Autoimmune postural orthostatic tachycardia syndrome
Open accessAbstract
The aim of this study was to evaluate the association between postural orthostatic tachycardia syndrome (POTS) and circulating antiganglionic acetylcholine receptor (gAChR) antibodies. We reviewed clinical assessments of Japanese patients with POTS, and determined the presence of gAChR antibodies in serum samples from those patients. Luciferase immunoprecipitation systems detected anti‐gAChRα 3 and β 4 antibodies in the sera from POTS (29%). Antecedent infections were frequently reported in patients in POTS patients. Moreover, autoimmune markers and comorbid autoimmune diseases were also frequent in seropositive POTS patients. Anti‐gAChR antibodies were detectable in significant number of patients with POTS, and POTS entailed the element of autoimmune basis.
AI snapshot
Written from the paper’s full text.
TL;DR
In Japanese patients with POTS, anti-ganglionic acetylcholine receptor antibodies were detected in 29% (10/34), more frequently than in NMS or controls, and seropositive POTS patients more often had autoimmune markers and comorbid autoimmune diseases. The authors conclude POTS may have an autoimmune basis, while noting the observational design and small sample size.
Key findings
- Anti-gAChR antibodies were detected in 29% (10 of 34) of POTS patients: anti-gAChRa3 in 8 (24%) and anti-gAChRb4 in 2 (6%); no seropositive POTS sample was positive for both. In NMS, 1 of 19 (5%) was positive for anti-gAChRa3; all 73 healthy controls were negative, and 1 OND patient with suspected amyloid neuropathy had anti-gAChRa3 antibodies.
- Mean antibody index for anti-gAChRa3 was 0.746 in POTS versus 0.305 in HC and 0.336 in OND (P < 0.001); for anti-gAChRb4 it was 0.536 in POTS versus 0.367 in HC and 0.302 in OND (P = 0.007). POTS versus NMS showed no significant difference in antibody prevalence (P = 0.479) or mean A.I. for anti-gAChRa3 and anti-gAChRb4 (P = 0.774 and 0.744).
- Compared with NMS, POTS patients were younger at assessment and onset (P = 0.004 and 0.013), more often female (24/34, 71% vs 7/19, 37%; P = 0.018), and more often reported antecedent infections (10/34, 29%; P = 0.010).
- Among POTS patients, seropositive patients were older (P = 0.012); antecedent infections were reported in 5/10 (50%) seropositive patients with no difference by serostatus; pupil abnormality and lower gastrointestinal symptoms were more frequent (P = 0.029 and 0.032), and other autoimmune diseases were more common (P < 0.001). IVMP was given to 3/10 seropositive patients, all with clinical improvement; 4/24 seronegative patients received IVMP, with 3 maintaining improvement in orthostatic intolerance and 1 showing no clinical improvement.
Methods
- The study reviewed Japanese patients with orthostatic intolerance; serum samples from 53 patients were obtained from general and teaching hospitals throughout Japan between January 2012 and August 2016. First analysis compared 34 POTS, 19 NMS, 34 OND, and 73 healthy controls; second analysis compared seropositive and seronegative POTS patients.
- Anti-gAChRa3 and anti-gAChRb4 antibodies were detected by luciferase immunoprecipitation system (LIPS) assays, expressed as antibody index (A.I.), with healthy control values normalized as <1.000 A.I. Clinical, neurological, and serologic assessments were performed, and questionnaires were sent to referring neurologists.
- Statistical analysis used SigmaPlot; normally distributed A.I. data were analyzed by one-way analysis of variance, and frequencies/non-normally distributed data by one-way analyses of variance of ranks; P < 0.05 was considered significant.
Limitations
- Stated: the study is limited by an observational design and small sample size; the authors state that a prospective, multicenter, clinical interventional study is necessary to confirm relationships between anti-gAChR antibody levels and POTS/autonomic symptom severity and the potential for immunotherapy.
- Stated: the majority of seropositive samples did not have high levels of autoantibodies for gAChR, so elevated antibodies to gAChR subunits may reflect secondary autoimmune responses to ganglionic neuron damage.
- Evident from the text: the cross-sectional seroprevalence comparison cannot establish causality, and the findings derive from Japanese patients, so generalizability to other populations may be limited.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 12 cited sources checked · 0 supported · 0 flagged
- Findingown data
Only one NMS patient (5%) was positive for anti-gAChRa3 antibodies.
“only one patient (5%) with NMS was positive for autoantibodies against gAChRa3.”
Quote in the paperSubstantial claim - Findingown data
Anti-gAChRa3 antibodies were detected in 8 of 34 POTS patients (24%).
“anti-gAChRa3 antibodies were detected in 8 samples (24%)”
Quote in the paperSubstantial claim - Findingown data
In all 73 healthy controls, anti-gAChRa3 and anti-gAChRb4 antibodies were absent.
“In all 73 HC, anti-gAChRa3 and anti-gAChRb4 antibodies were absent”
Quote in the paperSubstantial claim - Findingown data
There was no statistically significant difference between POTS and NMS in the prevalence of anti-gAChR antibodies (P = 0.479).
“no statistically significant difference was detected in between the POTS group and NMS group on the prevalence of anti-gAChR antibodies (P = 0.479).”
Quote in the paperNot a substantial claim - Findingown data
Other autoimmune diseases were more common in anti-gAChR antibody-positive POTS patients than in antibody-negative POTS patients (P < 0.001).
“Other autoimmune diseases were more common in anti-gAChR antibody-positive patients than in those who were antibody-negative (P < 0.001).”
Quote in the paperSubstantial claim
- Findingown data
The frequency of anti-gAChRa3 antibodies was statistically higher in POTS patients than in NMS patients (P = 0.041).
“The frequencies of gAChRa3 antibodies in patients with POTS were statistically higher than those in patients with NMS (P = 0.041).”
Quote in the paperSubstantial claim - Findingown data
No seropositive POTS sample was positive for both anti-gAChRa3 and anti-gAChRb4 antibodies.
