Distinct pathogenic influence of anti-HMGCR+ and anti-SRP+ immune-mediated necrotizing myopathy autoantibodies on engineered muscle function

Immune-mediated necrotizing myopathy (IMNM) is a subgroup of idiopathic inflammatory myopathies associated with anti-signal recognition particle (SRP) or anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) autoantibodies. However, the demonstration of a direct pathogenic effect of IMNM patient autoantibodies on skeletal muscle contractile force, independent of the downstream activation of the complement pathway, has yet to be reported. Thus, the goal of this study was to leverage a custom 3D-human skeletal muscle microtissue (hMMT) culture platform, that enables muscle cell contractile apparatus maturation and the analysis of contractile function, to evaluate the direct effect of total immunoglobulins (IgGs) isolated from IMNM patients with amplification of anti-SRP+ or anti-HMGCR+ autoantibodies. hMMTs capable of force generation were treated with total IgGs, isolated from 3 SRP+ and 3 HMGCR+ patients plasma, and delivered in complement inactivated media for 4 days. hMMT health was then evaluated by quantifying the peak force and contraction kinetics in response to electrical field stimulation and by performing histological analysis of sarcomere and myotube structures. Treating hMMTs with total IgGs from anti-HMGCR+ patients resulted in a decline in tetanus contractile force, though sarcomere Z-line architecture analysis revealed no significant influences on sarcomere organization. hMMT treatment with total IgGs from anti-SRP+ patients induced muscle atrophy, observed via significantly smaller myotube diameter, but this did not translate to a decline in contractile function. This study demonstrates that anti-SRP and anti-HMGCR autoantibodies exert direct, but distinct influences on IMNM-associated skeletal muscle pathogenesis, which may inform IMNM therapy development.