Autoantibodies against gAChR in humans and mouse models of autoimmune autonomic ganglionopathy

The ganglionic nicotinic acetylcholine receptor (gAChR) mediates fast synaptic transmission in all peripheral autonomic ganglia (sympathetic, parasympathetic, and enteric). Over the last two decades, evidence has accumulated for a role of autoantibodies against gAChR in the development of autoimmune autonomic ganglionopathy (AAG). In this review we provide an updated overview of the field, with a highlight on the role of autoimmunity against gAChR in the pathogenesis of AAG. Clinical data as well as findings from experimental disease models are summarized in sections focusing on the presence of autoantibodies against gAChR in patients with AAG, the function of gAChR antibodies, the association of antibodies against gAChR with AAG-related phenotypes, the in vivo pathogenicity of transferred autoantibodies against gAChR in mice, and mouse models of the disease induced by immunization with the nicotinic AChR. Based on a comprehensive assessment of the currently available data, we propose a hypothetical model for the role of autoantibodies against gAChR in the pathogenesis of AAG.