title: A rapid, fluorescence-based assay for detecting antigenic modulation of the acetylcholine receptor on human cell lines.
abstract: BACKGROUND
  Myasthenia gravis (MG) is an autoimmune disease affecting approximately 40,000 patients in the United States. One of the major mechanisms of disease pathology in MG is the binding, internalization, and eventual destruction of acetylcholine receptors (AChR) at the neuromuscular junction by cross-linking AChR-specific autoantibodies. This process, known as antigenic modulation, ultimately attenuates the ability of muscle cells to contract in response to signals from neurons, leading to muscle weakness and fatigue. For this reason, antigenic modulation of the AChR on cultured cells has become an important diagnostic tool for assessing the pathogenicity of AChR-specific autoantibodies. Traditionally, these assays have been done using radiolabeled AChR ligands such as (125)I alpha-bungarotoxin to determine relative AChR number. Here, we present a high-throughput immunofluorescent flow cytometry-based assay that can be used to quantify AChR levels on the cell surface and assess the efficacy of molecules designed to rescue antigenic modulation.
  
  
  METHODS
  AChR levels were quantified on human muscle cells before and after treatment with AChR antibodies via immunofluorescent labeling with the AChR monoclonal antibodies, mAb210 and mAb B3, followed by flow cytometry of EDTA-treated cells.
  
  
  RESULTS
  Using a novel, flow cytometry-based assay, antigenic modulation of the AChR was demonstrated on human cells using both AChR-specific monoclonal antibody and MG patient serum. The degree of antigenic modulation was dose responsive to antibody levels and could be reversed by preincubating antibodies with soluble AChR alpha subunit extracellular domain.
  
  
  CONCLUSIONS
  A rapid, nonradioactive assay was developed to determine the potential of AChR-specific antibodies in the serum of MG patients to bind and down-regulate the AChR. This assay can be used to assess the ability of putative therapeutics that rescue antigenic modulation and could be developed for the treatment of MG.
authors.affiliation: Department of Preclinical Discovery, Shire Human Genetic Therapies, 700 Main Street, Cambridge, MA 02139, USA. dkeefe@shire.com
authors.forename: Dennis
authors.initials: D
authors.lastname: Keefe
authors.forename: Donna
authors.initials: D
authors.lastname: Hess
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bosco
authors.forename: Socrates
authors.initials: S
authors.lastname: Tzartos
authors.forename: Jan
authors.initials: J
authors.lastname: Powell
authors.forename: Justin
authors.initials: J
authors.lastname: Lamsa
authors.forename: Serene
authors.initials: S
authors.lastname: Josiah
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology* / Q000494:pharmacology / Q000627:therapeutic use; D000937:Antigen-Antibody Reactions / Q000187:drug effects / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology*; D002460:Cell Line; D015536:Down-Regulation / Q000187:drug effects; D005434:Flow Cytometry / Q000379:methods*; D005453:Fluorescence; D006801:Humans; D009157:Myasthenia Gravis / Q000276:immunology / Q000378:metabolism; D011950:Receptors, Cholinergic / Q000032:analysis* / Q000276:immunology*; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D011950:Receptors, Cholinergic