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A growing body of evidence suggests that\n              <jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>\n              may be an autoimmune disorder. Antinuclear antibodies and elevations of ganglionic, adrenergic, and muscarinic acetylcholine receptor antibodies have all been reported.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We collected detailed clinical symptoms of 55 patients diagnosed with\n              <jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>\n              . We also evaluated serum levels of autoantibodies against 4 subtypes of G\u2010protein coupled adrenergic receptors and 5 subtypes of G\u2010protein coupled muscarinic acetylcholine receptors by\n              <jats:styled-content style=\"fixed-case\">ELISA<\/jats:styled-content>\n              . Our patients had a multitude of comorbidities, were predominantly young females, and reported viral\u2010like symptoms preceding episodes of syncope. We detected a significant number of patients with elevated levels of autoantibodies against the adrenergic alpha 1 receptor (89%) and against the muscarinic acetylcholine M\n              <jats:sub>4<\/jats:sub>\n              receptor (53%). Surprisingly, elevations of muscarinic receptor autoantibodies appeared to be dependent upon elevation of autoantibodies against the A\n              <jats:sub>1<\/jats:sub>\n              adrenergic receptor! Four patients had elevations of G\u2010protein coupled autoantibodies against all 9 receptor subtypes measured in our study. Five\n              <jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>\n              patients had no elevation of any autoantibody; similarly, controls were also negative for autoantibody elevations. There was a weak correlation of clinical symptom severity with G\u2010protein coupled autoantibodies.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Our observations provide further evidence that, in most cases,\n              <jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>\n              patients have at least 1 elevated G\u2010protein coupled adrenergic autoantibody and, in some instances, both adrenergic and muscarinic autoantibodies, supporting the hypothesis that\n              <jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>\n              may be an autoimmune disorder.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.013602","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T09:00:13Z","timestamp":1568019613000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":104,"title":["Postural Orthostatic Tachycardia Syndrome Is Associated With Elevated G\u2010Protein Coupled Receptor Autoantibodies"],"prefix":"10.1161","volume":"8","author":[{"suffix":"III","given":"William T.","family":"Gunning","sequence":"first","affiliation":[{"name":"Department of Pathology University of Toledo OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Kvale","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Toledo OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula M.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Toledo OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly L.","family":"Karabin","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair P.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2014.00220"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000267663.05398.40"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2012.04.014"},{"key":"e_1_3_1_5_2","first-page":"S19","article-title":"Postural tachycardia syndrome (POTS)","volume":"45","author":"Low PA","year":"1995","unstructured":"Low PA, Opfer\u2010Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, Suarez GA, Rummans TA. 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