Abstract
The thymus has been considered to play an important role in the pathogenesis of myasthenia gravis (MG), an autoimmune disease characterized by skeletal muscle weakness. However, the pathogenic role of the thymus still remains a mystery. The neuromuscular type of acetylcholine receptor (AChR) was the first self-protein associated with a defined autoimmune disease that was found to be expressed by thymic stromal populations. The studies described herein represent our efforts to determine how this “promiscuous” autoantigen expression may be involved in the immunopathogenesis of MG. We review our work, characterizating the expression of the α subunit of AChR (AChRα) in the thymus, and advance a new hypothesis that examines the intrathymic expression of this autoantigen in disease pathogenesis.
Similar content being viewed by others
References
Levinson AI, Zweiman B, Lisak RP: Immunopathogenesis and treatment of myasthenia gravis. J Clin Immunol 1987;7:187–197.
Patrick J, Lindstrom JM: Autoimmune response to acetylcholine receptor. Science 1973;180: 871–872.
Toyka KV, Drachman DB, Pestronk A, Kao J: Myasthenia gravis: passive transfer from man to mouse. Science 1975;190: 397–399.
Engel AG, Lambert EH, Howard, FM: Immune complexes (IgG and C3) at the motorendplate inmyasthenia gravis. Ultrastructural and light microscopic localization and electrophysiologic correlations. Mayo Clin Proc 1977;52:267–280.
Drachman DB, Angus CW, Adams RN, Michelson JD, Hoffman GJ: Myasthenic antibodies cross-link acetylcholine receptors to accelerate degradation. N Engl J Med 1978;298:1116–1122.
Almon RR, Andrew CG, Appel SH: Serum globulin in myasthenia gravis: Inhibition of bumgarotoxin binding to acetylcholine receptors. Science 1974;186:55–57.
Wekerle H, Ketelson UP, Zurn AD, et al.: Imrathymic pathogenesis of myasthenia gravis: transient expression of acetylcholine receptors on thymus-derived myogenic cells, Eur J Immunol 1978;8:579–582.
Levinson AI, Wheatley L: The thymus and the pathpogenesis of myasthenia gravis. Clin Immunol Immunopath 1995;78:1–5.
Castleman B: The pathology of the thymus gland in myasthenia gravis. Ann NY Acad Sci 1966; 135:496–505.
Genkins GA, Papatestos E, Horowitz SH, Kornfield P: Studies in myasthenia gravis: early thymectomy. Electrophysiologic and pathologic correlations. Am J Med 1975;58:517–524.
Olanow CW, Wechster AS, Sirotkin-Roses M, Stajich J, Russ AD: Thymectomy as primary therapy in myasthenia gravis. Ann NY Acad Sc 1987;505:595–606.
Genkins G, Sivar M, Tartter PI: Treatment strategies in myastheniagravis. Ann NY Acad Sci 1993; 681:603–608.
Levinson AI, Dziarski A, Lisak RP, Zweiman B, Moskovitz A, Brenner T, Abramsky O: Comparative immunoglobulin synthesis by blood lymphocytes of myasthenics and normals. Ann NY Acad Sci 1981;377:385–392.
Zweiman B, Levinson AI, Lisak RP: Phenotypic characterization of thymic B lymphocytes in myasthenia gravis. J Clin Immunol 1989;9:242–247.
Levinson AI, Zweiman B, Lisak RP: Pokeweed mitogen-induced immunoglobulin secretory responses of thymic B cells in myasthenia gravis: Selective secretion of IgG vs IgM cannot be explained by helper functions of thymic T cells. Clin Immunol Immunopath 1990;57:2 11–217.
Lisak RP, Levinson AI, Zweiman B, Kornstein MJ: Antibodies to acetylcholine receptor and tetanus toxoid: in vitro synthesis by thymic lymphocytes. J Immunol 1986;137: 1221–1225.
Newsom-Davis J, Willcox N, Calder L: Thymus cells in myasthenia gravis selectively enhance production of anti-acetylcholine-receptor antibody by autologous blood lymphocytes. N Engl J Med 1981;305:1313–1318.
Fujii Y, Hashimoto J, Monden Y, Ito T, Nakahara K, Kawashima Y: Specificactivation of lymphocytes against acetylcholine receptor in myasthenia gravis. J Immunol 1986;136:887–891.
Melms A, Schalke BC, Kirchner T, Muller-Hermelink HK, Albert E, Wekerle H: Thymus in myasthenia gravis. Isolation of T-lymphocyte lines specific for acetylcholine receptor from thymuses of myasthenic patients. J Clin Invest 1988; 81:902–908.
Sommer N, Willcox N, Harcourt GC, Newsom-Davis J: Myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor-reactive T cells. Ann Neurol 1990;28:312–319.
Naparstek Y, Holoshitz J, Eissenstein S, et al.: Effector T lymphocyte line cells migrate to the thymus and persist there. Nature 1982;300:262–264.
