Improving sensitivity of autoantibody testing for myasthenia gravis using cell-based assays: an evaluation of strategies that may be used in clinical practice.

Adrian Budhram, Ola Z Ismail, Kamala Sangam, Lulu L C D Bursztyn, Ario Mirian, Yiu-Chia Chang, Michael W Nicolle

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Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Adrian BudhramDepartment of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada.

Ola Z IsmailDepartment of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.

Kamala SangamDepartment of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada.

Lulu L C D BursztynDepartment of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada.

Ario MirianDepartment of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.

Yiu-Chia ChangDepartment of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada.

Michael W NicolleDepartment of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada.

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6 · The paper itself

Abstract

Introduction: 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. Methods: Quality improvement/quality assurance (QI/QA) evaluation of all patients at London Health Sciences Centre/St. Joseph's Health Care London (LHSC/SJHC) who underwent anti-AChR/MuSK fixed CBA testing from January 2023-January 2026. Results: 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. Conclusion: 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.

Indexed as

acetylcholine receptor antibodyautoantibody testingcell-based assaymuscle-specific kinase antibodymyasthenia gravis

Identifiers

PMID42491105

DOI10.3389/fneur.2026.1874030

PMCPMC13375981

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