Towards antigen-specific apheresis of pathogenic autoantibodies as a further step in the treatment of myasthenia gravis by plasmapheresis

Myasthenia gravis (MG), a prototypic antibody-mediated autoimmune disease, presents an excellent target for scientific research aimed at a better understanding of the disease itself and the source that triggers an autoimmune reaction in an organism. MG is a neuromuscular disease caused mainly by an autoimmune response against the nicotinic acetylcholine receptor (AChR) which interferes with neuromuscular transmission. This review focuses on our studies on the extracellular domains of human muscle AChR subunits in an effort to develop an approach for the specific therapeutic apheresis of autoantibodies from patients' sera using the immobilized subunits as immunoadsorbents. The ability of the anti-AChR antibodies isolated by this technique, but not of the depleted sera, to induce disease is also described.This review is dedicated to the late Prof. John Newsom-Davis, who was the first to introduce the use of plasmapheresis for MG.