Myasthenia gravis (MG) is an autoimmune disease. Dysfunction of the neuromuscular junction is the main character of this disease. It is considered to be a model of organ-specific autoimmune disease, due to the known and thoroughly characterized autoantigens. Creative Biolabs has rich experience in the treatment of autoimmune diseases. Our experts provide antibody development and cell therapy services.
The current treatment of autoimmune MG is based on a combination of lifestyle advice, immunosuppressive drugs, and interventions. Physical exercise should be encouraged in all MG patients as it carries no risk.
Pyridostigmine bromide is usually the first-line treatment and may be sufficient as a stand-alone treatment in patients with mild or moderate MG. Salbutamol, a selective B2-adrenergic agonist, is an effective treatment for patients with congenital myasthenic syndrome (CMS), including those with acetylcholine receptor (AChR) deficiency syndromes and patients with dok7 mutations. It may also have beneficial effects on muscle strength in patients with auto-immune MG. Ephedrine is another sympathomimetic agent that mainly affects adrenergic receptors. Ephedrine appears to have a beneficial effect on patients with CMS.
Corticosteroid treatment, usually using oral prednisone, is currently the mainstay of immunosuppressive treatment. Although prednisone has been used as a treatment for MG for several decades, there is limited evidence of its efficacy from controlled studies. A major advantage of prednisone, which is readily available worldwide at low cost, is its relatively rapid effect, which is especially important in severely affected patients. High-dose treatment is associated with a quick clinical response, with an onset of clinical improvement within 2-4 weeks. The response rate is higher in patients older than sixty years than in younger patients.
Non-steroidal immunosuppressive drugs are commonly added to the treatment regimen with a dual aim: to enhance the effect of prednisone on MG symptoms and to allow the tapering of corticosteroids to a minimum to reduce long term side effects.
Fig.1 Overview of medication trials in MG. (Tannemaat, 2020)
Currently, many new drugs for MG are being developed. These novel therapeutic interventions can be divided into treatment aimed at weakening the autoimmune response, strengthening the neuromuscular synapse, or a combination of both strategies.
There is an FDA-approved anti-CD20 monoclonal immunoglobulin has been used to treat rheumatoid arthritis successfully for several decades. However, the evidence for the efficacy of this antibody in the treatment of AChR MG is far less compelling.
The proteasome inhibitor bortezomib is highly effective at depleting short-lived and long-lived B-cells and may have the potential to be a novel treatment for MG, although its side effects, including sensorimotor polyneuropathy, may limit its clinical use.
The field of therapeutic antibodies has undergone rapid growth in recent years. However, there is still significant growth potential for the therapeutic antibody field. Therapeutic antibodies can be roughly separated into two broad categories. The first category involves the direct use of the naked antibody for disease therapy. For antibodies in the second category, additional engineering is performed to enhance their therapeutic efficacy. We provide you with the best services, including but not limited to:
Creative Biolabs provides comprehensive antibody development services. If you are interested in our services, please contact us.
Fig.2 Approaches for the development of therapeutic antibodies. (Lu, 2020)
References
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