Naparstek Y, Ben-Nun A, Holoshitz J, Reshef T, Frenkel A, Rosenberg M, Cohen IR: T lymphocyte lines producing or vaccinating against autoimmune encephalomyelitis (EAE). Functional activation induces peanut agglutinin receptors and accumulation in the brain and thymus of line cells. Eur J Immunol 1993;13:418–423.
Michie SA, Kirkpatrick EA, Rouse RV: Rate peripheral T cells migrate to and persist in normal mouse thymus. J Exp Med 1988;168: 1929–1934.
Hirokawa K, Utsuyama M, Sado T: Immunohistological analysis of immigration of thymocyte-precursors into the thymus: evidence for immigration of peripheral T cells into the thymic medulla. Cell Immunol 1989;119:160–170.
Gossmann J, Lohler J, Lehmann-Grube F: Entry of antivirally active T lymphocytes into the thymus of virus-infected mice. J Immunol 1991;146:293–297.
King C, Jamieson BD, Reddy K, Bali N, Concepcion RJ, Ahmed R: Viral infection of the thymus. J Virol 1992;66:3155–3160.
Herrath, MG, Dockter J, Nerenberg M, Gaairin JE, Oldstone MB: Thymic selection and adaptability of cytotoxic T lymphocyte responses in transgenic mice expressing a viral protein in the thymus. J Exp Med 1994;180: 1901–1910.
Agus D, Surh, CD, Sprent J: Reentry of T cells to the ault thymus is restricted to activated cells. J Exp Med 1991;173:1039–1046.
Jamieson BD, Somasundaram T, Ahmed R: Abrogation of tolerance to a chronic viral infection. J Immunol 1991;147:3521–3529.
Westermann J, Smith T, Peters U, et al.: Bothactivated and nonactivated leukocytes from the periphery continuously enter the thymic medulla of adult rats: phenotypes, sources and magnitude of traffic. Eur J Immunol 1991;26:1866–1874.
Hohlfeld R, Toyka KV, Tzartos SJ, Carson W, Conti-Tronconi B: Human helper T lymphocytes in myasthenia gravis recognize the nicotinic receptor a subunit. Proc Natl Acad Sci 1987;84:5379–5383.
Zhang Y, Schluep M, Frutiger S, Hughes GJ, Jeannet M, Steck A, Barkas T: Immunologic heterogeneity of autoreactive T lymphocytes against the nicotinic acetylcholine receptor in myasthenic patients. Eur J Immunol 1990;20:2577–2583.
Oshima M, Ashizawa T, Pollack MS, Atassi MZ: Autoimune T cell recognition of human acetylcholine receptor the sites of T cell recognition in myasthenia gravis on the extracellular part of the α-subunit. Eur J Immunol 1990;20: 2563–2569.
Fuji Y, Lindstrom J: Specificity of the T cell immune response to acetylcholine receptor in experimental autoimmune myasthenia gravis. J Immunol 1988;140: 1830–1837.
Engel W, Trotter JL, MacFarlin DE, McIntosh CL: Thymic epithelial cells contain acetylcholine receptor. Lancet 1977;1:1310–1311.
Fuchs S, Schmidt-Hopfeldd I, Tridente, G: Thymic lymphocytesbear a surface antigen which crossreacts with acetylcholine receptor. Nature 1980;287:162–164.
Kao I, Drachman DB: Thymic muscle cells bear acetylcholine receptors: possible relation to myasthenia gravis. Science 1977;195:74–75.
Wekerle H, Ketelson U-P, Zurn AD, Fulpius BW: Intrathymic pathogenesis of myasthenia gravis: transient expression of acetylcholine receptors on thymusderived myogenic cells. Eur J Immunol 1978;8:579–582.
Schluep MN, Wilcox N, Vincent A, Dhoot GK, Newsom-Davis J: Acetylcholine in human thymic myoid cells in situ: an immunologic study. Ann Neurol 1987; 22:212.
Wheatley L, Urso D., Tumas K, Maltzman J, Loh E, Levinson AI: Molecular characterization of the nicotinic acetylcholine receptor alpha chain in mouse thymus. J Immunol 1992;148:3105–3109.
Wheatley LM, Urso D, Zheng Y, Loh, Levinson AI: Molecular analysis of intrathymic nicotinic acetylcholine receptor. Ann NY Acad Sci 1993;681:74–82.
Zheng Y, Wheatley LM, Liu T, Levinson AI: Acetylcholine receptoral phasubnit mRNA expression in human thymus: Augmented expression in myasthenia gravis and upregulation by interferon-γ. Clin Immunol 1999;1:170–177.
Wakkach A, Guyon T, Bruand C, Tzartos S, Cohen-Kaminsky S, Berrih-Aknin S: Expression of acetylcholine receptor genes in human thymic epithelial cells. Implications for myasthenia gravis. J Immunol 1978;157: 3752–3760.
