The majority of patients with myasthenia gravis were shown to have T and B cells specific for a beta-bungarotoxin binding protein, presynaptic membrane receptor (PsmR). Such autoreactive T cells may be subdivided into different subsets according to the pattern of cytokine production. In this study the authors examined the subpopulation of the T cells by analysing their IFN-gamma and/or IL-4 secretion pattern. T cell response to human muscle acetylcholine receptor (AChR) was examined in parallel. PsmR-stimulated IFN-gamma secretion was found in 60%, and IL-4 secretion in 48% of the patients. Cells stimulated to secrete both IFN-gamma and IL-4 or IFN-gamma only were the most common patterns. Treatment of the cells with a mouse anti-human HLA-DR antibody abolished the secretion of cytokines. There was a positive correlation between the numbers of PsmR-reactive and AChR-reactive T cells. In conclusion, the results show that PsmR-stimulated T cells secreted IFN-gamma and/or IL-4. This T cell response is MHC class II restricted. Thus, this study indicates that both Th1/Th2 or Th0 subsets of the T cells are involved in the autoimmune response in the disease.