Antibody effector mechanisms in myasthenia gravis-Pathogenesis at the neuromuscular junction

Myasthenia gravis (MG) is an autoimmune disorder caused by autoantibodies that are either directed to the muscle nicotinic acetylcholine receptor (AChR) or to the muscle-specific tyrosine kinase (MuSK). These autoantibodies define two distinct subforms of the disease-AChR-MG and MuSK-MG. Both AChR a...

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Bibliographic Details
Published in:Autoimmunity (Chur, Switzerland) Switzerland), 2010-08, Vol.43 (5-6), p.353-370
Main Authors: Gomez, Alejandro M., Van Den Broeck, Joost, Vrolix, Kathleen, Janssen, Sofie P., Lemmens, Marijke A. M., Van Der Esch, Eline, Duimel, Hans, Frederik, Peter, Molenaar, Peter C., Martínez-Martínez, Pilar, De Baets, Marc H., Losen, Mario
Format: Article
Language:English
Subjects:
Animals
Autoantibodies - blood
Autoantibodies - immunology
complement
Fab arm exchange
Humans
IgG4
Immunoglobulin G - blood
Immunoglobulin G - immunology
Muscle Weakness - physiopathology
Muscular Atrophy - physiopathology
Myasthenia gravis
Myasthenia Gravis - immunology
Myasthenia Gravis - pathology
Myasthenia Gravis - physiopathology
neuromuscular junction
Neuromuscular Junction - immunology
Neuromuscular Junction - pathology
Neuromuscular Junction - physiopathology
Receptor Protein-Tyrosine Kinases - immunology
Receptor Protein-Tyrosine Kinases - metabolism
Receptors, Cholinergic - immunology
Receptors, Cholinergic - metabolism
Receptors, Nicotinic - immunology
Receptors, Nicotinic - metabolism
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Summary:Myasthenia gravis (MG) is an autoimmune disorder caused by autoantibodies that are either directed to the muscle nicotinic acetylcholine receptor (AChR) or to the muscle-specific tyrosine kinase (MuSK). These autoantibodies define two distinct subforms of the disease-AChR-MG and MuSK-MG. Both AChR and MuSK are expressed on the postsynaptic membrane of the neuromuscular junction (NMJ), which is a highly specialized region of the muscle dedicated to receive and process signals from the motor nerve. Autoantibody binding to proteins of the postsynaptic membrane leads to impaired neuromuscular transmission and muscle weakness. Pro-inflammatory antibodies of the human IgG1 and IgG3 subclass modulate the AChR, cause complement activation, and attract lymphocytes; together acting to decrease levels of the AChR and AChR-associated proteins and to reduce postsynaptic folding. In patients with anti-MuSK antibodies, there is no evidence of loss of junctional folds and no apparent loss of AChR density. Anti-MuSK antibodies are predominantly of the IgG4 isotype, which functionally differs from other IgG subclasses in its anti-inflammatory activity. Moreover, IgG4 undergoes a posttranslational modification termed Fab arm exchange that prevents cross-linking of antigens. These findings suggest that MuSK-MG may be different in etiological and pathological mechanisms from AChR-MG. The effector functions of IgG subclasses on synapse structure and function are discussed in this review.
ISSN:0891-6934
1607-842X
DOI:10.3109/08916930903555943