Beeson D, Morris A, Vincent A, Newsom-Davis J: The human muscle nicotinic acetylcholine receptor α-subunit exists as two isoforms: a novel exon. EMBO 1990;9:12101–2106.
Guyon T, Levasseur P, Truffault, C, Cottin F, Ohta K, Itoh N, Ohta M: Nicotinic acetylcholine receptor α-subunit variants in human myasthenia gravis: quantification of steady-state levels of messenger RNA in muscle biopsy using the polymerase chain reaction. J Clin Invest 1993;94:16.
Cohen-Kaminsky S, Delattre R, Devergne O, Rouet P, Gimond D, Berrih-Aknin S, Galanaud P: Synergistic induction of interleukin-6 production and gene expression in human thymic epithelial cells by LPS and cytokines. Cell Immunol 1978;138:79–93.
Emilie D, Creven MC, Cohen-Kaminsky S, Peuchmaur M, Devergne O, Berrih-Aknin S, Galanaud P: Insituproduction of interleukins in hyperplastic thymusfrom myasthenia gravis patients. Hum Pathol 1991;22:461–468.
Galy AHM Spits H: IL-1, IL-4, and IFN-γ differentially regulate cytokine production and cell surface molecule expression in cultured human thymic epithelial cells. J Immunol 1991;147:3823–3830.
Berrih-Aknin S, Arenzana-Seisdedos F, Cohen S, Devos R, Charron D, Virelizier J: Interferongamma modulates HLA class II antigen expression on cultured human thymic epithelial cells. J Immunol 1985;35:1165–1171.
Sprent J, Lo D, Gao E-K, Ron Y: T cell selection in the thymus. Immunol Rev 1988;101:173–190.
Kisielow P, Boehmer MV: Negative and positive selection of immature thymocytes: timing and the role of the ligand for T cell receptor. Semin Immunol 1990;2:35–44.
Anderson G, Moore NC, Owen JJ, Jenkinson EJ: Cellular interactions in thymocyte development. Ann. Rev Immunol 1996;14:73–99.
Alam SM, Travers PJ, Wung JL, Nasholds W, Redpath S, Jameson, SC, Gascoigne NR: T-cell-receptor affinity and thymocyte positive selection. Nature 1996; 381:616–620.
Hugo P, Kappler JW, Godfrey DI, Marrack PC: Thymicepithelial cell lines that mediate positive selection can also induce thymocyte clonal deletion. J Immunol 1994; 152:1022–1031.
Blackman M, Kappler J, Marrack P: The role of the TCR in positive and negative selection of developing cells. Science 1990;248: 1335–1341.
Bonomo A, Matzinger P: Thymus epithelium inducestissue-specific tolerance. J Exp Med 1993;177: 1153–1164.
Hoffman MW, Heath WR, Ruschmeyer D, Miller JF: Deletion of high-avidity T cells by thymic epithelium. Proc Nat Acad Sci USA 1995;92:9851–9855.
Klein L, Kyewski B: “Promiscuous” expression of tissue antigers in the thymus: a key to T-cell tolerance and autoimmunity? J Mol Med 2000;78:483–494.
Oehen SU, Ohashi PS, Burki K, Hengartner H, Zinkemagel RM, Aichele P: Escape of thymocytes and mature T cells from clonal deletion due to limiting tolerogen expression levels. Cell Immunol 1994;158:342–352.
Iwabuchi K, Nakayama KI, McCoy RL, et al.: Cellularandpeptide requirements for in vitro clonal deletion of immature thymocytes. Proc Natl Acad Sci USA 1992;89: 9000–9004.
Adelstein S, Prictchard-briscoe H, Anderson TA, et al.: Induction of self-tolerance in T cells but not B cells of transgenic mice expressing little self-antigen. Science 1991;251:1223–1225.
Shevach E: Regulatory T cells in autoimmunity. Adv Rev Immunol 2000;18:423–449.
Gowans JL, Knight E: The route of re-circulation of lymphocytes in the rat. Proc R Soc London B 1964; 159:257–282.
Mondino A., Khourts A, Jenkins MK: The anatomy of T-cell activation and tolerance. Proc Natl Acad Sci USA 1996;93:2245–2252.
Levinson A, Zheng Y, Murphy S, Moore J, Pletcher CH, Gaulton G: Peripheral T cell homing to the inflamed thymus: relevance to
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Levinson, A.I., Zheng, Y., Gaulton, G. et al. Intrathymic expression of neuromuscular acetylcholine receptors and the immunpathogenesis of myasthenia gravis. Immunol Res 27, 399–408 (2003). https://doi.org/10.1385/IR:27:2-3:399
Issue Date:
DOI: https://doi.org/10.1385/IR:27:2-3:399