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Thymic Disease, Autoimmunity, and Neuromuscular Junction Integrity in Myasthenia Gravis (TAILOR-MG)

30 april 2026 bijgewerkt door: Stefano Previtali, IRCCS San Raffaele

Thymic Disease, Autoimmunity, and Neuromuscular Junction Integrity in Myasthenia Gravis: An Observational Prospective Translational Cohort Study

The goal of this observational study is to investigate the clinical, immunological, and neuromuscular features associated with the development and progression of myasthenia gravis (MG) in adult patients with thymic abnormalities and/or MG-related antibodies, including individuals with or without clinically manifest disease.

The main questions it aims to answer are:

  • Whether integrated clinical, serological, and histopathological profiles are associated with the presence of MG and can predict disease onset or progression
  • Wheter systemic immune markers are associated with disease activity, progression, and neuromuscular junction alterations

Participants will:

  • Undergo clinical, neurological, and neurophysiological assessments at baseline and during follow-up
  • Provide blood samples for serological and immunological analyses
  • Provide thymic tissue and residual intercostal muscle samples (when undergoing clinically indicated thymectomy) for research analyses
  • Attend follow-up visits at 6, 12, and 18 months
  • Record daily symptoms using an electronic patient-reported outcome tool (for participants with MG)

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Gedetailleerde beschrijving

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterized by fluctuating muscle weakness and fatigability. In most cases, the disease is associated with antibodies directed against the acetylcholine receptor (AChR) and is frequently linked to thymic abnormalities, including thymoma and thymic hyperplasia. Despite the recognized role of the thymus in MG pathogenesis, the mechanisms driving the transition from thymic autoimmunity to clinically manifest disease remain incompletely understood, and reliable biomarkers for disease prediction and monitoring are lacking.

This study is a single-center, prospective, observational translational cohort designed to comprehensively characterize the clinical, neurophysiological, serological, immunological, and histopathological features of patients with thymic abnormalities and/or MG. The study adopts a multimodal approach integrating routine clinical assessments with advanced laboratory and tissue-based analyses, with the aim of identifying biological mechanisms and potential biomarkers associated with MG onset and progression.

A total of 40 adult participants will be enrolled and stratified into four predefined groups:

  1. patients with thymoma and MG-related antibodies,
  2. patients with other thymic abnormalities and MG-related antibodies,
  3. thymoma patients without MG-related antibodies (control group), and
  4. patients with established MG without thymic abnormalities. This design enables comparison across different clinical and immunological phenotypes and supports exploratory evaluation of circulating and tissue-based biomarkers.

At baseline, all participants will undergo standardized clinical and neurological evaluation, including validated MG-specific outcome measures, neurophysiological testing (repetitive nerve stimulation and single-fiber electromyography), and blood sampling for serological and immunological analyses. Imaging assessments, including chest CT for thymic characterization and orbital MRI for evaluation of extraocular muscle involvement, will be performed according to clinical indications. Participants will be followed longitudinally for 18 months, with scheduled evaluations at 6, 12, and 18 months. Follow-up assessments will include repeated clinical, neurophysiological, and serological measurements to capture disease evolution over time and to evaluate the relationship between biological markers and clinical outcomes.

In participants undergoing thymectomy as part of standard clinical care, thymic tissue will be collected for routine diagnostic purposes, with additional samples used for research analyses. Residual intercostal muscle tissue obtained within the surgical field will also be collected, without modification of the surgical procedure or additional risk to the patient. These samples will be used to investigate structural and molecular features of the neuromuscular junction, including receptor organization and evidence of immune-mediated damage.

Peripheral blood samples collected at baseline and follow-up visits will be used to characterize systemic immune profiles, including autoantibodies, cytokines, and complement activation products. These data will be integrated with clinical, neurophysiological, and histopathological findings to explore associations with MG onset, severity, and progression.

In participants with established MG, longitudinal symptom monitoring will be performed using an electronic patient-reported outcome tool based on questionnaires routinely used in clinical practice. Patients will record daily symptoms across key domains (ocular, bulbar, respiratory, and limb involvement), enabling high-resolution assessment of symptom fluctuations over time. These data will be compared with clinical outcome measures collected during scheduled visits to evaluate concordance and the potential added value of continuous symptom monitoring.

Overall, this study aims to provide an integrated characterization of MG across clinical, biological, and tissue levels, with the ultimate goal of identifying early predictors of disease development and progression, improving risk stratification, and supporting future strategies for personalized monitoring and intervention.

