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Green JD, Barohn RJ, Bartoccion E, Benatar M, Blackmore D, Chaudhry V, Chopra M, Corse A, Dimachkie MM, Evoli A, Florence J, Freimer M, Howard JF, Jiwa T, Kaminski HJ, Kissel JT, Koopman WJ, Lipscomb B, Maestri M, Marino M, Massey JM, McVey A, Mezei MM, Muppidi S, Nicolle MW, Oger J, Pascuzzi RM, Pasnoor M, Pestronk A, Provenzano C, Ricciardi R, Richman DP, Rowin J, Sanders DB, Siddiqi Z, Soloway A, Wolfe GI, Wulf C, Drachman DB, Traynor BJ. Epidemiological evidence for a hereditary contribution to myasthenia gravis: a retrospective cohort study of patients from North America. BMJ Open 2020; 10:e037909. [PMID: 32948566 PMCID: PMC7511637 DOI: 10.1136/bmjopen-2020-037909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To approximate the rate of familial myasthenia gravis and the coexistence of other autoimmune disorders in the patients and their families. DESIGN Retrospective cohort study. SETTING Clinics across North America. PARTICIPANTS The study included 1032 patients diagnosed with acetylcholine receptor antibody (AChR)-positive myasthenia gravis. METHODS Phenotype information of 1032 patients diagnosed with AChR-positive myasthenia gravis was obtained from clinics at 14 centres across North America between January 2010 and January 2011. A critical review of the epidemiological literature on the familial rate of myasthenia gravis was also performed. RESULTS Among 1032 patients, 58 (5.6%) reported a family history of myasthenia gravis. A history of autoimmune diseases was present in 26.6% of patients and in 28.4% of their family members. DISCUSSION The familial rate of myasthenia gravis was higher than would be expected for a sporadic disease. Furthermore, a high proportion of patients had a personal or family history of autoimmune disease. Taken together, these findings suggest a genetic contribution to the pathogenesis of myasthenia gravis.
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Affiliation(s)
- Joshua D Green
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging Intramural Research Program, Bethesda, Maryland, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Emanuela Bartoccion
- Institute of General Pathology, Catholic University, Fondazione Policlinico Universitario "A. Gemelli"-I.R.C.C.S, Rome, Italy
| | - Michael Benatar
- Department of Neurology, University of Miami, Coral Gables, Florida, USA
| | - Derrick Blackmore
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Vinay Chaudhry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Manisha Chopra
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea Corse
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amelia Evoli
- Istituto di Neurologia, Policlinico A. Gemelli IRCSS, Università Cattolica del S. Cuore, Rome, Italy
| | - Julaine Florence
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Miriam Freimer
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, USA
| | - James F Howard
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Theresa Jiwa
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Henry J Kaminski
- Department of Neurology, George Washington University, Washington, DC, USA
| | - John T Kissel
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Wilma J Koopman
- Department of Clinical Neurosciences, London Health Sciences Centre, London, Ontario, Canada
| | - Bernadette Lipscomb
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Mariapaola Marino
- Institute of General Pathology, Catholic University, Fondazione Policlinico Universitario "A. Gemelli"-I.R.C.C.S, Rome, Italy
| | - Janice M Massey
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - April McVey
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Michelle M Mezei
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Srikanth Muppidi
- Department of Neurology and Neurosciences, Stanford University, Stanford, California, USA
| | - Michael W Nicolle
- Division of Neurology, London Health Sciences Centre, London, Ontario, Canada
| | - Joel Oger
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert M Pascuzzi
- Department of Neurology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Carlo Provenzano
- Institute of General Pathology, Catholic University, Fondazione Policlinico Universitario "A. Gemelli"-I.R.C.C.S, Rome, Italy
| | | | - David P Richman
- Neurology, Center for Neuroscience, University of California, Davis, California, USA
| | - Julie Rowin
- APAC Centers for Pain Management Wellness and Integrative Neurology, Westchester, Illinois, USA
| | - Donald B Sanders
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Zaeem Siddiqi
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Aimee Soloway
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Gil I Wolfe
- Department of Neurology, University at Buffalo State University of New York, Buffalo, New York, United States
| | - Charlie Wulf
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Daniel B Drachman
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bryan J Traynor
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging Intramural Research Program, Bethesda, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Renton AE, Pliner HA, Provenzano C, Evoli A, Ricciardi R, Nalls MA, Marangi G, Abramzon Y, Arepalli S, Chong S, Hernandez DG, Johnson JO, Bartoccioni E, Scuderi F, Maestri M, Gibbs JR, Errichiello E, Chiò A, Restagno G, Sabatelli M, Macek M, Scholz SW, Corse A, Chaudhry V, Benatar M, Barohn RJ, McVey A, Pasnoor M, Dimachkie MM, Rowin J, Kissel J, Freimer M, Kaminski HJ, Sanders DB, Lipscomb B, Massey JM, Chopra M, Howard JF, Koopman WJ, Nicolle MW, Pascuzzi RM, Pestronk A, Wulf C, Florence J, Blackmore D, Soloway A, Siddiqi Z, Muppidi S, Wolfe G, Richman D, Mezei MM, Jiwa T, Oger J, Drachman DB, Traynor BJ. A genome-wide association study of myasthenia gravis. JAMA Neurol 2015; 72:396-404. [PMID: 25643325 DOI: 10.1001/jamaneurol.2014.4103] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Myasthenia gravis is a chronic, autoimmune, neuromuscular disease characterized by fluctuating weakness of voluntary muscle groups. Although genetic factors are known to play a role in this neuroimmunological condition, the genetic etiology underlying myasthenia gravis is not well understood. OBJECTIVE To identify genetic variants that alter susceptibility to myasthenia gravis, we performed a genome-wide association study. DESIGN, SETTING, AND PARTICIPANTS DNA was obtained from 1032 white individuals from North America diagnosed as having acetylcholine receptor antibody-positive