In the elderly there is a pronounced increase in susceptibility to infectious disease. Evidence for particular immune deficits that result in susceptibility to specific agents is lacking, however, and there is little information on the degree to which differences in the susceptibility among the elderly are due to genetic versus environmental effects. A strong association has been observed between eventual fatal pneumonia and elevated levels of IgM antibody to phosphocholine (PC) levels at age 70. In this study we evaluated the heritability of IgM and IgG antibody levels to phosphocholine in the elderly using monozygotic and dizygotic male twins. We observed genetic regulation of serum levels of IgM antibody to PC, a finding which suggests that susceptibility of the elderly to fatal pneumonia may be heritable. Levels of total IgM were under separate genetic control and there was no genetic effect on IgG and IgA levels or levels of IgG antibody to phosphocholine. © 1993 Academic Press. All rights reserved.