Studietype

Observationeel

Inschrijving (Geschat)

40

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Contact Back-up

Studie Locaties

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen
  • Oudere volwassene

Accepteert gezonde vrijwilligers

Nee

Bemonsteringsmethode

Kanssteekproef

Studie Bevolking

The study population consists of adult patients (≥18 years) undergoing evaluation for thymic abnormalities and/or myasthenia gravis at a tertiary referral center. Participants include individuals with thymoma or other thymic pathology, with or without MG-related antibodies and with or without clinically manifest myasthenia gravis, as well as patients with established myasthenia gravis without evidence of thymic abnormalities.

Participants are recruited from routine clinical care settings, including neurology and thoracic surgery units, and reflect a spectrum of clinical and immunological phenotypes relevant to disease development and progression. This population enables the investigation of the relationship between thymic pathology, systemic immune profiles, and neuromuscular junction involvement in myasthenia gravis.

Beschrijving

Inclusion Criteria:

  • Age ≥18 years at the time of informed consent
  • Ability to provide written informed consent and comply with study procedures
  • Availability of a serum sample for testing MG-related antibodies
  • Availability of chest imaging (CT and/or MRI) to classify thymic status

Participants must also meet the criteria for at least one of the following study groups:

Cohort 1: Thymoma with MG-related antibodies

  • Histologically or radiologically confirmed thymoma
  • Presence of at least one pathogenic MG-related antibody (AChR)
  • Presence or absence of clinically manifest myasthenia gravis

Cohort 2: Other thymic abnormalities with MG-related antibodies

  • Imaging or histological evidence of non-thymomatous thymic pathology (e.g., thymic hyperplasia)
  • Presence of at least one pathogenic MG-related antibody (AChR)
  • Presence or absence of clinically manifest myasthenia gravis

Cohort 3: Thymoma without MG-related antibodies

  • Histologically or radiologically confirmed thymoma
  • Negative for pathogenic MG-related antibodies (AChR)
  • No clinical diagnosis or symptoms suggestive of myasthenia gravis

Cohort 4: Myasthenia gravis without thymic abnormalities

  • Established clinical diagnosis of myasthenia gravis with consistent clinical features, supported by at least one of the following:

    1. Seropositivity for MG-related antibodies (AChR, MuSK, or LRP4), or
    2. Abnormal neuromuscular transmission demonstrated by SFEMG or RNS, or
    3. Improvement of MG signs with treatment such as oral acetylcholinesterase inhibitors, plasma exchange, IVIg, or corticosteroids
  • Absence of thymic abnormalities on CT or MRI

Exclusion Criteria:

  • Inability to provide informed consent
  • Other neuromuscular diseases that could interfere with interpretation of clinical or neurophysiological findings
  • Severe uncontrolled systemic illness that, in the investigator's judgment, may limit participation or confound study outcomes
  • Any medical or psychiatric condition, or history of substance abuse, that may compromise adherence to study procedures
  • Pregnancy or breastfeeding

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Patients with thymoma and MG-related antibodies
Patients with histologically or radiologically confirmed thymoma and presence of MG-related antibodies (AChR), with or without clinically manifest myasthenia gravis.
Patients with other thymic abnormalities and MG-related antibodies
Patients with non-thymomatous thymic pathology (e.g., thymic hyperplasia) and presence of MG-related antibodies (AChR), with or without clinically manifest myasthenia gravis.
Thymoma patients without MG-related antibodies
Patients with confirmed thymoma, negative for MG-related antibodies, and without clinical signs or diagnosis of myasthenia gravis.
Patients with established MG without thymic abnormalities
Patients with an established diagnosis of myasthenia gravis based on clinical, serological, and/or neurophysiological criteria, and no evidence of thymic abnormalities.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Qualitative assessment of neuromuscular junction structural abnormalities in intercostal muscle samples
Tijdsspanne: At the time of thymectomy (baseline)
The primary outcome is the qualitative assessment of neuromuscular junction structural abnormalities in residual intercostal muscle samples collected from participants undergoing clinically indicated thymectomy. Neuromuscular junction integrity will be evaluated using histological, immunofluorescence, and ultrastructural analyses, including assessment of acetylcholine receptor clustering, IgG and complement deposition, postsynaptic fold morphology, and features of synaptic remodeling or immune-mediated injury. Structural abnormalities will be described in terms of presence or absence and, where applicable, semi-quantitative grading. Findings will be compared across participant groups according to thymic pathology, MG-related antibody status, and the presence or absence of clinically manifest myasthenia gravis.
At the time of thymectomy (baseline)

