Myasthenia Gravis Support Group
Myasthenia gravis (MG) is a neuromuscular disease leading to fluctuating muscle weakness and fatiguability. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Although myasthenia gravis may affect any voluntary muscle, muscles that control eye and eyelid movement, facial expression, and...
From the Internet this week:
Researchers with the University of Alberta recently identified a unique biological marker for myasthenia gravis that might be used for a diagnostic test and to predict the course of the disease. It may also have implications for defining more personalized treatments.
They conducted what is known as metabolic analysis to identify a unique pattern of metabolites, i.e., products of the body’s metabolism, such as amino acids or antioxidants. They identified more than 10,000 molecules in the samples. Analyzing them, they identified a unique pattern of 12 metabolites found only in the myasthenia gravis patients.
“This is really important because now we have a way to easily separate a patient with myasthenia gravis from someone with rheumatoid arthritis or another autoimmune disease,” said Siddiqi. “What’s more, now we’re able to explore how those 12 metabolites change in mild, moderate or severe cases so we can make this biomarker more robust and more effective for predicting the course of the disease and developing treatment plans.”
Siddiqi points out that current diagnosis of the disease only tells doctors if the patient has the disease or not. No biomarkers can reliably predict the course of myasthenia gravis or what the best therapeutic options might be.
“Finding the antibodies is good for diagnosis, but they do not tell us how the patient will react to a specific drug or which drug will be most effective,” Siddiqi said. “What we’re trying to do with this biomarker discovery is develop treatments specific to the needs of the patient, to have more precise management and to be able to more accurately predict the effects of the treatments.”
To that end, the research group hopes to study patients at different stages of the disease to attempt to identify how the metabolites behave or can be quantified to develop a test or panel of tests that can be used to more accurately diagnose and describe the disease.
The research was published in the journal Metabolomics.
Have always wanted to see a measure for the severity or perhaps better still the efficacy of the treatment we receive. Doubt that it can that but it might just open up the way to do so in the future.
Peter
The test is probably something called liquid chromatography-tandem mass spectrometry which separates blood serum into its components by chemistry and mass. Remember, blood serum is after you take out the cells (including the antibodies to MG).
The results of the testing are most often shown as a graph with peaks on it for each of the metabolites when humans look at it. 1000s of peaks on a strip of paper .However, generally computers analyze the numbers that make the graphs and try to separate out each peak as a separate component of the serum.
The first step is looking at the peaks for a healthy controls -- do they have the same general set. Then compare with MG patients. Are there any differences -- any missing or added. Researchers found 12 extra peaks (in 1000s) in the MG patients, meaning 12 additional metabolites (the name for stuff in the blood of a particular type). And it was consistently so. That means this test shows MG patients a different way.
The value of that is not to identify myasthenia gravis , as all of these were antibody positive for ACHR.
What the researchers want to do is now look at the 12 metabolites. Maybe they have already identified what they are and named them and found how they are produced and why (probably not from the summary I read). But even if you don't know what they are, you can start some new tests.
Compare MG patient in crisis with one in remission -- are all 12 peaks there, are they just as strong? And so on, you keep looking at different levels or types of MG and at different stages in treatment, different treatments, and compare the peaks (the amount of the individual metabolite or the mix of them). Maybe the height of the peak (abundance of metabolite) measures the severity of the MG. Maybe if 4 of the ``12 shrink in abundance, we can say we are getting better. etc.
And if all goes as they hope, they can then start to do this test and say -- This person's treatment is working because the xxxmetabolites have been reduced abundance; this person may be going into crisis soon as they are increased in abundance. ; or this one will respond to Cellcept and this one won't. Or if 6 of the 12 are strong peaks and 6 are low, that means xxxxx. The hope is that variations in levels and mixes of the 12 markers will correspond to variations in MG disease stage.
I don't know if that answers your question or not, but from my meager knowledge of working on mass specs and chromotography a generation ago, it is the best I can remember. Maybe the researchers will figure out the exact metabolites; how and why each is made in our cells, and learn something about how MG changes us in addition to the antibodies. Maybe the metabolites are what trigger MG rather than being byproducts of MG. All sorts of fascinating questions and comparisons can be done in the future if this is an accurate finding (scientist peers will also try it now to make sure it wasn't some fluke or mistake).
For scientists, measuring is the key to progress. And having something to measure that is unique to MG opens a great deal of future research that may or may not lead to something useful, but scientists are always optimistic that will happen. And that the information will translate into treatment ideas.
Well, I don't know if that answered your question or not, but I thought I would give it a try. The details are not so important as the finding that 12 new markers are available to study MG.
Russ
Not bragging but it’s same situation. They had to reduce it to something routine before it was useful for clinical medicine. Not an quick process.