Clinical trial NCT03218761: POTS NET mRNA Functional Correlation With NET Activity
Official title: Validation of Norepinephrine Transporter (NET) mRNA as a Measure of Functional NET Expression in Postural Tachycardia Syndrome (POTS)
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: Postural Tachycardia Syndrome
Keywords: norepinephrine
norepinephrine transporter
Lead sponsor: Vanderbilt University Medical Center
Sponsor class: OTHER
Collaborators: name: National Institute of Neurological Disorders and Stroke (NINDS)
name: University of Calgary
name: Dysautonomia International
First posted: 2017-07-17
Enrollment: 200
Sex: ALL
Minimum age (years): 13
Maximum age (years): 80
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with POTS and Subjects without POTS who are not on drugs that inhibit the norepinephrine transporter and are willing to give their informed consent (or assent and parental consent) to participate in the project.

Brief summary: DNA Acetylation can be responsible for significant down-regulation of transcription of the Norepinephrine Transporter (NET). NET is an important clearance transporter that removes norepinephrine (NE) from sympathetic neuronal synapses. Very low levels of NET can "cause" Postural Tachycardia Syndrome (POTS) or make these patients more susceptible to certain medications. Quantified NET messenger RNA (mRNA) levels from a peripheral blood sample may be able to assess NET availability, which is simpler than older methods. This has not been validated against NET function. In this protocol, the investigators seek to assess whether these NET mRNA levels correlate with NET function. The investigators will assess the DHPG (NET dependent NE metabolite):NE ratio in POTS patients and control subjects from both plasma and urine samples.

Detailed description: Work from The Baker Institute in Melbourne, Australia has shown that there can be significant epigenetic modification of the Norepinephrine Transporter (NET). DNA Acetylation can be responsible for significant down-regulation of transcription. NET is an important clearance transporter that removes norepinephrine (NE) from sympathetic neuronal synapses.Very low levels of NET can produce a hyperadrenergic phenotype and can "cause" Postural Tachycardia Syndrome (POTS). The Baker Institute researchers have started using quantified NET mRNA levels from a peripheral blood sample to assess NET availability. This is a huge advance due to its simplicity, in contrast to a prior method which involved a vein biopsy to look at the level of protein expression.

In this protocol, the investigators seek to assess whether these NET messenger RNA (mRNA) levels correlate with NET function. When NET transports NE back into presynaptic neurons, a high percentage gets converted to a metabolite (DHPG) and then released into the blood stream. Therefore, the ratio of DHPG:NE ratio is decreased with reduced NET activity. The investigators will assess this DHPG:NE ratio in POTS patients and control subjects from both plasma and urine samples.

Eligibility criteria: Inclusion Criteria:

* • Postural Tachycardia Syndrome

  * Previously diagnosed with POTS

    • Control Subjects
  * Not diagnosed with POTS

    * Age between 13-80 years
    * Male and female subjects are eligible.
    * Able and willing to provide informed consent (if ≥18 years) or assent with parental consent (if age 13-17 years)

Exclusion Criteria:

* • Inability to give, or withdrawal of, informed consent

  * Use of serotonin-norepinephrine reuptake inhibitors (SNRI) or NET inhibitors within 1 month

    o These drugs pharmacologically block NET activity
  * Use of Tricyclic antidepressants within 1 week

    o Many tricyclic antidepressants pharmacologically block NET activity
  * Other factors which in the investigator's opinion would prevent the subject from completing the protocol.

Primary outcomes:
measure: Supine Plasma DHPG:NE correlation
timeFrame: 1 day
Secondary outcomes:
measure: Standing Plasma DHPG:NE correlation
timeFrame: 1 day
measure: Urine DHPG:NE correlation
timeFrame: 1 day
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Vanderbilt University Medical Center
state: Tennessee
Study officials:
affiliation: Vanderbilt University
name: Satish R Raj, MD MSCI
role: PRINCIPAL_INVESTIGATOR
References: