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Title: Antibody effector mechanisms in myasthenia gravis-Pathogenesis at the neuromuscular junction
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.
Martinez-Martinez, Pilar
Losen, Mario
Issue Date: 2010
Source: AUTOIMMUNITY, 43 (5-6). p. 353-370
Abstract: 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 arc 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.
Notes: [Gomez, Alejandro M.; Van den Broeck, Joost; Vrolix, Kathleen; Janssen, Sofie P.; Lemmens, Marijke A. M.; Van der Esch, Eline; Molenaar, Peter C.; Martinez-Martinez, Pilar; De Baets, Marc H.; Losen, Mario] Univ Maastricht, Dept Neurosci, Sch Mental Hlth & Neurosci, Neuroimmunol Grp, NL-6200 MD Maastricht, Netherlands. [Duimel, Hans; Frederik, Peter] Maastricht Univ, Electron Microscopy Unit, Dept Pathol, Maastricht, Netherlands. [De Baets, Marc H.] Hasselt Univ, Biomed Res Inst BIOMED, Neuroimmunol Grp, Diepenbeek, Belgium.
Keywords: Myasthenia gravis; neuromuscular junction; IgG4; Fab arm exchange; complement;Myasthenia gravis; neuromuscular junction; IgG4; Fab arm exchange; complement
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ISSN: 0891-6934
e-ISSN: 1607-842X
DOI: 10.3109/08916930903555943
ISI #: 000281961100003
Category: A1
Type: Journal Contribution
Validations: ecoom 2011
Appears in Collections:Research publications

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