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Type: Journal article
Title: Neutralization of muscarinic receptor autoantibodies by intravenous immunoglobulin in Sjögren syndrome
Other Titles: Neutralization of muscarinic receptor autoantibodies by intravenous immunoglobulin in Sjogren syndrome
Author: Smith, A.
Jackson, M.
Wang, F.
Cavill, D.
Rischmueller, M.
Gordon, T.
Citation: Human Immunology, 2005; 66(4):411-416
Publisher: Elsevier Science Inc
Issue Date: 2005
ISSN: 0198-8859
Statement of
Anthony J. Smith, Michael W. Jackson, Fang Wang, Dana Cavill, Maureen Rischmueller, Tom P. Gordon
Abstract: Autoantibodies that inhibit M3 muscarinic receptor (M3R)-mediated neurotransmission and cause bladder and bowel dysfunction have been reported in patients with Sjögren syndrome and belong to a family of functional autoantibodies that includes the thyroid-stimulating hormone receptor antibody present in Graves disease. We have recently reported that antiidiotypic antibodies present in pooled immunoglobulin (Ig) G or IgG from healthy individuals neutralize anti-M3R antibody-mediated inhibition of smooth muscle contraction in vitro. Here we extend these studies to the clinic by examining whether therapeutic doses of intravenous immunoglobulin (IVIG) provided to patients with autoimmune diseases neutralize anti-M3R activity in vivo and improve bladder and bowel symptoms. Three patients with primary Sjögren syndrome, dermatomyositis, and celiac disease, respectively, all of whom had anti-M3R activity on a functional bladder contractile assay, were provided a single course of IVIG at a dose of 400 mg/kg per day for 5 days. Anti-M3R activity was neutralized at 4 weeks after IVIG infusion, whereas levels of specific autoantibodies (anti-La, anti-Jo-1, and anti-tissue transglutaminase) were unchanged. Bladder and bowel scores revealed variable improvement after IVIG. Neutralization of anti-M3R activity by IVIG in vivo, presumably as a result of antiidiotypic antibodies directed specifically against anti-M3R autoantibodies, provides a clinical correlate of our in vitro findings. This offers a rationale for IVIG as a treatment for parasympathetic dysfunction in patients with autoantibodies inhibiting postganglionic cholinergic neurotransmission. We suggest the presence of a network of naturally occurring antiidiotypic antibodies that regulate the expression of functional autoantibodies against neuronal receptors and ion channels.
Keywords: Muscle, Smooth
Mice, Inbred BALB C
Sjogren's Syndrome
Immunoglobulins, Intravenous
Receptor, Muscarinic M3
DOI: 10.1016/j.humimm.2005.01.020
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