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Kurdi M, Alshareef A, Bamaga AK, Fadel ZT, Alrawaili MS, Hakamy S, Mohamed F, Abuzinadah AR, Addas BMJ, Butt NS. The Assessment of Major Histocompatibility Complex (MHC) Class-I Expression in Different Neuromuscular Diseases. Degener Neurol Neuromuscul Dis 2022; 11:61-68. [PMID: 35002356 PMCID: PMC8727622 DOI: 10.2147/dnnd.s340117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Major histocompatibility complex (MHC) class-1 antigen is a glycoprotein expressed in all nucleated cells. The aim of this study was to assess MHC class-I expression in different neuromuscular diseases. Methods The authors reviewed the data of 54 patients with neuromuscular diseases. Anti MHC class-I antibody was performed on the frozen muscle tissues using immunohistochemistry. MHC class-I was scored based on its expression on muscle fibers (0: normal, 1: expression <5 fibers, 2: expression in 5–10 fibers, 3: expression in >10 fibers). The pattern was only assessed in cases with MHC class-I scored 3 as: (1: Sarcocapillary, 2: Sarcocapillary and necrotic fibers, 3: Perifascicular). The relationship between MHC class-I expression and neuromuscular diseases was statistically analyzed. Results The mean age of the patients was 39.1 ± 18.5 years. Around 50% of patients showed normal CK levels and 5% of the cases showed elevated CK levels. There was a significance difference in MHC class-I expression between cases with normal and elevated CK levels when MHC class-I score was 3 (p= 0.020). There was a significant difference in MHC class-I expression among different neuromuscular diseases (p<0.001). All cases with idiopathic inflammatory myopathies (IIMs) have expressed MHC class-I in more than 10 fibers. MHC class-I was expressed in 15 cases of non-IIMs. Conclusion MHC class-I cannot be solely used as a biomarker to distinguish IIMs from non-IIMs. The presence of MHC class-I molecules in non-IIMs might be related to immunoproteasomes mechanism. Further studies, with different muscle proteins expression and genomic sequencing, must be conducted to understand the role of MHC Class-I in neuromuscular diseases.
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Affiliation(s)
- Maher Kurdi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia.,Neuromuscular Unit, Roya Medical Specialized Laboratories, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aysha Alshareef
- Department of Internal Medicine, King Abdulaziz University Hospital and Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed K Bamaga
- Neurology Division, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University and Hospital, Jeddah, Saudi Arabia
| | - Zahir T Fadel
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Moafaq S Alrawaili
- Department of Internal Medicine, King Abdulaziz University Hospital and Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sahar Hakamy
- Neuromuscular Unit, Roya Medical Specialized Laboratories, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fawaz Mohamed
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia.,Neuromuscular Unit, Roya Medical Specialized Laboratories, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad R Abuzinadah
- Department of Internal Medicine, King Abdulaziz University Hospital and Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bassam M J Addas
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nadeem Shafique Butt
- Department of Family Medicine and Community, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
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Iwasa K, Furukawa Y, Yoshikawa H, Yamada M. Caveolin-3 is aberrantly expressed in skeletal muscle cells in myasthenia gravis. J Neuroimmunol 2016; 301:30-34. [DOI: 10.1016/j.jneuroim.2016.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/06/2016] [Accepted: 10/31/2016] [Indexed: 01/01/2023]
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The HLA-B*4601-DRB1*0901 haplotype is positively correlated with juvenile ocular myasthenia gravis in a southern Chinese Han population. Neurol Sci 2015; 36:1135-40. [DOI: 10.1007/s10072-015-2235-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/28/2015] [Indexed: 01/27/2023]
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Rodríguez Cruz PM, Luo YB, Miller J, Junckerstorff RC, Mastaglia FL, Fabian V. An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies. Neuromuscul Disord 2014; 24:1025-35. [PMID: 25153265 DOI: 10.1016/j.nmd.2014.06.436] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 01/09/2023]
Abstract
Although there have been several previous reports of immunohistochemical staining for MHC antigens in muscle biopsies, there appears to be a lack of consensus about its routine use in the diagnostic evaluation of biopsies from patients with suspected inflammatory myopathy. Positive MHC-I staining is nonspecific but is widely used as a marker for inflammatory myopathy, whilst the role of MHC-II staining is not clearly defined. We investigated the sensitivity and specificity of MHC-I and MHC-II immunostaining for the diagnosis of inflammatory myopathy in a large group of biopsies from a single reference laboratory. Positive staining for MHC-I was found to have a high sensitivity in biopsies from patients with inflammatory myopathy but a very low specificity, as it was also common in other non-inflammatory myopathies and neurogenic disorders. On the other hand, MHC-II positivity had a much higher specificity in all major subgroups of inflammatory myopathy, especially inclusion body myositis. The findings indicate that the combination of MHC-I and MHC-II staining results in a higher degree of specificity for the diagnosis of inflammatory myopathy and that in biopsies with inflammation, positive MHC-II staining strongly supports the diagnosis of an immune-mediated myopathy. We recommend that immunohistochemical staining for both MHC-I and MHC-II should be included routinely in the diagnostic evaluation of muscle biopsies from patients with suspected inflammatory myopathy. However, as the sensitivity and interpretation of MHC staining may depend on the technique used, further studies are needed to compare procedures in different centres and develop standardised protocols.
