{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:05:42Z","timestamp":1768457142574,"version":"3.49.0"},"reference-count":46,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/501100010870","name":"Qingdao Municipal Science and Technology Bureau","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010870","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012905","name":"Department of Science and Technology of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012905","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jocn-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Neuroscience"],"published-print":{"date-parts":[[2019,11]]},"DOI":"10.1016\/j.jocn.2019.08.079","type":"journal-article","created":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T08:12:31Z","timestamp":1566979951000},"page":"31-37","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"special_numbering":"C","title":["Association between CTLA-4 gene polymorphism and myasthenia gravis in a Chinese cohort"],"prefix":"10.1016","volume":"69","author":[{"given":"Gao-Mei","family":"Cai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao-Xian","family":"Yue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-Chen","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Jun","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xian-Jun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai-Feng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jocn.2019.08.079_b0005","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s13317-010-0011-7","article-title":"The soluble CTLA-4 receptor and its role in autoimmune diseases: an update","volume":"1","author":"Saverino","year":"2010","journal-title":"Auto Immun Highlights"},{"key":"10.1016\/j.jocn.2019.08.079_b0010","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1006\/cimm.1995.0012","article-title":"Immunosuppression and induction of anergy by CTLA4Ig in vitro: effects on cellular and antibody responses of lymphocytes from rats with experimental autoimmune myasthenia gravis","volume":"166","author":"McIntosh","year":"1995","journal-title":"Cell Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0015","doi-asserted-by":"crossref","first-page":"6430","DOI":"10.4049\/jimmunol.166.10.6430","article-title":"Anti-CTLA-4 antibody treatment triggers determinant spreading and enhances murine myasthenia gravis","volume":"166","author":"Wang","year":"2001","journal-title":"J Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0020","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jneuroim.2004.04.010","article-title":"Immunosuppression of rat myasthenia gravis by oral administration of a syngeneic acetylcholine receptor fragment","volume":"152","author":"Maiti","year":"2004","journal-title":"J Neuroimmunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0025","doi-asserted-by":"crossref","first-page":"6676","DOI":"10.1073\/pnas.1131898100","article-title":"A dual altered peptide ligand down-regulates myasthenogenic T cell responses by up-regulating CD25- and CTLA-4-expressing CD4+ T cells","volume":"100","author":"Paas-Rozner","year":"2003","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.jocn.2019.08.079_b0030","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/S0165-5728(02)00228-X","article-title":"Abnormal expression of CTLA-4 by T cells from patients with myasthenia gravis: effect of an AT-rich gene sequence","volume":"130","author":"Wang","year":"2002","journal-title":"J Neuroimmunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0035","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/ana.410100506","article-title":"Humoral immunity in myasthenia gravis: biochemical characterization of acquired antireceptor antibodies and clinical correlations","volume":"10","author":"Tindall","year":"1981","journal-title":"Ann Neurol"},{"key":"10.1016\/j.jocn.2019.08.079_b0040","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1586\/eci.12.34","article-title":"Muscle autoantibodies in myasthenia gravis: beyond diagnosis?","volume":"8","author":"Meriggioli 1","year":"2012","journal-title":"Expert Rev Clin Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0045","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/0022-510X(83)90096-5","article-title":"Anti-acetylcholine receptor antibodies in myasthenia gravis. Part 2. Clinical and serological follow-up of individual patients","volume":"58","author":"Oosterhuis","year":"1983","journal-title":"J Neurol Sci"},{"key":"10.1016\/j.jocn.2019.08.079_b0050","doi-asserted-by":"crossref","first-page":"e114060","DOI":"10.1371\/journal.pone.0114060","article-title":"Repeated acetylcholine receptor antibody concentrations and association to clinical myasthenia gravis development","volume":"9","author":"Heldal","year":"2014","journal-title":"PLoS ONE"},{"key":"10.1016\/j.jocn.2019.08.079_b0055","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00439-004-1244-1","article-title":"CTLA-4 polymorphisms and systemic lupus erythematosus (SLE): a meta-analysis","volume":"116","author":"Lee","year":"2005","journal-title":"Hum Genet"},{"key":"10.1016\/j.jocn.2019.08.079_b0060","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s10875-012-9650-y","article-title":"Polymorphisms in the CTLA-4 gene and rheumatoid arthritis susceptibility: a meta-analysis","volume":"32","author":"Li","year":"2012","journal-title":"J Clin Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0065","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1471-2350-14-46","article-title":"The associations between the polymorphisms in the CTLA-4 gene and the