A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis.

Double-seronegative myasthenia gravis (dSN-MG, without detectable AChR and MuSK antibodies) presents a serious gap in MG diagnosis and understanding. Recently, autoantibodies against the low-density lipoprotein receptor-related protein 4 (LRP4) have been identified in several dSN-MG sera, but with dramatic frequency variation (∼2-50%). We have developed a cell based assay (CBA) based on human LRP4 expressing HEK293 cells, for the reliable and efficient detection of LRP4 antibodies. We have screened about 800 MG patient sera from 10 countries for LRP4 antibodies. The overall frequency of LRP4-MG in the dSN-MG group (635 patients) was 18.7% but with variations among different populations (range 7-32.7%). Interestingly, we also identified double positive sera: 8/107 anti-AChR positive and 10/67 anti-MuSK positive sera also had detectable LRP4 antibodies, predominantly originating from only two of the participating groups. No LRP4 antibodies were identified in sera from 56 healthy controls tested, while 4/110 from patients with other neuroimmune diseases were positive. The clinical data, when available, for the LRP4-MG patients were then studied. At disease onset symptoms were mild (81% had MGFA grade I or II), with some identified thymic changes (32% hyperplasia, none with thymoma). On the other hand, double positive patients (AChR/LRP4-MG and MuSK/LRP4-MG) had more severe symptoms at onset compared with any single positive MG subgroup. Contrary to MuSK-MG, 27% of ocular dSN-MG patients were LRP4 antibody positive. Similarly, contrary to MuSK antibodies, which are predominantly of the IgG4 subtype, LRP4 antibodies were predominantly of the IgG1 and IgG2 subtypes. The prevalence was higher in women than in men (female/male ratio 2.5/1), with an average disease onset at ages 33.4 for females and 41.9 for males. Overall, the response of LRP4-MG patients to treatment was similar to published responses of AChR-MG rather than to MuSK-MG patients.

Inherited congenital goiter in mice.

Congenital goiter (cog), a new autosomal recessive mutation in mice, has been mapped to the central region of chromosome 15. Young adult mutant mice are characterized by a reduced rate of growth, mild anemia, hypothyroidism, as indicated by significantly lower total serum T4 and T3, and elevated serum TSH. Thyroids from mutant mice are hypertrophied, deficient in colloid, show a reduced accumulation of iodine that is partially susceptible to perchlorate ion discharge, have modestly elevated serum immunoreactive thyroglobulin (Tg) levels, but are markedly deficient in glandular immunoreactive Tg content. Thyroid hormone therapy corrects the growth deficiency and prevents the thyroid hypertrophy resulting from excessive stimulation by TSH. These findings suggest that the cog mutant gene results in primary hypothyroidism in response to either defective synthesis or processing of Tg.

The role of genetically-determined primary alterations of the target organ in the development of spontaneous autoimmune thyroiditis in obese strain (OS) chickens.

Immunologists working in the field of autoimmunity tend to concentrate all their efforts on the elucidation of possible malfunctions of the immune system, particularly pathologic changes of immune regulation. Also in the OS model various groups of investigators emphasized this approach, although it was already clear early in the history of this model that SAT has a multigenic background. The fact that this disease cannot be transferred into normal, histocompatible animals without an appropriate non-MHC linked genetic background was a strong indication that detailed studies of thyroid-associated factors may be warranted for the elucidation of the pathogenesis of this disease and perhaps also its human counterpart, Hashimoto thyroiditis. Since several reviews on the immunologic aspects in the OS model have been published in recent years we have in this communication attempted to discuss the - mostly still rudimentary - findings concerning the target organ itself, including morphological changes before the beginning of infiltration, the analysis of Tg, the altered thyroid function before onset of SAT, the results of cross-breeding studies of OS and inbred normal chickens in respect to the susceptibility of the offspring for the transfer of SAT, the possible role of a virus infection and the aberrant expression of MHC class II antigens on TEC. Cross-breeding studies revealed that most probably a single gene is responsible for the primary altered thyroid function and at least 3 genes code for the susceptibility of the OS thyroid gland to the autoimmune attack. It is not yet clear for which of the above-mentioned observations each of these genes is responsible and what is/are the initial triggering mechanism(s). Ongoing studies in our laboratory concentrate on this question, specifically the potential role of endogenous viruses in this process.

Secondary changes of the motor endplate in Lambert-Eaton myasthenic syndrome: a quantitative study.

Underlying the Lambert-Eaton myasthenic syndrome (LEMS) is a decrease in the release of the neurotransmitter acetylcholine. Only few reports on light and transmission electron microscopical observations of motor endplates in LEMS are available and changes reported so far differ from those found in experimental blocking of acetylcholine release. We performed a quantitative study on intercostal muscle biopsies of five patients. The main light microscopical finding was an enlargement of the area of contact between nerve and muscle, which was interpreted as a compensatory phenomenon. At the ultrastructural level we found the mean postsynaptic area and membrane length of the neuromuscular junctions to be decreased, putatively due to small postsynaptic regions of newly created neuromuscular junctions. The secondary changes in LEMS endplates as seen in this study are similar to those reported in experimental blocking of acetylcholine release.