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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1980 Jul;43(7):611–621. doi: 10.1136/jnnp.43.7.611

Immune disease and HLA associations with myasthenia gravis.

P O Behan
PMCID: PMC490628  PMID: 6967515

Abstract

In the late 1950's laboratory and clinical evidence suggested that myasthenia gravis was an autoimmune disorder. Since then a voluminous literature has developed documenting the many immunological abnormalities that occur in this condition. Recent findings point to a central disorder of immunoregulation. It is postulated that the disease occurs as a result of host genetic and environmental influences-the latter being, as yet unidentified and possibly a virus.

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Selected References

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  1. ADNER M. M., SHERMAN J. D., ISE C., SCHWAB R. S., DAMESHEK W. AN IMMUNOLOGIC SURVEY OF FORTY-EIGHT PATIENTS WITH MYASTHENIA GRAVIS. N Engl J Med. 1964 Dec 24;271:1327–1333. doi: 10.1056/NEJM196412242712601. [DOI] [PubMed] [Google Scholar]
  2. ALTER M., TALBERT O. R. Myasthenia gravis in one monozygotic twin. Neurology. 1960 Aug;10:793–798. doi: 10.1212/wnl.10.8.793. [DOI] [PubMed] [Google Scholar]
  3. Aarli J. A., Heimann P., Matre R., Thunold S., Tönder O. Lymphocyte subpopulations in thymus and blood from patients with myasthenia gravis. J Neurol Neurosurg Psychiatry. 1979 Jan;42(1):29–34. doi: 10.1136/jnnp.42.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Abdou N. I., Lisak R. P., Zweiman B., Abrahamsohn I., Penn A. S. The thymus in myasthenia gravis. Evidence for altered cell populations. N Engl J Med. 1974 Dec 12;291(24):1271–1275. doi: 10.1056/NEJM197412122912403. [DOI] [PubMed] [Google Scholar]
  5. Allison A. C., Denman A. M., Barnes R. D. Cooperating and controlling functions of thymus-derived lymphocytes in relation to autoimmunity. Lancet. 1971 Jul 17;2(7716):135–140. doi: 10.1016/s0140-6736(71)92306-3. [DOI] [PubMed] [Google Scholar]
  6. BORNSTEIN B. Familial early infantile myasthenia gravis. Acta Paediatr. 1953 Sep;42(5):442–452. doi: 10.1111/j.1651-2227.1953.tb03641.x. [DOI] [PubMed] [Google Scholar]
  7. Behan P. O., Simpson J. A., Behan W. M. Letter: Decreased serum-IgA in myasthenia gravis. Lancet. 1976 Mar 13;1(7959):593–594. doi: 10.1016/s0140-6736(76)90398-6. [DOI] [PubMed] [Google Scholar]
  8. Behan P. O., Simpson J. A., Dick H. Letter: Immune response genes in myasthenia gravis. Lancet. 1973 Nov 3;302(7836):1033–1033. doi: 10.1016/s0140-6736(73)91130-6. [DOI] [PubMed] [Google Scholar]
  9. Behan W. M., Behan P. O. Immune complexes in myasthenia gravis. J Neurol Neurosurg Psychiatry. 1979 Jul;42(7):595–599. doi: 10.1136/jnnp.42.7.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Birnbaum G., Tsairis P. Suppressor lymphocytes in myasthenia gravis and effect of adult thymectomy. Ann N Y Acad Sci. 1976;274:527–535. doi: 10.1111/j.1749-6632.1976.tb47713.x. [DOI] [PubMed] [Google Scholar]
  11. Birnbaum G., Tsairis P. Thymic lymphocytes in myasthenia gravis. Ann Neurol. 1977 Apr;1(4):331–333. doi: 10.1002/ana.410010404. [DOI] [PubMed] [Google Scholar]
