1
|
Tv P, Tran TT, Hao HT, Hau NTH, Jain N, Reinis A. Postural orthostatic tachycardia syndrome-like symptoms following COVID-19 vaccination: An overview of clinical literature. Hum Antibodies 2023:HAB220013. [PMID: 37248893 DOI: 10.3233/hab-220013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Postural Orthostatic Tachycardia Syndrome (POTS) is a common condition affecting more than 170 people per 100,000 population. However, POTS following COVID-19 vaccination remains a rare reporting in the medical literature. OBJECTIVE We, herein, summarize and highlight the evidence that has been reported regarding POTS-like symptoms following COVID-19 vaccination. METHODS We conducted a literature search and summarized the findings in the form of a narrative commentary. All types of publications (case reports/series, original articles, letters to editors, brief communications etc.) in English language were included. RESULTS Whilst the exact pathogenetic mechanism behind POTS is yet to elucidated, there has been increasing evidence pointing towards an autoimmune dysfunction. Females were found to be predominantly affected (72%) with age range from 17 years to 52 years. Additionally, it seems that POTS-like symptoms could be triggered after immunization with Pfizer- BioNTech, Moderna, and Oxford-AstraZeneca COVID-19 vaccines. The symptoms typically appear within the first week, depending upon previous exposure to the virus and presence of other systemic conditions. In some patients, the condition is self-resolving. However, in others, non-pharmacological interventions coupled with negative ionotropic medications can be used for symptomatic management of the patients. CONCLUSIONS Timely diagnosis and proper treatment are quintessential for ensuring early alleviation (and in some cases complete resolution) of symptoms. Furthermore, there may be episodes of relapse. Overall prognosis of the new-onset POTS-like symptoms is difficult to predict based on current literature.
Collapse
Affiliation(s)
- Phu Tv
- Faculty of Medicine, Trà Vinh University, Trà Vinh, Vietnam
| | - Thu Thao Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, SC\̀acircumflexn Th, Vietnam
| | | | - Nguyen Thi Hien Hau
- Faculty of Medicine, College of Medicine and Pharmacy, Duy Tan University, Danang, Vietnam
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradinš University, Riga, Latvia
| |
Collapse
|
2
|
Miglis MG. Autonomic Dysfunction in the Central Nervous System Hypersomnias. CURRENT SLEEP MEDICINE REPORTS 2023. [DOI: 10.1007/s40675-023-00247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
3
|
Platelet Storage Pool Deficiency and Elevated Inflammatory Biomarkers Are Prevalent in Postural Orthostatic Tachycardia Syndrome. Cells 2022; 11:cells11050774. [PMID: 35269395 PMCID: PMC8909348 DOI: 10.3390/cells11050774] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
A significant number of postural orthostatic tachycardia syndrome (POTS) patients have platelet delta granule storage pool deficiency (δ-SPD). The etiology of POTS is unknown but a number of laboratories, including ours, have reported elevations of G-protein-coupled adrenergic receptor and muscarinic acetylcholine receptor autoantibodies in POTS patients, detected by a variety of techniques, suggesting that the disorder is an autoimmune condition. Thus, it could also be considered an inflammatory disease. In a pilot study, we investigated a limited number of platelet-related cytokines and chemokines and discovered many that were elevated. This case−control study validates our pilot study results that POTS patients have an activated innate immune system. Plasma of 35 POTS patients and 35 patients with unexplained bleeding symptoms and categorized as “non-POTS” subjects was analyzed by multiplex flow cytometry to quantify 16 different innate immune system cytokines and chemokines. Electron microscopy was used to quantify platelet dense granules. Ten of 16 biomarkers of inflammation were elevated in plasma from POTS patients compared to non-POTS subjects, with most of the differences extremely significant, with p values < 0.0001. Of particular interest were elevations of IL-1β and IL-18 and decreased or normal levels of type 1 interferons in POTS patients, suggesting that the etiology of POTS might be autoinflammatory. All POTS patients had δ-SPD. With a growing body of evidence that POTS is an autoimmune disease and having elevations of the innate immune system, our results suggest a potential T-cell-mediated autoimmunity in POTS characteristic of a mixed-pattern inflammatory disease similar to rheumatoid arthritis.