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Qualitative assessment of thymic histopathological features
Tijdsspanne: At the time of thymectomy (baseline)
Qualitative assessment of thymic histopathological features in thymic tissue collected from participants undergoing clinically indicated thymectomy. Thymic tissue will be evaluated for histopathological features including thymoma subtype, thymic hyperplasia, germinal centers, lymphoid infiltrates, and AIRE expression, where applicable. Histopathological findings will be described in terms of presence or absence and, where applicable, semi-quantitative grading. These features will be analyzed in relation to neuromuscular junction structural abnormalities identified in intercostal muscle samples, as well as according to MG-related antibody status and the presence or absence of clinically manifest myasthenia gravis.
At the time of thymectomy (baseline)
Change in Myasthenia Gravis Activities of Daily Living (MG-ADL) score
Tijdsspanne: Baseline, 6, 12, and 18 months
The MG-ADL is an 8-item scale assessing myasthenia gravis-related symptoms and functional impairment, with a total score ranging from 0 to 24. Higher scores indicate greater disease burden. Changes from baseline will be evaluated during follow-up and analyzed in relation to biological markers, neuromuscular junction findings, and electronically collected patient-reported symptom scores.
Baseline, 6, 12, and 18 months
Change in Quantitative Myasthenia Gravis (QMG) score
Tijdsspanne: Baseline, 6, 12, and 18 months
The QMG is a 13-item examiner-administered scale assessing muscle weakness and fatigability, with a total score ranging from 0 to 39. Higher scores indicate greater disease severity. Changes from baseline will be evaluated during follow-up and analyzed in relation to biological markers, neuromuscular junction findings, and electronically collected patient-reported symptom scores.
Baseline, 6, 12, and 18 months
Change in serum MG-related autoantibody levels over time
Tijdsspanne: Baseline, 6, 12, and 18 months
Measurement of serum levels of MG-related autoantibodies, including acetylcholine receptor (AChR) antibodies, assessed using cell-based assays and ELISA assays. Autoantibody levels will be reported as titers and evaluated at baseline and during follow-up to describe their distribution and longitudinal changes. These measurements will be analyzed in relation to clinical and neurophysiological findings, as well as thymyc histopathology and neuromuscular junction structural features.
Baseline, 6, 12, and 18 months
Change in plasma and serum levels of complement activation products
Tijdsspanne: Baseline, 6, 12, and 18 months
The secondary outcome is the change in plasma and serum levels of complement activation products, including C3b, C5a, and sC5b-9, assessed using immunoassay-based methods. Changes in complement activation product levels will be evaluated from baseline to follow-up visits and reported as concentrations. These measurements will be analyzed in relation to clinical and neurophysiological findings, as well as thymic histopathology and neuromuscular junction structural features.
Baseline, 6, 12, and 18 months
Change in mean daily composite MG symptom questionnaire score (electronically collected)
Tijdsspanne: Baseline and up to 18 months
The electronic tool consists of a structured daily questionnaire in which patients report symptom severity across four domains (ocular, bulbar, respiratory, and limb involvement), using a visual analogue scale (VAS, 0-10 for each item; 0 = no symptoms, 10 = maximum severity). Individual item scores are summed to generate a daily composite score (range 0-40), with higher scores indicating greater symptom burden. The mean daily composite score will be calculated over predefined time intervals during follow-up, and changes from baseline will be evaluated longitudinally. The questionnaire is based on domains derived from the Myasthenia Gravis Activities of Daily Living (MG-ADL) instrument. Patient-reported scores will be compared with MG-ADL and Quantitative Myasthenia Gravis (QMG) scores assessed at scheduled visits to evaluate concordance and the ability to capture symptom fluctuations over time.
Baseline and up to 18 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

IRCCS San Raffaele

Onderzoekers

  • Hoofdonderzoeker: Stefano C Previtali, IRCCS Ospedale San Raffaele

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

15 september 2026

Primaire voltooiing (Geschat)

14 september 2029

Studie voltooiing (Geschat)

1 december 2029

Studieregistratiedata

Eerst ingediend

22 april 2026

Eerst ingediend dat voldeed aan de QC-criteria

30 april 2026

Eerst geplaatst (Werkelijk)

6 mei 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

6 mei 2026

Laatste update ingediend die voldeed aan QC-criteria

30 april 2026

Laatst geverifieerd

1 april 2026

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • OSRSCP_TAILOR-MG

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

NEE

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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