  12. Bundey S. A genetic study of infantile and juvenile myasthenia gravis. J Neurol Neurosurg Psychiatry. 1972 Feb;35(1):41–51. doi: 10.1136/jnnp.35.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Bundey S., Doniach D., Soothill J. F. Immunological studies in patients with juvenile-onset myasthenia gravis and in their relatives. Clin Exp Immunol. 1972 Jul;11(3):321–332. [PMC free article] [PubMed] [Google Scholar]
  14. CELESIA G. G. MYASTHENIA GRAVIS IN TWO SIBLINGS. Arch Neurol. 1965 Feb;12:206–210. doi: 10.1001/archneur.1965.00460260096011. [DOI] [PubMed] [Google Scholar]
  15. Cohen S. M., Waxman S. Myasthenia gravis, chronic lymphocytic leukemia, and autoimmune hemolytic anemia. "A spectrum of thymic abnormalities? Arch Intern Med. 1967 Dec;120(6):717–720. [PubMed] [Google Scholar]
  16. Datta S. K., Schwartz R. S. Editorial: Infectious (?) myasthenia. N Engl J Med. 1974 Dec 12;291(24):1304–1305. doi: 10.1056/NEJM197412122912411. [DOI] [PubMed] [Google Scholar]
  17. DeGroot L. J., Perlo V., Gephart T., Schwab R. Remission of myasthenia and thyrotoxicosis after thymectomy. Ann Intern Med. 1967 Nov;67(5):1042–1044. doi: 10.7326/0003-4819-67-5-1042. [DOI] [PubMed] [Google Scholar]
  18. Engel A. G., Lambert E. H., Howard F. M. Immune complexes (IgG and C3) at the motor end-plate in myasthenia gravis: ultrastructural and light microscopic localization and electrophysiologic correlations. Mayo Clin Proc. 1977 May;52(5):267–280. [PubMed] [Google Scholar]
  19. FOLDES F. F., McNALL P. G. Unusual familial occurrence of myasthenia gravis. JAMA. 1960 Sep 24;174:418–420. doi: 10.1001/jama.1960.63030040024021c. [DOI] [PubMed] [Google Scholar]
  20. Feltkamp T. E., van den Berg-Loonen P. M., Nijenhuis L. E., Engelfriet C. P., van Rossum A. L., van Loghem J. J., Oosterhuis H. J. Myasthenia gravis, autoantibodies, and HL-A antigens. Br Med J. 1974 Jan 26;1(5899):131–133. doi: 10.1136/bmj.1.5899.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Fessard C., Frezal J., Roy C., Martinez F., Bardier A., Lamy M. Une observation familiale de myasthenie de la premiere enfance. Arch Fr Pediatr. 1968 Mar;25(3):291–299. [PubMed] [Google Scholar]
  22. Fritze D., Herrman C., Jr, Naeim F., Smith G. S., Walford R. L. HL-A antigens in myasthenia gravis. Lancet. 1974 Feb 16;1(7851):240–242. doi: 10.1016/s0140-6736(74)92548-3. [DOI] [PubMed] [Google Scholar]
  23. Fuchs S., Nevo D., Tarrab-Hazdai R., Yaar I. Strain differences in the autoimmune response of mice to acetylcholine receptors. Nature. 1976 Sep 23;263(5575):329–330. doi: 10.1038/263329a0. [DOI] [PubMed] [Google Scholar]
  24. GOULON M., TOURNILHAC M., LORIN M. C., NOUAILHAT F. [Familial myasthenia (apropos of 2 sisters with myasthenia)]. Rev Neurol (Paris) 1960 Aug;103:109–117. [PubMed] [Google Scholar]
  25. GREENBERG J. MYASTHENIA GRAVIS AND HYPERTHYROIDISM IN TWO SISTERS. Arch Neurol. 1964 Aug;11:219–222. doi: 10.1001/archneur.1964.00460200115011. [DOI] [PubMed] [Google Scholar]
  26. Gath I., Kayan A., Leegaard J., Sjaastad O. Myasthenia congenita: electromyographic findings. Acta Neurol Scand. 1970;46(3):323–330. doi: 10.1111/j.1600-0404.1970.tb05796.x. [DOI] [PubMed] [Google Scholar]
  27. Herman M. N. Familial myasthenia gravis. Report of a case in identical twins and review of family aggregates. Arch Neurol. 1969 Feb;20(2):140–146. doi: 10.1001/archneur.1969.00480080040004. [DOI] [PubMed] [Google Scholar]
