Aetiology

SYNAPTIC VESICLES containing ACETYLCHOLINE

-(p ^ O OPRESYNAPTIC NERVE ENDING A§00p TV

r Release of acetylcholine from vesicle

.. CHOLINERGIC RECEPTOR SITES

An immune process attacks the neuromuscular junction

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Antibodies bind to the receptor sites resulting in their destruction (complement mediated). These antibodies are referred to as ACETYLCHOLINE RECEPTOR ANTIBODIES. (AChR antibodies) and are demonstrated by radioimmunoassay in the serum of 90% of patients.

Human puritied lgG (containing AChR antibodies) injected into mice induces myasthenia-like disease in these recipient animals.

In human myasthenia gravis a reduction of acetylcholine receptor sites has been demonstrated in the postsynaptic folds. Reduced receptor synthesis and increased receptor destruction, as well as the blocking of receptor response to acetylcholine, all seem responsible for the disorder.

The role of the thymus-. Thymic abnormalities occur in 80% of patients. The main function of the thymus is to effect the production of T-cell lymphocytes, which participate in immune responses. Thymus dysfunction is noted in a large number of disorders which may be associated with myasthenia gravis, e.g. systemic lupus erythematosus.

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