{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:54:37Z","timestamp":1793915677614,"version":"4.8.0"},"reference-count":26,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["104079\/Z\/14\/Z"],"award-info":[{"award-number":["104079\/Z\/14\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Myasthenia Gravis Rare Disease Network \u2013 MGNet","award":["PTE FA 5U54NS115054-03, subaward 21-M73-INT"],"award-info":[{"award-number":["PTE FA 5U54NS115054-03, subaward 21-M73-INT"]}]},{"name":"Fulbright UK-US commission_MS-Research Society Award"},{"DOI":"10.13039\/501100000295","name":"Epilepsy Research UK","doi-asserted-by":"publisher","award":["P1201"],"award-info":[{"award-number":["P1201"]}],"id":[{"id":"10.13039\/501100000295","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V007173\/1"],"award-info":[{"award-number":["MR\/V007173\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"BMA Research Grants \u2013 2013 Vera Down grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Patients with myasthenia gravis without acetylcholine receptor (AChR) or muscle-specific kinase (MuSK) antibodies detected by radioimmunoprecipitation assays (RIAs) are classified as seronegative myasthenia gravis (SNMG). Live cell-based assays (l-CBAs) can detect additional antibodies to clustered AChR, MuSK and low-density lipoprotein receptor-related protein 4 (LRP4), but positivity rates are variable and both clinical relevance and utility of CBA platforms remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sera from 82 patients with SNMG were tested by l-CBAs. Human embryonic kidney cells were transfected to individually express clustered AChR, MuSK or LRP4; or transfected to jointly express both clustered adult AChR and MuSK. Sera from 30 and 20 patients positive by RIA for AChR or MuSK antibodies were used as comparators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>53 of 82 (72%) patients with SNMG had generalised and 29 (28%) had ocular disease. The clustered AChR CBA detected antibodies in 16 of 82 patients (19.5%; including 4 patients with solely fetal AChR antibodies), while 7 of 82 (8.5%) patients had MuSK antibodies. A novel exploratory combined adult AChR-MuSK l-CBA efficiently detected all these antibodies in a subset of the SNMG cohort. No LRP4 antibodies were identified. Overall, patients with SNMG with clustered AChR antibodies, CBA-positive MuSK-MG or triple seronegative were younger, had less severe disease than patients with RIA-positive MG and had a better clinical outcome when immunotherapy was started soon after disease onset, although the time interval from onset to immunotherapy was not different when compared with patients with RIA-positive MG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Around one-third of patients with SNMG had AChR or MuSK antibodies by l-CBAs, which were efficiently detected with a combined l-CBA. The results in this large and unselected cohort of patients with MG demonstrate the diagnostic usefulness of performing CBAs and the importance of making these tests more widely available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2022-329284","type":"journal-article","created":{"date-parts":[[2022,7,14]],"date-time":"2022-07-14T13:20:34Z","timestamp":1657804834000},"page":"995-1000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Clinical value of cell-based assays in the characterisation of seronegative myasthenia gravis"],"prefix":"10.1136","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1740-4522","authenticated-orcid":false,"given":"Valentina","family":"Damato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Spagni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4763-7784","authenticated-orcid":false,"given":"Gabriele","family":"Monte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Woodhall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Jacobson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Falso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6270-0956","authenticated-orcid":false,"given":"Raffaele","family":"Iorio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4142-2667","authenticated-orcid":false,"given":"Patrick","family":"Waters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7667-9748","authenticated-orcid":false,"given":"Sarosh R","family":"Irani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Vincent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Evoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,14]]},"reference":[{"key":"2023051801202576000_93.9.995.1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1080\/1744666X.2021.1936500","article-title":"Heterogeneity in myasthenia gravis: considerations for disease management","volume":"17","author":"Evoli","year":"2021","journal-title":"Expert Rev Clin Immunol"},{"key":"2023051801202576000_93.9.995.2","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1007\/s00415-020-10342-3","article-title":"Acetylcholine receptor antibody positivity rate in ocular myasthenia gravis: a matter of age?","volume":"268","author":"Monte","year":"2021","journal-title":"J Neurol"},{"key":"2023051801202576000_93.9.995.3","doi-asserted-by":"publisher","DOI":"10.1038\/85520"},{"key":"2023051801202576000_93.9.995.4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awg223"},{"key":"2023051801202576000_93.9.995.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2013.12.004"},{"key":"2023051801202576000_93.9.995.6","doi-asserted-by":"crossref","unstructured":"Marino M , Scuderi F , Samengo D , et al . 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