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D ‐penicillamine‐associated myasthenia gravis: Immunological and electrophysiological studies
Author(s) -
Fawcett Peter R. W.,
McLachlan Sandra M.,
Nicholson Louise V. B.,
Argov Zohar,
Mastaglia Frank L.
Publication year - 1982
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.880050409
Subject(s) - myasthenia gravis , acetylcholine receptor , penicillamine , autoantibody , in vivo , antibody , medicine , rheumatoid arthritis , immunology , endocrinology , immunoglobulin e , in vitro , pokeweed mitogen , pharmacology , chemistry , receptor , biology , peripheral blood mononuclear cell , biochemistry , microbiology and biotechnology
Immunological and electrophysiological features were investigated in a patient with rheumatoid arthritis who developed myasthenic symptoms after 10 months of treatment with D ‐penicillamine ( D ‐pen). After an initial rise, acetylcholine receptor (AChR) antibodies gradually fell from 24.4 nmole α‐bungarotoxin bound/liter to 1.8 nmole/liter following withdrawal of the drug, and this was associated with clinical and electrophysiological improvement. Immunoglobulin synthesis by peripheral blood lymphocytes cultured with pokeweed mitogen and D ‐pen was significantly increased at D ‐pen concentrations of 10–100 μg/ml in 2 patients with D ‐pen associated myasthenia gravis and 1 out of 3 normal individuals. Furthermore, lymphocytes from 1 myasthenic patient synthesized detactable AChR antibodies in vitro, and the amount of receptor antibody produced was increased in the presence of the drug. This effect was most marked at a concentration of 10 μg/ml which is thought to approximate the concentration in vivo. Our results confirm the in vivo findings of others that D ‐pen may have different effects on immunoglobulin production in different individuals and may also enhance the synthesis of at least 1 autoantibody, the AChR antibody.