/alter the HLA class II/T-cell receptor (TCR) interaction, and confer an increased level of susceptibility towards the development of EBV-associated autoimmune diseases or cancer in genetically predisposed individuals (HLA-DRB1* and DQB1* alleles). The main developments predisposing the factors of these diseases are: EBV infection; HLA class II risk alleles; sex; and tissue that is infiltrated with EBV-latent cells, forming ectopic lymphoid structures. Therefore, there is a need to identify treatments for eliminating cells with EBV latency, because the current treatments (e.g., antivirals and rituximab) are ineffective.
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2
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Preferential X Chromosome Inactivation as a Mechanism to Explain Female Preponderance in Myasthenia Gravis. Genes (Basel) 2022; 13:genes13040696. [PMID: 35456502 PMCID: PMC9031138 DOI: 10.3390/genes13040696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Myasthenia gravis (MG) is a neuromuscular autoimmune disease characterized by prevalence in young women (3:1). Several mechanisms proposed as explanations for gender bias, including skewed X chromosome inactivation (XCI) and dosage or sex hormones, are often involved in the development of autoimmunity. The skewed XCI pattern can lead to an unbalanced expression of some X-linked genes, as observed in several autoimmune disorders characterized by female predominance. No data are yet available regarding XCI and MG. We hypothesize that the preferential XCI pattern may contribute to the female bias observed in the onset of MG, especially among younger women. XCI analysis was performed on blood samples of 284 women between the ages of 20 and 82. XCI was tested using the Human Androgen Receptor Assay (HUMARA). XCI patterns were classified as random (XCI < 75%) and preferential (XCI ≥ 75%). In 121 informative patients, the frequency of skewed XCI patterns was 47%, significantly higher than in healthy controls (17%; p ≤ 0.00001). Interestingly, the phenomenon was observed mainly in younger patients (<45 years; p ≤ 0.00001). Furthermore, considering the XCI pattern and the other clinical characteristics of patients, no significant differences were found. In conclusion, we observed preferential XCI in MG female patients, suggesting its potential role in the aetiology of MG, as observed in other autoimmune diseases in women.
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3
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Ghafouri-Fard S, Azimi T, Hussen BM, Taheri M, Jalili Khoshnoud R. A Review on the Role of Non-Coding RNAs in the Pathogenesis of Myasthenia Gravis. Int J Mol Sci 2021; 22:12964. [PMID: 34884767 PMCID: PMC8657981 DOI: 10.3390/ijms222312964] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 01/10/2023] Open
Abstract
Myasthenia gravis (MG) is an autoimmune condition related to autoantibodies against certain proteins in the postsynaptic membranes in the neuromuscular junction. This disorder has a multifactorial inheritance. The connection between environmental and genetic factors can be established by epigenetic factors, such as microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). XLOC_003810, SNHG16, IFNG-AS1, and MALAT-1 are among the lncRNAs with a possible role in the pathoetiology of MG. Moreover, miR-150-5p, miR-155, miR-146a-5p, miR-20b, miR-21-5p, miR-126, let-7a-5p, and let-7f-5p are among miRNAs whose roles in the pathogenesis of MG has been assessed. In the current review, we summarize the impact of miRNAs and lncRNAs in the development or progression of MG.
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Affiliation(s)
- Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19835-35511, Iran;
| | - Tahereh Azimi
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran 19835-35511, Iran;
| | - Bashdar Mahmud Hussen
- Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq;
| | - Mohammad Taheri
- Institute of Human Genetics, Jena University Hospital, 07747 Jena, Germany
| | - Reza Jalili Khoshnoud
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran 19835-35511, Iran
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4
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Sindhu RK, Madaan P, Chandel P, Akter R, Adilakshmi G, Rahman MH. Therapeutic Approaches for the Management of Autoimmune Disorders via Gene Therapy: Prospects, Challenges, and Opportunities. Curr Gene Ther 2021; 22:245-261. [PMID: 34530709 DOI: 10.2174/1566523221666210916113609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/05/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autoimmune diseases are the diseases that result due to the overactive immune response, and comprise systemic autoimmune diseases like rheumatoid arthritis (RA), sjӧgren's syndrome (SS), and organ-specific autoimmune diseases like type-1 diabetes mellitus (T1DM), myasthenia gravis (MG), and inflammatory bowel disease (IBD). Currently, there is no long-term cure; but, several treatments exist which retard the evolution of the disease, embracing gene therapy, which has been scrutinized to hold immense aptitude for the management of autoimmune diseases. OBJECTIVE The review highlights the pathogenic mechanisms and genes liable for the development of autoimmune diseases, namely T1DM, type-2 diabetes mellitus (T2DM), RA, SS, IBD, and MG. Furthermore, the review focuses on investigating the outcomes of delivering the corrective genes with their specific viral vectors in various animal models experiencing these diseases to determine the effectiveness of gene therapy. METHODS Numerous review and research articles emphasizing the tremendous potential of gene therapy in the management of autoimmune diseases were procured from PubMed, MEDLINE, Frontier, and other databases and thoroughly studied for writing this review article. RESULTS The various animal models that experienced treatment with gene therapy have displayed regulation in the levels of proinflammatory cytokines, infiltration of lymphocytes, manifestations associated with autoimmune diseases, and maintained equilibrium in the immune response, thereby hinder the progression of autoimmune diseases. CONCLUSION Gene therapy has revealed prodigious aptitude in the management of autoimmune diseases in various animal studies, but further investigation is essential to combat the limitations associated with it and before employing it on humans.