  28. Herrmann C., Jr Myasthenia gravis occurring in families. Neurology. 1966 Jan;16(1):75–85. doi: 10.1212/wnl.16.1.75. [DOI] [PubMed] [Google Scholar]
  29. Herrmann C., Jr The familial occurrence of myasthenia gravis. Ann N Y Acad Sci. 1971 Sep 15;183:334–350. doi: 10.1111/j.1749-6632.1971.tb30763.x. [DOI] [PubMed] [Google Scholar]
  30. Hokkanen E. Myasthenia gravis. A clinical analysis of the total material from Finland with special reference to endocrinological and neurological disorders. Ann Clin Res. 1969 Sep;1(2):94–108. [PubMed] [Google Scholar]
  31. Jacob A., Clack E. R., Emery A. E. Genetic study of sample of 70 patients with myasthenia gravis. J Med Genet. 1968 Dec;5(4):257–261. doi: 10.1136/jmg.5.4.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. KEYNES G. Surgery of the thymus gland; second (and third) thoughts. Lancet. 1954 Jun 12;266(6824):1197–1202. doi: 10.1016/s0140-6736(54)92441-1. [DOI] [PubMed] [Google Scholar]
  33. Kaakinen A., Pirskanen R., Tiilikainen A. LD antigens associated with HL-A8 and myasthenia gravis. Tissue Antigens. 1975 Oct;6(4):175–182. doi: 10.1111/j.1399-0039.1975.tb00632.x. [DOI] [PubMed] [Google Scholar]
  34. Kawanami S., Kanaide A., Itoyama Y., Kuroiwa Y. Lymphocyte function in myasthenia gravis. J Neurol Neurosurg Psychiatry. 1979 Aug;42(8):734–740. doi: 10.1136/jnnp.42.8.734. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Keesey J., Lindstrom J., Cokely H. Anti-acetylcholine receptor antibody in neonatal myasthenia gravis. N Engl J Med. 1977 Jan 6;296(1):55–55. doi: 10.1056/NEJM197701062960125. [DOI] [PubMed] [Google Scholar]
  36. Kott E., Bornstein B. Familial early infantile myasthenia gravis with a 15-year follow-up. J Neurol Sci. 1969 May-Jun;8(3):573–578. doi: 10.1016/0022-510x(69)90015-x. [DOI] [PubMed] [Google Scholar]
  37. Kysela S., Steinberg A. D. Increased survival of NZB-W mice given multiple syngeneic young thymus grafts. Clin Immunol Immunopathol. 1973 Nov;2(1):133–136. doi: 10.1016/0090-1229(73)90043-3. [DOI] [PubMed] [Google Scholar]
  38. LEVIN P. M. Congenital myasthenia in siblings. Arch Neurol Psychiatry. 1949 Dec;62(6):745-58, illust. doi: 10.1001/archneurpsyc.1949.02310180046006. [DOI] [PubMed] [Google Scholar]
  39. Lefvert A. K., Bergström K., Matell G., Osterman P. O., Pirskanen R. Determination of acetylcholine receptor antibody in myasthenia gravis: clinical usefulness and pathogenetic implications. J Neurol Neurosurg Psychiatry. 1978 May;41(5):394–403. doi: 10.1136/jnnp.41.5.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Lennon V. A., Lindstrom J. M., Seybold M. E. Experimental autoimmune myasthenia: A model of myasthenia gravis in rats and guinea pigs. J Exp Med. 1975 Jun 1;141(6):1365–1375. doi: 10.1084/jem.141.6.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Lennon V. A., Seybold M. E., Lindstrom J. M., Cochrane C., Ulevitch R. Role of complement in the pathogenesis of experimental autoimmune myasthenia gravis. J Exp Med. 1978 Apr 1;147(4):973–983. doi: 10.1084/jem.147.4.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Lisak R. P., Abdou N. I., Zweiman B., Zmijewski C., Penn A. S. Aspects of lymphocyte function in myasthenia gravis. Ann N Y Acad Sci. 1976;274:402–410. doi: 10.1111/j.1749-6632.1976.tb47701.x. [DOI] [PubMed] [Google Scholar]