“no samples from the seropositive patients with POTS were positive for both antibodies.”
Quote in the paperNot a substantial claim - Findingown data
In patients with POTS, 29% (10 of 34) were positive for anti-gAChR antibodies by LIPS assay.
“Luciferase immunoprecipitation systems detected anti-gAChRa3 and b4 antibodies in the sera from POTS (29%).”
- Also stated in: § Frequencies of autoantibodies against gAChR in first analysis · plain
“Using the LIPS assay, we found that 29% (10 of 34) of patients with POTS were positive for autoantibodies.”
Quote in the paperSubstantial claim - Also stated in: § Frequencies of autoantibodies against gAChR in first analysis · plain
- Findingown data
Anti-gAChRb4 antibodies were detected in 2 of 34 POTS patients (6%).
“anti-gAChRb4 antibodies were detected in two samples (6%)”
Quote in the paperSubstantial claim - Findingown data
There was no statistically significant difference between POTS and NMS in mean antibody index for anti-gAChRa3 and anti-gAChRb4 (P = 0.774 and 0.744, respectively).
“No statistically significant difference was seen in between the POTS group and NMS group on the mean A.I. for anti-gAChRa3 and gAChRb4 antibodies (P = 0.774 and 0.744, respectively).”
Quote in the paperSubstantial claim - Findingown data
Anti-gAChR antibodies were detected more frequently in patients with POTS compared to NMS and controls.
“we could demonstrate that the anti-gAChR antibodies were detected more frequently in patients with POTS compared to NMS and controls.”
Quote in the paperSubstantial claim - Findingcitation
The prevalence of anti-gAChR antibodies in this study was higher than that in a previous study.
“The prevalence of anti-gAChR antibodies in this study was higher than that in previous study.17”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] source
Not checked in the free run.
- Interpretationown data
Anti-gAChR antibodies may be associated with POTS and its underlying autonomic dysfunction.
“suggesting that anti-gAChR antibodies may be associated with POTS and its underlying autonomic dysfunction.”
Quote in the paperSubstantial claim - Interpretationown data
POTS entailed the element of autoimmune basis.
“POTS entailed the element of autoimmune basis.”
Quote in the paperSubstantial claim- Rests on an assumption: POTS patients in this Japanese cohort are representative of POTS patients generally.
- Interpretationown data
POTS patients with an autoimmune basis were present in significant proportions.
“we demonstrated POTS patients with autoimmune basis were present in significant proportions.”
Quote in the paperSubstantial claim- Rests on an assumption: POTS patients in this Japanese cohort are representative of POTS patients generally.
- Interpretationreasoning
Elevated expression of antibodies to gAChR subunits may contribute to secondary autoimmune responses to ganglionic neuron damage in seropositive POTS patients.
“Therefore, elevated expression of antibodies to gAChR subunits may contribute to secondary autoimmune responses to ganglionic neuron damage in seropositive patients.”
Quote in the paperSubstantial claim - Study design and conductcitation
The diagnosis of POTS and NMS was confirmed using consensus statements.
“The diagnosis of POTS and NMS were confirmed using the consensus statement by the American Autonomic Society, the European Federation of Autonomic Societies, the Autonomic Research Group of the World Federation of Neurology and the Autonomic Disorders section of the American Academy of Neurology, and 2015 heart rhythm society expert consensus statement.[14][15][16]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14][15][16]
Not checked in the free run.
- Interpretationown data
POTS and NMS were clearly distinguishable by the prevalence of anti-gAChR antibodies.
“POTS and NMS were clearly distinguishable by the prevalence of anti-gAChR antibodies.”
Quote in the paperNot a substantial claim - Premisecitation
Sandroni and Low demonstrated occasional positivity to gAChR antibodies in POTS patients.
“Sandroni and Low demonstrated occasional positivity to gAChR antibodies in POTS patients.10”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] source
Not checked in the free run.
- May combine two claims. 7
- Classified as probably not a substantial claim. 5
- The quote only partly states this claim. 1
May combine two claims.
Findingown dataThe mean anti-gAChRb4 antibody index in POTS was 0.536, significantly greater than in healthy controls (0.367) or OND (0.302) (P = 0.007).
“The mean A.I. for anti-gAChRb4 antibodies in the POTS group was 0.536, which was also significantly greater than those obtained for the HC (0.367) or OND (0.302) groups (P = 0.007)”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe mean anti-gAChRa3 antibody index in POTS was 0.746, significantly greater than in healthy controls (0.305) or OND (0.336) (P < 0.001).
“The mean A.I. value for anti-gAChRa3 antibodies in the POTS group was 0.746, which was significantly greater than those obtained for the HC (0.305) or OND (0.336) groups (P < 0.001).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe mean anti-gAChRa3 antibody index in NMS was 0.638, and the mean anti-gAChRb4 antibody index in NMS was 0.421.
“the mean A.I. value for anti-gAChRa3 antibodies in the NMS group was 0.638, and the mean A.I. for anti-gAChRb4 antibodies in the NMS group was 0.421.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataAnti-gAChRa3 antibodies were detected in one OND patient with suspected amyloid neuropathy.
“anti-gAChRa3 antibodies were detected in the serum of one patient in the OND group, who had suspected amyloid neuropathy”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataSeropositive POTS patients demonstrated autoimmune markers and comorbid autoimmune diseases were frequent.
“Seropositive POTS patients demonstrated autoimmune markers and comorbid autoimmune diseases were frequent.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationAnti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.
“Anti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.18”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationPreviously, the authors reported the relationship among anti-gAChR antibodies, autonomic dysfunction, and autoimmune rheumatic diseases.
“Previously, we reported the relationship among the anti-gAChR antibodies, autonomic dysfunction, and autoimmune rheumatic diseases.[11][12][13]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11][12][13]
Not checked in the free run.
The quote only partly states this claim.
Study design and conductcitationThe cut-off points for the LIPS assay were verified using all data collected in previous studies.
