Autoantibody-mediated bowel and bladder dysfunction in a patient with chronic, nondiabetic neuropathy.
Physiological techniques can be used to detect novel autoantibodies causing alteration of autonomic function after passive transfer to mice. Previously, such antibodies have been detected in patients with type I diabetes mellitus, myasthenia gravis, and Sjogren's syndrome. We now describe a patient with an idiopathic nondiabetic neuropathy with prominent autonomic symptoms, including bladder and bowel dysfunction. Physiological assays of whole colon and bladder were used to determine the presence in the patient serum of functional autoantibodies capable of mediating autonomic dysfunction. Immunoglobulin G (IgG) from this patient was able to disrupt bladder and bowel function on passive transfer to mice. This is a new pattern of autoantibody-mediated abnormality. Although the target antigen is unknown, it is likely to be a cell-surface receptor or ion channel. This case highlights the usefulness of passive transfer studies in detecting functional antibodies in patients with autonomic neuropathy.
Autoimmunity Research Laboratory, Department of Immunology, Allergy and Arthritis, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia. michael.jackson@flinders.edu.au
Michael W
MW
Jackson
Thomas P
TP
Gordon
Pamela A
PA
McCombe
D000368:Aged; D000818:Animals; D001323:Autoantibodies / Q000097:blood; D020274:Autoimmune Diseases of the Nervous System / Q000276:immunology* / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000276:immunology* / Q000503:physiopathology; D002908:Chronic Disease; D003108:Colonic Diseases / Q000276:immunology* / Q000503:physiopathology; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D009122:Muscle Hypertonia / Q000276:immunology* / Q000503:physiopathology; D016065:Myoelectric Complex, Migrating / Q000502:physiology; D001745:Urinary Bladder Diseases / Q000276:immunology* / Q000503:physiopathology
D001323:Autoantibodies; D007074:Immunoglobulin G