Acetylcholine receptor antibodies and anti-idiotypic antibodies produced in blood lymphocyte cultures from patients with myasthenia gravis.

The production of acetylcholine receptor antibody idiotypes and of antibodies directed against receptor antibody idiotopes were studied in cultures of blood mononuclear cells from 11 patients with myasthenia gravis and 11 healthy donors. The antibody specificities were defined by their reaction with monoclonal anti-receptor and anti-idiotypic antibodies. Cells from eight patients but no controls produced both kinds of antibodies. These antibodies were less frequently found in patients' sera. In no patient were antibody specificities present in serum not detected in cell cultures. It is concluded that the B-cell repertoire of specific autoantibodies is more completely disclosed by analysis of blood cell cultures than by serum antibody determinations. The results suggest an idiotype-anti-idiotype regulation of anti-acetylcholine receptor autoimmunity in myasthenia gravis.