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Angiotensin II Type 1 Receptor Autoantibodies in Postural Tachycardia Syndrome, 2018, Yu et. al.

Discussion in 'Autonomic, Cardiovascular, and Respiratory' started by voner, Apr 10, 2018.

  1. voner

    voner Senior Member

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    https://www.ncbi.nlm.nih.gov/pubmed/29618472

    other authors include Dr. Satish Raj and Dr. Kem. Seems like a significant finding.
     
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  2. Gingergrrl

    Gingergrrl Senior Member

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    @voner Thanks for sending me this and for posting it here. Are there labs (outside of research studies) that test POTS patients for this angiotensin II autoantibody (AT1R)? I assume if someone had it, this would also be classified as "Autoimmune POTS" (like me who has the alpha & beta adrenergic autoantibodies, etc).

    It seems very significant and I know Dr. Kem is trying to solve the mystery behind POTS. I tried to contact him once but got no reply. Would the treatment be autoimmune like high dose IVIG, etc?
     
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  3. voner

    voner Senior Member

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    @Gingergrrl,

    I don’t know the answers to those questions. I doubt there’s any commercial lab that contest for these antibodies yet. Consider forwarding that paper onto your docs and see how they respond. Satish Raj used to be at Vanderbilt – who has a well published dysautonomia faculty. I hope someone else will comment.
     
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  4. Malea

    Malea

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    This study was shared some days ago in a german group on facebook, so I already had a look which lab would test these antibodies. I have found one here in Germany, its called "Labor Berlin".

    Unfortunately you can't just send your blood there but you will need a (I suspect german) doctor who will do that for you.

    So thats maybe just an option for german folks with cooperating doctors.

    Celltrend is testing Angiotensin autoantibodies, too. But its the wrong type.
     
    Last edited: Apr 11, 2018
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  5. Gingergrrl

    Gingergrrl Senior Member

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    Thank you @voner and I just replied to your PM.

    I suspect it is just a German lab and from my research the labs in Germany are much more advanced than other countries re: testing for autoantibodies and in some other medical procedures.

    Is that a new test that Cell Trend recently added? When I did the Cell Trend testing, they offered nine different autoantibody tests and I did all nine. Do you know if the angiotensin autoantibodies is something new? Also, when you said it is the "wrong type" does that mean it is not the one from @voner's article that potentially correlates with POTS?
     
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  6. Learner1

    Learner1 Forum Support Assistant

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    And, if one had these antibodies, what would the treatment be?
     
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  7. Gingergrrl

    Gingergrrl Senior Member

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    I wondered that too @Learner1 (and we are posting in all of the same threads today :hug:). Someone mentioned that it might be "losartan" but I have not had a chance to Google this yet and see what it is. Since I do not know if I have this autoantibody, I would not try it but was curious, like you, what the proposed treatment might be. It sounds like this is all at the experimental stage though.

    I would assume all of the meds to stop tachycardia are for symptom relief vs. something like IVIG can get to the root cause (if you have Autoimmune POTS vs. another kind of POTS). I would love to speed up the research on all of this but I know it is a slow and arduous process.
     
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  8. voner

    voner Senior Member

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    well.... take a look at this case (n=1) study paper...


    full paper:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142820/pdf/jcad_7_8_41.pdf

    pretty interesting. Losartan extended her exercise tolerance also.
     
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  9. voner

    voner Senior Member

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    ...and losartan significantly decreased her allodynia. That’s almost unheard of.
     

    Attached Files:

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  10. Gingergrrl

    Gingergrrl Senior Member

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    @voner Wow, thanks for finding this stuff and I am definitely going to read the study and research Losartan. I Googled Losartan and POTS and a lot of stuff came up. I have some reading to do and don't know enough about this to even comment yet.

    In 5+ years, I have been recommended just about every med on the planet for POTS by different docs but no one has ever even mentioned Losartan! Is this a new medication?
     
  11. voner

    voner Senior Member

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    and!!

    Dr. Julian Stewart has completed a double-blind clinical trial study on young POTS patients using losartan, but I could not find any publication about the study. Perhaps he has not published yet?

    https://clinicaltrials.gov/ct2/show/NCT01210430


    can anybody find this study published or any other info about it?
     
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  12. voner

    voner Senior Member

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    Wikipedia says it’s a little over 20 years old and it’s inexpensive.
     
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  13. Gingergrrl

    Gingergrrl Senior Member

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    Wow, that is so bizarre! I just printed out your study (from post #8) to read later. I don't know enough to comment yet but am fascinated b/c I thought I had heard of every POTS med & treatment that existed (beta blockers, CA+ Channel blockers, Midodrine, Droxidopa, Mestinon, IV saline, Salt tablets, etc).

