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Immunopathogenesis and treatment of myasthenia gravis

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References

  1. Lisak RP, Barchi RL: Myasthenia gravis.In Physiology Pharmacology and Biochemistry of Neuromuscular Transmission. Philadelphia, WB Saunders, 1982, pp 51–96

    Google Scholar 

  2. Lisak RP, Levinson AI, Zweiman B: Autoimmune aspects of myasthenia gravis. Concepts Immunopathol 2:65–101, 1985

    Google Scholar 

  3. Ashikawa T, Appel SH: Immunopathologic events at the endplate in myasthenia gravis. Springer Sem Immunopathol 8:177–196, 1985

    Google Scholar 

  4. Sterz R, Holdfield R, Rajki K,et al.: Effector mechanisms in myasthenia gravis. Muscle Nerve 9:306–312, 1986

    Google Scholar 

  5. Whiting PJ, Vincent A, Newsom-Davis J: Myasthenia gravis: Monoclonal anti-human AChR antibodies used to analyze antibody specificities and responses to treatment. Neurology 36:612–617, 1986

    Google Scholar 

  6. Vincent A, Newsom-Davis J: Acetylcholine receptor antibody characteristics in myasthenia gravis. I. Patients with generalized myasthenia or disease restricted to ocular muscles. Clin Exp Immunol 49:257–265, 1982

    Google Scholar 

  7. Penn AS, Schotland DL, Lamme S: Anti-muscle and antiacetylcholine receptor antibodies in myasthenia gravis.

  8. Christadoss P, Lindstrom J, Munro S, Talal N: Muscle acetylcholine receptor loss in murine experimental myasthenia gravis: Correlated with cellular, humoral and clinical responses. J Neuroimmunol 8:29–41, 1985

    Google Scholar 

  9. Pachner Ar, Kantor FS: In vitro and in vivo action of acetylcholine receptor educated suppressor T cell lines in murine experimental autoimmune myasthenia gravis. Clin Exp Immunol 56:659–668, 1984

    Google Scholar 

  10. Souroujon MC, Pachner AR, Fuchs S: The treatment of passively transferred experimental myasthenia with anti-idiotypic antibodies. Neurology 36:622–625, 1986

    Google Scholar 

  11. Corey AL, Richman DR, Shuman CA, Gomez CM, Arnason BGW: Use of monoclonal anti-acetylcholine receptor antibodies to investigate the macrophage inflammation of acute experimental myasthenia gravis. Neurology 35:1455–1460, 1986

    Google Scholar 

  12. Vincent A, Newson-Davis J: Acetylcholine receptor antibody characteristics in myasthenia gravis. II. Patients with penicillamine-induced myasthenia or idiopathic myasthenia of recent onset. Clin Exp Immunol 49:266–272, 1982

    Google Scholar 

  13. Skolnik PR, Lisak RP, Zweiman B: Monoclonal antibody analysis of blood T cell subsets in myasthenia gravis. Ann Neurol 11:170–176, 1982

    Google Scholar 

  14. Berrih S, Gaud C, Bach MA, LeBrigand H, Binet JP, Bach JF: Evaluation of T cell subsets in myasthenia gravis using anti-T cell monoclonal antibodies. Clin Exp Immunol 45:1–8, 1981

    Google Scholar 

  15. Berrih S, LeBrigand H, Levasseur P, Gaud C, Bach JF: Depletion of helper/inducer T cells after thymectomy in myasthenia patients. Clin Immunol Immunopath 28:272–281, 1983

    Google Scholar 

  16. Haynes BF, Harden EA, Olanow CW, Eisenbarth BS, Wechsler AS, Hensley LL, Roses AD: Effect of thymectomy on peripheral lymphocyte subsets in myasthenia gravis: Selective effect on T cells in patients with thymic atrophy. J Immunol 131:773–777, 1983

    Google Scholar 

  17. Miller AE, Hudson BS, Tindal RSA: Immune regulation in myasthenia gravis: Evidence for an increased suppressor T cell population. Ann Neurol 12:341–347, 1982

    Google Scholar 

  18. Engel WK, Trotter JL, McFarlin DE, McIntosh CL: Thymic epithelial cells contain acetylcholine receptor. Lancet 1:1310–1311, 1977

    Google Scholar 

  19. Morrell R: Acetylcholine binding sites on peripheral blood and CSF mononuclear cells from myasthenic patients. Ann NY Acad Sci 377:848–849, 1981

    Google Scholar 

  20. Richman DP, Antel JP, Burns JB, Arnason BGW: Nicotinic acetylcholine receptor on human lymphocytes. Ann NY Acad Sci 37:427–435, 1981

    Google Scholar 

  21. Shore A, Limatiblul S, Dosch HM, Gelfand EW: Identification of two serum components regulating the expression of T lymphocyte function in childhood myasthenia gravis. N Engl J Med 301:625–629, 1979

