Change of voltage-gated sodium channel repertoire in skeletal muscle of
a MuSK myasthenia gravis mouse model
Abstract
Muscle-specific kinase myasthenia gravis (MuSK MG) is caused by
autoantibodies against MuSK in the neuromuscular junction (NMJ). MuSK MG
patients have fluctuating, fatigable weakness, in particular of bulbar
muscles. Severity differs greatly between patients, in spite of
comparable autoantibody levels. One explanation for inter-patient and
inter-muscle variability in sensitivity might be variations in
compensatory muscle responses. Previously, we developed a passive
transfer mouse model for MuSK MG. In preliminary ex vivo experiments we
observed that muscle contraction, in particular of mice with milder
myasthenia, had become partially insensitive to μ-Conotoxin-GIIIB, a
blocker of skeletal muscle NaV1.4 voltage-gated sodium channels. We
hypothesized that changes in NaV channel expression profile, possibly
co-expression of (μ-Conotoxin-GIIIB insensitive) NaV1.5 type channels,
might lower the muscle fibre’s firing threshold and facilitate
neuromuscular synaptic transmission. To test this, we here performed
passive transfer in mice, using ‘high’, ‘intermediate’ and ‘low’ dosing
regimens of purified MuSK MG patient IgG4 and compared myasthenia
levels, μ-Conotoxin-GIIIB resistance, muscle fibre action potential
characteristics and firing thresholds. High- and intermediate-dosed mice
showed clear, progressive myasthenia, not seen in low-dosed animals.
However, diaphragm NMJ electrophysiology demonstrated almost equal
myasthenic severities amongst all regimens. Nonetheless, low-dosed mouse
diaphragms showed a much higher degree of μ-Conotoxin-GIIIB resistance.
This was not explained by upregulation of Scn5a (the NaV1.5 gene),
lowered muscle fibre firing thresholds or histologically detectable
upregulated NaV1.5 channels. It remains to be established which factors
are responsible for the μ-Conotoxin-GIIIB insensitivity and whether the
NaV repertoire change is compensatory beneficial, or a bystander effect.