IACFS/ME Conference: Dr Blair Grubb on POTS – Postural Tachycardia Syndrome

The 2^nd Virtual Scientific Conference for the International Association for Chronic Fatigue Syndrome/ Myalgia Encephalomyelitis was held on the 19^th – 21^st August 2021 (streamed on zoom). The conference promoted unpublished data and included both clinicians and biomedical researchers. 

The talks were grouped into different sections, including the longer 45 minute talks in the Professional Workshops and shorter talks covering topics of infectious diseases, immunology and clinical cases. 

We have chosen a selection of the talks which will hopefully be of interest to you, which are listed below. Here we report on our second talk in this series with a talk from Dr Blair Grubb who’s presentation focused on POTS (Postural Tachycardia Syndrome), with his presentation titled “Dysautonomia”. The further talks we will cover are shown below and these will be available in one report by the end of October 2021. 

Due to the format of the conference and the focus on unpublished data, no direct recordings or pictures are available freely as this may jeopardise publication. The full conference programme can be found on the IACFS/ME website here, where recorded presentations may be purchased. 

2. Dysautonomia 

Blair Grubb, MD  
University of Toledo; Toledo, OH, USA 

Dr Blair Grubbs is a distinguished university professor of medicine and paediatrics, his talk focused on research into POTS (Postural Tachycardia Syndrome).  Dr Grubb’s talk started with an introduction to the autonomic system which regulates all systems in the body which keep you alive, for example blood pressure, heart rate, temperature and gut processes (our bodies have no control over these processes). Dr Grubbs went on to explain the role of the autonomic system involving the brain and heart upon standing, and the role of the skeletal muscle pump. 

Dr Grubbs then gave a brief background to the five distinct ANS disorders (Autonomic Nervous System)- NCS, POTS, Dysautonomia, cerebral syncope and psychogenic syncope. Fatigue is a major component of all of these. Dr Grubbs talk then focused on POTS, definition and its history. 

Dr Grubbs research is currently investigating if POTS is an autoimmune disorder, due to the onset often following a viral infection (75% of cases);it frequently exists in people who already have autoimmune disorders or go on to develop other autoimmune conditions. Evidence for POTS as a autoimmune condition has previously been found, but it’s not until the last 10-15 years that technological advances have allowed cost-effective research. 

Research into POTS as an autoimmune disorder has found high levels of autoantibodies (typically Alpha 1 receptors and cholinergic muscarinic receptors (in 50% of patients)). Evidence has also been found for platelet dysfunction, with this being more common than first thought. Dr Grubbs then described the roles of innate auto-inflammatory and adaptive immunity, which can cause autoinflammatory and autoimmune responses, respectively. Research into the autoinflammatory role has looked at the levels of cytokines/ chemokine which have been found to be 20-30 times higher, suggesting a chronic inflammatory state. This gives more evidence for POTS being an autoimmune disease but also has an autoinflammatory component. Furthermore, the condition tends to develop after a COVID-19 infection. 

Dr Grubbs briefly described the treatment options for POTS, where medication is often used as a last resort. Alternatives are looked at first, such as increasing salt and water intake, reconditioning and stretch building. For reconditioning and exercise, water based activities (swimming) or rowing machines were recommended which can be done lying down or seated. 

Lastly Dr Grubbs stressed the impact that chronic illness has on the whole family and the impact on daily lives. He also emphasised the emotional stress caused, and that counselling does have a role with coping with the emotional side. 

Katrina Pears, Research Correspondent, ME Association