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Affiliation(s)
- Rakesh K Sindhu
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Piyush Madaan
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Parteek Chandel
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Rokeya Akter
- Department of Pharmacy, Jagannath University, Sadarghat, Dhaka-1100. Bangladesh
| | - G Adilakshmi
- Department of PhysicxVikramaSimahpuri University, P.G. Centre, kavil-524201, Andhra Pradesh. India
| | - Md Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka-1213. Bangladesh
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5
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Nadji BM, Fethi M, Esma M, Chahrazad B, Elias A, Smail D, Chafia TB, Rachida R, Nabila A. Human leukocyte antigens (HLA) association with myasthenia gravis (MG) and its myasthenia manifestations in Algerian patients. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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Alvarez CN, John RM. The Pediatric Primary Care Management of Myasthenia Gravis. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Li F, Yuan W, Wu X. Association of
CTLA‐4
polymorphisms with increased risks of myasthenia gravis. Ann Hum Genet 2018; 82:358-369. [DOI: 10.1111/ahg.12262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/07/2018] [Accepted: 06/01/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Fang Li
- The Center for Heart Development, State Key Lab of Development Biology, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Sciences Hunan Normal University Changsha Hunan China
| | - Wuzhou Yuan
- The Center for Heart Development, State Key Lab of Development Biology, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Sciences Hunan Normal University Changsha Hunan China
| | - Xiushan Wu
- The Center for Heart Development, State Key Lab of Development Biology, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Sciences Hunan Normal University Changsha Hunan China
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8
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Zagoriti Z, Lagoumintzis G, Perroni G, Papathanasiou G, Papadakis A, Ambrogi V, Mineo TC, Tzartos JS, Poulas K. Evidence for association of STAT4 and IL12RB2 variants with Myasthenia gravis susceptibility: What is the effect on gene expression in thymus? J Neuroimmunol 2018; 319:93-99. [PMID: 29576322 DOI: 10.1016/j.jneuroim.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease mediated by the presence of autoantibodies that bind mainly to the acetylcholine receptor (AChR) in the neuromuscular junction. In our case-control association study, we analyzed common variants located in genes of the IL12/STAT4 and IL10/STAT3 signaling pathways. A total of 175 sporadic MG patients of Greek descent, positively detected with anti-AChR autoantibodies and 84 ethnically-matched, healthy volunteers were enrolled in the study. Thymus samples were obtained from 16 non-MG individuals for relative gene expression analysis. The strongest signals of association were observed in the cases of rs6679356 between the late-onset MG patients and controls and rs7574865 between early-onset MG and controls. Our investigation of the correlation between the MG-associated variants and the expression levels of each gene in thymus did not result in significant differences.
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Affiliation(s)
- Zoi Zagoriti
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece.
| | - George Lagoumintzis
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Gianluca Perroni
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - George Papathanasiou
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Andreas Papadakis
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - John S Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vasilissis Sofias Avenue, 11521 Athens, Greece; Tzartos NeuroDiagnostics, 3, Eslin street, Athens 115 23, Greece
| | - Konstantinos Poulas
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece.
