# Post-Infectious Dysautonomia: Insights into Clinical Phenotypes and Disease Pathogenesis

> **NIH AI K23** · JOHNS HOPKINS UNIVERSITY · 2026 · $198,720

## Abstract

PROJECT SUMMARY/ABSTRACT
Dysautonomia, or autonomic nervous system dysfunction, is a common and disabling post-infectious syndrome
that can occur following COVID-19 and Lyme disease. Dysautonomia accounts for many of the symptoms in
Post-Acute Sequelae of COVID-19 (PASC, also called Long COVID) and Post-Treatment Lyme Disease (PTLD,
also called Chronic Lyme). Dysautonomia has a wide variety of manifestations, including POTS (Postural
orthostatic tachycardia syndrome), gastrointestinal dysmotility, interstitial cystitis, and neuropathic pain. A small-
fiber neuropathy is also often present. The mechanisms of dysautonomia in patients with PASC and PTLD are
not well understood. A subset of patients with dysautonomia have ganglionic acetylcholine receptor (gAchR)
autoantibodies and often respond to immunomodulatory therapy with intravenous immunoglobulin (IVIG),
implicating autoimmune destruction of small nerve fibers as a potential mechanism of dysautonomia. Some
patients without gAchR antibodies still respond to IVIG, suggesting that some autoantibodies remain to be
discovered. This project will leverage the clinical resources of the Johns Hopkins post-Acute COVID Clinic, the
Lyme Disease Research Center, and the POTS Clinic to identify patients with post-infectious dysautonomia.
Patients with confirmed PASC and PTLD dysautonomia will prospectively undergo objective autonomic testing
in the Autonomic Lab, histopathological examination of small-fiber nerve density on skin biopsy, and clinical
phenotyping using patient-reported outcome measures. In Aim 1, we will identify distinct clinical subgroups using
unbiased latent variable cluster analysis. In Aim 2, we will determine the clinical significance of small-fiber
neuropathy in post-infectious dysautonomia by investigating the association with disease severity, and will
correlate clinical outcomes with changes in nerve fiber density over time. In Aim 3, we will perform
immunoprecipitation and mass spectrometry to ident

## Key facts

- **NIH application ID:** 11242029
- **Project number:** 5K23AI180356-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Brittany Lee Adler
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** AI
- **Fiscal year:** 2026
- **Award amount:** $198,720
- **Award type:** 5
- **Project period:** 2025-01-01T00:00:00 → 2029-12-31T00:00:00

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11242029

## Citation

> US National Institutes of Health, RePORTER application 11242029, Post-Infectious Dysautonomia: Insights into Clinical Phenotypes and Disease Pathogenesis (5K23AI180356-02). Retrieved via AI Analytics 2026-07-11 from https://api.ai-analytics.org/grant/nih/11242029. Licensed CC0.

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