    The treatment that's finally helped me to move past my (limited) improvement with Atenolol & Midodrine is IVIG. But I can still trigger an episode if I do certain movements and can still only walk short distances. I don't want to get too excited yet b/c there may be a reason that I cannot tolerate this med or it is contra-indicated for me. Will read up first and be back later. Thx again!
     
  14. Learner1

    Learner1 Forum Support Assistant

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    So, after trying olmesartan and then telmisartan for over a year, I finally decided they were doing nothing to reduce my blood pressure which runs high, or POTS.

    My POTS is doing better with a combo of pyridostigmine and propranolol, while the propranolol is helping my BP.
     
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  15. Malea

    Malea

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    I don‘t want to get too excited yet... but I googled again for the Angiotensin-Autoantibodies at Celltrend and found they seem to not only test the wrong type (by which I meant the TYpe 2 not the Type 1 which was used in the study) but also the Angiotensin II Receptor 1 autoantibodies. Which should be the „right“ type.

    It‘s in german, unfortunately:
    http://www.celltrend.de/g-gekoppelte-rezeptor-auto-antikoerper-elisa.html
    http://www.celltrend.de/tl_files/inhalte/dateien/Produktinfo dt/AT1-AA Produktinfo dt-2012-06.pdf

    I have no idea if it is something new at celltrend, because I‘m very new to this whole autoantibody-topic. But the „product information“ (link number 2) says that this autoantibody test is used to find out if a transplant is accepted (that might the wrong word) by a body and also in testing for scleroderma. So maybe it is not totally new.


    Oh and I really have to remind myself of that we have advanced labs here in Germany and that it is quite a lucky situation. I often feel dismissed as a patient when you just can‘t get things tested but need a doctor who agrees that you get stuff tested. But not all labs are doing it like that and I feel like things are getting a little more patient-friendlier.
     
    Last edited: Apr 12, 2018
  16. Gingergrrl

    Gingergrrl Senior Member

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    I never got a chance to read the Losartan study from Voner but printed it out to read hopefully over the weekend. I'm not expecting any miracle cure for Autoimmune POTS but am curious to see what it says.

    Thanks for explaining that @Malea and it sounds like Cell Trend does not test for the autoantibodies in the study (so for now I guess they are only tested within a research study and not a commercial lab which is what I'd suspected).

    You definitely have lab tests and procedures that are not yet available in the US. In 2014, my doctor had wondered if I had a prior viral infection of the heart (like myocarditis) but said the only definitive test is a heart biopsy and that they are only done in Germany and not the US. I was not going to do one anyway but thought it was interesting that Germany was so much more advanced and open-minded (medically) than we are here. The autoantibody research that most interests me is also from Germany. But I know access to care is a separate issue from lab tests and research, etc.
     
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  17. Malea

    Malea

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    Sorry @Gingergrrl, I'm not good in explaining what I mean because of the language barrier.

    I googled again after you've asked about Celltrend. And I think they are also testing the antibodies from the study.
     
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  18. Gingergrrl

    Gingergrrl Senior Member

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    Thanks and I think I misunderstood your prior post (and your English is excellent)! So, Cell Trend actually does test the autoantibody from that study? Now I am confusing myself, and still have not read the study, but I think the one we are talking about is the "Angiotensin II, Type 1 Receptor Autoantibody" or (AT1R)? I don't think this test was available when I did the nine Cell Trend autoantibody tests in 2016, but maybe it was and I just did not know it?
     
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  19. Malea

    Malea

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    Yes, they're testing the AngiotensinII Recpt1-autoantibody. :) I don't know if its a new test.

    The price is 27 Euro.

    (If they still have my blood from the POTS-Panel last month, which they weren't sure about when I called, I will have the antibody tested.)
     
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  20. Sushi

    Sushi Moderation Resource Albuquerque

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    As I remember, Vanderbilt tested for this but probably only on patients in their Autonomic clinic--might be worth checking though.
    Here is an important point: there are a number of causes for POTS and while decreased NO is an important subset, it is probably not true for the majority. (increasing NO is Julian Stewart's usual treatment choice). If you increase NO, you increase vasodilation. The majority of POTS patients seem to respond better to vasoconstriction (hence Midodrine works). So it looks like testing is very important to determine treatment. For instance, testing showed that I was low in norepinephrine in the synapses. This is also a subset but not the majority. So I responded extremely well to Strattera, a norepinephrine reuptake inhibitor.
     
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