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Affiliation(s)
- Pedro M Rodríguez Cruz
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, Perth, Australia; Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Yue-Bei Luo
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, Perth, Australia; Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - James Miller
- Department of Neurology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Reimar C Junckerstorff
- Section of Neuropathology, Department of Anatomical Pathology, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Frank L Mastaglia
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, Perth, Australia; Institute for Immunology & Infectious Diseases, Murdoch University, Perth, Australia.
| | - Victoria Fabian
- Section of Neuropathology, Department of Anatomical Pathology, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
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Increased skeletal muscle expression of the endoplasmic reticulum chaperone GRP78 in patients with myasthenia gravis. J Neuroimmunol 2014; 273:72-6. [PMID: 24882382 DOI: 10.1016/j.jneuroim.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 12/22/2022]
Abstract
In myasthenia gravis (MG), damage to neuromuscular junctions may induce endoplasmic reticulum (ER) stress in skeletal muscles. In the current study, skeletal muscles obtained from patients with MG exhibited upregulation of glucose-regulated protein 78 (GRP78) mRNA that was activated by ER stress. Furthermore, GRP78 mRNA expression was higher in patients with MG and myositis than in patients with non-myopathy. We also observed a significant positive correlation between GRP78 mRNA expression and GRP78 protein levels and between GRP78 mRNA expression and age of MG onset. Our findings suggest that muscle weakness in MG might be caused by both neuromuscular junction disruption and ER stress.
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Pouwels S, de Boer A, Javaid MK, Hilton-Jones D, Verschuuren J, Cooper C, Leufkens HG, de Vries F. Fracture rate in patients with myasthenia gravis: the general practice research database. Osteoporos Int 2013; 24:467-76. [PMID: 22531999 PMCID: PMC3557375 DOI: 10.1007/s00198-012-1970-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/05/2012] [Indexed: 11/27/2022]
Abstract
SUMMARY The aim of this study was to evaluate fracture risk after onset of myasthenia gravis using the UK General Practice Research Database. Overall fracture risk is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use, but was increased in those using antidepressants, anxiolytics or anticonvulsants. INTRODUCTION Myasthenia gravis (MG) is a neuromuscular disease which has been associated with an increased falls risk and glucocorticoid-induced osteoporosis, recognized determinants of increased fracture risk. The aim of this study was to evaluate the risk of fracture after onset of MG. METHODS We conducted a retrospective cohort study using the UK General Practice Research Database (1987-2009). Each MG patient was matched by age, sex, calendar time and practice to up to six patients without a history of MG and we identified all fractures and those associated with osteoporosis. RESULTS Compared to the control cohort, there was no statistically significant increased risk observed in patients with MG for any fracture (adjusted hazard ratio [AHR] 1.11; 95 % confidence interval [CI], 0.84-1.47) or osteoporotic fractures (AHR 0.98 [95 % CI 0.67-1.41]). Further, use of oral glucocorticoids up to a cumulative dose exceeding 5 g prednisolone equivalents did not increase risk of osteoporotic fracture (AHR 0.99 [95 % CI, 0.31-3.14]) compared with MG patients without glucocorticoid exposure. However, fracture risk was higher in patients with MG prescribed antidepressants (AHR 3.27 [95 % CI, 1.63-6.55]), anxiolytics (AHR 2.18 [95 % CI, 1.04-4.57]) and anticonvulsants (AHR 6.88 [95 % CI, 2.91-16.27]). CONCLUSION Overall risk of fracture in patients with MG is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use but was increased in those using antidepressants, anxiolytics or anticonvulsants. These findings have implications in strategies preserving bone health in patients with MG.