myasthenia gravis and 1998 race/ethnicity-matched control individuals from January 2010 to January 2011. These samples were genotyped on Illumina OmniExpress single-nucleotide polymorphism arrays. An independent cohort of 423 Italian cases and 467 Italian control individuals were used for replication. MAIN OUTCOMES AND MEASURES We calculated P values for association between 8,114,394 genotyped and imputed variants across the genome and risk for developing myasthenia gravis using logistic regression modeling. A threshold P value of 5.0×10(-8) was set for genome-wide significance after Bonferroni correction for multiple testing. RESULTS In the overall case-control cohort, we identified association signals at CTLA4 (rs231770; P=3.98×10(-8); odds ratio, 1.37; 95% CI, 1.25-1.49), HLA-DQA1 (rs9271871; P=1.08×10(-8); odds ratio, 2.31; 95% CI, 2.02-2.60), and TNFRSF11A (rs4263037; P=1.60×10(-9); odds ratio, 1.41; 95% CI, 1.29-1.53). These findings replicated for CTLA4 and HLA-DQA1 in an independent cohort of Italian cases and control individuals. Further analysis revealed distinct, but overlapping, disease-associated loci for early- and late-onset forms of myasthenia gravis. In the late-onset cases, we identified 2 association peaks: one was located in TNFRSF11A (rs4263037; P=1.32×10(-12); odds ratio, 1.56; 95% CI, 1.44-1.68) and the other was detected in the major histocompatibility complex on chromosome 6p21 (HLA-DQA1; rs9271871; P=7.02×10(-18); odds ratio, 4.27; 95% CI, 3.92-4.62). Association within the major histocompatibility complex region was also observed in early-onset cases (HLA-DQA1; rs601006; P=2.52×10(-11); odds ratio, 4.0; 95% CI, 3.57-4.43), although the set of single-nucleotide polymorphisms was different from that implicated among late-onset cases. CONCLUSIONS AND RELEVANCE Our genetic data provide insights into aberrant cellular mechanisms responsible for this prototypical autoimmune disorder. They also suggest that clinical trials of immunomodulatory drugs related to CTLA4 and that are already Food and Drug Administration approved as therapies for other autoimmune diseases could be considered for patients with refractory disease.
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Affiliation(s)
- Alan E Renton
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Hannah A Pliner
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Carlo Provenzano
- Institute of General Pathology, Catholic University, Rome, Italy
| | - Amelia Evoli
- Institute of Neurology, Catholic University, Rome, Italy
| | - Roberta Ricciardi
- Department of Neuroscience, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Michael A Nalls
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Giuseppe Marangi
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland6Institute of Medical Genetics, Catholic University, Rome, Italy
| | - Yevgeniya Abramzon
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Sampath Arepalli
- Genomics Technology Group, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Sean Chong
- Genomics Technology Group, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Dena G Hernandez
- Genomics Technology Group, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Janel O Johnson
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | | | - Flavia Scuderi
- Institute of General Pathology, Catholic University, Rome, Italy
| | | | - J Raphael Gibbs
- Computational Biology Core, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland
| | - Edoardo Errichiello
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland9Rita Levi Montalcini Department of Neuroscience, University of Turin, Tu
| | - Adriano Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Gabriella Restagno
- Molecular Genetics Unit, Department of Clinical Pathology, ASO OIRM-S Anna, Turin, Italy
| | | | - Mark Macek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sonja W Scholz
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andrea Corse
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vinay Chaudhry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, Florida
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - April McVey
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Julie Rowin
- Department of Neurology, University of Illinois College of Medicine, Chicago
| | - John Kissel
- Department of Neurology, Ohio State University Medical Center, Columbus
| | - Miriam Freimer
- Department of Neurology, Ohio State University Medical Center, Columbus
| | - Henry J Kaminski
- Department of Neurology, George Washington University, Washington, DC
| | - Donald B Sanders
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Bernadette Lipscomb
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Janice M Massey
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Manisha Chopra
- Department of Neurology, University of North Carolina, Chapel Hill
| | - James F Howard
- Department of Neurology, University of North Carolina, Chapel Hill
| | - Wilma J Koopman
- Department of Clinical Neurosciences, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W Nicolle
- Department of Clinical Neurosciences, London Health Sciences Centre, London, Ontario, Canada
| | - Robert M Pascuzzi
- Department of Neurology, Indiana University-Purdue University, Indianapolis
| | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Charlie Wulf
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Julaine Florence
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Derrick Blackmore
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Aimee Soloway
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Zaeem Siddiqi
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Srikanth Muppidi
- Department of Neurology, University at Buffalo SMBS, State University of New York, Buffalo
| | - Gil Wolfe
- Department of Neurology, University at Buffalo SMBS, State University of New York, Buffalo
| | - David Richman
- Department of Neurology, University of California, Davis Medical Center
| | - Michelle M Mezei
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theresa Jiwa
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Oger
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel B Drachman
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bryan J Traynor
- Neuromuscular Diseases Research Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Porter Neuroscience Research Center, Bethesda, Maryland11Department of Neurology, Johns Hopkins School of Medicine, Baltimore, M
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