Neuronal nicotinic acetylcholine receptor antibodies in autoimmune central nervous system disorders.

Background: Neuronal nicotinic acetylcholine receptors (nAChRs) are abundant in the central nervous system (CNS), playing critical roles in brain function. Antigenicity of nAChRs has been well demonstrated with antibodies to ganglionic AChR subtypes (i.e., subunit α3 of α3ß4-nAChR) and muscle AChR autoantibodies, thus making nAChRs candidate autoantigens in autoimmune CNS disorders. Antibodies to several membrane receptors, like NMDAR, have been identified in autoimmune encephalitis syndromes (AES), but many AES patients have yet to be unidentified for autoantibodies. This study aimed to develop of a cell-based assay (CBA) that selectively detects potentially pathogenic antibodies to subunits of the major nAChR subtypes (α4ß2- and α7-nAChRs) and its use for the identification of such antibodies in "orphan" AES cases. Methods: The study involved screening of sera derived from 1752 patients from Greece, Turkey and Italy, who requested testing for AES-associated antibodies, and from 1203 "control" patients with other neuropsychiatric diseases, from the same countries or from Germany. A sensitive live-CBA with α4ß2-or α7-nAChR-transfected cells was developed to detect antibodies against extracellular domains of nAChR major subunits. Flow cytometry (FACS) was performed to confirm the CBA findings and indirect immunohistochemistry (IHC) to investigate serum autoantibodies' binding to rat brain tissue. Results: Three patients were found to be positive for serum antibodies against nAChR α4 subunit by CBA and the presence of the specific antibodies was quantitatively confirmed by FACS. We detected specific binding of patient-derived serum anti-nAChR α4 subunit antibodies to rat cerebellum and hippocampus tissue. No serum antibodies bound to the α7-nAChR-transfected or control-transfected cells, and no control serum antibodies bound to the transfected cells. All patients positive for serum anti-nAChRs α4 subunit antibodies were negative for other AES-associated antibodies. All three of the anti-nAChR α4 subunit serum antibody-positive patients fall into the AES spectrum, with one having Rasmussen encephalitis, another autoimmune meningoencephalomyelitis and another being diagnosed with possible autoimmune encephalitis. Conclusion: This study lends credence to the hypothesis that the major nAChR subunits are autoimmune targets in some cases of AES and establishes a sensitive live-CBA for the identification of such patients.

[Autoimmune Autonomic Ganglionopathy and Acute Autonomic Sensory Neuropathy].

Autoimmune autonomic ganglionopathy (AAG) and acute autonomic sensory neuropathy (AASN) are immune-mediated neuropathies that affect the autonomic and/or dorsal root ganglia. Autoantibodies against the nicotinic ganglionic acetylcholine receptor (gAChR) detected in the sera of patients with AAG play a key role in the pathogenesis of this condition. Notably, gAChR antibodies are not detected in the sera of patients with AASN. Currently, AAG and AASN are not considered to be on the same spectrum with regard to disease concept based on clinical symptoms and laboratory findings. However, extra-autonomic brain symptoms (including psychiatric symptoms and personality changes) and endocrine disorders occur in both diseases, which suggests shared pathophysiology between the two conditions.

Inmunogénesis de la miastenia gravis / The immunogenesis of myasthenia gravis

La principal inspiración de esta actualización proviene de las publicaciones periódicas que hace la New York Academy of Sciences, la cual destina un número, cada 3-4 años, a tratar los nuevos aspectos tanto clínicos como de ciencias básicas sobre el comportamiento anormal de la transmisión neuromuscular en la Miastenia Gravis. Una parte breve del trabajo se destina a la historia fascinante del descubrimiento de la Miastenia autoinmune experimental. Enseguida se revisa parcialmemte la composición molecular del receptor nicotímico de la Acetilcolina (RAc) en el músculo. Posteriormente se suceden las referencias a la producción de anticuerpos de la clase IgG contra las subunidades alfa del receptor de Ac, la interacción de los linfocitos B como células presentadoras en el contexto del complejo mayor de histocompatibilidad de la clase II y su participación de la tríada, que se completa con el antígeno y los receptores de los linfocitos T. Se alude al empleo de los polipéptidos sintéticos que reproducen secuencias aminoácidas de las subunidades de los receptores del músculo humano y que permitirían, eventualmente, utilizarlos como una suerte de inactivadores de las células T autoinmunes. Una sección importante se refiere a la presencia en la Miastenia Gravis de clonos patológicos de las células T en el suero de los pacientes, contra las cadenas alfa del RAc, pero también se enfatiza la presencia de clonos de células T autoinmunes en el sistema inmunitario normal. Se señala que no se sabe con certeza por qué se rompe la tolerancia autoinmunitaria. Termina la revisión analizando extensamente la participación del Timo en la formación de anticuerpos contra la placa motora sin eludir la complejidad y el misterio que reside en la intimidad histológica y molecular de dicho proceso. Se plantea la duda que sea el Timo el factor causal de la MG y se postula que su patología hiperplásica o tumoral sería un epifenómeno de un proceso más general de alteración autoinmunitaria