Immunoadsorption to remove ß2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME.

Abstract

INTRODUCTION:

Infection-triggered disease onset, chronic immune activation and autonomic dysregulation in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) point to an autoimmune disease directed against neurotransmitter receptors. We had observed elevated autoantibodies against ß2 adrenergic receptors, and muscarinic 3 and 4 acetylcholine receptors in a subset of patients. Immunoadsorption (IA) was shown to be effective in removing autoantibodies and improve outcome in various autoimmune diseases.

METHODS:

10 patients with post-infectious CFS/ME and elevated ß2 autoantibodies were treated with IA with an IgG-binding column for 5 days. We assessed severity of symptoms as outcome parameter by disease specific scores. Antibodies were determined by ELISA and B cell phenotype by flow cytometry.

RESULTS:

IgG levels dropped to median 0.73 g/l (normal 7-16 g/l) after the 4th cycle of IA, while IgA and IgM levels remained unchanged. Similarly, elevated ß2 IgG antibodies rapidly decreased during IA in 9 of 10 patients. Also 6 months later ß2 autoantibodies were significantly lower compared to pretreatment. Frequency of memory B cells significantly decreased and frequency of plasma cells increased after the 4th IA cycle. A rapid improvement of symptoms was reported by 7 patients during the IA. 3 of these patients had long lasting moderate to marked improvement for 6-12+ months, 2 patients had short improvement only and 2 patients improved for several months following initial worsening.

CONCLUSIONS:

IA can remove autoantibodies against ß2 adrenergic receptor and lead to clinical improvement. B cell phenotyping provides evidence for an effect of IA on memory B cell development. Data from our pilot trial warrants further studies in CFS/ME.

• Authors: Carmen Scheibenbogen, Madlen Loebel, Helma Freitag, Anne Krueger, Sandra Bauer, Michaela Antelmann, Wolfram Doehner, Nadja Scherbakov, Harald Heidecke, Petra Reinke, Hans-Dieter Volk, Patricia Grabowski
• Journal: PloS one (PLoS One) Vol. 13 Issue 3 Pg. e0193672 ( 2018) ISSN: 1932-6203 [Electronic] United States
• PMID: 29543914 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• ADRB2 protein, human
• Autoantibodies
• Peptides
• Receptor, Muscarinic M3
• Receptor, Muscarinic M4
• Receptors, Adrenergic, beta-2

Topics

• Adsorption
• Adult
• Autoantibodies (metabolism)
• B-Lymphocytes
• Blood Component Removal (instrumentation, methods)
• Fatigue Syndrome, Chronic (immunology, microbiology, therapy)
• Female
• Humans
• Male
• Middle Aged
• Peptides (administration & dosage, immunology)
• Receptor, Muscarinic M3 (immunology)
• Receptor, Muscarinic M4 (immunology)
• Receptors, Adrenergic, beta-2 (immunology)
• Treatment Outcome