title: Antibodies to muscle and ganglionic acetylcholine receptors (AchR) in celiac disease.
abstract: BACKGROUND
  About 2.5% of patients with idiopathic peripheral neuropathy or idiopathic dysautonomia have underlying celiac disease (CD). Antibodies to ganglioside have been reported in CD patients with neuropathy. No data are so far available on the presence in CD of acetylcholine receptor (AChR) antibodies. Muscle AChR antibodies are found in patients with myasthenia gravis, and ganglionic AChR antibodies in patients with autoimmune autonomic neuropathy.
  
  
  OBJECTIVE
  To determine the frequency of AChR antibodies in CD patients and assess possible correlations with neurological manifestations.
  
  
  METHODS
  Seventy CD patients (16 M, 54 F, mean age 36 years) underwent neurological and electrophysiological evaluation. AChR antibodies were detected with radioimmunoprecipitation assay. Sera from 15 age-matched patients with systemic lupus erythematosus (SLE) and 10 with Sjogren syndrome were studied as controls.
  
  
  RESULTS
  None of our CD patients complained of autonomic symptoms or fatigable weakness. Borderline titres (0.03-0.05 nmol/l) of ganglionic AChR antibodies were present in 4 patients, one affected with type I diabetes and one with subclinical neuropathy. Three of the 4 patients underwent cardiovascular autonomic function tests, which showed no abnormalities. Low levels of ganglionic AChR antibodies (0.05-0.10 nmol/l) were found in 2 SLE control patients, one of whom had a severe sicca complex. Muscle AChR antibodies (>1.0 nmol/l) were found in two CD patient and one control patient with SLE. Neither had symptoms or signs of myasthenia gravis.
  
  
  CONCLUSIONS
  CD is occasionally associated with neurologic disease, and with antibody reactivity to neuronal antigens. None of our CD patients had autonomic failure or significant levels of ganglionic AChR antibodies. Two CD patient and one control with SLE had muscle AChR antibodies without clinical evidence of myasthenia. The presence of antibodies in CD and in SLE patients may reflect a non-specific autoimmune response in these patients or may indicate subclinical autoimmune autonomic and neuromuscular involvement.
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy. chiara.briani@unipd.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Briani
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Susanna
authors.initials: S
authors.lastname: Ruggero
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toffanin
authors.forename: Milena
authors.initials: M
authors.lastname: Luca
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Albergoni
authors.forename: Anna
authors.initials: A
authors.lastname: D'Odorico
authors.forename: Francesca
authors.initials: F
authors.lastname: Grassivaro
authors.forename: Marta
authors.initials: M
authors.lastname: Lucchetta
authors.forename: Franca
authors.initials: F
authors.lastname: De Lazzari
authors.forename: Italo
authors.initials: I
authors.lastname: Balzani
authors.forename: Leontino
authors.initials: L
authors.lastname: Battistin
authors.forename: Steven
authors.initials: S
authors.lastname: Vernino
mesh_terms: D000328:Adult; 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; D002446:Celiac Disease / Q000276:immunology / Q000503:physiopathology*; D045744:Cell Line, Tumor; D005260:Female; D005725:Ganglia, Autonomic / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D008297:Male; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D009132:Muscles / Q000276:immunology* / Q000378:metabolism; D011950:Receptors, Cholinergic / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic