AChR; AChRAB; ACRAB; anti-AchR Ab; Myasthenia gravis (MG) autoantibodies; Muscle-specific Tyrosine Kinase; Muscle Specific Tyrosine Kinase
Acetylcholine Receptor Antibodies with MuSK Reflex by RIPA, Serum; test site BCN
Test
Aliases/Synonyms
Method
Radioimmunoprecipitation Assay (RIPA)
Method Description
Acetylcholine Receptor (AChR) Antibodies: This radioimmunoprecipitation assay (RIPA) uses a double antibody precipitation technique using the Kronus antigen, a genetically engineered acetylcholine receptor to assess presence of myasthenia gravis-related autoantibodies.
BC Neuroimmunology offers two AChR antibody RIPA protocols, qualitative and quantitative. All positive qualitative assays are repeated using the quantitative assay to permit comparison of titres and results reported as nanomoles of Human Acetylcholine Receptors precipitated by 1 litre of serum (nmol/L).
AChR analysis by live cell-based assay (CBA) may be performed and reported as a confirmatory assay for borderline RIPA screen results.
MuSK testing is performed after AchR Ab testing and will not be done if the patient is AchR Ab positive.
Report Includes
Acetylcholine Receptor Antibodies RIPA Screen; Acetylcholine Receptor Antibodies RIPA Quantitation; Acetylcholine Receptor Antibodies CBA Screen (optional); MuSK RIPA Screen
Specimens
Serum
Clinical Utility
Myasthenia gravis (MG) is an autoimmune disorder that leads to weakness and diminished control over voluntary muscles. It results from reduced signaling in the neuromuscular junction (NMJ) that connects nerves to muscle fibers. Typically, the areas of reduced functioning are the muscles of the eyes, face, and throat. There are three types of acquired MG: ocular (OMG), bulbar predominant (BMG), and generalized (GMG).
In MG, the body produces antibodies (Ab) that bind with receptors in the NMJ, blocking or destroying them, thereby preventing chemical signaling from the brain to the muscles.
The majority of cases (about 85%) of MG are caused by autoantibodies targeting the acetylcholine receptors (AChR). Approximately 6% of cases are caused by autoantibodies targeting the extracellular domain of muscle specific tyrosine-kinase (MuSK) receptors. Amongst the approximately 15% of cases of MG that are found to be AChR Ab-negative, however, MuSK Abs have been reported in patients with frequencies ranging from 0 – 64%, depending on ethnic group and geographic location.
The remaining cases are considered double-seronegative MG, as the patients sera appears negative for both AChR and MuSK antibodies. These cases can be caused by autoantibodies to a variety of other proteins, including but not limited to lipoprotein-related protein 4 (LRP4), agrin, and cortactin.
Test Location
BC Neuroimmunology Lab, Room S-157, 2211 Wesbrook Mall, Vancouver BC V6T 2B5
Test Version
7-Jun-2024
Specimen
Specimens
Serum
Collection Containers
Gold top (SST)
Sample Volume
5 mL
Minimum Volume
1 mL
Patient Preparation
Please indicate if patient is on or has recently had IVIG treatment.
Collection & Handling
Handling Information
Store and send frozen (preferred).
Stability
Refrigerated | 7 days |
---|---|
Frozen | 30 days |
Additional Stability Information
If the specimen thaws, it is unsuitable for analysis.
Test Version
7-Jun-2024
Performance / Interpretation
Method
Radioimmunoprecipitation Assay (RIPA)
Method Description
Acetylcholine Receptor (AChR) Antibodies: This radioimmunoprecipitation assay (RIPA) uses a double antibody precipitation technique using the Kronus antigen, a genetically engineered acetylcholine receptor to assess presence of myasthenia gravis-related autoantibodies.
BC Neuroimmunology offers two AChR antibody RIPA protocols, qualitative and quantitative. All positive qualitative assays are repeated using the quantitative assay to permit comparison of titres and results reported as nanomoles of Human Acetylcholine Receptors precipitated by 1 litre of serum (nmol/L).
AChR analysis by live cell-based assay (CBA) may be performed and reported as a confirmatory assay for borderline RIPA screen results.
MuSK testing is performed after AchR Ab testing and will not be done if the patient is AchR Ab positive.
Turnaround Time
30 days
Results
Name | Units | Reference Range | Conversion Factor | |
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Acetylcholine Receptor Antibodies Screen by RIPA |
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Acetylcholine Receptor Antibodies by RIPA | nmol/L |
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Acetylcholine Receptor Antibodies by CBA, Confirmatory (Optional) |
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MuSK Ab by RIPA |
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Test Location
BC Neuroimmunology Lab, Room S-157, 2211 Wesbrook Mall, Vancouver BC V6T 2B5
Test Version
7-Jun-2024
Interface / Setup
HL7 Interface Codes
Order Code | Result Codes | Units |
---|---|---|
View HL7 Codes |
Test Version
7-Jun-2024