Myasthenia gravis (MG) is an acquired autoimmune disease characterized by impaired transmission at the neuromuscular junction, primarily manifesting as fluctuating muscle weakness, fatigability, and partial paralysis. Due to its long disease course, treatment resistance, and frequent relapses, it places a significant burden on patients and their families. In recent years, advances in molecular biology have provided growing evidence that mitochondrial dysfunction impairs muscle function and affects immune cell proliferation and differentiation in patients. Mitochondria, as the cell's energy source, play a critical role in various pathological processes in MG, including oxidative stress, dynamic abnormalities, mitophagy, and mitochondrial metabolism. The role of mitochondrial dysfunction in the pathogenesis of MG has garnered increasing attention. This manuscript primarily explores mitochondrial function and abnormal morphological changes in MG, as well as mitochondrial quality control, metabolic reprogramming, and their potential mechanisms in the pathological changes of the disease. It also reviews the current status of drug therapies aimed at improving mitochondrial function. The goal is to provide novel perspectives and strategies for future mitochondrial-targeted therapies in MG.

Myasthenia gravis (MG) is a rare and refractory autoimmune disease, and Qi Shen Di Huang (QSDH) drug formulary is an in-hospital herbal decoction with proven clinical efficacy in treating MG. Currently, most of the research on the QSDH drug formulary has concentrated on its clinical efficacy, and there is a lack of systematic study on the material basis. The active compounds and their mechanism of action have not been entirely determined. Therefore, this study sought to identify the active compounds in the QSDH drug formulary and analyze the key targets and potential mechanisms. We used ultra-performance liquid chromatography Q Exactive-mass spectrometry (UHPLC-QE-MS) and Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database to identify and screen 85 active ingredients corresponding to 59 potential targets (17 herbs) associated with myasthenia gravis, and further identified AKT1 as the primary core target and the PI3K/AKT signaling pathway as the most substantial enriched pathway. Molecular docking and UPLC-MS analysis identified quercetin, luteolin, wogonin, kaempferol, laccasein, and epigallocatechin gallate are the core compounds of the QSDH drug formulary. In vivo rat studies showed that the QSDH drug formulary reduced Lennon’s clinical score and decreased acetylcholine receptor antibody levels in peripheral blood rats with experimental autoimmune myasthenia gravis. In addition, the QSDH drug formulary downregulated P-PI3K/PI3K and P-Akt/Akt protein expression. Collectively, these findings describe the role and potential mechanism of the QSDH drug formulary in the treatment of MG, which exerts potential value by acting on AKT targets and regulating the PI3K/AKT signaling pathway and providing a theoretical reference for QSDH drug formulary application in the clinical treatment of MG.

Purpose: The objectives of this study were to determine the preventive effects of statins on stroke. Methods: The published randomized controlled trials of statins for stroke prevention were searched from PubMed, EMBASE, Cochrane Library, and China Journal databases. We performed the meta-analysis via calculating the odds ratio (OR) and 95% confidence interval (CI) to study the mortality rate, incidence, and recurrence rate of patients with stroke in the prevention group and the control group. Chi-square-based Q test and I ² statistics were performed to test the potential heterogeneity; we conducted the sensitivity analysis to assess the stability of our analysis. Moreover, we performed the Begg and Egger tests to assess the publication bias. Results: Nine studies were included to perform meta-analysis, which included 15,497 patients (prevention group [n = 4114]; control group [n = 11383]). We found that the statins were not associated with the patients with stroke in mortality rate (OR = 1.00, 95% CI [0.82, 1.23]) and incidence (OR = 0.94, 95% CI [0.46, 1.92]) between the 2 groups. However, there was a significant differences in recurrence rate between the 2 groups (OR = 0.31, 95% CI [0.19, 0.51]). Conclusions: Our findings indicated that the statins were associated with the patients with stroke in recurrence rate, but there was no significant correlation with the mortality and morbidity of patients with stroke.