risk of Graves' disease in the Chinese population","volume":"14","author":"Du","year":"2013","journal-title":"BMC Med Genet"},{"key":"10.1016\/j.jocn.2019.08.079_b0070","doi-asserted-by":"crossref","first-page":"3162","DOI":"10.1210\/jc.2007-0147","article-title":"Cytotoxic T-lymphocyte associated antigen 4 gene polymorphisms and autoimmune thyroid disease: a meta-analysis","volume":"92","author":"Kavvoura","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"10.1016\/j.jocn.2019.08.079_b0075","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1530\/EJE-09-0618","article-title":"Cytotoxic T lymphocyte antigen-4 Ala17 polymorphism is a genetic marker of autoimmune adrenal insufficiency: Italian association study and meta-analysis of European studies","volume":"162","author":"Brozzetti","year":"2010","journal-title":"Eur J Endocrinol"},{"key":"10.1016\/j.jocn.2019.08.079_b0080","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/aje\/kwi165","article-title":"CTLA-4 gene polymorphisms and susceptibility to type 1 diabetes mellitus: a HuGE review and meta-analysis","volume":"162","author":"Kavvoura","year":"2005","journal-title":"Am J Epidemiol"},{"key":"10.1016\/j.jocn.2019.08.079_b0085","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3109\/08820139.2013.803114","article-title":"CTLA-4 +49 A\/G and -318 C\/T polymorphisms and susceptibility to multiple sclerosis: a meta-analysis","volume":"42","author":"Gyu Song","year":"2013","journal-title":"Immunol Invest"},{"key":"10.1016\/j.jocn.2019.08.079_b0090","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0165-5728(98)00119-2","article-title":"Genetic association of Ctla-4 to myasthenia gravis with thymoma","volume":"88","author":"Huang","year":"1998","journal-title":"J Neuroimmunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0095","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/sj.gene.6363816","article-title":"CDS1 and promoter single nucleotide polymorphisms of the CTLA-4 gene in human myasthenia gravis","volume":"3","author":"Wang","year":"2002","journal-title":"Genes Immun"},{"key":"10.1016\/j.jocn.2019.08.079_b0100","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1002\/ana.20577","article-title":"A CTLA4 high genotype is associated with myasthenia gravis in thymoma patients","volume":"58","author":"Chuang","year":"2005","journal-title":"Ann Neurol"},{"key":"10.1016\/j.jocn.2019.08.079_b0105","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1365-2796.2007.01879.x","article-title":"Two SNPs in the promoter region of the CTLA-4 gene affect binding of transcription factors and are associated with human myasthenia gravis","volume":"263","author":"Wang","year":"2008","journal-title":"J Intern Med"},{"key":"10.1016\/j.jocn.2019.08.079_b0110","doi-asserted-by":"crossref","first-page":"e101986","DOI":"10.1371\/journal.pone.0101986","article-title":"CTLA4 variants and haplotype contribute genetic susceptibility to myasthenia gravis in northern Chinese population","volume":"9","author":"Sun","year":"2014","journal-title":"PLoS ONE"},{"key":"10.1016\/j.jocn.2019.08.079_b0115","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jaut.2013.12.006","article-title":"Late-onset myasthenia gravis-CTLA4 (low) genotype association and low-for-age thymic output of na\u00efve T cells","volume":"52","author":"Chuang","year":"2014","journal-title":"J Autoimmun"},{"key":"10.1016\/j.jocn.2019.08.079_b0120","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1001\/jamaneurol.2014.4103","article-title":"A genome-wide association study of myasthenia gravis","volume":"72","author":"Renton","year":"2015","journal-title":"JAMA Neurol"},{"key":"10.1016\/j.jocn.2019.08.079_b0125","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1196\/annals.1405.040","article-title":"Myasthenia gravis in the elderly: is it different","volume":"1132","author":"Aarli","year":"2008","journal-title":"Ann N Y Acad Sci"},{"key":"10.1016\/j.jocn.2019.08.079_b0130","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1001\/archneur.56.4.457","article-title":"TNFA and TNFB polymorphisms in myasthenia gravis","volume":"56","author":"Skeie","year":"1999","journal-title":"Arch Neurol"},{"key":"10.1016\/j.jocn.2019.08.079_b0135","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/mus.20950","article-title":"Lifetime course of myasthenia gravis","volume":"37","author":"Grob","year":"2008","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.jocn.2019.08.079_b0140","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s10072-015-2375-y","article-title":"Association study between IL-17A and IL-17F gene polymorphism and myasthenia gravis in Chinese patients","volume":"37","author":"Yue","year":"2016","journal-title":"Neurol Sci"},{"key":"10.1016\/j.jocn.2019.08.079_b0145","first-page":"107","article-title":"The fundamentals of modern statistical","author":"Laird","year":"2011","journal-title":"Genetics"},{"key":"10.1016\/j.jocn.2019.08.079_b0150","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/bioinformatics\/bth457","article-title":"Haploview: analysis and visualization of LD and haplotype maps","volume":"21","author":"Barrett","year":"2005","journal-title":"Bioinformatics"},{"key":"10.1016\/j.jocn.2019.08.079_b0155","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jocn.2017.02.049","article-title":"Rs3761389 polymorphism in autoimmune regulator (AIRE) gene is associated with susceptibility of myasthenia gravis in Chinese patients","volume":"40","author":"Zhang","year":"2017","journal-title":"J Clin