POTS-diagnostics

A test panel for POTS patients is available. In addition to auto-antibodies against the Beta-1 adrenergic receptor, auto-antibodies against the Beta-2adrenergic receptor, auto-antibodies against the muscarinic cholinergic Receptor 3 (M3) and auto-antibodies against the muscarinic cholinergic Receptor 4 (M4) we will test muscarinic cholinergic Receptor 1 (M1), muscarinic cholinergic Receptor 2 (M2), muscarinic cholinergic Receptor 5 (M5), as well as Alpha-1 adrenergic receptor auto-antibodies and Alpha-2 adrenergic receptor auto-antibodies. Prof. Dr. Kem, University of Oklahoma Health Sciences Center and VA Medical Center, described the occurrence of AT1R antibodies in sera from POTS patients. Therefore, the CellTrend POTS test profile has been extended to AT1R-Ab testing. The costs for Beta-1, Beta-2 and M1-M5, ATR1 and ETAR are € 27,- ($ 33,-) each, for Alpha-1 and-2 € 112,- ($ 139,-) each and in total € 467,- ($ 575,-). It is also possible to send samples (IMPORTANT: Only send the seperated sera after centrifugation, not the entire unprocessed blood or plasma sample) for auto-antibody POTS-diagnostic to the CellTrend lab.

  • Angiotensin-II-Receptor-1 (AT1R) IgG-auto-antibodies
  • Endothelin-Receptor-A (ETAR) IgG-auto-antibodies
  • Beta-1 adrenergic receptor auto-antibodies
  • Beta-2 adrenergic receptor auto-antibodies
  • Muscarinic cholinergic (M1) receptor auto-antibodies
  • Muscarinic cholinergic (M2) receptor auto-antibodies
  • Muscarinic cholinergic (M3) receptor auto-antibodies
  • Muscarinic cholinergic (M4) receptor auto-antibodies
  • Muscarinic cholinergic (M5) receptor auto-antibodies
  • Alpha-1 adrenergic receptor auto-antibodies
  • Alpha-2 adrenergic receptor auto-antibodies

CFS-diagnostics

Together with Prof. Dr. Carmen Scheibenbogen, University Hospital Charite Berlin, CellTrend developed a straightforward Immuno-Assay for the diagnostic  of the Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The results have been published in Brain, Behavior, and Immunity.  A first clinical trial for treatment has been successfully completed and is published in PLoS ONE (Scheibenbogen C. et al 2018).

Auto-antibodies against the Beta-2 adrenergic receptor, auto-antibodies against the muscarinic cholinergic Receptor 3 (M3) and auto-antibodies against the muscarinic cholinergic Receptor 4 (M4) are elevated in a subset of 20-30% of all patients suffering from Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Tests are available in our lab, it is possible to send samples (IMPORTANT: Only send the seperated sera after centrifugation, not the entire unprocessed blood or plasma sample) for auto-antibody CFS-diagnostic to the CellTrend lab. The costs per biomarker are € 27,- ($ 33,-) and in total € 108,- ($ 132,-).

  • Beta-1 adrenergic receptor auto-antibodies
  • Beta-2 adrenergic receptor auto-antibodies
  • Muscarinic cholinergic (M3) receptor auto-antibodies
  • Muscarinic cholinergic (M4) receptor auto-antibodies

 

Complex regional pain syndrome (CRPS)

Complex regional pain syndrome (CRPS, Morbus Sudeck) is a debilitating disease associated with vasomotor, sudomotor, and sensory disturbances in an affected limb or region of the body (1). The pathophysiological mechanisms of CRPS are not fully understood, and anti-beta-2 adrenergic receptors, anti-alpha-1 adrenergic receptors, and anti-muscarinic cholinergic receptors 2 aab have recently been associated with this condition (2, 3). Due to the suspected auto-immune nature of the disease (in at least a subset of patients), steroids, intravenous immunoglobulin (IVIG), and rituximab have been tried and shown to have variable responses (4, 5, 6). There are a few studies that have reported the efficacy of therapeutic plasma exchange (TPE) on this condition (7, 8). 37 out of 44 (84%) of CRPS patients who underwent TPE (5–7 TPEs over 2–3 weeks) had reported positive response in terms of pain and improvement of other systemic symptoms. The majority required ongoing maintenance TPEs and/ or immunosuppressive medications and adjunctive therapies, to maintain symptomatic improvement.

  • Alpha-1 adrenergic receptor auto-antibodies
  • Beta-2 adrenergic receptor auto-antibodies
  • Muscarinic cholinergic (M2) receptor auto-antibodies

 

Small Fiber Neuropathy (SFN)

Small Fiber Neuropathy (SFN) is a subtype of neuropathy that is characterized by the selective involvement of non-myelinated or thinly-myelinated sensory fibers is marked. Its pathogenesis includes a wide range of immune-mediated, metabolic, toxic, hereditary and genetic disorders. SFN has been described in connection with Sjögren’s syndrome, celiac disease, systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus type 1, inflammatory bowel disease, sarcoidosis and paraneoplastic syndrome. Some data also suggest an association with Hashimoto’s thyroiditis. Clinical symptoms of SFN can manifest as isolated sensory disorders as well as isolated autonomic disorders.

Intravenous immunoglobulin therapy (IVIG) showed a significant effect in treating patients with autoimmune mediated SFN in two large retrospective studies with comparable response rates (77% and 83% of patients).

Autoantibodies against fibroblast growth factor receptor-3 (FGFR3-IgG) and tri-sulfate heparin di-saccharide (TSHDS-IgM) are elevated in SFN. A clinical study is currently evaluating the efficacy of IVIG administration in FGFR3-Ab and TSHDS-Ab positive patients.

  • FGFR3 auto-antibodies
  • TSHDS auto-antibodies

 

  1. S Bruehl. Complex regional pain syndrome. 351, h2730 (2015)
  2. D Kohr, P Singh, M Tschernatsch, M Kaps, E Pouokam, M Diener, W Kummer, F Birklein, A Vincent, A Goebel, G Wallukat, F Blaes. Autoimmunity against the beta2 adrenergic receptor and muscarinic-2 receptor in complex regional pain syndrome. Pain 152, 2690–2700 (2011)
  3. E Dubuis, V Thompson, MI Leite, F Blaes, C Maihofner, D Greensmith, A Vincent, N Shenker, A Kuttikat, M Leuwer, A Goebel. Longstanding complex regional pain syndrome is associated with activating autoantibodies against alpha- 1a adrenoceptors. Pain 155, 2408–2417 (2014)
  4. Prednisolone in complex regional pain syndrome. Atalay NS, Ercidogan O, Akkaya, N, Sahin F. Pain Physician 2014;17: 179–185
  5. A Goebel, M Stock, R Deacon, G Sprotte, A Vincent. Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1. Ann Neurol. 57, 463–464 (2005)
  6. JE Hendrickson, ET Hendrickson, EA Gehrie, D Sidhu, G Wallukat, I Schimke, AT Tormey. Complex Regional Pain Syndrome and Dysautonomia in a 14-Year-Old Girl Responsive to Therapeutic Plasma Exchange. J Clin Apher. 31(4), 368-374 (2016)
  7. E Aradillas, RJ Schwartzman, JR Grothusen, A Goebel, GM Alexander. Plasma exchange therapy in patients with complex regional pain syndrome. Pain Physician 18, 383–394 (2015)
  8. F Blaes, B Dharmalingam, M Tschernatsch, A Feustel, T Fritz, D Kohr, P Singh, M Kaps, G Szalay. Improvement of complex regional pain syndrome after plasmapheresis. Eur J Pain 19, 503–507 (2015).