  43. MACKAY R. I. Congenital myasthenia gravis. Arch Dis Child. 1951 Aug;26(128):289–293. doi: 10.1136/adc.26.128.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. MACRAE D. Myasthenia gravis in early childhood. Pediatrics. 1954 Jun;13(6):511–520. [PubMed] [Google Scholar]
  45. MILLICHAP J. G., DODGE P. R. Diagnosis and treatment of myasthenia gravis in infancy, childhood, and adolescence: a study of 51 patients. Neurology. 1960 Nov;10:1007–1014. doi: 10.1212/wnl.10.11.1007. [DOI] [PubMed] [Google Scholar]
  46. McKEEVER G. E. Myasthenia gravis in a mother and her newborn son. J Am Med Assoc. 1951 Sep 22;147(4):320–322. doi: 10.1001/jama.1951.73670210013007f. [DOI] [PubMed] [Google Scholar]
  47. McLean W. T., Jr, McKone R. C. Congenital myasthenia gravis in twins. Identical twins with crises in the newborn period. Arch Neurol. 1973 Oct;29(4):223–226. doi: 10.1001/archneur.1973.00490280035004. [DOI] [PubMed] [Google Scholar]
  48. Mori R., Kawanami S. Destruction of cultured thymus cells by autologous lymphocytes from a patient with myasthenia gravis. Lancet. 1973 Jan 27;1(7796):210–210. doi: 10.1016/s0140-6736(73)90051-2. [DOI] [PubMed] [Google Scholar]
  49. Motoki R., Harada M., Chiba A., Honda K. A case of myasthenia gravis of identical twin brothers. Int Surg. 1966 Jun;45(6):674–677. [PubMed] [Google Scholar]
  50. Möller E., Hammarström L., Smith E., Matell G. HL-A8 and LD-8a in patients with myasthenia gravis. Tissue Antigens. 1976 Jan;7(1):39–44. doi: 10.1111/j.1399-0039.1976.tb01027.x. [DOI] [PubMed] [Google Scholar]
  51. NASTUK W. L., PLESCIA O. J., OSSERMAN K. E. Changes in serum complement activity in patients with myasthenia gravis. Proc Soc Exp Biol Med. 1960 Oct;105:177–184. doi: 10.3181/00379727-105-26050. [DOI] [PubMed] [Google Scholar]
  52. NASTUK W. L., PLESCIA O. J., OSSERMAN K. E. Changes in serum complement activity in patients with myasthenia gravis. Proc Soc Exp Biol Med. 1960 Oct;105:177–184. doi: 10.3181/00379727-105-26050. [DOI] [PubMed] [Google Scholar]
  53. NASTUK W. L., STRAUSS A. J., OSSERMAN K. E. Search for a neuromuscular blocking agent in the blood of patients with myasthenia gravis. Am J Med. 1959 Mar;26(3):394–409. doi: 10.1016/0002-9343(59)90248-7. [DOI] [PubMed] [Google Scholar]
  54. Naeim F., Keesey J. C., Herrmann C., Jr, Lindstrom J., Zeller E., Walford R. L. Association of HLA-B8, DRw3, and anti-acetylcholine receptor antibodies in myasthenia gravis. Tissue Antigens. 1978 Nov;12(5):381–386. doi: 10.1111/j.1399-0039.1978.tb01347.x. [DOI] [PubMed] [Google Scholar]
  55. Namba T., Brunner N. G., Brown S. B., Muguruma M., Grob D. Familial myasthenia gravis. Report of 27 patients in 12 families and review of 164 patients in 73 families. Arch Neurol. 1971 Jul;25(1):49–60. doi: 10.1001/archneur.1971.00490010059009. [DOI] [PubMed] [Google Scholar]
  56. OSSERMAN K. E., TENG P. Studies in myasthenia gravis: neonatal and juvenile types. J Mt Sinai Hosp N Y. 1956 Sep-Oct;23(5):711–727. [PubMed] [Google Scholar]