“To evaluate the diagnostic accuracy of this assay, we verified the cut-off points for all data collected in the previous study.12,13”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [12] source
Not checked in the free run.
- cites [13]
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenThis study is limited by an observational design and small sample size.
“This study is limited by an observational design and small sample size.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationAnti-gAChR antibodies are associated with autonomic dysfunction (e.g., POTS) in autoimmune rheumatic diseases.
“we noted the possibility that anti-gAChR antibodies are associated with autonomic dysfunction (e.g., POTS) in autoimmune rheumatic diseases.12,13”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [12] source
Not checked in the free run.
- cites [13]
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationAn autoimmune basis has been suggested as a causal mechanism of POTS.
“An autoimmune basis has been suggested as a causal mechanism of POTS”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5][6][7]
Not checked in the free run.
May combine two claims.
PremisecitationBlitshteyn determined a high prevalence of positive ANA and other autoantibodies and a high prevalence of comorbid autoimmune disorders in patients with POTS.
“Blitshteyn recently determined the high prevalence of positive ANA and other autoantibodies and the high prevalence of comorbid autoimmune disorders that exist in patients with POTS.8,9”
Quote in the paperSubstantial claim0 of 2 sources checked
The paper relies on this without support.
POTS patients in this Japanese cohort are representative of POTS patients generally.
“We reviewed clinical assessments of Japanese patients with POTS, and determined the presence of gAChR antibodies in serum samples from those patients.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An antecedent history of suspected viral infection is reported in 20-50% of POTS patients.
“An antecedent history of suspected viral infection is reported in 20–50% of patients (Sandroni et al., 1999; Shaw et al., 2019; Watari et al., 2018).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Watari et al., 2018
Other autoantibodies with a proposed aetiological role in POTS include antibodies against nicotinic acetylcholine receptors in autonomic ganglia and Sjögren autoantibodies.
“Other autoantibodies with a proposed aetiological role in POTS include antibodies against nicotinic acetylcholine-receptor in autonomic ganglia [26] and Sj€ ogren autoantibodies [41,49], detected in POTS through antibody screening programmes.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [26]
Between 20% and 50% of POTS patients report a preceding suspected viral infection.
“The antecedent history of suspected viral infection is reported by between 20% and 50% of all patients [23,26].”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [26]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Claim of clear distinction conflicts with nonsignificant antibody-prevalence comparison
MajorThe discussion says antibody prevalence clearly distinguished POTS from NMS, but the results report no statistically significant difference in that prevalence between the groups (P = 0.479).
“POTS and NMS were clearly distinguishable by the prevalence of anti-gAChR antibodies.”
“However, no statistically significant difference was detected in between the POTS group and NMS group on the prevalence of anti-gAChR antibodies (P = 0.479).”
Cites
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-011-0119-5 · Cited by 1,697 · see citing works
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.02.004 · Cited by 1,243 · see citing works
Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013 · see citing works
Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia?
Schondorf, R., & Low, P. A. (1993) · Neurology · doi:10.1212/wnl.43.1_part_1.132 · Cited by 548 · see citing works
Postural orthostatic tachycardia syndrome: the Mayo clinic experience
Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., Low, P. A., Lennon, V. A., & Shen, W.-K. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)61027-6 · Cited by 516 · cited 1× · see citing works
“The prevalence of anti-gAChR antibodies in this study was higher than that in previous study.(17) Anti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.”
ResultPostural tachycardia syndrome: a heterogeneous and multifactorial disorder
Benarroch, E. E. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.08.013 · Cited by 370 · cited 4× · see citing works
“Postural orthostatic tachycardia syndrome (POTS) is the most common form of orthostatic intolerance characterized by lightheadedness, presyncope and palpitations, and nonorthostatic symptoms, such as fatigue, abnormalities of sleep, myofascial pain, nausea, and migraine headache.(2) Gastrointestinal (GI) disturbances…”
BackgroundInfluentialAutoimmune Basis for Postural Tachycardia Syndrome
Li, H., Yu, X., Liles, C., Khan, M., Vanderlinde‐Wood, M., Galloway, A., Zillner, C., Benbrook, A., Reim, S., Collier, D., et al. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.113.000755 · Cited by 255 · see citing works
Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS)
Blitshteyn, S. (2015) · Lupus · doi:10.1177/0961203315587566 · Cited by 116 · cited 4× · see citing works
“The prevalence of anti-gAChR antibodies in this study was higher than that in previous study.17 Anti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.18 Although POTS is pathophysiolog…”
BackgroundInfluentialNakane, S., Higuchi, O., Koga, M., Kanda, T., Murata, K., Suzuki, T., Kurono, H., Kunimoto, M., Kaida, K., Mukaino, A., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0118312 · Cited by 78 · cited 2× · see citing works
“Serum gAChRa3 and b4 antibodies were detected using Luciferase immunoprecipitation system (LIPS) assays, as described previously.(11) Antibody levels were expressed as the antibody index (A.”
MethodSelf-citationLoavenbruck, A., Iturrino, J., Singer, W., Sletten, D. M., Low, P. A., Zinsmeister, A. R., & Bharucha, A. E. (2015) · Neurogastroenterology & Motility · doi:10.1111/nmo.12480 · Cited by 63 · cited 1× · see citing works
“Gastrointestinal (GI) disturbances are common and prolonged in patients with POTS, and it remains unknown whether extravascular volume depletion and deconditioning contribute to POTS in patients with other autonomic symptoms.(3,4) The pathophysiology of POTS is heterogeneous and includes impaired sympathetically-media…”
BackgroundOther autonomic neuropathies associated with ganglionic antibody
Sandroni, P., & Low, P. A. (2009) · Autonomic Neuroscience · doi:10.1016/j.autneu.2008.10.022 · Cited by 63 · cited 1× · see citing works
“Sandroni and Low demonstrated occasional positivity to gAChR antibodies in POTS patients.(10) Previously, we reported the relationship among the anti-gAChR antibodies, autonomic”
BackgroundPostural Orthostatic Tachycardia Syndrome (POTS) – A novel member of the autoimmune family
Dahan, S., Tomljenovic, L., & Shoenfeld, Y. (2016) · Lupus · doi:10.1177/0961203316629558 · Cited by 55 · cited 4× · see citing works
“The prevalence of anti-gAChR antibodies in this study was higher than that in previous study.17 Anti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.18 Although POTS is pathophysiolog…”
BackgroundInfluentialWang, X.-L., Ling, T.-Y., Charlesworth, M. C., Figueroa, J. J., Low, P., Shen, W.-K., & Lee, H.-C. (2013) · Translational Research · doi:10.1016/j.trsl.2013.03.002 · Cited by 41 · see citing works
Connective tissue disorders: systemic lupus erythematosus, Sjögren's syndrome, and scleroderma.