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Affiliation(s)
- S. Pouwels
- Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, the Netherlands
| | - A. de Boer
- Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, the Netherlands
| | - M. K. Javaid
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D. Hilton-Jones
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - J. Verschuuren
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C. Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H. G. Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, the Netherlands
| | - F. de Vries
- Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, the Netherlands
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Universiteitsweg 99, 3584 CG Utrecht, the Netherlands
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Abstract
Human heart failure is a disease with multifactorial causes, considerable morbidity, and high mortality. Several circulating autoantibodies, some of them being heart-specific, play a crucial role in the progression and induction of heart failure. However the precise mechanisms on how these autoantibodies perpetuate or even induce an organ specific autoimmune response are not yet fully understood. Also it is being a matter of current research to elucidate a potential pathophysiological role of the innate immune system in generating auto-reactive antibodies. In this review we will summarize the current available literature on circulating autoantibodies which are related to human heart failure. We will present clinical and animal studies that demonstrate the occurrence and pathophysiological relevance of several autoantibodies in heart failure, as well as point out biological mechanisms on molecular and cellular level. Finally the beneficial therapeutic effects of numerous clinical studies that target the humoral arm of the immune system by using either intravenous immunoglobulins and/or immunoadsorption will be critically discussed.
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Affiliation(s)
- Ziya Kaya
- From the Department of Internal Medicine III (Z.K., C.L., H.A.K.), University of Heidelberg, Germany
| | - Christoph Leib
- From the Department of Internal Medicine III (Z.K., C.L., H.A.K.), University of Heidelberg, Germany
| | - Hugo A. Katus
- From the Department of Internal Medicine III (Z.K., C.L., H.A.K.), University of Heidelberg, Germany
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Suzuki S, Utsugisawa K, Iwasa K, Satoh T, Nagane Y, Yoshikawa H, Kuwana M, Suzuki N. Autoimmunity to endoplasmic reticulum chaperone GRP94 in myasthenia gravis. J Neuroimmunol 2011; 237:87-92. [PMID: 21774995 DOI: 10.1016/j.jneuroim.2011.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/02/2011] [Accepted: 06/20/2011] [Indexed: 12/25/2022]
Abstract
Immune responses to ER stress have been closely related to the pathogenesis of autoimmune diseases. Using an immunoprecipitation assay, 24 (7.1%) of 336 MG serum samples immunoprecipitated a 90-kDa protein from the muscle cellular extracts, but none of the disease or healthy control sera. The 90-kDa protein was affinity-purified and found to match to ER chaperon GRP94 by matrix-assisted laser desorption/ionization-time of flight mass spectroscopy analysis. The frequency of associated autoimmune diseases was much higher in the anti-GRP94-positive than the -negative patients (71% versus 11%, p<0.001). Autoimmunity to ER chaperone GRP94 is associated with a subset of MG patients who have additional autoimmune diseases.
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Affiliation(s)
- Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
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Abstract
The study of complex genetics in autoimmune diseases has progressed at a tremendous pace over the last 4 years, as a direct result of the enormous gains made by genome wide association studies (GWAS). Novel genetic findings are continuously being reported alongside the rapid development of genetic technologies, sophisticated statistical analysis, and larger sample collections. It is now becoming clear that multiple genes contribute to disease risk in many complex genetic disorders including rheumatoid arthritis (RA) and that there are common genetic risk factors that underlie a spectrum of autoimmune diseases. This review details the current genetic landscape of RA, and describes what GWAS has taught us in terms of missing heritability, subsets of disease, existence of genetic heterogeneity, and shared autoimmune risk loci. Finally, this review addresses the initial challenges faced in translating the wealth of genetic findings into determining the biological mechanisms that contribute to the relationship between genotype and phenotype. Unraveling the mechanism of how genes directly influence the cause of RA will lead to a better understanding of the disease and will ultimately have a direct clinical impact, informing the development of new therapies that can be utilized in the treatment of RA.
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Affiliation(s)
- Kate McAllister
- Arthritis Research United Kingdom Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Stephen Eyre
- Arthritis Research United Kingdom Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Gisela Orozco
- Arthritis Research United Kingdom Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, UK
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