New research validates the theory that POTS may be an autoimmune disorder

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New research validates the theory that POTS may be an autoimmune disorder

Industrious work from researchers at The University of Toledo could help in diagnosing and treating postural orthostatic tachycardia syndrome

There are various symptoms of postural orthostatic tachycardia syndrome (POTS) and can also be confounding. They include pain, fatigue, bleeding issues, and anxiety. The most common ones are light-headedness and heart palpitations. A few POTS-affected patients also experience brain fog or gastrointestinal problems. For patients most seriously affected, simply changing their position from sitting to standing up can cause unconsciousness.

POTS is seen widely and is common but still seems to remain a mystery to be unraveled. Some physicians claim they have never heard of it and POTS does not come with a standardized lab test to confirm its diagnosis. There is neither a specified treatment nor a cure for this condition. But Dr. William Gunning and Dr. Blair Grubb from The University of Toledo provide hope saying that this situation could be changing due to the dedication and persistence of researchers.

Dr. Grubb, a cardiologist at The University of Toledo Medical Center and Distinguished University Professor in the UToledo College of Medicine and Life Sciences says that “for a long time, people were questioning the very existence of this disorder.”

Dr. Grubb has been studying the POTS condition for over three decades and has been seeing patients for the same. He claims that his team and he are noticing great progress and have almost come close to proving that POTS is an autoimmune disorder, a long-held theory in the medical field.

Dr. Gunning, a professor of pathology in the UToledo College of Medicine and Life Sciences and expert in platelet disorders, along with Dr. Grubb is collaborating on novel research that examines patients' plasma to detect any autoantibodies or inflammatory markers.

These doctors and a team of UToledo scientists have conducted a retrospective study of 34 POTS patients. It was observed that there was a considerable elevation of five inflammatory markers characteristic of an innate immune condition. About this, Grubb said “this is a brilliant leap forward in the journey. Not only does this study provide additional credibility to the existence of POTS, but also an idea of pathophysiology. This means that it is plausible for POTS to have a very simple diagnostic test, which is not the case right now.

These identified markers in the research were a mixture of specific cytokines and chemokines. These markers are similar to those observed in patients who are diagnosed with other autoimmune disorders, like multiple sclerosis, psoriasis, and rheumatoid arthritis.

This paper is published in the journal Clinical Medicine and it builds on existing deep research done over several years led by Grubb and Gunning. The research pair in 2019 published the largest study of POTS patients to date, reporting that 89% of these patients showed elevated levels of autoantibodies against the adrenergic alpha 1 receptor. These two publications together make the strongest evidence suggesting that POTS is an autoimmune disorder.

There is also another hypothesis by these doctors where they believe that POTS may be started by a viral infection.

Gunning states that “there is yet to be clarity on whether POTS is inherited or acquired. But viral infections cannot be disregarded as being the catalyst for the initiation of POTS. Moreover, many previously diagnosed COVID-19 patients are being termed as ‘long-haulers’. They have similar symptoms to POTS and many of them have contacted POTS post-COVID. On this POTS in post-COVID patients, Gunning says that “this makes an additional evidence in the theory that due to a viral infection, there is a start of a flow of chemicals made by the innate immune system in the growth of autoantibodies.”

Grubb and Gunning have noticed the recent Epstein-Barr viral infections when checking the medical histories of many patients. However, this theory remains to be tested. Further research and expansion of the investigation are required to give validation to the study on inflammatory marks.

As of now, physicians only have the capability to treat the POTS symptoms. In the event that POTS is confirmed to be an autoimmune disorder, the knowledge of the related inflammatory markers could aid in the specific treatment for this unique condition.

Grubb is one of the world's leading experts in syncope and disorders of the autonomic nervous system. He has spent all of his medical career treating POTS patients and he believes that these new discoveries reflect perseverance and commitment. He says that “research in POTS is speedy and it is due to the access and use of new technology and collaboration between researchers. We are making the much-needed progress and are on the frontier of innovations and research.”

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