Streifler, J., & Molad, Y. (2014) · Handbook of Clinical Neurology · doi:10.1016/b978-0-7020-4086-3.00030-8 · Cited by 39 · see citing works
Mukaino, A., Nakane, S., Higuchi, O., Nakamura, H., Miyagi, T., Shiroma, K., Tokashiki, T., Fuseya, Y., Ochi, K., Umeda, M., et al. (2016) · Modern Rheumatology · doi:10.3109/14397595.2016.1147404 · Cited by 36 · cited 2× · see citing works
“To evaluate the diagnostic accuracy of this assay, we verified the cut-off points for all data collected in the previous study.(12,13)”
BackgroundMethodSelf-citationWang, Z., Low, P. A., & Vernino, S. (2010) · Experimental Neurology · doi:10.1016/j.expneurol.2009.12.016 · Cited by 34 · cited 4× · see citing works
“The prevalence of anti-gAChR antibodies in this study was higher than that in previous study.17 Anti-gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS.18 Although POTS is pathophysiolog…”
BackgroundInfluentialAutoimmunoreactive IgGs from patients with postural orthostatic tachycardia syndrome
Wang, X.-L., Chai, Q., Charlesworth, M., Figueroa, J. J., Low, P., Shen, W., & Lee, H.-C. (2012) · PROTEOMICS - Clinical Applications · doi:10.1002/prca.201200049 · Cited by 34 · see citing works
Clinical challenges in the diagnosis and management of postural tachycardia syndrome
Jones, P., Shaw, B., & Raj, S. (2016) · Practical Neurology · doi:10.1136/practneurol-2016-001405 · Cited by 34 · see citing works
Maeda, Y., Migita, K., Higuchi, O., Mukaino, A., Furukawa, H., Komori, A., Nakamura, M., Hashimoto, S., Nagaoka, S., Abiru, S., et al. (2016) · PLOS ONE · doi:10.1371/journal.pone.0146048 · Cited by 25 · cited 2× · see citing works
“To evaluate the diagnostic accuracy of this assay, we verified the cut-off points for all data collected in the previous study.(12,13)”
BackgroundMethodSelf-citationTreatment of autoimmune diseases by inhibition of T-cell costimulation
Wofsy, D., & Daikh, D. (2002) · Modern Rheumatology · doi:10.3109/s101650200000 · Cited by 11
Flagged first, then by citations
Cited by
Sorted by citations
Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies.
Dani, M., Dirksen, A., Taraborrelli, P., Torocastro, M., Panagopoulos, D., Sutton, R., & Lim, P. (2020) · Clinical medicine (London) · doi:10.7861/clinmed.2020-0896 · Cited by 654 · see citing works
Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management
Fedorowski, A. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12852 · Cited by 352 · see citing works
Vernino, S., Bourne, K. M., Stiles, L. E., Grubb, B. P., Fedorowski, A., Stewart, J. M., Arnold, A. C., Pace, L. A., Axelsson, J., Boris, J. R., et al. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102828 · Cited by 304 · see citing works
Blitshteyn, S., & Whitelaw, S. (2021) · Immunologic research · doi:10.1007/s12026-021-09185-5 · Cited by 267 · see citing works
Post-COVID syndrome. A case series and comprehensive review
Anaya, J., Rojas, M., Salinas, M., Rodríguez, Y., Roa, G., Lozano, M., Rodríguez-Jimenez, M., Montoya, N., Zapata, E., Monsalve, D., et al. (2021) · medRxiv · doi:10.1016/j.autrev.2021.102947 · Cited by 216 · see citing works
Postural Orthostatic Tachycardia Syndrome.
Safavi-Naeini, P., & Razavi, M. (2019) · Texas Heart Institute Journal · doi:10.32388/252647 · Cited by 177
Stella, A. B., Furlanis, G., Frezza, N. A., Valentinotti, R., Ajčević, M., & Manganotti, P. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10735-y · Cited by 146 · see citing works
Scientific Advances in and Clinical Approaches to Small-Fiber Polyneuropathy
Oaklander, A., & Nolano, M. (2019) · JAMA Neurology · doi:10.1001/jamaneurol.2019.2917 · Cited by 140 · see citing works
Postural orthostatic tachycardia syndrome as a sequela of COVID-19
Ormiston, C. K., Świątkiewicz, I., & Taub, P. (2022) · Heart Rhythm · doi:10.1016/j.hrthm.2022.07.014 · Cited by 125 · see citing works
Autoimmunity in postural orthostatic tachycardia syndrome: Current understanding
Vernino, S., & Stiles, L. E. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.005 · Cited by 107 · see citing works
Shoenfeld, Y., Ryabkova, V., Scheibenbogen, C., Brinth, L., Martínez-Lavín, M., Ikeda, S., Heidecke, H., Watad, A., Bragazzi, N. L., Chapman, J., et al. (2020) · Clinical Immunology · doi:10.1016/j.clim.2020.108384 · Cited by 74 · see citing works
Mathias, C. J., Owens, A., Iodice, V., & Hakim, A. (2021) · American Journal of Medical Genetics Part C: Seminars in Medical Genetics · doi:10.1002/ajmg.c.31951 · Cited by 65 · see citing works
“There is recent and increasing evidence both on measurement of antibody levels and in response to immunotherapy that autoimmune mechanisms may be causative or contributory (Al-Ansari & Robertson, 2021; Gunning et al., 2019; Vernino & Stiles, 2018; Watari et al., 2018).”