Collapse
|
4
|
Haen P, Crescence L, Mege D, Altié A, Dubois C, Panicot-Dubois L. Oral Squamous Cell Carcinoma Is Associated with a Low Thrombosis Risk Due to Storage Pool Deficiency in Platelets. Biomedicines 2021; 9:biomedicines9030228. [PMID: 33668375 PMCID: PMC7996194 DOI: 10.3390/biomedicines9030228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
Venous thrombo-embolism (VTE) disease is the second most common cause of mortality in cancer patients, and evaluation and prevention of thrombosis risk is essential. VTE-associated risk varies according to the type of tumor disease. Oral cancer is the most frequent type of head and neck cancer, and it represents approximately 2.1% of all cancers worldwide. Most tumors are squamous cell carcinomas and are mainly due to tobacco and alcohol abuse. VTE risk associated with oral squamous cell carcinoma (OSCC) is low. However, many studies have shown that OSCC has the following biological features of cancers associated with a high thrombosis risk: modified thrombosis and fibrinolysis mechanisms; strong expression of procoagulant proteins; secretion of procoagulant microparticles; and production of procoagulant cytokines. Using an original mouse model of tongue squamous cell carcinoma, our study aimed to clarify this paradoxical situation. First, we showed that OSCC tumors have a pro-aggregatory phenotype and a high local thrombosis risk. Second, we found that tongue tumor mice do not have an elevated systemic thrombosis risk (the risk of an "at distance" thrombosis event such as lower extremity deep venous thrombosis or pulmonary embolism) and even show a reduction in risk. Third, we demonstrated that tongue tumor mice show a reduction in platelet reactivity, which explains the low systemic thrombosis risk. Finally, we found that tongue tumor mice present granule pool deficiency, thereby explaining the reduction in platelet reactivity and systemic thrombosis risk.
Collapse
Affiliation(s)
- Pierre Haen
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
- Department of Oral and Maxillofacial Surgery, Laveran Military and Academic Hospital, 13384 Marseille, France
| | - Lydie Crescence
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
- Aix Marseille Université, PIVMI, 13885 Marseille, France
| | - Diane Mege
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, 13885 Marseille, France
| | - Alexandre Altié
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
| | - Christophe Dubois
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
- Aix Marseille Université, PIVMI, 13885 Marseille, France
| | - Laurence Panicot-Dubois
- Aix Marseille Université, INSERM 1263, INRAE, C2VN, 13885 Marseille, France; (P.H.); (L.C.); (D.M.); (A.A.); (C.D.)
- Aix Marseille Université, PIVMI, 13885 Marseille, France
- Correspondence:
| |
Collapse
|
5
|
Gunning WT, Stepkowski SM, Kramer PM, Karabin BL, Grubb BP. Inflammatory Biomarkers in Postural Orthostatic Tachycardia Syndrome with Elevated G-Protein-Coupled Receptor Autoantibodies. J Clin Med 2021; 10:623. [PMID: 33562074 PMCID: PMC7914580 DOI: 10.3390/jcm10040623] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
A growing body of evidence suggests that postural orthostatic tachycardia syndrome (POTS) may be an autoimmune disorder. We have reported in a previous manuscript that 89% of POTS patients (n = 55) had elevations in G-protein-coupled adrenergic A1 receptor autoantibodies and 53% had elevations in muscarinic acetylcholine M4 receptor autoantibodies, as assessed by ELISA. Patients with autoimmune disorders have been reported with a variety of elevated cytokines and cytokines (such as rheumatoid arthritis); thus, we evaluated a limited number of cytokines/chemokines in POTS patients with elevated adrenergic and muscarinic receptor autoantibodies. We utilized the plasma of 34 patients from a previous study; all of the patients (100%) had autoantibodies against the A1 adrenergic receptor and 55.9% (19/34) had autoantibodies against the M4 muscarinic acetylcholine receptor. In particular, the plasma cytokine/chemokine levels were measured as biomarkers of inflammation by Quantibody® technology (Raybiotech, Peachtree Corners, GA, USA). We also evaluated the platelet dense granule numbers, as these patients frequently complain of symptoms related to platelet dysfunction. Patients were predominantly young females who displayed a multitude of co-morbidities but generally reported viral-like symptoms preceding episodes of syncope. Eighty five percent (29/34) had platelet storage pool deficiency. Patients had elevations in five of ten cytokine/chemokines biomarkers (IL1β, IL21, TNFα, INFγ, and CD30), whereas two biomarkers had decreased levels (CD40L and RANTES). Our observations demonstrate that POTS patients known to have autoantibodies against the G-protein-coupled adrenergic A1 receptor have abnormal plasma concentrations of inflammatory cytokines.
Collapse
Affiliation(s)
| | - Stanislaw M. Stepkowski
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH 43614, USA;
| | - Paula M. Kramer
- Department of Pathology, University of Toledo, Toledo, OH 43614, USA;
| | - Beverly L. Karabin
- Department of Medicine, University of Toledo, Toledo, OH 43614, USA; (B.L.K.); (B.P.G.)
| | - Blair P. Grubb
- Department of Medicine, University of Toledo, Toledo, OH 43614, USA; (B.L.K.); (B.P.G.)
| |
Collapse
|
6
|
Riley R, Khan A, Pai S, Warmke L, Winkler M, Gunning W. A Case of Chronic Thrombocytopenia in a 17-Year-Old Female. Lab Med 2019; 50:406-420. [PMID: 31228350 DOI: 10.1093/labmed/lmz013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Storage pool deficiency (SPD) is a group of rare platelet disorders that result from deficiencies in α-granules, δ-granules, or both. One type of α-SPD is gray platelet syndrome (GPS), caused by mutations in the neurobeachin-like 2 (NBEAL2) gene that results in a bleeding diathesis, thrombocytopenia, splenomegaly, and progressive myelofibrosis. Due to the lack of α-granules, platelets have a gray and degranulated appearance by light microscopy. However, definitive diagnosis of GPS requires confirmation of α-granule deficiency by electron microscopy. Treatment is nonspecific, with the conservative utilization of platelet transfusions being the most important form of therapy. We present a case of a 17-year-old female with a past medical history of thrombocytopenia, first identified at the age of five. Her clinical symptomatology included chronic fatigue, gingival bleeding, bruising, menorrhagia, and leg pain. This report will discuss both the clinical and the pathophysiologic aspects of this rare platelet disorder.
