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Research News at Vanderbilt

Viral illness may spur ‘standing up’ disorder


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.

Media Inquiries:
Bill Snyder, (615) 322-4747

  • 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.

    • Stella

      The mechanism is essentially the same. Let them figure out the viral cause, and then will lead to looking at the vaccine. My hypothesis is that it has less to do with the components of the vaccine itself, and more to do with a genetic predisposition to how certain girls respond to the vaccine… myself included. It’s easy for people to say “Why don’t we research this,” and I understand the frustration – trust me – but what you don’t seem to understand is that is not a lack of interest on the researcher’s part, but a lack of government and NIH funding. Advocate for awareness and funding, and something can be done.

  • 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!

  • TCP1960

    Possibly viral-based in some people, but mine came on 7 years ago after having ME for 23 years (ME started after Epstein Barr Virus). I have since been found to have Ehler’s Danlos Syndrome which pre-disposed me to getting ME and POTS. Neuropathy appeared at the same time.

    • DDG1959

      Hi TCP1960
      I have Ehlers Danlos myself, have had shingles 3 times, Chronic pain syndrome and have POTS. The key to your survival and saneness is a great Rheumatologist.

  • Kim Bell Schneider

    I’m glad to see that there is research being done on the viral relation to autonomic failure. I had a virus 13 years before I was diagnosed that left me with a binocular defect, and right sided neuritis. Although I went to all the right doctors to no avail, I continued to function until 10 years later, when I started to develop all the symptoms of PAF. I prayed, found an ENT online in Birmingham, who without my knowledge had done a thesis on autonomic vertigo, and he sent me to the Autonomic Disorder Center of Alabama in Birmingham. I have PAF, MVP, Sleep Apnea, and Fibromyalgia. I also have a herpes virus, and as you know, EBV, chickenpox, shingles, and mono are all herpes viruses that continue to lie dormant in the nerve ganglia, even when you are not symptomatic. I’m stating this for those who commented below and maybe above, and who may not know this information. I know that is what caused all my trouble from the beginning. Thank you for doing all this research. It will certainly help in the generations to come, and the younger patients here, as well.

    I’m curious as to why most patients with this disorder end up being diagnosed with Fibromyalgia, which is considered a CNS nerve sensitivity disorder (a whole different spectrum of the nervous system). I just read an article recently that there have been studies with patients with Lyme disease and they now believe there is a correlation to Fibromyalgia. I have had the Lyme rash, but was treated. Although I have lived in the woods with deer in our backyard, and have been hiking up the mountain with my sons for at least 15 out of the 21 years that we have lived in Huntsville; so I’m sure there were other times that I have been exposed. I know the testing is not necessarily accurate, as well, and I know I am off the subject now, but have always been curious about this being correlated with autonomic failure, as well.

  • Sarah Robinson
  • Jennifer

    It’s weird to read everyone had mono or ebv. I too have had that as well as Lyme disease 15 years ago. I have never been the same since. I am highly allergic to foods and I think I am becoming sensitive to chemicals ( hair color). When I was pregnant I felt the best I ever felt only had a FEW minor reactions but I felt great and my skin was amazing. I definitely think there is a connection to having a virus and getting pots. I was in a study 15 years ago but did not get too far 2years ago I was diagnosed with pots.

  • moonstone1

    Hey Edward, I developed POTS after a viral illness and/or flu shot 1 year ago. I’d like to chat with you sometime if you are willing. Thanks.

  • Stephanie M

    My daughter is also 15 and has POTS, diagnosed after virus 2 yrs ago. Some days are good and some are very bed. It is frustrating for them and for the parents trying to help and encourage. Does your daughter contend with headaches, continuous dizziness?.

  • Julie Miller

    My daughter’s Dr gave her some exercises to do while in a chair and laying down, don’t give up, there is hope

  • Integrative Resources

    same with me. i developed POTS after vaccines.

  • durindakpena

    Can celiac disease cause Pots?