BackgroundBecker, R. (2021) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-021-02549-6 · Cited by 58 · see citing works
Golden, E. P., & Vernino, S. A. (2019) · Clinical Autonomic Research · doi:10.1007/s10286-019-00611-1 · Cited by 64 · see citing works
Autonomic dysfunction and HPV immunization: an overview
Blitshteyn, S., Brinth, L., Hendrickson, J., & Martínez-Lavín, M. (2018) · Immunologic research · doi:10.1007/s12026-018-9036-1 · Cited by 54 · see citing works
Kharraziha, I., Axelsson, J., Ricci, F., Di Martino, G., Persson, M., Sutton, R., Fedorowski, A., & Hamrefors, V. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.015989 · Cited by 54 · see citing works
Autoimmunity in Long Covid and POTS
El-Rhermoul, F.-Z., Fedorowski, A., Eardley, P., Taraborrelli, P., Panagopoulos, D., Sutton, R., Lim, P., & Dani, M. (2023) · Oxford Open Immunology · doi:10.1093/oxfimm/iqad002 · Cited by 48 · see citing works
Is postural orthostatic tachycardia syndrome (POTS) a central nervous system disorder?
Blitshteyn, S. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10502-z · Cited by 46 · see citing works
Boris, J. R., Huang, J., & Bernadzikowski, T. (2019) · Clinical Autonomic Research · doi:10.1007/s10286-019-00622-y · Cited by 40 · see citing works
Liao, Y., & Du, J.-B. (2020) · Neuroscience Bulletin · doi:10.1007/s12264-020-00497-4 · Cited by 39 · see citing works
Postural Orthostatic Tachycardia Syndrome (POTS): An Update for Clinical Practice.
Sebastian, S. A., Co, E. L., Panthangi, V., Jain, E., Ishak, A., Shah, Y., Vasavada, A., & Padda, I. (2022) · Current problems in cardiology · doi:10.1016/j.cpcardiol.2022.101384 · Cited by 33 · see citing works
Is post-COVID syndrome an autoimmune disease?
Anaya, J., Herrán, M., Beltrán, S., & Rojas, M. (2022) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2022.2085561 · Cited by 32 · see citing works
Adrenergic Autoantibody‐Induced Postural Tachycardia Syndrome in Rabbits
Li, H., Zhang, G.-G., Zhou, L.-P., Nuss, Z., Beel, M., Hines, B., Murphy, T., Liles, J., Zhang, L., Kem, D., et al. (2019) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.119.013006 · Cited by 31 · see citing works
“Antiganglionic acetylcholine receptor antibodies were found to be variably present in POTS patients.(11,13) Our group first reported the presence of activating autoantibodies (AAb) to the a1-adrenergic (a1AR) and b1/ 2-adrenergic receptors (b1/2AR) in a significant proportion of patients with POTS in 2014.”
BackgroundAutoimmune autonomic ganglionopathy: an update on diagnosis and treatment
Nakane, S., Mukaino, A., Higuchi, O., Watari, M., Maeda, Y., Yamakawa, M., Nakahara, K., Takamatsu, K., Matsuo, H., & Ando, Y. (2018) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2018.1540304 · Cited by 31 · see citing works
“It has been indicated the detection of gAChR Abs in 10 to 20% of POTS patients [62].”
BackgroundSelf-citationBlitshteyn, S. (2023) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-023-01307-w · Cited by 30 · see citing works
Neuroimmune Pathophysiology of Long COVID
Moen, J. K., Baker, C. A., & Iwasaki, A. (2025) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13855 · Cited by 25 · see citing works
Horowitz, R. I., & Freeman, P. (2018) · Healthcare · doi:10.3390/healthcare6040129 · Cited by 25 · see citing works
“This can be summed up by “the 4 R’s”: Replace (hormones), Repair (mitochondria) [61,146], Rebalance (ANS) [82,147,148], and Re-inoculate (G.”
BackgroundInfluentialPostural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management
Chen, G.-Z., Du, J.-B., Jin, H.-F., & Huang, Y.-Q. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2020.00474 · Cited by 24 · see citing works
Billig, S. C. I., Schauermann, J. C., Rolke, R., Katona, I., Schulz, J. B., & Maier, A. (2019) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000000770 · Cited by 21 · see citing works
“POTS could be caused by an autoimmune process affecting small fibers in the hands, the feet, and even the heart.(2,8,17,18) Antibodies may attach to different structures, such as adrenergic and muscarinic receptors, and result in various pathomechanisms, as already suspected.”
BackgroundEmerging biomarkers for cardiac arrhythmias.
Hammerer-Lercher, A., Namdar, M., & Vuilleumier, N. (2019) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2019.11.012 · Cited by 20 · see citing works
Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review
Lau, D. H., Fedorowski, A., Raj, S. R., Schild, C., Pace, L., Blitshteyn, S., Raj, V., Boris, J. R., Kavi, L., Seeley, M., et al. (2026) · Heart Lung and Circulation · doi:10.1016/j.hlc.2025.09.004 · Cited by 21 · see citing works
A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2
Singh, T., Zidar, D. A., McCrae, K., Highland, K., Englund, K., Cameron, S., & Chung, M. K. (2023) · Circulation Research · doi:10.1161/circresaha.122.322228 · Cited by 19 · see citing works
Autoimmune autonomic ganglionopathy: Ganglionic acetylcholine receptor autoantibodies.