    Google Scholar 

  22. Kelley RE, Keesy JC, Goymerac V, Larrick SB, Kebo D, Buffkin D: Immunoregulation of total IgG synthesis in myasthenia gravis. Ann NY Acad Sci 377:403–410, 1981

    Google Scholar 

  23. Mischak RP, Dau PC: Lymphocyte binding antibodies and suppressor cell activity in myasthenia gravis. Ann Ny Acad Sci 377:436–446, 1981

    Google Scholar 

  24. Koethe SM, Cook A, McQuillen DP, McQuillen MP: Clinical and immunologic correlations in myasthenia gravis: Measurement of ConA stimulated suppressor cell activity. NY Acad Sci 377:447–454, 1981

    Google Scholar 

  25. Zilko PJ, Dawkins RL, Homes K, Witte CK: Genetic control of suppressor lymphocyte function in myasthenia gravis: Relationship of impaired suppressor function HLAB8/DRW3 and cold reactive lymphocytotoxic antibodies. Clin Immunol 14:222–230, 1979

    Google Scholar 

  26. Newsom-Davis J, Willcox NA, Vincent A: Immunological abnormalities in myasthenia gravis.In Neuroimmunology, PO Beehan, F Spreafico (eds). Raven Press, New York, 1984, pp 275–283.

    Google Scholar 

  27. Levinson AI, Lisak RP, Zweiman B, Kornstein M: Phenotypic and functional analysis of lymphocytes in myasthenia gravis. Spring Harbor Semin Immunopathol 8:209–233, 1985

    Google Scholar 

  28. Lisak RP, Levinson AI, Zweiman B, Kornstein MJ: Antibodies to acetylcholine receptor and tetanus toxoid: In vitro synthesis by thymic lymphocytes. J Immunol 137:1221–1225, 1986

    Google Scholar 

  29. Fujii Y, Hashimoto J, Monden Y, Ito T, Nakahara K, Kawashima Y: Specific activation of lymphocytes against acetylcholine receptor in the thymus in myasthenia gravis. J Immunol 136:887–891, 1986

    Google Scholar 

  30. Newsom-Davis J, Willcox N, Calder L: Thymus cells in myasthenia gravis selectively enhance production of antiacetylcholine receptor antibody by autologous blood lymphocytes. N Engl J Med 305:1312–1318, 1981

    Google Scholar 

  31. Lisak RP, Laramore C, Levinson AI, Zweiman B, Moskovitz AR: Suppressor T cells in myasthenia gravis (MG) and antibodies to acetylcholine receptor. Ann Neurol 19:87–89, 1986

    Google Scholar 

  32. Lisak RP, Laramore C, Levinson AI, Zweiman B, Moskovitz AR, Whitte A: In vitro synthesis of antibodies to acetylcholine receptor (anti AChR ab) by circulating lymphocytes: Role of suppressor T cells in normal subjects. Neurology 34:802–805, 1984

    Google Scholar 

  33. Lefvert AK: Anti-idiotypic antibodies against the receptor antibodies in myasthenia gravis. Scand J Immunol 13:493–497, 1981

    Google Scholar 

  34. Lefvert AK, Pirskanen R, Svanborg E: Anti-idiotypic antibodies, acetylcholine receptor antibodies and disturbed neuromuscular function in healthy relatives to patients with myasthenia gravis. J Neuroimmunol 9:41–53, 1985

    Google Scholar 

  35. Dwyer DS, Bradley RJ, Urquhart CK, Kearney J: Naturally occurring anti-idiotypic antibodies in myasthenia gravis patients. Nature 30:611–614, 1984

    Google Scholar 

  36. Stephansson K, Dieperink ME, Richman DP, Gomez CM, Marton LS: Sharing of antigenic determinants between the nicotinic acetylcholine receptor and proteins in Escherichia coli, Proteus vulgaris, and Klebsiella pneumoniae. N Engl J Med 312:221–225, 1984

    Google Scholar 

  37. Dwyer DS, Vakil M, Kearney JF: Idiotypic network connectivity and a possible case of myasthenia gravis. J Exp Med 164:1310–1318, 1986

    Google Scholar 

  38. Erlanger BF, Cleveland WL, Wassermann NH, Ku HH, Hill BL, Wan KK, Sarahgarajan R, Penn AS: The autoidiotypic route to antireceptor antibodies. Ann NY Acad Sci 475:219–226, 1986

    Google Scholar 

  39. Kao I, Drachman DB: Thymic muscle cells bear acetylcholine receptors: Possible relation to myasthenia gravis. Science 195:74–75, 1977

    Google Scholar 

  40. Werkele H, Ketelsen UP, Zurn AD: Intrathymic pathogenesis of myasthenia gravis: Transient expression of acetylcholine receptors on thymus derived myogenic cells. Eur Immunol 8:579–583, 1978

    Google Scholar 

  41. Fuchs S, Schmidt-Hopfield I, Tridente G, Tarrab-hazdai R: Thymic lymphocytes bear a surface antigen which crossreacts with acetylcholine receptor. Nature 287:162–164, 1980

