Autoantibodies Blocking M3 Muscarinic Receptors Cause Postganglionic Cholinergic Dysautonomia

A 10‐year‐old girl presented with ileus, urinary retention, dry mouth, lack of tears, fixed dilated pupils, and diffuse anhidrosis 7 days after a febrile illness. We hypothesized that her syndrome was due to autoimmunity against muscarinic acetylcholine receptors, blocking their activation. Using an...

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Bibliographic Details
Published in:Annals of neurology 2020-12, Vol.88 (6), p.1237-1243
Main Authors: Palma, Jose‐Alberto, Gupta, Achla, Sierra, Salvador, Gomes, Ivone, Balgobin, Bhumika, Norcliffe‐Kaufmann, Lucy, Devi, Lakshmi A., Kaufmann, Horacio
Format: Article
Language:English
Subjects:
Acetylcholine receptors (muscarinic)
Antibodies
Autoantibodies
Autoimmunity
Autonomic nervous system
Cholinergics
Dysautonomia
Receptor mechanisms
Receptors
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Summary:A 10‐year‐old girl presented with ileus, urinary retention, dry mouth, lack of tears, fixed dilated pupils, and diffuse anhidrosis 7 days after a febrile illness. We hypothesized that her syndrome was due to autoimmunity against muscarinic acetylcholine receptors, blocking their activation. Using an indirect enzyme‐linked immunosorbent assay for all 5 muscarinic receptors (M1–M5), we identified in the patient's serum antibodies that selectively bound to M3 receptors. In vitro functional studies confirmed that these autoantibodies selectively blocked M3 receptor activation. Thus, autoantibodies against M3 acetylcholine receptors cause acute postganglionic cholinergic dysautonomia. ANN NEUROL 2020;88:1237–1243
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25882