Press Releases

No. 22/October 21, 2005

20 Years of Fainting Spells – Researchers in Berlin Discover Cause for Severe Neurological Disorder – First Hope for Effective Therapy

As soon as the 43-year-old patient stood upright, his blood pressure dropped from 140 to 50 mm on the mercury column within a few seconds. Over the last 20 years, he had had recurrent fainting spells with loss of consciousness. He also reported decreased sweating, dry mouth, dry eyes, distended abdomen, and problems with digestion. His colon was so dilated that his liver had shifted from the right to the left side of his abdomen and his stomach was squeezed between his liver and spleen. He could hardly eat or drink anything anymore and was so emaciated that he was afraid he would slowly starve to death. Now, Dr. Christoph Schröder, Professor Friedrich Luft, and Professor Jens Jordan from the Clinical Research Center of the Franz Volhard Clinic (Charité and Helios Clinics Berlin Buch and the Max Delbrück Center for Molecular Medicine, MDC, Berlin-Buch) have shown that an autoantibody that blocks ganglionic receptors of the autonomous (vegetative) nervous system causes the grave and rare disease. The autonomic nervous system regulates vital processes such as heartbeat, blood pressure, blood glucose level, metabolism, lung and bladder function, and digestion. On four consecutive days, they replaced the blood plasma of the patient with donor plasma and thus washed the antibodies out of the blood. At the same time, he received medications (prednisolone and azathioprine) to suppress antibody formation. As a result, the patient’s health condition and quality of life improved dramatically and he was able to resume his work. One year after the treatment, his condition remains stable. “For the first time, there is hope for an effective treatment for these patients”, Professor Jordan explained. The paper has now been published in the New England Journal of Medicine (NEJM)* (Vol. 353, Nr. 15, pp. 1585-1590, October 13, 2005).

The autoantibodies work like ganglionic blockers - drugs that used to be prescribed to treat severe hypertension. Both the patient’s autoantibodies and ganglionic blockers occupy the binding site (receptor) for acetylcholine. The neurotransmitter acetylcholine is required for the transmission of sympathetic and parasympathetic nervous system activity. Both branches of the autonomic nervous system balance organ functions. By removing the antibodies and suppressing their new formation through drugs, the clinicians proved that it was in fact the autoantibodies which caused the patient’s severe neurological disorder. Why the patient’s body forms these antibodies, however, is unknown. Professor Jordan, who also heads a research group on disorders of the autonomic nervous system at the MDC, and his colleagues point out that patients with severe blood pressure drops while standing up and additional disorders of the autonomic nervous system should be tested for antibodies against ganglionic acetylcholine receptors.

* Plasma Exchange for Primary Autoimmune Autonomic Failure
Christoph Schroeder, Steven Vernino, Andreas L. Birkenfeld, Jens Tank, Karsten Heusser, Axel Lipp, Thomas Benter, Carsten Lindschau, Ralph Kettritz, Friedrich C. Luft and Jens Jordan

From the Franz Volhard Clinical Research Center and the Max Delbrück Center for Molecukar Medicine (C.S., A.L.B., J.T., K.H., C.L., R.K., F.C.L., J.J.) , Medical University Charité (C.S., A.L.B., J.T., K.H., C.L., R.K., F.C.L., J.J) and Helios Klinikum (T.B.) – all in Berlin; and the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.V.). Address reprints request to Dr. Jordan at the Franz Volhard Clinical Research Center, Wiltbergstr. 50, Haus 129, 13125 Berlin Germany, or at jordan@fvk.charite-buch.de

Press and Public Affairs
Max Delbrück Center for Molecular Medicine(MDC) Berlin-Buch
Barbara Bachtler
Robert-Rössle-Str. 10
13125 Berlin
Phone: +49/30/9406-38 96
Fax.: +49/30/9406-38 33
e-mail: bachtler@mdc-berlin.de
http://www.mdc-berlin.de

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