Background: Myasthenia gravis (MG) is an autoimmune disease related to the production of autoantibodies. It is mediated by antibodies against acetylcholine receptor (AChR), muscle specific kinase (MuSK) or other AChR related proteins in the postsynaptic muscle membrane, which interfere with the transmission of signals at the neuromuscular junction, resulting in clinical symptoms of skeletal muscle weakness and fatigue, leading to the occurrence and development of MG. At present, the incidence rate of Mg is increasing year by year. At present, the method of invigorating spleen, replenishing qi and tonifying kidney in traditional Chinese medicine has been widely used in the clinical treatment of MG, and the effect is good. The purpose of this study was to systematically evaluate the efficacy and safety of the method of invigorating the spleen, supplementing qi and tonifying the kidney in the treatment of MG. Methods: We will search from the following eight databases: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Sinomed, Wanfang, and Vip. All randomized controlled trial (RCT) literature has been searched and classified since the establishment of the database to date. In this study, two researchers independently screened and evaluated the quality of the retrieved literature. Cochrane risk bias assessment tool was used to evaluate the risk of bias. The meta-analysis uses RevMan 5.3 software provided by Cochrane Collaboration Network for meta analysis. Results: This study compared the main outcome indicators: clinical response rate, recurrence rate, incidence of adverse reactions, quantitative myasthenia gravis score (QMG). Secondary outcomes were clinical absolute score, quality of life score (QOL), levels of inflammatory factors such as IL-6, IL-10, and serum acetylcholine receptor antibody (AChR-Ab) levels. Conclusion: The purpose of this study was to evaluate the efficacy and safety of the method of invigorating the spleen, supplementing qi and tonifying the kidney in treating MG, and to provide evidence based medicine.

Background: Immunosuppressive drugs are routinely used to treat myasthenia gravis (MG). However, current recommendations provide limited evidence to support treatment options, leading to considerable variation in practice among healthcare specialists. Hence, we present a protocol for a systematic review and network meta-analysis (NMA) to update the evidence by comparing the efficacy and acceptability of oral immunosuppressive drugs for the treatment of MG. Methods: We will conduct a systematic review and NMA of all randomized controlled trials evaluating the following oral immunosuppressive drugs for the treatment of MG. Published studies will be searched using the following databases from inception to November 23, 2021: CENTRAL, the CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, and 3 Chinese databases (Chinese Biomedical Literatures Database, CNKI, and Wan Fang database). Assessment of study eligibility and data extraction will be conducted independently by 2 reviewers. The main outcome will be a quantitative MG scoring system. We will conduct Bayesian NMA to synthesize all evidence for each outcome and obtain a comprehensive ranking of all treatments. The quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Results: The objective of this study was to assess the relative clinical efficacy and acceptability of first-line immunosuppressants for the treatment of MG, using a systematic review and NMA approach. Conclusion: In the absence of head-to-head trials comparing therapies, evidence from this NMA of available clinical trials will inform clinicians, patients, and families the risk-benefit profiles of different treatment options.

Immune-mediated rippling muscle disease (iRMD) is a rare autoimmune myopathy characterized by mechanically triggered, wave-like skeletal muscle contractions. Its coexistence with myasthenia gravis (MG) has been described, but detailed clinicopathological and longitudinal characterization of anti-cavin-4-positive iRMD coexisting with isolated ocular MG remains limited. Here, we report a 35-year-old man who developed painless, water-like rippling movements of the right thigh in 2023, followed by occasional palpitations and mild creatine kinase elevation in 2024. In July 2025, he developed fluctuating right ptosis without diplopia, bulbar symptoms, or limb weakness. Serology showed anti-acetylcholine receptor antibody positivity and high-titer anti-cavin-4 antibodies. Electromyography revealed mild myogenic changes with electrically silent rippling activity. Muscle biopsy showed mild myopathic changes and mosaic caveolin-3 expression. Chest CT showed no thymic hyperplasia or thymoma, and cardiac evaluation showed no structural heart disease or clinically significant arrhythmia. These findings supported anti-cavin-4-positive iRMD coexisting with isolated AChR-positive ocular MG. At follow-up, the patient reported reduced rippling activity, preserved limb strength, and persistent mild fatigue-related ptosis. Among the cases identified in our search, this was the youngest documented case with isolated ocular MG and the first anti-cavin-4-positive ocular-MG case with muscle-biopsy documentation. The case extends the documented age and mild-severity spectrum of iRMD associated with MG or AChR antibody positivity.