Cardiac involvements in myasthenia gravis associated with anti-Kv1.4 antibodies

Shigeaki Suzuki, A. Baba, K. Kaida, K. Utsugisawa, Y. Kita, J. Tsugawa, G. Ogawa, Y. Nagane, M. Kuwana, N. Suzuki

Research output: Contribution to journalArticle

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Abstract

Background and purpose: There is no general consensus as to whether autoimmune myasthenia gravis (MG) is associated with heart diseases, despite the fact that myocarditis, a serious cardiac involvement treatable by immunotherapy, is a complication of MG. It has been observed previously that MG patients with clinically suspected myocarditis had anti-Kv1.4 antibodies. The purpose of this study was to disclose the association between anti-Kv1.4 antibodies and cardiac involvements in MG patients. Methods: Anti-Kv1.4 antibody was detected by an immunoprecipitation assay using 35S-labeled rhabdomyosarcome cellular extract as the antigen source. Cardiac findings including electrocardiography (ECG) and clinical features of clinically suspected myocarditis in MG patients with anti-Kv1.4 antibodies were investigated. Ultrasound echocardiography (UCG) of ex vivo chick embryos was performed to determine the suppressive effects of sera with or without anti-Kv1.4 antibodies on heart muscle functions. Results: Seventy (10.8%) of 650 MG patients had anti-Kv1.4 antibodies and 60% of them had abnormal ECG findings with high frequencies of T-wave abnormality and QT prolongation. Clinically suspected myocarditis was found in eight MG patients with anti-Kv1.4 antibodies but in none of the MG patients without anti-Kv1.4 antibodies. Most patients showed rapid deterioration with lethal arrhythmias such as ventricular tachycardia, sick sinus syndrome, or complete atrial ventricular block and severe heart failure. It was concluded using UCG of ex vivo chick embryos that MG serum with anti-Kv1.4 antibodies suppressed heart muscle functions. Conclusion: It has been demonstrated that anti-Kv1.4 antibodies are possible markers for cardiac involvements in MG patients.

Original languageEnglish
Pages (from-to)223-230
Number of pages8
JournalEuropean Journal of Neurology
Volume21
Issue number2
DOIs
Publication statusPublished - 2014 Feb

Fingerprint

Myasthenia Gravis
Anti-Idiotypic Antibodies
Myocarditis
Chick Embryo
Myocardium
Electrocardiography
Radio Waves
Sick Sinus Syndrome
Ventricular Tachycardia
Serum
Immunoprecipitation
Immunotherapy
Echocardiography
Cardiac Arrhythmias
Heart Diseases
Heart Failure
Antigens

Keywords

  • Anti-Kv1.4 antibody
  • Chick embryos
  • Clinically suspected myocarditis
  • Myasthenia gravis
  • Thymoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Suzuki, S., Baba, A., Kaida, K., Utsugisawa, K., Kita, Y., Tsugawa, J., ... Suzuki, N. (2014). Cardiac involvements in myasthenia gravis associated with anti-Kv1.4 antibodies. European Journal of Neurology, 21(2), 223-230. https://doi.org/10.1111/ene.12234

Cardiac involvements in myasthenia gravis associated with anti-Kv1.4 antibodies. / Suzuki, Shigeaki; Baba, A.; Kaida, K.; Utsugisawa, K.; Kita, Y.; Tsugawa, J.; Ogawa, G.; Nagane, Y.; Kuwana, M.; Suzuki, N.

In: European Journal of Neurology, Vol. 21, No. 2, 02.2014, p. 223-230.

Research output: Contribution to journalArticle

Suzuki, S, Baba, A, Kaida, K, Utsugisawa, K, Kita, Y, Tsugawa, J, Ogawa, G, Nagane, Y, Kuwana, M & Suzuki, N 2014, 'Cardiac involvements in myasthenia gravis associated with anti-Kv1.4 antibodies', European Journal of Neurology, vol. 21, no. 2, pp. 223-230. https://doi.org/10.1111/ene.12234
Suzuki, Shigeaki ; Baba, A. ; Kaida, K. ; Utsugisawa, K. ; Kita, Y. ; Tsugawa, J. ; Ogawa, G. ; Nagane, Y. ; Kuwana, M. ; Suzuki, N. / Cardiac involvements in myasthenia gravis associated with anti-Kv1.4 antibodies. In: European Journal of Neurology. 2014 ; Vol. 21, No. 2. pp. 223-230.
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AB - Background and purpose: There is no general consensus as to whether autoimmune myasthenia gravis (MG) is associated with heart diseases, despite the fact that myocarditis, a serious cardiac involvement treatable by immunotherapy, is a complication of MG. It has been observed previously that MG patients with clinically suspected myocarditis had anti-Kv1.4 antibodies. The purpose of this study was to disclose the association between anti-Kv1.4 antibodies and cardiac involvements in MG patients. Methods: Anti-Kv1.4 antibody was detected by an immunoprecipitation assay using 35S-labeled rhabdomyosarcome cellular extract as the antigen source. Cardiac findings including electrocardiography (ECG) and clinical features of clinically suspected myocarditis in MG patients with anti-Kv1.4 antibodies were investigated. Ultrasound echocardiography (UCG) of ex vivo chick embryos was performed to determine the suppressive effects of sera with or without anti-Kv1.4 antibodies on heart muscle functions. Results: Seventy (10.8%) of 650 MG patients had anti-Kv1.4 antibodies and 60% of them had abnormal ECG findings with high frequencies of T-wave abnormality and QT prolongation. Clinically suspected myocarditis was found in eight MG patients with anti-Kv1.4 antibodies but in none of the MG patients without anti-Kv1.4 antibodies. Most patients showed rapid deterioration with lethal arrhythmias such as ventricular tachycardia, sick sinus syndrome, or complete atrial ventricular block and severe heart failure. It was concluded using UCG of ex vivo chick embryos that MG serum with anti-Kv1.4 antibodies suppressed heart muscle functions. Conclusion: It has been demonstrated that anti-Kv1.4 antibodies are possible markers for cardiac involvements in MG patients.

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