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Clinical Autonomic Research
Published in: Clinical Autonomic Research 1/2024

08-12-2023 | Anxiety | Research Article

Anxiety and dysautonomia symptoms in patients with a NaV1.7 mutation and the potential benefits of low-dose short-acting guanfacine

Authors: Rita de Cássia Collaço, Maxime Lammens, Carley Blevins, Kristen Rodgers, Andrei Gurau, Suguru Yamauchi, Christine Kim, Jeannine Forrester, Edward Liu, Jinny Ha, Yuping Mei, Corrine Boehm, Elizabeth Wohler, Nara Sobreira, Peter C. Rowe, David Valle, Malcolm V. Brock, Frank Bosmans

Published in: Clinical Autonomic Research | Issue 1/2024

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Abstract

Purpose

Guanfacine is an α2A-adrenergic receptor agonist, FDA-approved to treat attention-deficit hyperactivity disorder and high blood pressure, typically as an extended-release formulation up to 7 mg/day. In our dysautonomia clinic, we observed that off-label use of short-acting guanfacine at 1 mg/day facilitated symptom relief in two families with multiple members presenting with severe generalized anxiety. We also noted anecdotal improvements in associated dysautonomia symptoms such as hyperhidrosis, cognitive impairment, and palpitations. We postulated that a genetic deficit existed in these patients that might augment guanfacine susceptibility.

Methods

We used whole-exome sequencing to identify mutations in patients with shared generalized anxiety and dysautonomia symptoms. Guanfacine-induced changes in the function of voltage-gated Na+ channels were investigated using voltage-clamp electrophysiology.

Results

Whole-exome sequencing uncovered the p.I739V mutation in SCN9A in the proband of two nonrelated families. Moreover, guanfacine inhibited ionic currents evoked by wild-type and mutant NaV1.7 encoded by SCN9A, as well as other NaV channel subtypes to a varying degree.

Conclusion

Our study provides further evidence for a possible pathophysiological role of NaV1.7 in anxiety and dysautonomia. Combined with off-target effects on NaV channel function, daily administration of 1 mg short-acting guanfacine may be sufficient to normalize NaV channel mutation-induced changes in sympathetic activity, perhaps aided by partial inhibition of NaV1.7 or other channel subtypes. In a broader context, expanding genetic and functional data about ion channel aberrations may enable the prospect of stratifying patients in which mutation-induced increased sympathetic tone normalization by guanfacine can support treatment strategies for anxiety and dysautonomia symptoms.
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Metadata
Title
Anxiety and dysautonomia symptoms in patients with a NaV1.7 mutation and the potential benefits of low-dose short-acting guanfacine
Authors
Rita de Cássia Collaço
Maxime Lammens
Carley Blevins
Kristen Rodgers
Andrei Gurau
Suguru Yamauchi
Christine Kim
Jeannine Forrester
Edward Liu
Jinny Ha
Yuping Mei
Corrine Boehm
Elizabeth Wohler
Nara Sobreira
Peter C. Rowe
David Valle
Malcolm V. Brock
Frank Bosmans
Publication date
08-12-2023
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 1/2024
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-023-01004-1

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