ERUM globulin, particularly the IgG fraction, of patients with myasthenia gravis reacts with skeletal muscle, cardiac muscle and thymic epithelial cells, as well as nuclei of various tissues.1-7 These findings indicate a possible role of the serum globulin in the pathogenesis of myasthenia gravis. However, there is no evidence that the serum globulin is directly responsible for the neuromuscular block in myasthenic patients; in fact, after administration of serum from patients with high titers of muscle antibody to other myasthenic patients, neuromuscular transmission improved, suggesting that the globulin may exert a protective effect.8,9There have been only a few studies on lymphocytes in myasthenia gravis. Tissue culture of lymphocytes of myasthenic patients responded normally in deoxyribonucleic acid synthesis and blast transformation to stimulation by phytohemagglutinin,10 responses considered to be indicative of the immunological competence of lymphocytes. Delayed hypersensitivity induced by 1-chloro-2, 4-dinitrobenzene, which is mediated by lymphocytes, has been reported to be either reduced11 or normal12 in patients with myas¬ thenia gravis.We have found that lymphocytes of myas¬ thénie patients caused a more severe system¬ ic graft-versus-host reaction in mice than normal human lymphocytes.13 In the pres¬ ent study, the local effect of lymphocytes of patients with myasthenia gravis on rats has been evaluated.
Materials and MethodsCirculating lymphocytes were isolated by ster¬ ile procedures from the blood of myasthénie patients, normal humans, and rabbits, according to the method of Coulson and Chalmers.14 Isolated lymphocytes with a purity of 96% to 99% were resuspended to a final concentration of 15,000 cells per cubic millimeter in medium 199, a culture medium with known chemical composition. Suspensions of erythrocytes from myasthénie patients and from normal humans were prepared during the isolation of lympho¬ cytes, and the erythrocyte concentration in medium 199 was adjusted to the concentration of the lymphocyte suspension. Serum was sepa¬ rated from coagulated blood by centrifugation.The patients studied in this investigation are described in Table 1. Prior to obtaining blood, medication was withheld for at least 12 hours, and, when necessary, respiration was supported mechanically. Normal human blood was ob¬ tained from one woman and four men, age 22 to 43 years. Blood was also obtained from five normal rabbits and four rabbits that had been immunized with a saline extract of rat skeletal muscle. The extract was the supernatant ob¬ tained by centrifugation for 15 minutes at 13,-000 X g of a homogenate of a mixture of one part by weight of rat skeletal muscle and five parts by volume of physiologic saline. Equal volumes of the extract and Freund's complete adjuvant were mixed, and 0.2 ml of the mixture was injected into the footpads of rabbits once every two weeks for 12 weeks. An additional intravenously administered booster injection of 0.5 ml of extract was given one week before obtaining blo...