Autoimmunity against the ß2 adrenergic receptor and muscarinic-2 receptor in complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a painful condition affecting one or more extremities of the body, marked by a wide variety of symptoms and signs that are often difficult to manage because the pathophysiology is incompletely understood. Thus, diverse treatments might be ineffective. A recent report revealed the presence of autoantibodies against differentiated autonomic neurons in CRPS patients. However, it remained unclear how the antibodies act in the development of CRPS. We therefore aimed to characterize these antibodies and identify target antigens. Functional properties of affinity-purified immunoglobulin G of control subjects or CRPS patients were assessed using a cardiomyocyte bioassay. Putative corresponding receptors were identified using antagonistic drugs, and synthesized peptide sequences corresponding to segments of these receptors were used to identify the target epitopes. Chinese hamster ovary cells were transfected with putative receptors to ensure observed binding. Further, changes in the intracellular Ca(2+) concentration induced by agonistic immunoglobulin G were measured using the Ca(2+)-sensitive fluorescent dye fura-2 assay. Herein, we demonstrate the presence of autoantibodies in a subset of CRPS patients with agonistic-like properties on the ß(2) adrenergic receptor and/or the muscarinic-2 receptor. We identified these autoantibodies as immunoglobulin G directed against peptide sequences from the second extracellular loop of these receptors. The identification of functionally active autoantibodies in serum samples from CRPS patients supports an autoimmune pathogenesis of CRPS. Thus, our findings contribute to the further understanding of this disease, could help in the diagnosis in future, and encourage new treatment strategies focusing on the immune system.

Skeletal muscle cell MHC I expression: implications for statin-induced myopathy.

Statins can induce necrotizing or inflammatory myopathies in some patients. Increased major histocompatibility complex class I (MHC I) expression has been shown in muscle biopsies of statin-induced myopathy. Therefore, we investigated the effect of statins on the expression of MHC I in muscle cells. Using flow cytometry and polymerase chain reaction (PCR), the rhabdomyosarcoma cell line TE671 and primary cultured skeletal muscle cells (SKMC) were investigated for MHC I expression after incubation with different statins and/or interferon-gamma (IFN-gamma). TE671 and SKMC express MHC I in the untreated condition. Statins alone reduced the expression of MHC I in SKMC and had no effect on MHC I in TE671 cells. Statins potentiated the MHC I-inducing effect of IFN-gamma in TE671, but not in SKMC, neither at the protein level nor at the mRNA level. The increased muscle MHC I expression in statin-induced myopathy might not be induced directly by statins themselves.

Influence of statins on MHC class I expression.

Statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are widely prescribed for their cholesterol-lowering properties to reduce atherogenesis and cardiovascular morbidity. However, compelling evidence exists that statins also have extensive immunomodulatory properties that operate independently of lipid lowering. Consequently, much attention has been directed toward their immunomodulatory effect and their potential as therapeutic agents for the treatment of autoimmune diseases. Statins have the ability to modulate a broad range of proinflammatory immune mechanisms through inhibition of small GTPases and other prenylated proteins. One of the statins' immunomodulatory effects is downregulation of MHC class II expression. In contrast, patients with statin-induced myopathy show high MHC class I expression. In this review, the effect of statins on MHC class I expression is reviewed alongside statins' effect on immune function.

Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen.

Complex regional pain syndrome, which is characterised by pain and trophic disturbances, develops frequently after peripheral limb trauma. There is an increasing evidence of an involvement of the immune system in CRPS, and recently we showed that CRPS patients have autoantibodies against nervous system structures. Therefore we tested the sera of CRPS patients, neuropathy patients and healthy volunteers for surface-binding autoantibodies to primary cultures of autonomic neurons and differentiated neuroblastoma cell lines using flow cytometry. Thirteen of 30 CRPS patients, but none of 30 healthy controls and only one of the 20 neuropathy sera had specific surface binding to autonomic neurons (p<0.001). The majority of the sera reacted with both sympathetic and myenteric plexus neurons. Interestingly, 6/30 CRPS sera showed binding to undifferentiated SH-SY5Y neuroblastoma cells. However, differentiation of SH-SY5Y into a cholinergic phenotype induced a surface antigen, which is recognised by 60% of CRPS sera (18/30), but not by controls (p<0.001). Our data show that about 30-40% of CRPS patients have surface-binding autoantibodies against an inducible autonomic nervous system autoantigen. These data support an autoimmune hypothesis in CRPS patients. Further studies must elucidate origin and function of these autoantibodies in CRPS.