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January 29, 2021Research

Ganglionic Acetylcholine Receptor Antibodies in Postural Tachycardia Syndrome

View ORCID ProfileMeredith Bryarly, View ORCID ProfileSatish R. Raj, Lauren Phillips, View ORCID ProfileLinda S. Hynan, Luis E. Okamoto, Amy C. Arnold, Sachin Y. Paranjape, Megan Vernino, Bonnie K. Black, View ORCID ProfileSteven Vernino
First published January 29, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001047
Meredith Bryarly
aDepartment of Neurology, UT Southwestern Medical Center, Dallas, TX
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  • ORCID record for Meredith Bryarly
Satish R. Raj
bAutonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
dDepartment of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
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Lauren Phillips
aDepartment of Neurology, UT Southwestern Medical Center, Dallas, TX
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Linda S. Hynan
eDepartments of Population & Data Sciences and Psychiatry, UT Southwestern Medical Center, Dallas, TX
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Luis E. Okamoto
bAutonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Amy C. Arnold
bAutonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
cNeural & Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, PA
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Sachin Y. Paranjape
bAutonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Megan Vernino
aDepartment of Neurology, UT Southwestern Medical Center, Dallas, TX
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Bonnie K. Black
bAutonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Steven Vernino
aDepartment of Neurology, UT Southwestern Medical Center, Dallas, TX
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Citation
Ganglionic Acetylcholine Receptor Antibodies in Postural Tachycardia Syndrome
Meredith Bryarly, Satish R. Raj, Lauren Phillips, Linda S. Hynan, Luis E. Okamoto, Amy C. Arnold, Sachin Y. Paranjape, Megan Vernino, Bonnie K. Black, Steven Vernino
Neurol Clin Pract Jan 2021, 10.1212/CPJ.0000000000001047; DOI: 10.1212/CPJ.0000000000001047

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ABSTRACT

Background: Postural Tachycardia Syndrome (POTS), the most common form of dysautonomia, may be associated with autoimmunity in some cases. Autoantibodies against the ganglionic acetylcholine receptor (gAChR) have been reported in a minority of POTS patients but the prevalence and clinical relevance is unclear.

Methods: Clinical information and serum samples were systematically collected from POTS participants and healthy control volunteers (n=294). The level of positive gAChR antibodies was classified as very low (0.02-0.05 nmol/L), low (0.05-0.2 nmol/L) and high (>0.2 nmol/L).

Results: Fifteen of 217 POTS patients (7%) had gAChR antibodies (8 very low; 7 low). Six of the 77 healthy controls (8%) were positive (3 very low; 3 low). There were no clinical differences between seropositive and seronegative POTS patients.

Conclusions: Prevalence of gAChR antibody did not differ between POTS and healthy controls, and none had high antibody levels. POTS patients were not clinically different based on seropositivity. Low levels of gAChR antibodies are not clinically important in POTS.

  • Received August 24, 2020.
  • Accepted December 10, 2020.
  • © 2021 American Academy of Neurology

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