Immunological markers of myasthenia gravis
Summary. Aim — to study the specific immunological markers in patients with myasthenia gravis. Materials and methods. 182 patients with myasthenia gravis were examined (147 (80.8%) with generalized and 35 (19.2%) — with ocular form). Clinical and neurological examination were performed, the class of myasthenia was determined according to the MGFA. The levels of antibodies to acetylcholine receptors (AchR-AB) and muscle-specific tyrosine kinase (MuSK-AB) were determined by immunoassay, the detection of antibodies to titin and SOX1 was performed by indirect immunofluorescence. Results. AchR-AB were found in the majority (68.1%) of the patients, significantly more common in those with generalized form (73.5%), and less frequently (45.7%) with ocular form (p=0.002). In 10.9% of patients with generalized myasthenia, MuSK-AB were detected, and these antibodies were not detected in patients with ocular form. Antibodies to SOX1 were diagnosed in 5.5% of the examined only with the generalized form and correlated with mortality (ρ=0.16; p<0.05). Antibodies to titin were detected in almost a third of all patients (53.1%) and strongly correlated with thymoma (ρ=0.70; p<0.001) and with thymectomy (in patients with history of thymoma) (ρ=0.65; p<0.001). Conclusions. It is supposed to perform immunological examination to patients with myasthenia gravis with the detection of AchR-AB, and if not found — MuSK-AB. It is expedient to carry out research on antibodies to titin in order to detect pathological changes of thymus at preclinical stages to patients with myasthenia gravis without changes in thymus and without thymoma.
- Kalbus O.I. (2018) Kliniko-imunolohichni spivstavlennia u khvorykh na miasteniiu. zhurn. med. biol. sport., 1: 135–138.
- Kulikova S.L. (2014) Antitela k atsetilholinovyim retseptoram v diagnostike razlichnyih form miastenii. Nevrologiya i neyrohirurgiya. Vostochnaya Evropa, 1: 73–82.
- Sanadze A.G. (2017) Miasteniya i miastenicheskie sindromyi: Rukovodstvo. GEOTAR-Media, Moskva, 256.
- Shkolnik V.M., Kalbus A.I., Baranenko A.N., Pogorelov A.V. (2014) Miasteniya: sovremennyie podhodyi k diagnostike i lecheniyu. Ukr. nevrol. zhurn., 2: 12–17.
- Andersen J.B., Heldal A.T., Engeland A., Gilhus N.E. (2014) Myasthenia gravis epidemiology in a national cohort; combining multiple disease registries. Acta neurologica Scandinavica. Supplementum, 198: 26–31.
- Blum S., Lee D., Gillis D. et al. (2015) Clinical features and impact of myasthenia gravis disease in Australian patients. J. Clin. Neurosci., 22(7): 1164–1169.
- Breiner A., Young J., Green D. et al. (2015) Canadian administrative health data can identify patients with myasthenia gravis. Neuroepidemiology, 44: 108–113.
- Breiner A., Widdifield J., Katzberg H.D. et al. (2016) Epidemiology of myasthenia gravis in Ontario, Canada. Neuromuscular Disorders, 26(1): 41–46.
- Carr A.S., Cardwell C.R., McCarron P.O., McConville J. (2010) A systematic review of population based epidemiological studies in Myasthenia Gravis. BMC Neurol., 10: 46.
- Engel A.G. (Ed.) (2012) Myasthenia gravis and myasthenic disorders (2 ed.). Oxford University Press, Oxford, 304 p.
- Skeiea G.O., Apostolskib S., Evolic A. et al. (2010) Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur. J. Neur., 17: 1–10.