Systemic iujection of monoclonal antibodies to neural acetylcholinesterase in adult rats caused a syndrome with permanent, complement-mediated destruction of presynaptic fibers in sympathetic ganglia and adrenal medulla. Ptosis, hypotension, bradycardia, and postural syncope ensued. In sympathetic ganglia, acetyicholinesterase activity disappeared from neuropil but not from nerve cell bodies. Choline acetyltransferase activity and ultrastructurally defined synapses were also lost. Electrical stimulation of presynaptic fibers to the superior cervical ganglion ceased to evoke end-organ responses. On the other hand, direct ganglionic stimulation remained effective, and the postganglionic adrenergic system appeared intact. Motor performance and the choline acetyltransferase content of skeletal muscle were preserved, as was parasympathetic (vagal) function. This model of selective cholinergic autoimmunity represents another tool for autonomic physiology and may be relevant to the pathogenesis of human dysautonomias.At least two autoimmune disorders are caused by antibodies to exposed antigens of peripheral cholinergic synapses. In myasthenia gravis, the target is the nicotinic receptor of skeletal muscle (1-3). In the Lambert-Eaton myasthenic syndrome, it is the presynaptic voltage-gated calcium channel (4-7). Because acetylcholinesterase (AChE) is anchored in cholinergic synaptic membranes (8), this enzyme is accessible to immunoglobulins and might also be a target of autoimmunity.We recently observed long-lasting eyelid drooping (ptosis) in rats injected with monoclonal anti-AChE antibodies that neither inhibit enzymatic activity nor reach epitopes in the central nervous system in vivo (9). With these antibodies we have created a model of autoimmunity to peripheral neuronal AChE, comprising striking and permanent damage to preganglionic sympathetic neurons without evident effect on other cholinergic systems. The characteristics of this syndrome were defied by physiological, biochemical, and morphological experiments.MATERIALS AND METHODS Antibody lajections. Murine IgG monoclonal antibodies ZR 2, 3, 4, 5, and 6, raised against rat brain AChE, were purified by chromatography on DEAE-Affigel Blue (Bio-Rad) as described (10). These antibodies avidly bound all molecular forms of AChE and showed no preferences for enzyme from particular tissues. Each antibody was directed against a different epitope of AChE, but none interacted with the active site or interfered with the catalytic activity of the enzyme (10). The antibodies chosen for these experiments had no in vivo access to their epitopes on brain AChE (9). The purified IgGs were injected as an equal-part mixture (total, 1.5 mg in 2 ml of 0.9% NaCl) into the tail vein of 300-g adult male Sprague-Dawley rats. Controls received identical amounts of normal mouse IgG or a murine anti-human AChE monoclonal IgG that did not recognize rat AChE.Some rats were pretreated with cobra venom factor to deplete hemolytic complement. The protein, purified as described (11), ...