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9
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Sharma S, Malmeström C, Lindberg C, Meisel S, Schön K, Verolin M, Lycke NY. A Sensitive Method for Detecting Peptide-specific CD4 + T Cell Responses in Peripheral Blood from Patients with Myasthenia Gravis. Front Immunol 2017; 8:1370. [PMID: 29114250 PMCID: PMC5660702 DOI: 10.3389/fimmu.2017.01370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/05/2017] [Indexed: 01/04/2023] Open
Abstract
Myasthenia gravis (MG) is an autoimmune neurological disorder typified by skeletal muscle fatigue and most often production of autoantibodies against the nicotinic acetylcholine receptor (AChR). The present study was undertaken to assess the extent of AChR-peptide recognition in MG patients using co-culturing (DC:TC) of autologous monocyte-derived dendritic cells (moDCs) and highly enriched CD4+ T cells from the blood as compared to the traditional whole peripheral blood mononuclear cell (PBMC) cultures. We found that the DC:TC cultures were highly superior to the PBMC cultures for detection of reactivity toward HLA-DQ/DR-restricted AChR-peptides. In fact, whereas DC:TC cultures identified recognition in all MG patients the PBMC cultures failed to detect responsiveness in around 40% of the patients. Furthermore, reactivity to multiple peptides was evident in DC:TC cultures, while PBMC cultures mostly exhibited reactivity to a single peptide. No healthy control (HC) CD4+ T cells responded to the peptides in either culture system. Interestingly, whereas spontaneous production of IFNγ and IL-17 was observed in the DC:TC cultures from MG patients, recall responses to peptides enhanced IL-10 production in 9/13 MG patients, while little increase in IFNγ and IL-17 was seen. HCs did not produce cytokines to peptide stimulations. We conclude that the DC: TC culture system is significantly more sensitive and better identifies the extent of responsiveness in MG patients to AChR-peptides than traditional PBMC cultures.
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Affiliation(s)
- Sapna Sharma
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Clas Malmeström
- Laboratory for Clinical Immunology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Sarah Meisel
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Karin Schön
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Nils Yngve Lycke
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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10
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Ayyar BV, Atassi MZ. Development of humanized scFv antibody fragment(s) that targets and blocks specific HLA alleles linked to myasthenia gravis. Appl Microbiol Biotechnol 2017; 101:8165-8179. [DOI: 10.1007/s00253-017-8557-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 01/13/2023]
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11
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Ludwig RJ, Vanhoorelbeke K, Leypoldt F, Kaya Z, Bieber K, McLachlan SM, Komorowski L, Luo J, Cabral-Marques O, Hammers CM, Lindstrom JM, Lamprecht P, Fischer A, Riemekasten G, Tersteeg C, Sondermann P, Rapoport B, Wandinger KP, Probst C, El Beidaq A, Schmidt E, Verkman A, Manz RA, Nimmerjahn F. Mechanisms of Autoantibody-Induced Pathology. Front Immunol 2017; 8:603. [PMID: 28620373 PMCID: PMC5449453 DOI: 10.3389/fimmu.2017.00603] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/08/2017] [Indexed: 12/22/2022] Open
Abstract
Autoantibodies are frequently observed in healthy individuals. In a minority of these individuals, they lead to manifestation of autoimmune diseases, such as rheumatoid arthritis or Graves' disease. Overall, more than 2.5% of the population is affected by autoantibody-driven autoimmune disease. Pathways leading to autoantibody-induced pathology greatly differ among different diseases, and autoantibodies directed against the same antigen, depending on the targeted epitope, can have diverse effects. To foster knowledge in autoantibody-induced pathology and to encourage development of urgently needed novel therapeutic strategies, we here categorized autoantibodies according to their effects. According to our algorithm, autoantibodies can be classified into the following categories: (1) mimic receptor stimulation, (2) blocking of neural transmission, (3) induction of altered signaling, triggering uncontrolled (4) microthrombosis, (5) cell lysis, (6) neutrophil activation, and (7) induction of inflammation. These mechanisms in relation to disease, as well as principles of autoantibody generation and detection, are reviewed herein.
