In myasthenia gravis (MG) an autoimmune response against muscle acetylcholine receptor (AChR) occurs. Embryonic muscle AChR contains a y subunit, substituted in adult muscle by a homologous e subunit. Antibodies and CD4 + cells specific for embryonic AChR have been demonstrated in MG patients.We identified sequence segments of the human y subunit forming epitopes recognized by four embryonic AChR-specific CD4' T cell lines, propagated from MG patients' blood by stimulation with synthetic peptides corresponding to the human -y subunit sequence. Each line had an individual epitope repertoire, but two 20-residue sequence regions were recognized by three lines of different HLA haplotype. Most T epitope sequences were highly diverged between the y and the other AChR subunits, confirming the specificity of the T cells for embryonic AChR. These T cells may have been sensitized against AChR expressed by a tissue other than innervated skeletal muscle, possibly the thymus, which expresses an embryonic muscle AChR-like protein, containing a y subunit. Several sequence segments forming T epitopes are similar to regions of microbial and /or mammalian proteins unrelated to the AChR. These findings are consistent with the possibility that T cell cross-reactivity between unrelated proteins ("molecular mimicry"), proposed as a cause of autoimmune responses, is not a rare event. (J. Clin. Invest. 1992Invest. . 90:1558Invest. -1567