Preprint [...] Plasmapheresis in [ME/CFS] Patients with Elevated β-Adrenergic and M3-Muscarinic Receptor Antibodies – a Pilot Study, 2025, Oesch-Régeni et al

Effect on Quality of Life of Therapeutic Plasmapheresis in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients with Elevated β-Adrenergic and M3-Muscarinic Receptor Antibodies – a Pilot Study

Boglárka Oesch-Régeni, Nicolas Germann, Georg Hafer, Dagmar Schmid, Norbert Arn

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Background/Objectives
Recent studies brought evidence that the Long-Covid / post-COVID-19 Syndrome (PCS) and the related Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have an autoimmune pathomechanism[1]. It could be triggered by various infectious pathogens, like SARS-CoV-2, which may be one of the most common triggering factors of the disease.

The identification of increased levels of autoantibodies alleged with the typical symptom-constellation of post-exertional malaise, sleeping disorders, cognitive malfunction, postural orthostatic tachycardia syndrome (POTS), etc. and several subjective health problems can lead to the correct diagnosis. ME/CFS patients have a high suffering level. Making a correct diagnosis is challenging, as well as the therapy of the complex and individual constellation of physical and psychical symptoms.

Methods
Our aim was to identify the ME/CFS patients correctly, including an initial rule-in screening by investigating other possible causes (pulmonal/cardial/endocrine, etc.). In 7 cases we applied plasmapheresis (PE) with repetitive autoantibody-measurements.

Additionally, according to references from literature, for monitoring the clinical outcomes psychometric follow-up assessments had been conducted: with the ISI (insomnia), FSS (fatigue), HADS (depression and anxiety) and EQ-5D-5L (quality of life) questionnaires.

Patients who met the inclusion criteria received 4 PE sessions on day 1, 5, 30 and 60 and a low-dose intravenous immunoglobulin (IVIG) therapy after each treatment. The psychometric evaluation had been conducted before the first PE, 2 weeks after the second and two weeks after the last PE-therapy. All 4 antibodies were measured two times per patient over the course of the study at standardized sampling time points: baseline before starting PE and 2 weeks after the last PE.

Results
It could be found a negative correlation between the β-Adrenergic and M3-muscarinic receptor antibodies concentration and the quality of life measurements assessed with the EQ-5D-5L questionnaire.

Conclusions
In this pilot study a correlation could be shown between the autoantibody-concentration and the physical and psychical wellbeing of the treated ME/CFS patients. These first results should be seen as a hypothesis-building assessment, further investigation is needed to validate these promising pilot-study results of therapeutic PE and IVIG in ME/CFS cases.

Link (Preprint: Preprints.org) [Open Access]

 

They studied patients that crashed after participating in a 6 minute walk test…

3/7 had to stop the treatment due to crashing, but at least one of them (and 5/7 in total) reported a subjective benefit.