  57. Opelz G., Keesey J., Glovsky M. M., Gale R. P. Autoreactivity between lymphocytes and thymus cells in myasthenia gravis. Arch Neurol. 1978 Jul;35(7):413–415. doi: 10.1001/archneur.1978.00500310015003. [DOI] [PubMed] [Google Scholar]
  58. Osborne D., Simcock J. Myasthenia gravis in identical twins. Br Med J. 1966 Apr 23;1(5494):1025–1026. doi: 10.1136/bmj.1.5494.1025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Papatestas A. E., Genkins G., Horowitz S. H., Kornfeld P. Thymectomy in myasthenia gravis: pathologic, clinical, and electrophysiologic correlations. Ann N Y Acad Sci. 1976;274:555–573. doi: 10.1111/j.1749-6632.1976.tb47715.x. [DOI] [PubMed] [Google Scholar]
  60. Patrick J., Lindstrom J. Autoimmune response to acetylcholine receptor. Science. 1973 May 25;180(4088):871–872. doi: 10.1126/science.180.4088.871. [DOI] [PubMed] [Google Scholar]
  61. Piantelli M., Lauriola L., Carbone A., Evoli A., Tonali P., Musiani P. Subpopulations of T lymphocytes in myasthenia gravis patients. Clin Exp Immunol. 1979 Apr;36(1):85–89. [PMC free article] [PubMed] [Google Scholar]
  62. Pirskanen R. Genetic associations between myasthenia gravis and the HL-A system. J Neurol Neurosurg Psychiatry. 1976 Jan;39(1):23–33. doi: 10.1136/jnnp.39.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Pirskanen R., Tiilikainen A., Hokkanen E. Histocompatibility (HL-A) antigens associated with myasthenia gravis. A preliminary report. Ann Clin Res. 1972 Oct;4(5):304–306. [PubMed] [Google Scholar]
  64. Reinherz E. L., Rubinstein A., Geha R. S., Strelkauskas A. J., Rosen F. S., Schlossman S. F. Abnormalities of immunoregulatory T cells in disorders of immune function. N Engl J Med. 1979 Nov 8;301(19):1018–1022. doi: 10.1056/NEJM197911083011902. [DOI] [PubMed] [Google Scholar]
  65. Sahashi K., Engel A. G., Linstrom J. M., Lambert E. H., Lennon V. A. Ultrastructural localization of immune complexes (IgG and C3) at the end-plate in experimental autoimmune myasthenia gravis. J Neuropathol Exp Neurol. 1978 Mar-Apr;37(2):212–223. doi: 10.1097/00005072-197803000-00008. [DOI] [PubMed] [Google Scholar]
  66. Sandilands G. P., Gray K., Cooney A., Anderson J. R., Simpson J. A., Behan P. O. Letter: Rosette tests following thymectomy. Lancet. 1975 Jan 18;1(7899):171–172. doi: 10.1016/s0140-6736(75)91479-8. [DOI] [PubMed] [Google Scholar]
  67. Seybold M. E., Howard F. M., Jr, Duane D. D., Payne W. S., Harrison E. G., Jr Thymectomy in juvenile myasthenia gravis. Arch Neurol. 1971 Nov;25(5):385–392. doi: 10.1001/archneur.1971.00490050019001. [DOI] [PubMed] [Google Scholar]
  68. Shirai T., Miyata M., Nakase A., Itoh T. Lymphocyte subpopulation in neoplastic and non-neoplastic thymus and in blood of patients with Myasthenia gravis. Clin Exp Immunol. 1976 Oct;26(1):118–123. [PMC free article] [PubMed] [Google Scholar]
  69. Shore A., Limatibul S., Dosch H. M., Gelfand E. W. Identification of two serum components regulating the expression of T-lymphocyte function in childhood myasthenia gravis. N Engl J Med. 1979 Sep 20;301(12):625–629. doi: 10.1056/NEJM197909203011202. [DOI] [PubMed] [Google Scholar]
  70. Simpson J. A., Behan P. O., Dick H. M. Studies on the nature of autoimmunity in myasthenia gravis. Evidence for an immunodeficiency type. Ann N Y Acad Sci. 1976;274:382–389. doi: 10.1111/j.1749-6632.1976.tb47699.x. [DOI] [PubMed] [Google Scholar]
