Ganglionic acetylcholine receptor autoantibody: oncological, neurological, and serological accompaniments.
OBJECTIVE
To describe the clinical utility of the nicotinic ganglionic acetylcholine receptor (alpha3-AChR) autoantibody as a marker of neurological autoimmunity and cancer.


METHODS
Case-control study.


METHODS
Mayo Clinic, Rochester, Minnesota.


METHODS
A total of 15,000 patients seen at Mayo Clinic (2005-2007) and evaluated on a service basis for paraneoplastic neurological autoimmunity for whom clinical information was obtained retrospectively by medical record review as well as 457 neurologically asymptomatic patients or control subjects of whom 173 were healthy, 245 had lung cancer, and 39 had systemic lupus erythematosus or Sjögren syndrome.


METHODS
Neurological, oncological, and serological associations of alpha3-AChR autoantibody seropositivity.


RESULTS
Of 15,000 patients tested on a service basis, 1% were seropositive (median, 0.12 nmol/L; range, 0.03-18.8 nmol/L; normal, < or =0.02 nmol/L), 55% were male, and the median age was 65 years. Cancer was found (new or by history) in 24 of 78 patients evaluated for cancer while at Mayo Clinic (30%); 43% had adenocarcinoma (more patients had breast cancer than prostate, lung, and gastrointestinal cancers; each of the latter groups had about the same number of patients). Of 12 patients with high antibody values (> or =1.00 nmol/L), 83% had pandysautonomia. Of 85 patients with medium antibody values (0.10-0.99 nmol/L), neurological presentations were more diverse and included peripheral neuropathies (36%), dysautonomia (20%, usually limited), and encephalopathy (13%). Of 58 patients with low antibody values (0.03-0.09 nmol/L), 54% had a nonautoimmune neurological disorder or no neurological disorder. Of 245 control patients with lung cancer, 7.8% were seropositive. Only 1 of 212 control patients without cancer (0.5%) was seropositive (P < .001).


CONCLUSIONS
The detection of alpha3-AChR autoantibody aids the diagnosis of neurological autoimmunity and cancer.
McKeon
Andrew
A
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Lennon
Vanda A
VA
Lachance
Daniel H
DH
Fealey
Robert D
RD
Pittock
Sean J
SJ
D000230:Adenocarcinoma / Q000150:complications / Q000276:immunology; D000368:Aged; D001323:Autoantibodies / Q000032:analysis / Q000097:blood*; D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D004660:Encephalitis / Q000276:immunology; D005260:Female; D005725:Ganglia, Autonomic / Q000276:immunology* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000276:immunology*; D020361:Paraneoplastic Syndromes, Nervous System / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000276:immunology; D011237:Predictive Value of Tests; D054969:Primary Dysautonomias / Q000276:immunology; D011978:Receptors, Nicotinic / Q000276:immunology*; D012189:Retrospective Studies
D001323:Autoantibodies; D015415:Biomarkers; D011978:Receptors, Nicotinic