    Google Scholar 

  42. Levinson AI, Zweiman B, Lisak RP, Moskovitz A: Thymic B cell activation in myasthenia gravis. Neurology 34:462–468, 1984

    Google Scholar 

  43. Lisak RP, Zweiman B, Skolnik P, Levinson AI, Moskovitz A, Guerrero F: Thymic lymphocyte subpopulations in myasthenia gravis. Neurology 33:868–872, 1983

    Google Scholar 

  44. Kornstein MJ, Brooks JJ, Anderson AO, Levinson AJ, Lisak RP, Zweiman B: Immunohistology of the thymus in myasthenia gravis. Am J Pathol 117:184–194, 1984

    Google Scholar 

  45. Kornstein MJ, Hoxie JA, Levinson AI, Brooks J: Immunohistology of human thymomas. Arch Pathol Lab Med 109:460–463, 1985

    Google Scholar 

  46. Chilosi M, Ianucci A, Fiore-Donati L, Tridente G, Pampanin M, Pizzolo G, Ritter M, Bofill M, Hanossy G: Myasthenia gravis: Immunohistological heterogeneity in microenvironmental organization of hyperlastic and neoplastic thymuses suggesting different mechanisms of tolerance breakdown. J Neuroimmunol 11:191–204, 1986

    Google Scholar 

  47. Thomas JA, Willcox NA, Newsome-Davis J: Immunohistological studies of the thymus in myasthenia gravis. Correlation with clinical state and thymocyte culture responses. Neuroimmunology 3:319–335, 1982

    Google Scholar 

  48. Levinson AI, Zweiman B, Lisak RP: Isotype restriction of thymic B cell immunoglobulin synthesis in myasthenia gravis. Ann NY Acad Sci (in press).

  49. Lisak RP: Myasthenia gravis: Mechanisms and management. Hosp Pract 18:101–109, 1983

    Google Scholar 

  50. Johns TR: Treatment of myasthenia gravis: Long-term administration of corticosteroids with remarks on thymectomy.In Adv Neurol 17, RC Griggs, RT Moxleg III (eds). New York, Raven Press, 1977, pp 99–122

    Google Scholar 

  51. Drachman DB: Myasthenia gravis. N Engl J Med 298:130–142, 186–193, 1978

    Google Scholar 

  52. Lisak RP, Barchi RL: Myasthenia gravis.In Treatment and Management, Philadelphia, WB Saunders, 1982, pp 184–238

    Google Scholar 

  53. Mertens HG, Balzereit F, Leipert M: The treatment of severe myasthenia gravis with immunosuppressive drugs. Eur Neurol 2:321–339, 1969

    Google Scholar 

  54. Matell G, Bergstrom K, Franksson C, Hammarstrom L, Lefvert AK, Moller E, Von Reis G, Smith E: Effects of some immunosuppressive procedures on myasthenia gravis. Ann NY Acad Sci 274:608–622, 1976

    Google Scholar 

  55. Hertel G, Merten HG, Reuther P, Richer K: The treatment of myasthenia gravis with azathioprine.In Plasmapharesis and the Immunobiology of Myasthenia Gravis, PC Dau (ed). Boston, Houghton Mifflin, 1979, pp 315–328

    Google Scholar 

  56. Witt AS, Cornblath DR, Parry G, Lisak RP, Schatz NS: Azathioprine in the treatment of myasthenia gravis. Ann Neurol 15:602–605, 1984

    Google Scholar 

  57. Tindall RSA, Rollins JR, Phillips JT, Greenlee, RG, Belendink G: A double-blind, placebo-controlled trial to determine the efficacy of cyclosporin A on the treatment of myasthenia gravis. Neurology 36 (Suppl):196–197, 1986

    Google Scholar 

  58. Pinching AJ, Peters DK, Newsom-Davis J: Remission of myasthenia gravis following plasma exchange. Lancet 2:1373–1376, 1976

    Google Scholar 

  59. Dau PC, Lindstrom JM, Cassel CK, Denys EH, Shev EE, Spitler LE: Plasmapharesis and immunosuppressive drug therapy in myasthenia gravis. N Engl J Med 297:1134–1140, 1977

    Google Scholar 

  60. Lisak RP: Plasma exchange in neurologic diseases. Arch Neurol 41:654–657, 1984

    Google Scholar 

  61. Newsom-Davis J, Ward CD, Wilson SG, Pinching AJ, Vincent A: Plasmapharesis: Short and long-term benefits.In Dau PC (ed). Plasmapharesis and the Immunobiology of Myasthenia Gravis, PC Dau (ed). Boston, Houghton Mifflin, 1979, pp 199–208

    Google Scholar 

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Levinson, A.I., Zweiman, B. & Lisak, R.P. Immunopathogenesis and treatment of myasthenia gravis. J Clin Immunol 7, 187–197 (1987). https://doi.org/10.1007/BF00915723

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