Neurosci"},{"key":"10.1016\/j.jocn.2019.08.079_b0160","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.clim.2008.05.006","article-title":"Identification of CTLA-4 isoforms produced by alternative splicing and their association with myasthenia gravis","volume":"128","author":"Gu","year":"2008","journal-title":"Clin Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0165","doi-asserted-by":"crossref","first-page":"6606","DOI":"10.4049\/jimmunol.165.11.6606","article-title":"CTLA-4 gene polymorphism at position 49 in exon 1 reduces the inhibitory function of CTLA-4 and contributes to the pathogenesis of Graves\u2019 disease","volume":"165","author":"Kouki","year":"2000","journal-title":"J Immunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0170","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0165-5728(00)00191-0","article-title":"Dinucleotide repeat expansion in the CTLA-4 gene leads to T cell hyper-reactivity via the CD28 pathway in myasthenia gravis","volume":"105","author":"Huang","year":"2000","journal-title":"J Neuroimmunol"},{"key":"10.1016\/j.jocn.2019.08.079_b0175","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/nature01621","article-title":"Association of the T-cell regulatory gene CTLA4 with susceptibility to autoimmune disease","volume":"423","author":"Ueda","year":"2003","journal-title":"Nature"},{"issue":"3","key":"10.1016\/j.jocn.2019.08.079_b0180","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1038\/sj.gene.6363752","article-title":"CTLA-4 gene expression is influenced by promoter and exon 1 polymorphisms","volume":"2","author":"Ligers","year":"2001","journal-title":"Genes Immun"},{"issue":"4","key":"10.1016\/j.jocn.2019.08.079_b0185","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1759-7714.2012.00121.x","article-title":"PTPN22 and CTLA-4 gene polymorphisms in resected thymomas and thymus for myasthenia gravis","volume":"3","author":"Zheng","year":"2012","journal-title":"Thorac Cancer"},{"key":"10.1016\/j.jocn.2019.08.079_b0190","doi-asserted-by":"crossref","first-page":"4771","DOI":"10.1007\/s12035-016-0024-y","article-title":"Gene polymorphisms for both auto-antigen and immune-modulating proteins are associated with the susceptibility of autoimmune myasthenia gravis","volume":"54","author":"Li","year":"2017","journal-title":"Mol Neurobiol"},{"key":"10.1016\/j.jocn.2019.08.079_b0195","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/neuonc\/nou001","article-title":"Atypical neurological complications of ipilimumab therapy in patients with metastatic melanoma","volume":"16","author":"Liao","year":"2014","journal-title":"Neuro Oncol"},{"key":"10.1016\/j.jocn.2019.08.079_b0200","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1200\/JCO.2013.51.1683","article-title":"Myasthenia gravis induced by ipilimumab in patients with metastatic melanoma","volume":"33","author":"Johnson","year":"2015","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.jocn.2019.08.079_b0205","first-page":"548","article-title":"Myasthenia gravis induced by ipilimumab in a patient with advanced melanoma","volume":"23","author":"Montes","year":"2016","journal-title":"Eur J Nuerol"},{"key":"10.1016\/j.jocn.2019.08.079_b0210","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/mus.24648","article-title":"Myasthenia gravis associated with ipilimumab and nivolumab in the treatment of small cell lung cancer","volume":"52","author":"Loochtan","year":"2015","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.jocn.2019.08.079_b0215","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S1470-2045(15)00544-6","article-title":"Safety and antitumour activity of durvalumab plus tremelimumab in non-small cell lung cancer: a multicentre, phase 1b study","volume":"17","author":"Antonia","year":"2016","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.jocn.2019.08.079_b0220","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3389\/fonc.2019.00084","article-title":"Successful treatment of myasthenia gravis following PD-1\/CTLA-4 combination checkpoint blockade in a patient with metastatic melanoma","volume":"9","author":"Werner","year":"2019","journal-title":"Front Oncol"},{"key":"10.1016\/j.jocn.2019.08.079_b0225","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1007\/s10072-018-3471-6","article-title":"Ipilimumab treatment associated with myasthenic crises and unfavorable disease course","volume":"39","author":"Derle","year":"2018","journal-title":"Neurol Sci"},{"key":"10.1016\/j.jocn.2019.08.079_b0230","unstructured":"https:\/\/www.clinicaltrials.gov\/ct2\/show\/NCT03059888?term=abatacept&cond=Myasthenia+Gravis&rank=1."}],"container-title":["Journal of Clinical Neuroscience"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0967586819300852?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0967586819300852?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:19:28Z","timestamp":1760822368000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0967586819300852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":46,"alternative-id":["S0967586819300852"],"URL":"https:\/\/doi.org\/10.1016\/j.jocn.2019.08.079","relation":{},"ISSN":["0967-5868"],"issn-type":[{"value":"0967-5868","type":"print"}],"subject":[],"published":{"date-parts":[[2019,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Association between CTLA-4 gene polymorphism and myasthenia gravis in a Chinese cohort","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical Neuroscience","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jocn.2019.08.079","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 Elsevier Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}