title: Antibodies against gonadotropin-releasing hormone (GnRH) and destruction of enteric neurons in 3 patients suffering from gastrointestinal dysfunction.
abstract: BACKGROUND
  Antibodies against gonadotropin-releasing hormone (GnRH) and gastrointestinal dysmotility have been found after treatment with GnRH analogues. The aim of this study was to examine the presence of such antibodies in patients with dysmotility not subjected to GnRH treatment and study the anti-GnRH antibody effect on enteric neurons viability in vitro.
  
  
  METHODS
  Plasma and sera from 3 patients suffering from either enteric dysmotility, irritable bowel syndrome (IBS) or gastroparesis were analysed for C-reactive protein (CRP), and for GnRH antibodies and soluble CD40 by ELISA methods. Primary cultures of small intestinal myenteric neurons were prepared from rats. Neuronal survival was determined after the addition of sera either from the patients with dysmotility, from healthy blood donors, antiserum raised against GnRH or the GnRH analogue buserelin. Only for case 1 a full-thickness bowel wall biopsy was available for immunohistochemical analysis.
  
  
  RESULTS
  All 3 patients expressed antibodies against GnRH. The antibody titer correlated to the levels of CD40 (rs = 1.000, p < 0.01), but not to CRP. Serum from case 3 with highest anti-GnRH antibody titer, and serum concentrations of sCD40 and CRP, when added to cultured rat myenteric neurons caused remarkable cell death. In contrast, serum from cases 1 and 2 having lower anti-GnRH antibody titer and lower sCD40 levels had no significant effect. Importantly, commercial antibodies against GnRH showed no effect on neuron viability whereas buserelin exerted a protective effect. The full-thickness biopsy from the bowel wall of case 1 showed ganglioneuritis and decrease of GnRH and GnRH receptor.
  
  
  CONCLUSIONS
  Autoantibodies against GnRH can be detected independently on treatment of GnRH analogue. Whether the generation of the antibody is directly linked to neuron degeneration and chronic gastrointestinal symptoms in patients with intestinal dysmotility, remains to be answered.
authors.affiliation: Department of Clinical Sciences, Gastroenterology Division, Skåne University Hospital, Malmö, Lund University, Lund, Sweden. bodil.ohlsson@med.lu.se
authors.forename: Bodil
authors.initials: B
authors.lastname: Ohlsson
authors.forename: Eva
authors.initials: E
authors.lastname: Ekblad
authors.forename: Béla
authors.initials: B
authors.lastname: Veress
authors.forename: Agneta
authors.initials: A
authors.lastname: Montgomery
authors.forename: Sabina
authors.initials: S
authors.lastname: Janciauskiene
mesh_terms: D000368:Aged; D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000494:pharmacology; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002064:Buserelin / Q000494:pharmacology; D002097:C-Reactive Protein / Q000378:metabolism; D019013:CD40 Antigens / Q000097:blood; D002470:Cell Survival / Q000187:drug effects; D002478:Cells, Cultured; D003106:Colon / Q000473:pathology; D017615:Enteric Nervous System / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood* / Q000473:pathology / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000187:drug effects / Q000473:pathology; D051381:Rats; D055815:Young Adult
chemical_list: D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D019013:CD40 Antigens; D007987:Gonadotropin-Releasing Hormone; D002097:C-Reactive Protein; D002064:Buserelin