Urriola, N., & Adelstein, S. (2021) · Autoimmunity Reviews · doi:10.1016/j.autrev.2021.102988 · Cited by 18 · see citing works
Autoimmune Autonomic Neuropathy: From Pathogenesis to Diagnosis
Nakane, S., Koike, H., Hayashi, T., & Nakatsuji, Y. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25042296 · Cited by 17 · see citing works
“We mentioned the agonistic mechanism of autoantibodies when we reported on autoimmunity in postural orthostatic tachycardia syndrome (POTS) [20].”
BackgroundSelf-citationCarod-Artal, F. J., & García-Moncó, J. (2021) · Neurology Perspectives · doi:10.1016/j.neurop.2021.07.005 · Cited by 16 · see citing works
Plasma Exchange Therapy in Postural Tachycardia Syndrome: A Novel Long-term Approach?
Wells, R., Hissaria, P., Elliott, A., Sanders, P., Page, A., Baumert, M., & Lau, D. H. (2019) · American Journal of Medicine · doi:10.1016/j.amjmed.2019.10.016 · Cited by 15 · see citing works
Narasimhan, B., Calambur, A., Moras, E., Wu, L.-L., & Aronow, W. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s380270 · Cited by 14 · see citing works
“It has been used off-label in patients with POTS and is reported to improve quality of life and reduce resting heart rates.69,70 Pyridostigmine (an acetylcholinesterase inhibitor) has been used with some benefit, particularly in patients with autoimmune / paraneoplastic POTS.”
BackgroundInfluentialGunning, W., Kramer, P. M., Cichocki, J. A., Karabin, B., Khuder, S., & Grubb, B. (2022) · Cells · doi:10.3390/cells11050774 · Cited by 14 · see citing works
Blitshteyn, S., Funez-dePagnier, G., Szombathy, A., & Hutchinson, M. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1647203 · Cited by 13 · see citing works
The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study
O'Dell, J., Walker, A., Latham, A., Parisian, D. J., Branch, L. E., Vanderburg, D. D., Cox, A. A., Chavis, S., & Smith, S. E. (2025) · Journal of Patient Experience · doi:10.1177/23743735251314651 · Cited by 13 · see citing works
“35,36 Moreover, similarly to what was reported for POTS, 25 27% of participants from our cohort report concomitant autoimmune and in fl ammatory conditions.”
Eftekhari, H., Maddock, H., Pearce, G., Raza, S., Kavi, L., Lim, P. B., Osman, F., & Hayat, S. (2021) · Autonomic Neuroscience: Basic & Clinical · doi:10.1016/j.autneu.2021.102808 · Cited by 13 · see citing works
“One broad call has been to improve the understanding of different POTS aetiologies (3), reflected in increasing research into autoimmunity and mast cell activation disorder (34-36).”
BackgroundAutoimmunity in Syndromes of Orthostatic Intolerance: An Updated Review
Pena, C., Moustafa, A., Mohamed, A.-R., & Grubb, B. P. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14040435 · Cited by 13 · see citing works
“The results of this study provided evidence for the presence of AT1R antibodies in POTS patients [11].”
ResultVaranasi, S., Sathyamoorthy, M., Chamakura, S. R., & Shah, S. A. (2021) · Cureus · doi:10.7759/cureus.18398 · Cited by 12 · see citing works
“Most patients with POTS have elevated autoantibodies to at least one of a wide range of receptors associated with autonomic function: adrenergic receptors (beta1 and beta2), muscarinic receptors (M2 and M4), acetylcholine receptors (N type and P/Q type), opioid-like 1 receptors, and angiotensin II type 1 receptors [8].”
BackgroundHuang, K. Z., & Dellon, E. S. (2019) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld.2014.1121.281.syd · Cited by 12 · see citing works
Spera, F. R., Mistrulli, R., Salerno, L., Vannini, F., Muthukkattil, M. L., Falcetti, R., Segal, T. Y., Barbato, E., & Buonsenso, D. (2024) · Current Clinical Microbiology Reports · doi:10.1007/s40588-024-00217-w · Cited by 11 · see citing works
“Although the exact relationship between IST and POTS is unknown, the overlapping multisystemic and autonomic abnormalities seen in selected IST patients suggest that these two syndromes may share some common pathophysiologic mechanisms [8].”
Zhang, R., Mayuga, K., Shields, R., Cantrell, C., & Wilson, R. G. (2022) · Cureus · doi:10.7759/cureus.31021 · Cited by 10 · see citing works
“Ganglionic acetylcholine receptor (gAChR) antibodies have also been suggested as a marker of neuropathic POTS and have previously been reported to be present in up to 14-29% of patients tested [3,13].”
BackgroundRodriguez, B., Hochstrasser, A., Eugster, P. J., Grouzmann, E., Müri, R., & Z'Graggen, W. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.968725 · Cited by 10 · see citing works
“In recent years, an increasing number of studies reported the presence of autoantibodies against G-coupled protein receptors in patients with neuropathic POTS, suggesting an immune-mediated pathogenesis in a subset of these patients (Li et al., 2014; Fedorowski et al., 2017; Ruzieh et al., 2017; Watari et al., 2018; G…”
BackgroundProconvertase Furin Is Downregulated in Postural Orthostatic Tachycardia Syndrome
Spahic, J., Ricci, F., Aung, N., Axelsson, J., Melander, O., Sutton, R., Hamrefors, V., & Fedorowski, A. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00301 · Cited by 10 · see citing works
Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
Park, J.-H., Park, S., Kim, N.-H., Lee, Y., Chang, Y., & Song, T.-J. (2024) · Medicina · doi:10.3390/medicina60081325 · Cited by 9 · see citing works
“In addition, POTS has been observed in conjunction with various autoimmune and connective tissue disorders, including Hashimoto’s thyroiditis, irritable bowel syndrome, rheumatoid arthritis, and Ehlers–Danlos syndrome [25].”
