A sensitive non-isotopic assay for acetylcholine receptor autoantibodies.

BACKGROUND: Detection and measurement of serum acetylcholine receptor autoantibodies (AChRAb) are useful in the diagnosis and management of myasthenia gravis (MG). An immunoprecipitation assay (IPA) based on AChR labelled with 125I-alpha bungarotoxin is widely used for measurement of AChRAb, but a non-isotopic assay of sensitivity and specificity comparable to IPA is not available as yet. METHODS: A new AChRAb ELISA, which is based on the ability of AChRAb to compete with 3 different AChR monoclonal antibodies (MAbs 1-3) for binding sites on affinity purified fetal and adult-type AChR preparations, is described. The sensitivity and specificity of the ELISA were assessed by comparing assay results with a conventional IPA. RESULTS: There was good agreement between the IPA and the ELISA for measurement of AChRAb (r = 0.85; n = 83; p <0.001). 76/83 MG sera were positive in the ELISA, whilst 72/83 were positive by IPA. Eight sera were positive in the ELISA (inhibition range 18%-46%) but negative by IPA (0.33-0.47 nmol/L toxin bound) and 4 sera were negative in the ELISA (inhibition range -1% to15%) whilst positive by IPA (0.56-2.9 nmol/L toxin bound). Overall 80/83 (96%) of the MG sera were AChRAb positive in one or both assays. In addition, all 191 control serum samples which were negative for AChRAb by IPA were below or equal to 16% of inhibition in our ELISA. The AChRAb ELISA also showed good inter-assay and intra-assay precision. CONCLUSION: The AChRAb ELISA we have described has sensitivity and specificity at least as high as our current radioactive IPA. It has good precision and good handling characteristics making it suitable for routine use.

Muscle-specific receptor tyrosine kinase autoantibodies--a new immunoprecipitation assay.

BACKGROUND: It has been reported that measurement of autoantibodies to a muscle-specific receptor tyrosine kinase (MuSK) may be useful in the assessment and management of patients with acetylcholine receptor antibody (AChRAb)-negative myasthenia gravis (MG). METHODS: A new and convenient assay for MuSKAb measurement based on 125I-labeled purified recombinant MuSK is described. In the assay, serum samples (5 microl) were incubated with 50 microl of 125I-MuSK and any immune complexes formed precipitated with antihuman IgG (50 microl). RESULTS: With this assay, MuSKAbs were detected in 8/33 (24%) sera from AChRAb-negative MG patients studied. In contrast, no MuSKAb was detected in 53 AChRAb-positive MG patient sera; furthermore, 0/18 Lambert-Eaton myasthenic syndrome sera, 0/5 non-MG neuromuscular disease sera, 0/95 control autoimmune disease sera, and 0/50 healthy blood donor sera contained detectable MuSKAb. In this assay, inter-assay coefficients of variation (n = 5) were 6.8%, 5.9%, and 3.6% for samples with MuSKAbs at 0.73, 0.32, and 0.11 nmol/l, respectively. Similar results were obtained with 125I-labeled rat and human MuSK. CONCLUSION: The 125I-MuSK immunoprecipitation assay we have described provides a simple, specific, and precise procedure for detecting MuSKAbs.

Autoantibodies to human tryptophan hydroxylase and aromatic L-amino acid decarboxylase.

OBJECTIVE: To assess the prevalence of autoantibodies (Abs) to tryptophan hydroxylase (TPH) and aromatic l-amino acid decarboxylase (AADC) in patients with different autoimmune diseases and to analyse their respective epitopes. DESIGN: TPH and AADC Abs were measured in an immunoprecipitation assay using (35)S-labelled full-length and fragments of TPH and AADC. METHODS: Patients with different autoimmune adrenal diseases (n=84), non-adrenal autoimmune diseases (n=37), idiopathic vitiligo (n=8) and 56 healthy blood donors were studied. RESULTS: Fourteen of twenty-three (61%) of patients with autoimmune polyglandular syndrome (APS) type I and 1/34 (3%) of patients with isolated Addison's disease (AD) were positive for TPH Abs. None of the patients with APS type II (n=27), coeliac disease (n=10), autoimmune thyroid disease (AITD) (n=11), type 1 diabetes mellitus (DM) (n=16) or idiopathic vitiligo (n=8) was positive for TPH Abs. AADC Abs were detected in 12/23 (52%) patients with APS type I, in 1/29 (3%) patients with APS type II and 1/34 (3%) patients with isolated AD. None of the patients with coeliac disease, type 1 DM, AITD or idiopathic vitiligo was positive for AADC Abs. TPH Abs were found to interact with the C-terminal amino acids (aa) 308-423, central aa 164-205 and N-terminal aa 1-105 of the TPH molecule. AADC Ab binding epitopes were within the C-terminal aa 382-483, the central aa 243-381 and the N-terminal aa 1-167. CONCLUSIONS: Our study suggests that TPH Abs and AADC Abs react with several different epitopes and that different epitopes are recognized by different sera. The prevalence of TPH Abs and AADC Abs in patients with APS type I in our study is in agreement with previous reports. TPH Abs and AADC Abs were found very rarely in patients with other forms of autoimmune adrenal disease and were not detected in patients with non-adrenal autoimmune diseases.