B-Lymphocyte Depletion in Patients With ME/cfs: A Randomized, Double-Blind, Placebo-Controlled Trial (2019) Fluge et al

[Jonathan Edwards]

@Jonathan Edwards

Do you have a thoughts on VanElzakkers Twitter-comments on immunosuppression and ME? The theories behind both Rituximab and Cyclophosphamide was “switch off, switch on”, not permanent suppression, was it not?

Presumably Dr van Elszakker is not familiar with the reason why we use rituximab in autoimmunity. It is to remove clones making the autoantibodies that cause symptoms. If a subset of people with ME had hidden autoantibodies - and that was quite plausible - then rituximab makes as much sense as it does in the dozen or so illnesses where it works beautifully. He is probably not very familiar with clinical immunology.

 

[Jonathan Edwards]

I am not sure that 'comorbid autoimmunity ' or mast cell activation makes much sense though!

I agree with Dr v E that feeling bad is often part of the immune response - which is precisely why getting rid of immune cells, i.e. B cells, works when it does. I think he is assuming that immune responses are always good, which clearly in autoimmunity they are not.

 

[Rain]

@Jonathan Edwards thank you! Very helpful.

(I was not the one discussing with him on Twitter, should have made that clear.)