BackgroundSunami, Y., Sugaya, K., Miyakoshi, N., Iwazaki, O., & Takahashi, K. (2022) · Immunologic research · doi:10.1007/s12026-021-09256-7 · Cited by 9 · see citing works
“In addition to the demographic features (age of onset and disease duration), the following eight assessment items were selected for their potential link to the autoimmune etiology of POTS based on previous studies of autonomic autoimmune neuropathy and POTS [7, 9]: the proportion of patients younger or older than 20 y…”
BackgroundKelley, M. A., & Oaklander, A. (2020) · Canadian journal of pain = Revue canadienne de la douleur · doi:10.1080/24740527.2020.1712652 · Cited by 9 · see citing works
“Primary Sjögren’s syndrome (often seronegative21) is the most common systemic autoimmune disease associated with SFN, and efficacy of treatment with pooled intravenous immunoglobulins was recently reported.22 Other iiSFN appears to develop as part of ill-defined systemic dysimmune/inflammatory conditions, with selecti…”
BackgroundCardiovascular dysautonomia in postacute sequelae of SARS‐CoV‐2 infection
Ståhlberg, M., Mahdi, A., Johansson, M., Fedorowski, A., & Olshansky, B. (2023) · Cardiovascular Electrophysiology · doi:10.1111/jce.16117 · Cited by 7 · see citing works
Blitshteyn, S., Doherty, T., & Steinman, L. (2026) · ImmunoTargets and Therapy · doi:10.2147/itt.s581262 · Cited by 6 · see citing works
G protein-coupled receptors related to autoimmunity in postural orthostatic tachycardia syndrome
Sunami, Y., Sugaya, K., & Takahashi, K. (2024) · Immunological Medicine · doi:10.1080/25785826.2024.2370079 · Cited by 6 · see citing works
“[11,12], surgery, trauma, pregnancy or excessive psychosocial stress.”
Insights into postural orthostatic tachycardia syndrome after COVID-19 in pediatric patients
Cui, Y.-X., Du, J.-B., & Jin, H. (2024) · World Journal of Pediatrics · doi:10.1007/s12519-024-00796-0 · Cited by 6 · see citing works
“Although POTS may have several underlying mechanisms and etiologies, increasing evidence suggests that it may be related to autoimmune disease, and several autoreactive immunoglobulin G antibodies have been identified [47, 48].”
Fan, S.-J., Cui, Y., Liao, Y., & Jin, H.-F. (2023) · Children · doi:10.3390/children10071093 · Cited by 6 · see citing works
Postural tachycardia syndrome (POTS) and antiphospholipid syndrome (APS): What do we know so far?
Noureldine, H., Hasbani, G. E., Eldine, M. N., Nour-Eldine, W., Taher, A., & Uthman, I. (2021) · Revue neurologique (Paris) · doi:10.1016/j.neurol.2021.10.006 · Cited by 5 · see citing works
gAChR antibodies in children and adolescents with acquired autoimmune dysautonomia in Japan
Yamakawa, M., Watari, M., Torii, K.-I., Kuki, I., Miharu, M., Kawazu, M., Mukaino, A., Higuchi, O., Maeda, Y., Ikeda, T., et al. (2021) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51317 · Cited by 5 · see citing works
Self-citationUtility of salivary gland biopsy in diagnosing Sjogren's syndrome in a POTS patient population.
Pasadyn, S. R., Warren, C., & Wilson, R. G. (2020) · Autonomic Neuroscience: Basic & Clinical · doi:10.1016/j.autneu.2020.102694 · Cited by 5 · see citing works
Zawadka-Kunikowska, M., Rzepiński, Ł., Cieślicka, M., Klawe, J., & Tafil-Klawe, M. (2023) · Neurological Sciences · doi:10.1007/s10072-023-06927-1 · Cited by 4
“found that antiganglionic nicotinic acetylcholine receptor (gAChR) antibodies occurred more frequently in patients with POTS compared to HCs, suggesting that anti-gAChR antibodies may be associated with POTS and its underlying autonomic [32].”
BackgroundPathophysiology and Classification of PoTS
Lloyd, M., & Raj, S. (2020) · Postural Tachycardia Syndrome · doi:10.1007/978-3-030-54165-1_5 · Cited by 4 · see citing works
Unmasking the true face of postural orthostatic tachycardia syndrome
Fedorowski, A. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12917 · Cited by 4 · see citing works
Dysautonomia in ‘long COVID’: Case report
Banerjee, A., & Kumar, S. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_74_23 · Cited by 3 · see citing works
Postural Tachycardia Syndrome and COVID-19: Focus on Ivabradine Therapy
DIXIT, K., & Frishman, W. H. (2022) · Cardiology in Review · doi:10.1097/crd.0000000000000503 · Cited by 4 · see citing works
“20,21 The presence of such antibodies, especially those affecting sympathetic activity, may impair ganglionic transmission and cause some forms of dys-autonomia in these patients.”
BackgroundGoto, Y., Sunami, Y., Sugaya, K., Nakane, S., & Takahashi, K. (2021) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.cn-001598 · Cited by 4 · see citing works
Self-citationPOTS and Antiphospholipid Syndrome: An Unlikely Association
Zee, K., & Qureshi, S. (2021) · Case Reports in Rheumatology · doi:10.1155/2021/9942668 · Cited by 3
Fedorowski, A., Hamrefors, V., & Ricci, F. (2020) · Orthostatic Hypotension in Older Adults · doi:10.1007/978-3-030-62493-4_13 · Cited by 3 · see citing works
Bilen, M. M., Vuran, G., Yılmazer, M., Meşe, T., & Doğan, C. (2025) · Anatolian journal of cardiology · doi:10.14744/anatoljcardiol.2025.5435 · Cited by 2
Dysautonomia in immune‐mediated neuropathies
Kaida, K. (2021) · Neurology and Clinical Neuroscience · doi:10.1111/ncn3.12529 · Cited by 2
Autoimmune Autonomic Disorders
Vernino, S. A. (2020) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000812 · Cited by 35 · see citing works
Biomédica, R., Clínico, C., & Mayo (2023) · doi:10.32776/revbiomed · Cited by 2
Dysimmune small fiber neuropathies
Oaklander, A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-814572-2.00010-8 · Cited by 2 · see citing works
Crouch, T. B., Chelimsky, G., Boylan, L. R., Maxwell, M., Westcott, G., Chase, S., Redman, T., Burch, J. B., Gharbo, R. S., Wells, M., et al. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1829434 · Cited by 1 · see citing works
“Existing biomedical models of POTS have identified multiple potential contributors, including hypovolemia, hyperadrenergic physiology, neuropathic mechanisms, autoimmune processes, connective tissue abnormalities, and cardiovascular deconditioning (Fu et al., 2010; Watari et al., 2018).”
