Role of autoantibody levels as biomarkers in the management of patients with myasthenia gravis: A systematic review and expert appraisal

Abstract

Background and purpose: Although myasthenia gravis (MG) is recognized as an immunoglobulin G autoantibody-mediated disease, the relationship between autoantibody levels and disease activity in MG is unclear. We sought to evaluate this landscape through systematically assessing the evidence, testing the impact of predefined variables on any relationship, and augmenting with expert opinion. Methods:In October 2020, a forum of leading clinicians and researchers in neurology from across Europe (Expert Forum for Rare Autoantibodies in Neurology in Myasthenia Gravis) participated in a series of virtual meetings that took place alongside the conduct of a systematic literature review (SLR).Results: Forty-two studies were identified meeting inclusion criteria. Of these, 10 reported some correlation between a patient's autoantibody level and disease severity.Generally, decreased autoantibody levels (acetylcholine receptor, muscle-specific kinase, and titin) were positively and significantly correlated with improvements in disease severity (Quantitative Myasthenia Gravis score, Myasthenia Gravis Composite score,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Reply to the Letter to the Editor in response to “Role of autoantibody levels as biomarkers in the management of patients with myasthenia gravis: A systematic review and expert appraisal”

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We appreciate the comments from Li et al [1] on aspects of our article entitled "Role of Autoantibody Levels as Biomarkers in the Management of Patients With Myasthenia Gravis: A Systematic Review and Expert Appraisal." [2] We agree that titin autoantibody Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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Autoantibody levels as biomarkers of disease activity in the management of myasthenia gravis

“…The activity of MG is difficult to define. Although a correlation was found between AChR antibody level and severity at group level in Meisel et al's report [1], inconsistent trends of AChR antibody level and severity were found in a certain proportion of individual patients, either at a time-point or over an interval [4].…”

“…We appreciate Meisel et al [1] for exploring the correlation between antibody level and activity of myasthenia gravis (MG). However, some concerns are raised here.…”

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We appreciate Meisel et al [1] for exploring the correlation between antibody level and activity of myasthenia gravis (MG). However, some concerns are raised here.The correlation between titin antibody level and MG severity was found to be different in various patients with different thymus pathology and related to different therapeutic mechanisms.

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Ocular Myasthenia Gravis: A Current Overview

“…Instead, clinical disease characteristics and laboratory data (eg, autoantibody status, thymus histology) should guide management alongside the clinical outcomes. 86 Recently, microRNAs (miRNAs), non-coding RNA secreted by many cell types, emerged as relevant molecules in the pathogenesis of several human disorders, including neuromuscular disorders such as myasthenia. Of these miRNAs, miR-150-5p, miR-21-5p, and miR-30e-5p levels have been reported to correlate with the clinical response after immunosuppression and to predict the generalization of OMG in some studies.…”