Update on postural orthostatic tachycardia syndrome (POTS)

I have done prior posts on POTS (POTS Revisited) and been requested to check the latest research. Checking PUBMED statistics, we see there have been many papers in the last few years

From https://pubmed.ncbi.nlm.nih.gov/?term=+Postural+orthostatic+tachycardia+syndrome+&sort=pubdate&sort_order=asc

Trying Citizen Science

We have 55 samples annotated with POTS and we recently added enzymes to the system. Time to go on a statistical fishing expedition… and we found some fish, all of them small one (i.e. too low production)

EnzymeNamePOTS AverageNo POTS AverageTest StatisticObs
crotonobetainyl-CoA reductase1741500-5.3151128
L-carnitine CoA-transferase1771381-5.0420431
D-apionate oxidoisomerase5731541-4.5786129
nitrite reductase (NO-forming)531117941-4.4625451
5-aminopentanamidase590016862-4.3163151
phosphatidyl-myo-inositol alpha-mannosyltransferase552317379-4.1609450
cysteinylglycine-S-conjugate dipeptidase561117868-4.1582348
polyphosphate—glucose phosphotransferase562117638-4.0976448
8-oxo-dGDP phosphatase572517788-4.0517347
8-oxo-(d)GTP phosphatase593017351-3.9343248
lactocepin14118104-3.9051450
formyl-CoA transferase599817156-3.8491146
oxalyl-CoA decarboxylase623418799-3.8026339
galactofuranosylgalactofuranosylrhamnosyl-N-acetylglucosaminyl-diphospho-decaprenol beta-1,5/1,6-galactofuranosyltransferase571414910-3.6073450
lipid II isoglutaminyl synthase (glutamine-hydrolysing)829222101-3.593754
galactan exo-1,6-beta-galactobiohydrolase (non-reducing end)687619457-3.5312935
N-acetylhexosamine 1-kinase687619434-3.5263735
dehydrogluconokinase671018931-3.5200736
Pup amidohydrolase571815393-3.5116647
prokaryotic ubiquitin-like protein ligase571815393-3.5116647
all-trans-retinol dehydrogenase (NAD+)648417326-3.4796641
gamma-glutamyl hercynylcysteine S-oxide hydrolase687619217-3.4786735
glucosyl-3-phosphoglycerate phosphatase780418811-3.47450
isopenicillin-N epimerase636717710-3.4454638
2-acetylphloroglucinol acetyltransferase629515991-3.4397145
phosphatidylinositol dimannoside acyltransferase889920502-3.3803350
dolichyl-phosphate-mannose—protein mannosyltransferase815617812-3.3424654
sorbose reductase614415938-3.2934941
tRNA (adenine57-N1/adenine58-N1)-methyltransferase809318743-3.2685348
tRNA (adenine58-N1)-methyltransferase809318743-3.2685348

This is actually a happy path because for too low, we can identify probiotics that produces these missing enzymes. Three bifidobacterium are at the top of the list. Custom Probiotics daily recommended dosage for these are 350-400 BCFU /day.

bacillus pumilus8
bacillus simplex2
bacillus velezensis8
bifidobacterium adolescentis26
bifidobacterium animalis subsp. lactis bb-1226
bifidobacterium longum26
clostridium beijerinckii5
clostridium butyricum5
enterococcus durans1
enterococcus faecalis1
lactobacillus acidophilus4
lactobacillus helveticus4
lactobacillus kefiri2
lactobacillus paracasei2
lactobacillus plantarum1
lactobacillus rhamnosus (strain atcc 53103 / gg)2
lactobacillus salivarius2
lactococcus lactis3
leuconostoc lactis2
streptococcus thermophilus3

Bottom Line

We have deduced which probiotics should help POTS (if taken in sufficient dosage) by using citizen science on the annotated-with-symptoms uploads, the KEGG Enzyme data and statistics. We may not know the why’s of these enzymes missing causing POTS, but we have some ideas of where to start looking for explanations. Until then, we at least know what to try.

There have been NO STUDIES using Bifidobacterium probiotics with POTS published.

Again consult with your medical professional first.