{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:19:04Z","timestamp":1783059544417,"version":"3.54.6"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Testing for acetylcholine receptor and muscle-specific kinase antibodies (anti-AChR and anti-MuSK) is of central diagnostic importance in myasthenia gravis (MG), yet practical evaluations of strategies to improve sensitivity using cell-based assays (CBAs) are lacking. We evaluated strategies to improve sensitivity of autoantibody testing for MG using CBAs at our center, including repeat fixed CBA at routine 1:10 dilution, send-out live CBA, and fixed CBA at lower 1:5 dilution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Quality improvement\/quality assurance (QI\/QA) evaluation of all patients at London Health Sciences Centre\/St. Joseph\u2019s Health Care London (LHSC\/SJHC) who underwent anti-AChR\/MuSK fixed CBA testing from January 2023\u2013January 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 3-year evaluation period, 973 patients underwent anti-AChR\/MuSK fixed CBA at routine 1:10 dilution. Of these, 127 (13.1%) exhibited autoantibody positivity, 3 (0.3%) were indeterminable, and 843 (86.6%) were negative. Testing of 78 patients represented repeat testing after initially negative anti-AChR\/MuSK fixed CBA, of whom 4 (5%) were positive. Thirteen patients with negative\/indeterminable anti-AChR\/MuSK fixed CBA underwent send-out live CBA, of whom 4 (31%) were positive. Of all 131 anti-AChR\/MuSK-positive patients identified, 123 (94%) had positivity on initial fixed CBA, 4 (3%) on repeat fixed CBA, and 4 (3%) on send-out live CBA. Among 8 samples with negativity by fixed CBA at 1:10 dilution from patients with subsequent autoantibody positivity, 4 (50%) exhibited positivity at 1:5 dilution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Repeat fixed CBA at routine 1:10 dilution, send-out live CBA, and fixed CBA at lower 1:5 dilution are all strategies that may improve sensitivity of autoantibody testing for MG at our center.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1874030","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:39:02Z","timestamp":1783057142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving sensitivity of autoantibody testing for myasthenia gravis using cell-based assays: an evaluation of strategies that may be used in clinical practice"],"prefix":"10.3389","volume":"17","author":[{"given":"Adrian","family":"Budhram","sequence":"first","affiliation":[{"name":"Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre","place":["London, ON, Canada"]},{"name":"Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola Z.","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamala","family":"Sangam","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu L. C. D.","family":"Bursztyn","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre","place":["London, ON, Canada"]},{"name":"Department of Ophthalmology, Western University, St. Joseph\u2019s Health Care London","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ario","family":"Mirian","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, St. Michael\u2019s Hospital","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiu-Chia","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Nicolle","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre","place":["London, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"120084","DOI":"10.1016\/j.jns.2021.120084","article-title":"Comparison of fixed cell-based assay to radioimmunoprecipitation assay for acetylcholine receptor antibody detection in myasthenia gravis","volume":"432","author":"Mirian","year":"2022","journal-title":"J Neurol Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100846","DOI":"10.1016\/j.lanwpc.2023.100846","article-title":"A multicentre, prospective, double-blind study comparing the accuracy of autoantibody diagnostic assays in myasthenia gravis: the SCREAM study","volume":"38","author":"Li","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1212\/NXI.0000000000200038","article-title":"Comparison of fixed and live cell-based assay for the detection of AChR and MuSK antibodies in myasthenia gravis","volume":"10","author":"Spagni","year":"2023","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"110826","DOI":"10.1016\/j.clinbiochem.2024.110826","article-title":"The changing landscape of autoantibody testing in myasthenia gravis in the setting of novel drug treatments","author":"Mousavi","year":"2024","journal-title":"Clin Biochem"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"577895","DOI":"10.1016\/j.jneuroim.2022.577895","article-title":"LRP4-IgG service line testing in seronegative myasthenia gravis and controls","volume":"368","author":"Klein","year":"2022","journal-title":"J Neuroimmunol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e70072","DOI":"10.1111\/sji.70072","article-title":"Diagnostic performance of three serological assays in myasthenia gravis: a prospective multicentre study","volume":"102","author":"Cuomo","year":"2025","journal-title":"Scand J Immunol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1017\/cjn.2021.23","article-title":"Neural antibody testing for autoimmune encephalitis: a Canadian single-centre experience","volume":"48","author":"Budhram","year":"2021","journal-title":"Can J Neurol Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1380541","DOI":"10.3389\/fneur.2024.1380541","article-title":"Myelin oligodendrocyte glycoprotein antibody titers by fixed cell-based assay: positive predictive value and impact of sample collection timing","volume":"15","author":"Budhram","year":"2024","journal-title":"Front Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"666","DOI":"10.7326\/0003-4819-146-9-200705010-00155","article-title":"The ethics of using quality improvement methods in health care","volume":"146","author":"Lynn","year":"2007","journal-title":"Ann Intern Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1002\/mus.20854","article-title":"Frequency of seronegativity in adult-acquired generalized myasthenia gravis","volume":"36","author":"Chan","year":"2007","journal-title":"Muscle Nerve"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e16435","DOI":"10.1111\/ene.16435","article-title":"Concordance between radioimmunoassay and fixed cell-based assay in subjects without myasthenia gravis: optimizing the diagnostic approach","volume":"31","author":"Falso","year":"2024","journal-title":"Eur J Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1459423","DOI":"10.3389\/fimmu.2025.1459423","article-title":"Efficiency of cell-based assays in detecting AChR antibodies in myasthenia gravis sera with low antibody concentrations as determined by radioimmunoprecipitation assay","volume":"16","author":"Tzartos","year":"2025","journal-title":"Front Immunol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e200554","DOI":"10.1212\/NXI.0000000000200554","article-title":"Low prevalence and inconsistency of LRP4-IgG detection in suspected myasthenia gravis: a multicenter CBA comparison","volume":"13","author":"Gligora","year":"2026","journal-title":"Neurol Neuroimmunol Neuroinflamm"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1874030\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:39:03Z","timestamp":1783057143000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1874030\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":13,"alternative-id":["10.3389\/fneur.2026.1874030"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1874030","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"article-number":"1874030"}}