title: Autoimmune autonomic ganglionopathy: IgG effects on ganglionic acetylcholine receptor current.
abstract: BACKGROUND
  Autoimmune autonomic ganglionopathy (AAG) is an acquired immune-mediated form of diffuse autonomic failure. Many patients have serum antibodies that bind to the ganglionic acetylcholine receptors (AChRs) that mediate fast synaptic transmission in autonomic ganglia. Previous clinical studies and observations in animal models suggest that AAG is an antibody-mediated neurologic disorder.
  
  
  METHODS
  Using whole-cell patch clamp techniques, we recorded ganglionic AChR currents in cultured human IMR-32 cells and examined the effects of bath application of IgG derived from patients with AAG.
  
  
  RESULTS
  IgG from seven patients with AAG all produced a progressive decline in whole-cell ganglionic AChR current, whereas IgG from control subjects had no effect. The effect was abolished at low temperature. Fab antibody fragments had no effect unless a secondary antibody was added concurrently. IgG from one patient also produced a more immediate reduction of ganglionic AChR current.
  
  
  CONCLUSIONS
  The characteristics of antibody-mediated inhibition of ganglionic acetylcholine receptor (AChR) current are consistent with modulation and blocking of the membrane AChR, analogous to the effects of muscle AChR antibodies in myasthenia gravis. Our observations demonstrate that antibodies in patients with autoimmune autonomic ganglionopathy (AAG) cause physiologic changes in ganglionic AChR function and confirm that AAG is an antibody-mediated disorder.
authors.affiliation: Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9036, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.forename: P A
authors.initials: PA
authors.lastname: Low
authors.forename: J
authors.initials: J
authors.lastname: Jordan
authors.forename: R
authors.initials: R
authors.lastname: Freeman
authors.forename: C H
authors.initials: CH
authors.lastname: Gibbons
authors.forename: C
authors.initials: C
authors.lastname: Schroeder
authors.forename: P
authors.initials: P
authors.lastname: Sandroni
authors.forename: S
authors.initials: S
authors.lastname: Vernino
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000276:immunology*; D001342:Autonomic Nervous System Diseases / Q000276:immunology*; D045744:Cell Line, Tumor; D005260:Female; D005725:Ganglia, Autonomic / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008564:Membrane Potentials; D008875:Middle Aged; D018408:Patch-Clamp Techniques; D011817:Rabbits; D011950:Receptors, Cholinergic / Q000276:immunology* / Q000378:metabolism
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D011950:Receptors, Cholinergic