Putative role of antireticulin antibody in antiacetylcholine-receptor-antibody-negative myasthenia gravis
T. U. Hoogenraad and F. H. Gmelig Meyling
It has recently been demonstrated that pathogenic immunoglobulins circulate
in the blood of patients with acetylcholine-receptor-antibody
(A-AChR)-negative myasthenia gravis (MG). Evidence has been presented that
in this form of MG the neuromuscular transmission is impaired by antibodies
that bind to endplate determinants other than the AChR. We describe three
patients with clinical manifestations of A-AChR-negative MG in whom
antibody directed to reticulin (A-Ret) was detected. Antibody directed to
reticulin is usually associated with celiac disease; however, none of the
patients had symptoms or signs of celiac disease. To our knowledge, the
association of A-Ret with A-AChR-negative MG has not been reported before.
We postulate that A-Ret might help to differentiate between A-AChR-negative
MG and congenital myasthenia. Further studies are needed to determine
whether A-Ret plays a pathogenic role in A-AChR-negative MG or should
instead be considered as an epiphenomenon.
