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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Efficacy of Repeat Immunoadsorption. Scheibenbogen et al. 2020

Discussion in 'BioMedical ME/CFS Research' started by John Mac, Jul 30, 2020 at 2:30 PM.

  1. John Mac

    John Mac Senior Member (Voting Rights)

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    https://www.mdpi.com/2077-0383/9/8/2443
     
  2. Caesar

    Caesar Established Member (Voting Rights)

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    I'm sorry to ask. But what is a modified IA protocol?
     
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  3. Trish

    Trish Moderator Staff Member

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    In the full paper they explain: 'Patients who had responded to the first IA (IA1) were retreated with a modified IA protocol (IA2) about two years later. Here, IA cycles were given with longer intervals.'
    So the immunoadsorption was done on days 1, 2, 3, 6, 7 on the first version, and days 1, 2, 4, 6, 8 on the modified version.
     
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  4. hinterland

    hinterland Senior Member (Voting Rights)

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    IA = Immunoadsorption.

    From Wikipedia:
     
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  5. butter.

    butter. Senior Member (Voting Rights)

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    looks placeboish
     
  6. John Mac

    John Mac Senior Member (Voting Rights)

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    A placebo controlled trial should answer that. The researchers suggest that.
    Just because there is a fall in a biological measurement doesn't mean that it is the cause of the symptom improvement, it could easily just be placebo.
     
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  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    An 80-90% decline in total IgG sounds seriously bad news to me. We used to worry if there was a 50% reduction with rituximab. Unless there is some good reason why this is considered acceptable, perhaps in the short term, I would not recommend continuing to study this protocol.
     
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  8. Jaybee00

    Jaybee00 Senior Member (Voting Rights)

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    You mean they would be very vulnerable to contracting/dying from an infection with that much IgG depletion?
     
    Last edited: Jul 30, 2020 at 7:28 PM
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  9. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    They are removing them from the plasma only so it's a bit different to Rituximab I believe. How quickly do they come back? By the way, Fig 3 shows the values for all patients normalised to 1 at the start. I think the square data points are total values.
    Full text PDF : https://www.mdpi.com/2077-0383/9/8/2443/pdf
     
  10. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    The point is that they might be. Resistance to infection is complicated and some people manage on low IgG levels but an 80-90% reduction puts someone into seriously risky territory.
     
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  11. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Plasma is the only relevant compartment for antibodies so it is the same as for rituximab. They are not affecting B cells but the relevance of affecting B cells is only through the knock on effect on plasma antibodies in both situations.
     
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  12. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I have only had a quick look at the paper but it seems only to give us IgG and antibody levels for 9 days. This is completely meaningless from my perspective since to be any use one would want antibodies to go down for months at least.

    (The paper is published in something I have never heard of called Journal of Clinical Medicine, which sounds to me like one of the new journals that will publish anything. Peer review should have insisted on longer term Ig levels - that is if I am right that these are not given.)

    The key point is that treatment aimed at reducing antibody levels is only a reasonable idea if there is some specificity that lasts over months. Rituximab is useful because for reasons we do not fully understand there is very useful specificity. It does not look as if there is any here.
     
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  13. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    Okay, lost in the mass of text was a statement that they replaced IgG after IA. The focus was on removing damaging antibodies and partially replacing the good ones. However, I thought IgG infusions had a half life of 21 days......
     
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  14. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    They say that IA reduced memory B cells as well
    I'm not sure what they mean by frequency........... maybe lost in translation?
     

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