End-plate voltage-gated sodium channels are lost in clinical and experimental myasthenia gravis
✍ Scribed by Dr Robert L. Ruff; Vanda A. Lennon
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 997 KB
- Volume
- 43
- Category
- Article
- ISSN
- 0364-5134
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✦ Synopsis
Abstract
This study examined the loss of voltage‐gated Na^+^ channels as well as acetylcholine receptors (AChRs) form the endplate region in patients with acquired myasthenia gravis (MG) and in rats with experimental autoimmune passively transferred MG (PTMG). Rats received a monoclonal IgG antibody directed against an extracellular epitope of the nicotinc acetylcholine receptor of muscle (AChR) to produce PTMG. At the end‐plate border we examined miniature end‐plate potentials (MEPPs), sodium current (I~Na~) amplitude, and action potential (AP) properties; the latter two were also examined on the extrajunctional membrane. In the normal situation, the safety factor for neuromuscular transmission is ensured by the large I~Na~ at the end plate, which reduces the AP threshold. Among different fiber types, I~Na~ was largest for type IIb fibers and smallest for type I fibers. When end‐plate border properties of fibers form 3 MG patients and 15 PTMG rats were compared with controls, I~Na~ was reduced, AP thresholds were higher, and rates of AP rise were reduced. Amplitudes of MEPPs and I~Na~ at the end plate indicated that loss of AChRs was greater than loss of Na~+~ channels in patients with MG and rats with PTMG; I~Na~ was reduced to about 60% of control values, whereas MEPPs were reduced to less than 30% of control values. On the extrajunctional membrane, I~Na~ and AP thresholds and rates ofrise were similar for MG patients, PTMG rats, and controls. This evidence for loss of voltage‐gated Na~+~ channels at the motor end plate in both patients with MG and in rats with PTMG reveals a hitherto unrecognized consequence of the end‐plate damage initiated by the binding of complement‐fixing IgG to end‐plate AChRs.