Immunoadsorption to remove ß2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME.
Scheibenbogen, Carmen, Loebel, Madlen, Freitag, Helma et al. · PloS one · 2018 · DOI
Quick Summary
This small study tested whether a blood-cleaning procedure called immunoadsorption could help ME/CFS patients who have specific antibodies attacking their nervous system. Ten patients received this treatment over 5 days, and seven reported symptom improvement during the procedure. Three patients had improvements lasting 6-12+ months, suggesting the treatment may help some people, though more research is needed.
Why It Matters
This study provides biological evidence that at least a subset of ME/CFS patients may have an autoimmune mechanism targeting autonomic nervous system receptors, and demonstrates that autoantibody removal can produce clinical benefit. Identifying autoimmune subgroups could lead to targeted treatments and help explain heterogeneous disease mechanisms in ME/CFS.
Observed Findings
Seven of 10 patients reported rapid symptom improvement during immunoadsorption treatment.
Elevated β2 adrenergic receptor IgG antibodies decreased in 9 of 10 patients and remained significantly lower 6 months post-treatment.
IgG levels dropped to 0.73 g/l (median) after 4 IA cycles, while IgA and IgM levels remained unchanged.
Memory B cell frequency significantly decreased and plasma cell frequency significantly increased after the 4th IA cycle.
Three patients maintained moderate-to-marked symptom improvement for 6-12+ months following treatment.
Inferred Conclusions
A subset of CFS/ME patients with post-infectious onset and β2 autoantibodies may benefit from immunoadsorption treatment.
Autoantibody-mediated autonomic dysregulation may represent a mechanistically distinct CFS/ME subtype amenable to targeted therapy.
Larger controlled trials are warranted to define the therapeutic role of IA in CFS/ME.
Remaining Questions
What proportion of the total CFS/ME population has elevated β2 adrenergic receptor autoantibodies, and are other autoantibody patterns associated with different clinical presentations?
What This Study Does Not Prove
This pilot study does not establish that immunoadsorption is an effective or safe treatment for ME/CFS broadly, as it involved only 10 patients without a control group and lacks blinding. The mechanism by which autoantibody removal improves symptoms is not definitively established. Results cannot be generalized to CFS/ME patients without elevated β2 autoantibodies or those with non-infectious disease onset.
What are the mechanisms by which β2 autoantibody removal improves symptoms—do they involve restoration of autonomic function, altered cytokine production, or other pathways?
Why did only 3 of 7 responding patients maintain long-term improvement, and can baseline clinical or immunological characteristics predict durable response?
Would repeated immunoadsorption courses or maintenance therapy extend clinical benefit in responders?