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Affiliation(s)
- Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Lübeck, Germany
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Ziya Kaya
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Sandra M. McLachlan
- Thyroid Autoimmune Disease Unit, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, United States
| | - Lars Komorowski
- Institute for Experimental Immunology, Affiliated to Euroimmun AG, Lübeck, Germany
| | - Jie Luo
- Department of Neuroscience, University of Pennsylvania Medical School, Philadelphia, PA, United States
| | | | | | - Jon M. Lindstrom
- Department of Neuroscience, University of Pennsylvania Medical School, Philadelphia, PA, United States
| | - Peter Lamprecht
- Department of Rheumatology, University of Lübeck, Lübeck, Germany
| | - Andrea Fischer
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | | | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | - Basil Rapoport
- Thyroid Autoimmune Disease Unit, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, United States
| | - Klaus-Peter Wandinger
- Department of Neurology, Institute of Clinical Chemistry, University Medical-Centre Schleswig-Holstein, Lübeck, Germany
| | - Christian Probst
- Institute for Experimental Immunology, Affiliated to Euroimmun AG, Lübeck, Germany
| | - Asmaa El Beidaq
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Alan Verkman
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, CA, United States
| | - Rudolf A. Manz
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Falk Nimmerjahn
- Department of Biology, Institute of Genetics, University of Erlangen-Nuremberg, Erlangen, Germany
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12
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Boldingh MI, Maniaol A, Brunborg C, Dekker L, Lipka A, Niks EH, Verschuuren J, Tallaksen C. Prevalence and clinical aspects of immigrants with myasthenia gravis in northern Europe. Muscle Nerve 2017; 55:819-827. [PMID: 27641227 DOI: 10.1002/mus.25408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Multiethnic studies can provide etiological clues toward the genetic and environmental influence of a disease. The aim of this study was to determine prevalence and clinical features of myasthenia gravis (MG) in immigrants compared with native patients in 2 population-based cohorts. METHODS This cross-sectional study included 843 MG patients (375 from Norway and 468 from the Netherlands). Ethnic background was defined by questionnaires. RESULTS Among the participating MG patients, 163 of 843 (19.3%) were first or second generation immigrants, mainly from Europe, Asia, and South America. No marked prevalence differences were found between immigrants and native ethnic groups. MG with muscle specific kinase antibodies and MG with thymoma were more frequent in Asian MG immigrants compared with other ethnic groups (8% vs. 0-4%; P < 0.001 and 21% vs. 6-10%; P < 0.001), respectively. CONCLUSIONS Our findings indicate that Asian immigrant MG patients carry genetic factors or environmental/lifestyle factors which contribute to their specific phenotype, even after migration. Muscle Nerve 55: 819-827, 2017.
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Affiliation(s)
- Marion Ingeborg Boldingh
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angelina Maniaol
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway
| | - Cathrine Brunborg
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Luuk Dekker
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Alexander Lipka
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Erik Harmen Niks
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Jan Verschuuren
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Chantal Tallaksen
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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13
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Li HF, Hong Y, Xie Y, Hao HJ, Sun RC. Precision medicine in myasthenia graves: begin from the data precision. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:106. [PMID: 27127759 DOI: 10.21037/atm.2016.02.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myasthenia gravis (MG) is a prototypic autoimmune disease with overt clinical and immunological heterogeneity. The data of MG is far from individually precise now, partially due to the rarity and heterogeneity of this disease. In this review, we provide the basic insights of MG data precision, including onset age, presenting symptoms, generalization, thymus status, pathogenic autoantibodies, muscle involvement, severity and response to treatment based on references and our previous studies. Subgroups and quantitative traits of MG are discussed in the sense of data precision. The role of disease registries and scientific bases of precise analysis are also discussed to ensure better collection and analysis of MG data.
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Affiliation(s)
- Hai-Feng Li
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yu Hong
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yanchen Xie
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Hong-Jun Hao
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Ren-Cheng Sun
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
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14
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Salvado M, Canela M, Ponseti JM, Lorenzo L, Garcia C, Cazorla S, Gili G, Raguer N, Gamez J. Study of the prevalence of familial autoimmune myasthenia gravis in a Spanish cohort. J Neurol Sci 2016; 360:110-4. [DOI: 10.1016/j.jns.2015.11.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
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15
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16
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Congenital myasthenic syndrome due to mutation in CHRNE gene with clinical worsening and thymic hyperplasia attributed to association with autoimmune-myasthenia gravis. Neuromuscul Disord 2015; 25:928-31. [PMID: 26363966 DOI: 10.1016/j.nmd.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023]
Abstract
We report a patient with congenital myasthenic syndrome (CMS) due to mutation in CHRNE with symptoms since the age of 4; mild to moderate fatigable weakness involved mainly ocular, bulbar and limb muscles; functional impact of the disease in their development and physical activity was modest. By the age of 34, the patient experienced gradual worsening of fatigue with dyspnoea and pronounced limb weakness, requiring significant increase of pyridostigmine. Further, a remarkable and sustained clinical improvement followed thymectomy with hyperplastic thymus. Despite of the absence of detectable antibodies to acetyl-choline receptor (AChR) (including clustered-AChR), muscle-specific kinase and low-density lipoprotein receptor-related protein-4 antibodies in the serum obtained nine years after thymectomy, the clinical, genetic and histological features are in keeping with the extremely rare association of two rare neuromuscular junction disorders - CMS and myasthenia gravis (MG). The inexistence of other conditions that could potentially associate with thymic hyperplasia also supports the diagnosis of MG.
