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Anti-Titin Antibodies in Myasthenia Gravis
Tight Association With Thymoma and Heterogeneity of Nonthymoma Patients
Ana Maria Yamamoto, PhD;
Philippe Gajdos, MD, PhD;
Bruno Eymard, MD, PhD;
Christine Tranchant, MD, PhD;
Jean-Marie Warter, MD, PhD;
Lucienne Gomez, BSc;
Charles Bourquin, MD;
Jean-François Bach, MD, PhD;
Henri-Jean Garchon, MD, PhD
Arch Neurol. 2001;58:885-890.
Background Titin is the major autoantigen recognized by anti–striated muscle
antibodies, which are characteristic of generalized myasthenia gravis (MG).
Objective To seek a correlation between anti-titin antibodies and other features
of MG patients, including histopathology, age at diagnosis, anti–acetylcholine
receptor (anti-AChR), autoantibody titers, and clinical severity.
Methods A novel, highly specific radioligand assay was performed on a large
group of 398 patients with generalized MG.
Results Among thymectomized patients, anti-titin antibodies were present in
most patients with thymoma (56/70 [80%]), contrasting with only a minority
of patients with thymus atrophy or hyperplasia (17/165 [10%]). They were also
present in 64 (41%) of 155 nonthymectomized patients who had a radiologically
normal thymus. In these patients and in those who had a histologically normal
thymus, anti-titin antibodies were associated with a later age at onset of
disease and with intermediate titers of anti-AChR antibodies. After controlling
for these 2 variables, disease severity was not significantly influenced by
anti-titin antibodies.
Conclusions Anti-titin antibodies are a sensitive marker of thymoma associated with
MG in patients 60 years and younger, justifying the insistent search for a
thymoma in MG patients of this age group who have these antibodies. In nonthymoma
patients, anti-titin antibodies represent an interesting marker complementary
to the anti-AChR antibody titer, identifying a restricted subset of patients.
These clinical correlations should prompt further studies to examine the mechanisms
leading to the production of anti-titin antibodies.
From the Service d'Immunologie/INSERM U25, Hôpital Necker, Paris,
France (Drs Yamamoto, Bach, and Garchon and Ms Gomez); Service de Réanimation,
Hôpital Raymond Poincaré, Garches, France (Dr Gajdos); Service
de Neurologie, Institut de Myologie, Hôpital de la Salpêtrière,
Paris (Dr Eymard); Service de Neurologie, Hôpital Civil, Centre Hospitalière
Régionale Universitaire, Strasbourg, France (Drs Tranchant and Warter);
and Association Française Contre les Myopathies, Evry, France (Dr Bourquin).
Corresponding author: Ana Maria Yamamoto, PhD, INSERM U25, 161 rue
de Sèvres, 75743 Paris CEDEX 15, France (e-mail: yamamoto{at}necker.fr).
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