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Research at Vanderbilt

Viral illness may spur ‘standing up’ disorder

by | Posted on Thursday, Mar. 13, 2014 — 10:04 AM

Circulating “autoantibodies” possibly triggered by a viral illness may contribute an abnormally rapid heart rate or tachycardia upon standing that affects 500,000 Americans, mostly young women, according to researchers at the University of Oklahoma and Vanderbilt University.

Their findings, published Feb. 26 by the Journal of the American Heart Association, could lead to new treatments for the condition, called postural tachycardia syndrome, or POTS.

Symptoms also include shortness of breath and weakness upon standing, and exercise “intolerance” that have lasted for at least six months.

Satish Raj, M.D., MSCI

“The cause of POTS is probably multifactorial, with different underlying causes in different patients” said co-author Satish Raj, M.D., MSCI, associate professor of Medicine and Pharmacology at Vanderbilt and consultant at the Vanderbilt Autonomic Dysfunction Center. In some patients, however, symptoms occur after a “viral-type” illness, he said.

In the current study, researchers evaluated blood samples from patients with POTS and also from healthy individuals. They found evidence of antibodies in blood samples from patients that bind to receptors on cells regulating vascular tone and to other receptors on cells involved in the regulation of heart rate.

“Our research found autoantibodies caused changes that altered cell function,” said senior author David Kem, M.D., George Lynn Cross Research Professor of Medicine at the University of Oklahoma Health Sciences Center and a member of its Heart Rhythm Institute.

“These autoantibodies interfere with normal changes in the system that control the ability of blood vessels to become narrower and prevent the expected drop of blood pressure as the patient stands,” Kem said.

The body compensates for this by increasing sympathetic nerve activity, which helps maintain blood pressure but directly speeds up the heart rate.

“We’re just at the beginning of a series of studies to try to understand what this means in terms of its potential for impacting the patient care in the clinic,” Raj said.

“This opens up a new avenue of investigations, both to better characterize and understand the cause, and potentially to look at different treatments.”

Luis Okamoto, M.D., research instructor in Medicine at Vanderbilt, also contributed to the research. National Institutes of Health grants supporting the Vanderbilt research included HL102387, NS065736 and TR000445.

Contact:
Bill Snyder, (615) 322-4747
william.snyder@Vanderbilt.Edu


  • Atara Kennedy

    This is such great news. Patients are eager for help. I would like to see and request that data be collected on NCS patients as well. Both NCS and POTS are forms of dysautonomia. In NCS cases, as I understand, the vessels dilate rather than contract, causing a decrease in blood supply to the upper body. Patients exist with both NCS and POTS.

  • Atara Kennedy

    Thank you Dr. Okamoto, Dr. Raj, and Dr. Kem. I sincerely thank you.

  • CaronRyalls

    I’m not at all surprised to discover that some POTS may be autoimmune based, but I don’t think it’s just a viral trigger. Many girls are developing POTS after having the HPV vaccine. Why are Vanderbilt researchers not also looking at this subset of POTS as autoimmunity has often been associated with vaccines. Discovering why certain girls develop POTS after the HPV vaccine, will help to learn more about POTS and will also help to create safer vaccines, or at least help to screen those girls for whom the HPV vaccine might present a greater risk. It’s time more researchers took up the mantel to find out why this is happening.

  • TCP1960

    I have ME/CFS and autonomic and peripheral neuropathy and POTS. EBV started my ill health so this doesn’t surprise me. I’m just checking out shortness of breath which is getting worse and I’ve had tachycardia constantly for two decades maybe longer.

  • TCP1960

    I have ME/CFS and autonomic and peripheral neuropathy and POTS. EBV started my ill health so this doesn’t surprise me. I’m just checking out shortness of breath which is getting worse and I’ve had tachycardia constantly for two decades maybe longer.

  • Emily

    Thank you for your work on discovering the causes of POTS. I have POTS and it is a debilitating illness making people bed bound in the prime of their life. Many see a link with infections, I have a chronic strep gut infection and have had campylobacter in the past. I wish you every success with the next stage of your research, we’re counting on you!

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