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Olfactory and gustatory dysfunction in Myasthenia gravis: A study in Turkish patients. J Neurol Sci 2015; 356:188-92. [PMID: 26148933 DOI: 10.1016/j.jns.2015.06.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Myasthenia gravis (MG) is commonly viewed as a muscle disorder. Less is known about neurosensory function and dysfunction in MG. We aim to evaluate olfactory and gustatory behavior in Turkish patients with MG, and compare these results with age and sex-matched healthy controls. MATERIAL/METHODS 30 individuals with MG, and 30 healthy volunteers were studied. Olfactory function was studied with the Sniffin' sticks test. Taste strip test was used for studying taste function. The t-test was used for analyzing continuous variables, and the chi-square test for categorical data. Clinical staging and medication status were included in a model analyzed using analysis of variances. RESULTS MG patients showed significantly lower olfactory (p<0.001) and gustatory scores (p<0.001) than the healthy controls. In addition, olfactory loss correlated with the severity of the disease. Medications for MG did not influence these results. CONCLUSION This study replicates the olfactory dysfunction found elsewhere in MG. Further, gustatory dysfunction, an activity unrelated to muscle strength, was also unveiled. Medications used for treating MG must not be blamed for the chemosensory dysfunction found in this neurological disorder.
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Xu G, Zheng K, Lu X, Wang J, Chai Y, Wang J. Association between polymorphisms in the promoter region of T cell immunoglobulin and mucin domain-3 and myasthenia gravis-associated thymoma. Oncol Lett 2015; 9:1470-1474. [PMID: 25663933 PMCID: PMC4314971 DOI: 10.3892/ol.2015.2845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 12/12/2014] [Indexed: 11/06/2022] Open
Abstract
Thymoma is a type of benign or low-grade malignant tumor, occurring on the thymic epithelium. Patients with thymoma may also suffer from myasthenia gravis (MG), presenting MG-associated thymoma. T cell immunoglobulin and mucin domain-3 (Tim-3), a subtype of the Tim protein family, may be an important immune regulatory and pivotal molecule associated with tumor development. In order to understand the etiology and pathogenesis of MG-associated thymoma in the Han population of North China, the present study investigated the association between a polymorphism on the -574 locus in the promoter of Tim-3 and the risk of MG-associated thymoma in the Han Chinese population. In total, 116 patients with thymoma and MG were enrolled into the MG-associated thymoma group, while 124 patients with thymoma, but without MG, were enrolled into the non-MG-associated thymoma group. Examinations were conducted to reach a definite diagnosis of thymoma and MG and rule out other autoimmune diseases. Allele-specific polymerase chain reaction (AS-PCR) was performed to determine the polymorphism on the -574 locus of Tim-3 in all the subjects. PCR products were randomly selected for sequencing. Statistically significant differences were detected between the distribution frequencies of the GT+TT genotype and T allele on the -574 locus of the MG-associated thymoma group (31.03 vs. 12.90%, respectively; χ2=11.609, P=0.001) and the non-MG-associated thymoma group (15.52 vs. 6.45%, respectively; χ2=10.198, P=0.001). In conclusion, the present study indicated that an association may exist between the polymorphism of the -574 locus in the Tim-3 promoter and MG-associated thymoma.
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Affiliation(s)
- Guowu Xu
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Kai Zheng
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xing Lu
- Department of Intensive Care Unit, Tianjin Third Central Hospital, Tianjin 300170, P.R. China
| | - Jinxiang Wang
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yanfen Chai
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Junyi Wang
- Department of Intensive Care Unit, Tianjin Third Central Hospital, Tianjin 300170, P.R. China
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Benamer HTS, Bredan A. The epidemiology of myasthenia gravis in Arab countries: a systematic review. Muscle Nerve 2014; 51:144-5. [PMID: 25088247 DOI: 10.1002/mus.24350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hani T S Benamer
- Neurology Department, New Cross Hospital, Wolverhampton, UK; Department of Neurology, Queen Elizabeth Neuroscience Centre, Birmingham, UK
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