Chopra, P. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1806502 · Cited by 1 · see citing works
The neuromuscular evaluation of postural orthostatic tachycardia syndrome
Owens, M., & Kaur, D. (2023) · Muscle and Nerve · doi:10.1002/mus.27953 · Cited by 1 · see citing works
“2% to 20%, with several small series noting an association with ganglionic acetylcholine receptor antibody (AChR-Ab) positivity, up to 29%.(5,7,8) Epidemiological estimates in POTS are challenging as all data have been reported from autonomic specialty centers with a variable diagnostic approach, and current symptom s…”
BackgroundKluczna, A., Mularska, E., & Dzierżanowski, T. (2022) · European Journal of Medical Research · doi:10.1186/s40001-022-00685-0 · Cited by 1 · see citing works
“Cohort studies indicated the infectious etiology of POTS and the relationship with autoimmune diseases or disorders [25, 30].”
BackgroundJost, K., Rodriguez, B., Söll, N., Hoepner, R., & Z'Graggen, W. (2022) · F1000Research · doi:10.12688/f1000research.109373.1 · Cited by 1 · see citing works
“5 (3-14) Orthostatic arm and/or leg pain Presence N (%) 1 (5) 2 (10) Duration median (range) 5 4 (1-7) Restless legs syndrome Presence N (%) 1 (5) Duration median (range) 7 Orthostatic headache Presence N (%) 2 (10) 1 (5) Duration median (range) 6 (5-7) 3”
BackgroundInfluentialOrthostatic Hypotension in Older Adults
Işık, A., & Soysal, P. (2021) · doi:10.1007/978-3-030-62493-4 · Cited by 1
Is PoTS an Autoimmune Condition?
Rull, G., & Lobo, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-54165-1_20 · Cited by 1 · see citing works
Crouch, T. B., Chase, S., Redman, T., Wells, M., Ashar, Y., Schubiner, H., Maxwell, M., Popoff, E. E., Chelimsky, G., & Chelimsky, T. (2026) · Research Square · doi:10.21203/rs.3.rs-11010997/v1
Postural Orthostatic Tachycardia Syndrome and Dermatomyositis.
Jun, S., Xie, L., Gomes, L. L. A., Saksena, S., Wei, E., Stone, C. J., Faden, D. F., Yang, X.-W., Eldaboush, A., & Werth, V. (2026) · JAMA dermatology · doi:10.1001/jamadermatol.2026.2132
Crouch, T. B., Chase, S., Redman, T., Wells, M., Ashar, Y., Schubiner, H., Maxwell, M., Popoff, E. E., Chelimsky, G., & Chelimsky, T. (2026) · Research Square · doi:10.21203/rs.3.rs-10021161/v1
“Most of the existing research on POTS has focused on structural, peripheral contributors to POTS, such as cardiovascular and immunologic pathophysiological mechanisms [7, 8].”
Blitshteyn, S. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15041477
Syndrome de tachycardie posturale orthostatique
Seder, E., Deharo, J., & Maillé, B. (2023) · EMC - Cardiologie · doi:10.1016/s1166-4568(22)41769-4
Garonzi, M. P. (2022) · L'Espace Politique · doi:10.4000/espacepolitique.10568
[Autoimmune autonomic ganglionopathy].
Nakane, S. (2019) · Rinshō shinkeigaku Clinical neurology · doi:10.5692/clinicalneurol.cn-001354
Self-citationClinical Translation of Discoveries in Cardiomyocyte Biology
Kartha, C. (2021) · Cardiomyocytes in Health and Disease · doi:10.1007/978-3-030-85536-9_20
Endothelial and Autonomic Assessments in the Management of COVID-19
Maarek, A. (2021) · Open Journal of Preventive Medicine · doi:10.4236/ojpm.2021.1112033
“Moreover, autonomic disorders such as OH and postural orthostatic tachycardia syndrome (POTS) have been linked to autoantibodies [43] [44] such as α-/β-adrenoceptors and muscarinic receptors [45] [46], which commonly precede infections in POTS [44] as well as provide a link between autoimmune biomarkers and autoimmune…”
Background
- Authors
- Watari, M., Nakane, S., Mukaino, A., Nakajima, M., Mori, Y., Maeda, Y., Masuda, T., Takamatsu, K., Kouzaki, Y., Higuchi, O., Matsuo, H., & Ando, Y.
- Affiliations
- Kumamoto University (JP)
- Kumamoto University Hospital (JP)
- Nagasaki Kawatana Medical Center (JP)
- Department of Neurology Kumamoto Rosai Hospital Yatsushiro Japan
- Corresponding author
- Nakane, Shunya
- ORCID
- Venue
- Annals of Clinical and Translational Neurology
- Publisher
- Wiley
- Published
- 2018-02-28
- Volume
- 5
- Issue
- 4
- Pages
- 486-492
- ISSN
- 2328-9503 (ISSN-L)
- PMC
- PMC5899914
- OpenAlex
- W2790633734
- Cited by
- 94
- References
- 20
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 12 · 2022: 11 · 2021: 20 · 2020: 14 · 2019: 10 · 2018: 5
- FWCI
- 12.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Clinical and Translational Neurology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Ministry of Education, Culture, Sports, Science and Technology
- Japan Society for the Promotion of Science (25461305, 16K09695)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- postural orthostatic tachycardia syndrome, autoantibodies, antecedent infection, autoimmune disease comorbidity, autoimmune markers
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