  71. Smith C. I., Hammarström L., Möller E., Lefvert A. K., Matell G. No significant correlation of HLA-B8 and amount of antibodies directed to acetylcholine receptor protein in patients with myasthenia gravis. Tissue Antigens. 1978 Nov;12(5):387–395. doi: 10.1111/j.1399-0039.1978.tb01348.x. [DOI] [PubMed] [Google Scholar]
  72. Strelkauskas A. J., Callery R. T., McDowell J., Borel Y., Schlossman S. F. Direct evidence for loss of human suppressor cells during active autoimmune disease. Proc Natl Acad Sci U S A. 1978 Oct;75(10):5150–5154. doi: 10.1073/pnas.75.10.5150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Säfwenberg J., Hammarström L., Lindblom J. B., Matell G., Möller E., Osterman P. O., Smith C. I. HLA-A, -B, -C and -D antigens in male patients with myasthenia gravis. Tissue Antigens. 1978 Aug;12(2):136–142. doi: 10.1111/j.1399-0039.1978.tb01309.x. [DOI] [PubMed] [Google Scholar]
  74. Säfwenberg J., Lindblom J. B., Osterman P. O. HL-A frequencies in patients with myasthenia gravis. Tissue Antigens. 1973;3(6):465–469. doi: 10.1111/j.1399-0039.1973.tb00516.x. [DOI] [PubMed] [Google Scholar]
  75. Tarrab-Hazdai R., Aharonov A., Silman I., Fuchs S., Abramsky O. Experimental autoimmune myasthenia induced in monkeys by purified acetylcholine receptor. Nature. 1975 Jul 10;256(5513):128–130. doi: 10.1038/256128a0. [DOI] [PubMed] [Google Scholar]
  76. Toyka K. V., Drachman D. B., Griffin D. E., Pestronk A., Winkelstein J. A., Fishbeck K. H., Kao I. Myasthenia gravis. Study of humoral immune mechanisms by passive transfer to mice. N Engl J Med. 1977 Jan 20;296(3):125–131. doi: 10.1056/NEJM197701202960301. [DOI] [PubMed] [Google Scholar]
  77. WALSH F. B., HOYT W. F. External ophthalmoplegia; as part of congenital myasthenia in siblings: myasthenia gravis in children: report of a family showing congenital myasthenia. Am J Ophthalmol. 1959 May;47(5 Pt 2):28–34. [PubMed] [Google Scholar]
  78. WAROT P., DELAHOUSSE J. MYASTH'ENIE INFANTILE CHEZ DEUX FR'ERES. Lille Med. 1964 Oct;12:690–695. [PubMed] [Google Scholar]
  79. Waldmann T. A., Blaese R. M., Broder S., Krakauer R. S. Disorders of suppressor immunoregulatory cells in the pathogenesis of immunodeficiency and autoimmunity. Ann Intern Med. 1978 Feb;88(2):226–238. doi: 10.7326/0003-4819-88-2-226. [DOI] [PubMed] [Google Scholar]
  80. Warrier C. B., Pillai T. D. Familial myasthenia gravis. Br Med J. 1967 Sep 30;3(5569):839–840. doi: 10.1136/bmj.3.5569.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Weigle W. O. Recent observations and concepts in immunological unresponsiveness and autoimmunity. Clin Exp Immunol. 1971 Oct;9(4):437–447. [PMC free article] [PubMed] [Google Scholar]
  82. Whiteley A. M., Schwartz M. S., Sachs J. A., Swash M. Congenital myasthenia gravis: clinical and HLA studies in two brothers. J Neurol Neurosurg Psychiatry. 1976 Dec;39(12):1145–1150. doi: 10.1136/jnnp.39.12.1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Yoshida T., Tsuchiya M., Ono A., Yoshimatsu H., Satoyoshi E., Tsuji K. HLA antigens and myasthenia gravis in Japan. J Neurol Sci. 1977 Jun;32(2):195–201. doi: 10.1016/0022-510x(77)90234-9. [DOI] [PubMed] [Google Scholar]

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