Autoimmunity in Syndromes of Orthostatic Intolerance: An Updated Review.

Area of Science:

• Autonomic Neuroscience
• Immunology
• Cardiovascular Physiology

Background:

• Orthostatic intolerance (OI) encompasses dysautonomic disorders such as postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH), often indicating severe autonomic failure.
• The precise causes of OI remain unclear but are associated with factors like peripheral neuropathy, renin-aldosterone imbalances, hypovolemia, and autoimmune mechanisms.
• Specific autoantibodies targeting adrenergic, cholinergic, and angiotensin II type I receptors have been implicated in OI pathogenesis.

Purpose of the Study:

• To review current literature on the connection between autoimmune processes and orthostatic intolerance syndromes.
• To explore the role of autoantibodies in the development of POTS and OH.
• To summarize evidence regarding the efficacy of immunomodulatory treatments for OI.

Main Methods:

• Literature review of contemporary research.
• Analysis of studies implicating autoantibodies in OI.
• Examination of case series reporting outcomes of immunomodulation therapy.

Main Results:

• Evidence suggests a significant association between autoimmune processes and the development of POTS and OH.
• Autoantibodies against key receptors are implicated in the underlying pathology of OI.
• Immunomodulatory therapies have demonstrated positive effects on autonomic symptoms in OI patients.

Conclusions:

• Autoimmunity is a key factor in the pathogenesis of orthostatic intolerance, including POTS and OH.
• Targeting autoimmune mechanisms through immunomodulation offers a potential therapeutic strategy for OI.
• Further research is warranted to fully elucidate the autoimmune basis of OI and optimize treatment approaches.