Influence of alpha-fetoprotein on the in vitro and in vivo immune response to acetylcholine receptor

Novel approaches to treatment of autoimmune neuroinflammation and lessons for drug development

Drug development, and especially that intended for central nervous system (CNS) disorders, still poses a challenge. We investigated both the use of bifunctional compounds designed for multiple targeting and enhanced CNS permeability, and of recombinant alpha-fetoprotein (AFP), a natural pregnancy-associated immunomodulating protein for the treatment of CNS inflammation. Bifunctional compounds showed a novel pharmacokinetic profile due to the conjugation, yet retained, and even improved pharmacodynamics. AFP was well tolerated and decreased various aspects of neuroinflammation, including disease severity, axonal loss and damage, T-cell reactivity, and antigen presentation. Our results show that both strategies may serve as future drug modalities.

[Neonatal myasthenia gravis]

BACKGROUND

Myasthenia gravis, an autoimmune disease of young women, is due to the dysfunction of neuromuscular transmission. The newborn of a myasthenic mother inconstantly presents a transitory neonatal myasthenic syndrome. Maternal aggravation, or even myasthenic crisis with respiratory failure, can occur in the first three months post-partum.

CASE REPORT

Mrs. S., para two without appreciable medical history, delivered normally a boy weighing 4 kg with an Apgar score of 10/10. At 3 h of life the newborn was admitted to the neonatal care unit for grunting and axial hypotonia. Diagnoses of maternal-fetal infection and fetal distress were excluded. The dissociated pattern of neurological disorders (refusal to drink, axial hypotonia, hypomimia, but good contact and normal alertness) led to search for neuromuscular causes or poison. Myasthenia gravis was then considered and confirmed by maternal electromyography, allowing the diagnosis of transient neonatal myasthenia gravis and early diagnosis and treatment of the maternal myasthenic crisis in a specialized care unit. The outcome of both mother and child was favorable under treatment.

CONCLUSION

Lack of maternal myasthenia gravis history should not result in excluding the diagnosis of transitory neonatal myasthenia gravis when evocative neonatal neurological signs are present. The symptomatology in the newborn may indeed reveal maternal myasthenia gravis, allowing an early diagnosis in both the mother and the newborn.

Electroencephalographic changes in experimental autoimmune myasthenia gravis

A number of reports have suggested that central disturbances of cholinergic function may occur in patients with myasthenia gravis. The present study was designed in order to examine cortical electroencephalographic (EEG) activity in Lewis rats with experimental autoimmune myasthenia gravis (EAMG). Experiments were performed on conscious rats with clinical EAMG and demonstrable antibodies against the acetylcholine receptor. The animals showed no gross changes in cortical EEG discharge in terms of cycles and durations of wake, desynchronized sleep, and synchronized sleep, as compared with control rats. However, abnormalities characterized by single spikes or waves, and by spike and wave complexes, were observed, most commonly during synchronization of the EEG. Use of computerized frequency analysis of the EEG records revealed the presence of three basic differences in EEG discharge in myasthenic animals: (1) additional high-amplitude, low frequency (< 4 Hz) activity was recorded, especially during synchronized sleep; (2) decreases in mid-range (4-7 Hz) activity were recorded, particularly during periods of wakefulness; and, (3) increases in high frequency (> 8 Hz) spike discharge were observed at all times, although this was most evident during periods of synchronized sleep. The data provide further evidence for alterations in central cholinergic function in myasthenia gravis.

Inhibition by alpha-fetoprotein fractions of hemagglutination reactions between A and B antigens of human red blood cells and specific antisera

It is shown that fetal alpha-fetoprotein (AF)-rich fractions, isolated by chemical methods, can inhibit the agglutination reaction of human AB red blood cells (RBC) with specific antisera. Hemagglutination was not inhibited by other amniotic fluid or umbilical cord serum proteins in equivalent concentrations or by other pregnancy-associated hormones. The inhibitory effect is related to the amount of antibodies and AF fractions. It seems that AF interferes with the interaction between the antibody and the cell-surface antigens by preventing the binding of the antibodies to the cells. It is suggested that the ability of AF to inhibit hemagglutination reactions in vitro may play a role during pregnancy on the immune reaction between anti-A and anti-B antibodies and the corresponding RBC antigens, as well as on the manifestations or hemolytic disease of the newborn.

Activity of multiple sclerosis during pregnancy and puerperium

The influence of pregnancy on multiple sclerosis was studied in 338 women by determining in each trimester of pregnancy and post partum the number of relapses and the corresponding relapse rate. Eighty-five relapses occurred in association with 199 pregnancies, most (65) in the postpartum period, and a low number of relapses (2) were recorded in the last trimester of pregnancy. Comparing the average exacerbation rate of the study group with that of patients with multiple sclerosis in Israel (0.28 relapses per person per year), we found a statistically significant decrease in the third trimester (0.04) and a high increase in the first three months post partum (0.82). This pattern of remissions at the end of pregnancy and exacerbations post partum is similar to that observed in other putative autoimmune diseases.

Suppressive effect of pregnancy on the development of experimental allergic encephalomyelitis in rabbits

In the present study we have investigated the influence of pregnancy on the induction and development of experimental autoimmune encephalomyelitis (EAE) in rabbits in relation to the time of gestation. Randomly bred rabbits were immunized with encephalitogenic bovine brain homogenate in complete Freund's adjuvant before or during pregnancy. The appearance of EAE was delayed and occurred only after delivery, abortion, or fetal resorption. The incidence of the disease was lower and the duration longer. The levels of antibodies to myelin basic protein, an autoantigen of EAE, as measured by solid phase radioimmunoassay, were lower in the pregnant rabbits as compared to the nonpregnant animals. The suppressive influence of pregnancy on the induction and the development of EAE confirms previous reports demonstrating amelioration of autoimmune diseases and other immunological reactions during the second half of human pregnancy. This effect might be partially attributed to the increased level of alpha-fetoprotein (AFP) and/or other pregnancy-associated factors in maternal serum.

Acetylcholine receptors and myasthenia gravis

Recent years have seen considerable progress in understanding the nature of the molecular events involved in neuromuscular transmission. The acetylcholine receptor (AChR) has been purified to homogeneity and acetylcholine-induced ion transport has been reconstituted by incorporation of pure AChR into artificial membranes. Immunization against purified AChR induces a condition, clinically and physiologically similar to the human disease myasthenia gravis, which is due to circulating anti-AChR antibodies. This model, experimental autoimmune myasthenia gravis, is proving useful for investigating the role of genetic factors in determining the immune response to AChRs and for testing various experimental approaches to specific treatment. Myasthenia gravis is an autoimmune disease in which there is loss of acetylcholine receptors at the neuromuscular junction. Anti-AChR antibodies can be detected in the majority of patients and they cause loss of AChR by a variety of mechanisms. Anti-AChR antibody is heterogeneous and not restricted in idiotype. The role of the thymus in MG is still uncertain, but recent experiments implicate the presence of a cell type in MG thymus which may be involved in autosensitization to AChR.