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Seronegative <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">SNMG<\/jats:styled-content>) without antibodies against acetylcholine receptor (<jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR) and muscle\u2010specific kinase (Mu<jats:styled-content style=\"fixed-case\">SK<\/jats:styled-content>) by routine assays accounts for about 20% of all <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Plasma from 81 Chinese <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> patients previously found to be seronegative was tested by routine assays for <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR and Mu<jats:styled-content style=\"fixed-case\">SK<\/jats:styled-content> antibodies. These samples were screened by (i) a novel, highly sensitive radioimmunoassay for <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR antibodies; (ii) cell\u2010based assays for clustered <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR, Mu<jats:styled-content style=\"fixed-case\">SK<\/jats:styled-content> and lipoprotein receptor\u2010related protein 4 (<jats:styled-content style=\"fixed-case\">LRP<\/jats:styled-content>4) antibodies; (iii) a radioimmunoassay for titin antibodies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Antibodies to <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR, Mu<jats:styled-content style=\"fixed-case\">SK<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> LRP<\/jats:styled-content>4 and titin were found in 25% (20\/81), 4% (3\/81), 7% (6\/81) and 6% (5\/78) of <jats:styled-content style=\"fixed-case\">SNMG<\/jats:styled-content> patients, respectively. In total, 37% of <jats:styled-content style=\"fixed-case\">SNMG<\/jats:styled-content> patients were found to be positive for at least one of the tested antibodies. <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR antibody positive patients had more severe disease (<jats:italic>P<\/jats:italic> = 0.008) and a trend towards fewer remissions\/minimal manifestations than <jats:styled-content style=\"fixed-case\">AC<\/jats:styled-content>hR antibody negative patients. The four patients with coexistence of antibodies had more severe disease, whilst the seronegative patients had milder <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> (<jats:italic>P<\/jats:italic> = 0.015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Detection of multiple muscle antibodies by more sensitive assays provides additional information in diagnosing and subgrouping of <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> and may guide <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13300","type":"journal-article","created":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T06:18:47Z","timestamp":1493878727000},"page":"844-850","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Multiple antibody detection in \u2018seronegative\u2019 myasthenia gravis patients"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3125-2855","authenticated-orcid":false,"given":"Y.","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Zisimopoulou","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Hellenic Pasteur Institute Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Trakas","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Hellenic Pasteur Institute Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Karagiorgou","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Hellenic Pasteur Institute Athens Greece"},{"name":"Tzartos NeuroDiagnostics Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Stergiou","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Hellenic Pasteur Institute Athens Greece"},{"name":"Tzartos NeuroDiagnostics Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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