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Nature - Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?, 2021, Bornstein et al

Discussion in 'BioMedical ME/CFS Research' started by Kalliope, Jun 19, 2021.

  1. Kalliope

    Kalliope Senior Member (Voting Rights)

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    Nature - molecular psychiatry
    Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis? - Bornstein et al

    Abstract

    As millions of patients have been infected by SARS-CoV-2 virus a vast number of individuals complain about continuing breathlessness and fatigue even months after the onset of the disease.

    This overwhelming phenomenon has not been well defined and has been called “post-COVID syndrome” or “long-COVID” [1].

    There are striking similarities to myalgic encephalomyelitis also called chronic fatigue syndrome linked to a viral and autoimmune pathogenesis.

    In both disorders neurotransmitter receptor antibodies against ß-adrenergic and muscarinic receptors may play a key role.

    We found similar elevation of these autoantibodies in both patient groups.

    Extracorporeal apheresis using a special filter seems to be effective in reducing these antibodies in a significant way clearly improving the debilitating symptoms of patients with chronic fatigue syndrome.

    Therefore, such a form of neuropheresis may provide a promising therapeutic option for patients with post-COVID-19 syndrome.

    This method will also be effective when other hitherto unknown antibodies and inflammatory mediators are involved.
     
  2. Wonko

    Wonko Senior Member (Voting Rights)

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    ?

    'clearly'?

    So ME has been cured then?

    Am I the only one who doesn't know?

    Is it just me or....is the world full of......
     
  3. Kalliope

    Kalliope Senior Member (Voting Rights)

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    I'm struggling to understand this sentence. I don't know what "neuropheresis" mean.

    Urban Dictionary says:

    Does it have other meanings?
     
  4. Trish

    Trish Moderator Staff Member

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    Do they mean plasmapheresis?
     
  5. dave30th

    dave30th Senior Member (Voting Rights)

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    I assume so.
     
  6. Kalliope

    Kalliope Senior Member (Voting Rights)

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  7. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    betwixt and between
    Last edited: Jun 19, 2021
  8. Kalliope

    Kalliope Senior Member (Voting Rights)

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  9. Andy

    Andy Committee Member (& Outreach when energy allows)

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    From the paper
    "Targeting neurotransmitters AB in ME/CFS
    Based on recent studies employing the monoclonal anti-CD20 antibody rituximab [9] in patients with ME/CFS there is reason to believe that the reduction of these neurotransmitters AB may be a promising target for therapy. In these studies, depletion of CD20+ B cells with rituximab led in a majority of patients with ME/CFS to a complete or at least partial remission. Since this beneficial effect occurred only several months after initiation of treatment with rituximab, it may be attributed to the wash-out of the autoantibodies due to the elimination of the short-lived antibody producing plasma cells related to the CD20+ memory B cells. A more immediate therapeutic strategy with less side effects may involve immune apheresis or other forms of extracorporeal apheresis such a neuro- or cerebropheresis [10].

    Using immunoadsorption in patients with post-infectious ME/CFS with an IgG-binding column for 5 days in an observational study with ten patients induced a rapid improvement in seven patients [11, 12]. We have also used extracorporeal apheresis (INUSpheresis) enabling a significant reduction of total IgG and all neurotransmitter receptors of up to 50% as well as inflammatory proteins such as CRP or RANTES. In a clinical observation in patients with ME/CFS, extracorporeal apheresis used over either 2 or 4 days induced a significant improvement of symptoms based on disease-specific scores. ME/CFS patients with a clear-cut infection-triggered increase of autoantibodies seemed to have the most significant and sustainable clinical benefits. However, it is also highly conceivable that clinical improvement seen in patients subjected to therapeutic extracorporeal apheresis may have multiple causes, not only related to reduction in autoantibodies against neurotransmitters but also other yet unknown autoantibodies, inflammatory proteins, and rheological factors."


    References

    Ref 9 is to the 2015 phase 2 publication from Fluge and Mella, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129898

    Ref 10, Extracorporeal apheresis therapy for Alzheimer disease—targeting lipids, stress, and inflammation, https://www.nature.com/articles/s41380-019-0542-x

    Ref 11 Immunoadsorption to remove ß2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME (2018) Scheibenbogen et al

    Ref 12 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Efficacy of Repeat Immunoadsorption. Scheibenbogen et al. 2020
     
  10. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    Indeed.

    Interesting co-authorship. From a quiick glance, nobody from the Scheibenbogen team involved, but in addition to the three staff members from the private clinic linked above, mostly affiliations with renowned universities, including two authors from the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK.
     
  11. Kalliope

    Kalliope Senior Member (Voting Rights)

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    ... and of course no declaration of conflicts of interest..
     
  12. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Simple answer to the title: No.
    Apheresis has an effect for a week or so - what's the point?
     
    cfsandmore, Michelle, shak8 and 10 others like this.
  13. Perrier

    Perrier Senior Member (Voting Rights)

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    Is this not what Dr Scheibenbogen worked on? Or am I inaccurate ?
     
  14. Trish

    Trish Moderator Staff Member

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  15. Braganca

    Braganca Established Member (Voting Rights)

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    Seems like as a treatment it is too invasive and not long enough lasting. But would apheresis at least help us as a diagnostic — if it improved symptoms dramatically, we’d at least know that yes, there is something in our blood? (or would it prove something in plasma?)

    Apherisis is offered at hematology centers to blood cancer patients I believe.
     
    Michelle, Hutan, MeSci and 4 others like this.
  16. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    I don’t really understand the process, but it sounds rather like a ‘fishing exercise’ if you will pardon the pun:

    Not clear what either no response or a positive response actually means, though obviously interesting if you get a positive response even if it is transitory.
     
  17. TiredSam

    TiredSam Moderator Staff Member

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    Nope, that's the one.
     

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