Collapse
Affiliation(s)
- Roger Riley
- Departments of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond
| | - Asad Khan
- Departments of Pediatrics, Virginia Commonwealth University (VCU) School of Medicine, Richmond
| | - Shella Pai
- Departments of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond
| | - Laura Warmke
- Department of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston
| | | | - William Gunning
- Department of Pathology, University of Toledo College of Medicine, Toledo, Ohio
| |
Collapse
|
7
|
Gunning WT, Kvale H, Kramer PM, Karabin BL, Grubb BP. Postural Orthostatic Tachycardia Syndrome Is Associated With Elevated G-Protein Coupled Receptor Autoantibodies. J Am Heart Assoc 2019; 8:e013602. [PMID: 31495251 PMCID: PMC6818019 DOI: 10.1161/jaha.119.013602] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background The etiology of postural orthostatic tachycardia syndrome (POTS) is yet to be established. The disorder is often misdiagnosed as chronic anxiety or a panic disorder because the autonomic failure in these patients is not severe. A growing body of evidence suggests that POTS may be an autoimmune disorder. Antinuclear antibodies and elevations of ganglionic, adrenergic, and muscarinic acetylcholine receptor antibodies have all been reported. Methods and Results We collected detailed clinical symptoms of 55 patients diagnosed with POTS. We also evaluated serum levels of autoantibodies against 4 subtypes of G‐protein coupled adrenergic receptors and 5 subtypes of G‐protein coupled muscarinic acetylcholine receptors by ELISA. Our patients had a multitude of comorbidities, were predominantly young females, and reported viral‐like symptoms preceding episodes of syncope. We detected a significant number of patients with elevated levels of autoantibodies against the adrenergic alpha 1 receptor (89%) and against the muscarinic acetylcholine M4 receptor (53%). Surprisingly, elevations of muscarinic receptor autoantibodies appeared to be dependent upon elevation of autoantibodies against the A1 adrenergic receptor! Four patients had elevations of G‐protein coupled autoantibodies against all 9 receptor subtypes measured in our study. Five POTS patients had no elevation of any autoantibody; similarly, controls were also negative for autoantibody elevations. There was a weak correlation of clinical symptom severity with G‐protein coupled autoantibodies. Conclusions Our observations provide further evidence that, in most cases, POTS patients have at least 1 elevated G‐protein coupled adrenergic autoantibody and, in some instances, both adrenergic and muscarinic autoantibodies, supporting the hypothesis that POTS may be an autoimmune disorder.
Collapse
|
8
|
Astudillo L, Laure A, Fabry V, Pugnet G, Maury P, Labrunée M, Sailler L, Pavy-Le Traon A. [Postural tachycardia syndrome (PoTS): An up-to-date]. Rev Med Interne 2018; 39:627-634. [PMID: 29909001 DOI: 10.1016/j.revmed.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 03/13/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
Abstract
Postural tachycardia syndrome (PoTS) is a multifactorial syndrome defined by an increase in heart rate ≥30bpm, within 10minutes of standing (or during a head up tilt test to at least 60°), in absence of orthostatic hypotension. It is associated with symptoms of cerebral hypoperfusion that are worse when upright and improve in supine position. Patients have an intense fatigue with a high incidence on quality of life. This syndrome can be explained by many pathophysiological mechanisms. It can be associated with Ehlers-Danlos disease and some autoimmune disorders. The treatment is based on nonpharmacological measures and treatment with propranolol, fludrocortisone or midodrine.
Collapse
Affiliation(s)
- L Astudillo
- Service de médecine interne, CHU Purpan, Toulouse, France; Institut national de la santé et de la recherche médicale (Inserm), UMR1037, France; Société de médecine, chirurgie et pharmacie de Toulouse, France
| | - A Laure
- Société de médecine, chirurgie et pharmacie de Toulouse, France
| | - V Fabry
- Service de neurologie, France
| | - G Pugnet
- Service de médecine interne, CHU Purpan, Toulouse, France; Institut national de la santé et de la recherche médicale (Inserm), UMR1027, France
| | - P Maury
- Service de cardiologie, France
| | - M Labrunée
- Service de médecine physique et réadaptation, France
| | - L Sailler
- Service de médecine interne, CHU Purpan, Toulouse, France; Institut national de la santé et de la recherche médicale (Inserm), UMR1027, France
| | - A Pavy-Le Traon
- Service de neurologie, France; Institut National de la santé et de la recherche médicale (Inserm), UMR1048, France
| |
Collapse
|