Musk

MuSK (muscle-specific kinase) is a single-member receptor tyrosine kinase family essential for neuromuscular junction formation. Its extracellular region contains three immunoglobulin-like domains and a frizzled-like cysteine-rich domain. In developing muscle, the heparan-sulfate proteoglycan agrin released from motor neuron terminals binds LRP4, which recruits and activates MuSK, triggering a signaling cascade with Dok7 that leads to rapsyn-mediated clustering of acetylcholine receptors at the synaptic membrane. MuSK also specifies postsynaptic differentiation and retrogradely signals to presynaptic terminals. Autoantibodies against MuSK cause a severe form of myasthenia gravis with prominent bulbar weakness, distinguishable from classic acetylcholine receptor antibody disease, and treated with complement inhibitors and B-cell-directed therapies.