Myasthenia gravis: State of the art and new therapeutic strategies

J Neuroimmunol. 2019 Dec 15:337:577080. doi: 10.1016/j.jneuroim.2019.577080. Epub 2019 Oct 15.

Abstract

Myasthenia Gravis (MG) - an autoimmune neuromuscular disease - is known by the production of autoantibodies against components of the neuromuscular junction mainly to the acetylcholine receptor, which cause the destruction and compromises the synaptic transmission. This disease is characterized by fluctuating and fatigable muscle weakness, becoming more intensive with activity, but with an improvement under resting. There are many therapeutic strategies used to alleviate MG symptoms, either by improving the transmission of the nerve impulse or by ameliorating autoimmune reactions with e.g. steroids, immunosuppressant drugs, or monoclonal antibodies (rituximab and eculizumab). Many breakthroughs in the discovery of new therapeutic targets have been reported, but MG remains to be a chronic disease where the symptoms are kept in the majority of patients. In this review, we discuss the different therapeutic strategies that have been used over the years to alleviate MG symptoms, as well as innovative therapeutic approaches currently under study.

Keywords: Acetylcholine receptors; Eculizumab; Immunosuppressant drugs; Myasthenia gravis; Neuromuscular junction; Rituximab; Steroids.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / pharmacology
  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal, Humanized / pharmacology
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Autoantibodies / blood*
  • Autoantibodies / drug effects
  • Autoantibodies / immunology
  • Complement Inactivating Agents / pharmacology
  • Complement Inactivating Agents / therapeutic use*
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use*
  • Myasthenia Gravis / blood*
  • Myasthenia Gravis / drug therapy*
  • Myasthenia Gravis / immunology
  • Neuromuscular Junction / drug effects
  • Neuromuscular Junction / immunology
  • Neuromuscular Junction / metabolism
  • Receptors, Cholinergic / immunology
  • Receptors, Cholinergic / metabolism
  • Review Literature as Topic

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Autoantibodies
  • Complement Inactivating Agents
  • Immunosuppressive Agents
  • Receptors, Cholinergic
  • eculizumab