Recent approaches to the development of antigen-specific immunotherapies for myasthenia gravis

Abstract

Acquired autoimmune myasthenia gravis (MG) is the most common disease that affects the neuromuscular junction (NMJ). MG is associated with autoantibodies (auto-Abs) to components of the NMJ. About 85–90% of MG patients have auto-Abs against the muscle nicotinic acetylcholine receptor (AChR), while about half of the remaining patients have auto-Abs against muscle-specific kinase. Auto-Abs, in combination with local deposition of complement, reduce the number of available post-synaptic nicotinic AChRs and thereby impair neuromuscular transmission. Current medications for MG are non-specific and include acetylcholinesterase inhibitors, immunosuppressants, plasma exchange, intravenous Ig administration and thymectomy. Treatments that selectively target the anti-AChR auto-Abs may prove to be more effective and free of side-effects. We here review two approaches aimed at the development of antigen-specific therapies for MG. The first is specific apheresis of Abs from patients' sera using immobilised recombinant AChR domains as immunoadsorbents. Indeed, we have recently shown that the combined recombinant extracellular domains of all human AChR subunits are capable of specifically immunoadsorbing the majority of pathogenic auto-Abs from several MG sera. The second therapeutic approach is the development of non-pathogenic anti-AChR monoclonal Abs that could potentially be used as protective agents by blocking the binding of patients' auto-Abs to the AChR.

Keywords::

• Acetylcholine receptor
• autoantibodies
• extracellular domains
• monoclonal antibodies
• myasthenia gravis
• therapy

Acknowledgements

We thank G. Patrinos for critical reading of the manuscript.

Declaration of interest: Original studies in the authors' laboratories summarised in this article have been supported by grants from the European Commission, the MDA of USA, AFM and the Greek GSRT. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.