Angela Vincent, MBBS (Hon PhD Bergen), FRCPath, FMedSci, FRS, University of Oxford, Oxford, UK, discusses fetal and adult acetylcholine receptors (AChRs) in autoimmune myasthenic syndromes. In pregnant mothers with fetal-AChR specific antibodies, these can cross the placenta to bind with and block AChRs in the fetus, leading to developmental abnormalities or death. However, if the pregnant mother receives treatment for myasthenia gravis (MG), then the risks to the fetus can be reduced. Prof Vincent highlights two important aspects: some mothers do not have MG, but they do have the fetal-AChR specific antibodies. And recently, it has become clear that some surviving children from similar mothers, despite not having severe myasthenic syndromes, have a persistent facial myopathy. With those aspects in mind, a treatment mouse model was used to show that preventing the transfer of potentially pathogenic fetal-specific AChR antibodies can protect the developing fetus. The anti-neonatal Fc receptor (FcRn) monoclonal antibody used in the study is a current treatment for MG. After promising animal trials, research is ongoing about whether it can be used in humans to prevent harmful antibodies from crossing the placenta. This interview took place during the European Academy of Neurology 2021 congress.
