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

The idea of infection inducing autoimmunity is very old and in the great majority of diseases wrong. In the few situations where the immune system caues harm after infection the immune reactions tends to be short lived, leaving damage but not continuing (rheumatic fever and guillain-barre). Nodding disease might fit and also narcolepsy.

Ritiximab would not touch rheumatic fever.

I am not overenthusiastic abkout these high tech trawling for antigen studies but they might tirn something up. People have looked before (in the UK) andnot found anything.

 

I've struggled to understand this for some time i.e. rituximab kills B-cells and B-cells produce antibodies. On the face of it, if you have a B-cell autoimmune (auto-antibodies) disease then rituximab would successfully treat this.
Are there other cells (not B-cells) which produce antibodies (and therefore potentially auto-antibodies) and if so could you provide details?
Is rituximab only effective against some B-cells i.e. there are other B-cells which produce antibodies and if so could you provide details?

T-cell autoimmunity has been discounted; Ron Davis speaking at the emerge conference last month.

Thanks

@Jonathan Edwards

 

I would not discount T cells. All we know is that one preliminary finding from Mark Davis did not hold up. T cells cause post infective illnesses of pther sorts.

There is a reason why rituximab does not work for all autoantibody based illnesses. Antibodies are actually made by daughters of B cells called plasma cells. Plasma cells can live for decades and rituximab cannot touch them. The lucky thing about sevdral autoimmune disease is that the relevant plasma cells only live about 3-6 months. They probably stay in spleen rather than getting dug in to bone marrow. So continued autoantibody produ tion needs replenish.ent from B cells. So killing B cells with ritux blcks the supply of new antibodies.

 

I saw this diagram and think I’m probably low on foxo1 and irf4,this effects the pro b stage according to this diagram
https://www.researchgate.net/figure...ll-differentiation-and-the-key_fig1_230895853
Even if rituximab is a fail,do B cells still play a part in ME

 

RTX6_Studieprotokoll_supl1_02042019 to large to upload

 

We were given 20 mg anti histamine (H1) and 1 g paracetamol 1 hr before (to reduce reactions and discomfort), and then of course cortisol and lastly MabThera.

 

I can't remember, did we ever send a thank you card to Fluge and Mella?

 

New Scientist just put an article out on this:

https://www.newscientist.com/articl...r-chronic-fatigue-syndrome-fails-large-trial/

Paywalled after a couple of paragraphs.

 

Dagens Medisin has an article today about RituxME and has interviewed Øystein Fluge.

Dagens Medisin: Norsk studie: Legemiddel hadde ikke effekt på ME
google translation: Norwegian study: Medication had no effect on ME

Fluge says the results of the study show how important it is to do double-blind and randomized placebo-controlled studies.

- The purpose of the study was to either strengthen or weaken the hypothesis that B cells were important for the symptom maintenance of ME.

- When the result is negative, it is good that it is unambiguous and clear. We should be happy about that. The purpose is not to go for one or the other - but to know what is actually true, says Fluge.

- It is so that some patients say that they have experienced the effect of this medicine. Of course, for a single patient it is difficult to know what has caused improvement - but at group level we can safely say that rituximab has no effect.

 

We need an Honest Scientist award.

 

Does anyone have access to the paper? Can't seem to read it.

 

Has anyone been able to access the full paper? I’ve still not managed to get it to come up on Scihub, though I’ve been having Scihub issues lately.

 

Nope, I can't get it via Sci hub either.

 

Bugger!

 

Do you remember what brand of cortisone and what dose you got?

 

I am fairly sure everyone uses the data sheet recommendation of 100mg methylprednisolone IV.

 

“One hour before infusions, all patients received premedication with 1 g of oral acetaminophen, 10 mg of cetirizine, and 8 mg of dexamethasone.”

 

Oh, you can't access it now either? Was just linking to a table in another thread, not realising it might not be accessible to all.

I can read it now, not sure why.

 

There is something odd about access to this. I cannot get it through my college account. I would have to use something called Athens that I do not have a registration for.