Background: Postural Orthostatic Tachycardia Syndrome (POTS) is the most common form of autonomic dysfunction with a heterogeneous pathogenesis and presentation. A small percentage of patients with POTS show evidence for autoantibodies, which suggests a B cell related immune pathology. Aim: We previously showed expansion of the α/β double negative T cells and a decreased HLA-DR-to-CD69 ratio in approximately 15% of a small cohort of POTS patients. We, therefore sought to study peripheral blood T cell subsets and their correlations to autoantibodies in POTS. Methods: We assayed peripheral blood white blood cells of 100 POTS (75 female and 25 male) and 100 age and sex matched controls for cell surface markers that designate subsets of T, B, NK and dendritic cells using flow cytometry. Results: We found a statistically significant increase in total T cells, and un-switched memory B cells as well as an increase in IL-2 receptor expression in T cells (p < 0.01). Serum autoantibodies were present in 5-28% of our POTS cohort. Patients with high levels of AChR binding, and blocking antibodies had a positive relationship with increase in T cells and their double negative subsets (p = 0.0039), whereas patients with ANA showed correlations with B cell surface IgD and CD8 cells (p = 0.0007). Interestingly in patients with anti-thyroglobulin antibodies, a positive correlation was observed only with plasmacytoid dendritic cells (p = 0.0378). Conclusions: There is a distinct correlation between specific autoantibodies and various T, B and dendritic cell subsets suggesting a heterogeneous nature of autoimmune abnormalities in POTS.
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