New Diagnostics and Treatment for POTS – An Inflammatory Disease with Significant Impact on Quality of Life in Young Individuals

The autonomic nervous system (ANS) plays a crucial role for maintaining homeostasis in several organ systems, including the cardiovascular and respiratory systems. Postural orthostatic tachycardia syndrome (POTS) is a dysautonomic disorder characterized by an excessive increase in heart rate when upright, accompanied by a broad spectrum of cardiovascular and non-cardiovascular symptoms including orthostatic intolerance, physical deconditioning, palpitations, sleep disturbance, fatigue, muscle weakness and pain as well as cognitive impairment including concentration difficulties, for the latter decreased cerebral oxygenation has been proposed as an explanation. POTS affects mostly young, otherwise healthy subjects leading to severe individual suffering in otherwise healthy young individuals. The condition has been increasingly recognized in in recent years, both as a complication of covid-19 and other infectious and inflammatory diseases, and the condition is likely to affect 0,2-1 % of the population. Different pathophysiological mechanisms have been suggested to interact and overlap in POTS including specific consequences following viral infections such as covid-19. In general an inflammatory autoimmune genesis involving the production of auto-antibodies that interacts with the cardiovascular system is the currently most accepted explanation of this condition. Whereas POTS is well the defined and identified as a significant health problem by a number of organisations, including the American Academy of Neurology; American Heart Association; European Federation of Autonomic Societies; European Society of Cardiology the current diagnostic and therapeutic options of POTS are still insufficient. Of special concern, a causative treatment is lacking and treatments focus on relieving symptoms, often with only partial effect.

In this project we aim to enhance the understanding of the pathophysiological changes POTS by means of further characterizing the inflammatory auto-antibodies found in this condition. Secondly, based on the well known fact that the function of the ANS in other conditions can be improved by physical activity, we will assess a special exercise program as a novel treatment in POTS patients. A cohort of 200 well characterised POTS patients will be included in the project.