Is ME an autoimmune disease? Examining evidence and a small treatment trial.

by Sasha Nimmo

European researchers have examined the evidence that Myalgic Encephalomyelitis (International Consensus Criteria) may be an autoimmune disease, stating “disease onset is often reported to be triggered by infections and the link between infections and autoimmune diseases is well established”. A group of German scientists tested this theory, using a process called immunoadsorption to remove antibodies in 10 people with ME (Canadian Consensus Criteria).

Researchers from Germany, Spain and Latvia say there is compelling evidence that autoimmune mechanisms play a role in ME. They published ‘Myalgic Encephalomyelitis /Chronic Fatigue Syndrome – Evidence for an autoimmune disease‘ in the June 2018 edition of Autoimmune Reviews.

Sotzny et al examined the Norwegian rituximab trials and say that the ‘encouraging results from first clinical trials warrant larger studies with rituximab and other strategies targeting autoantibodies’. They point out there may be subsets of patients with ME and research on well-defined cohorts is required.

“Immune dysfunction in ME/CFS, as for other autoimmune disease, is a multifaceted hallmark that requires further studies using new technologies, standardized assays and well defined cohorts to clearly define common patterns.”

“The identification of autoantibodies in ME/CFS patients and the clinical benefit associated with B cell depleting therapy provide strong evidence that, at least in a subset of ME/CFS patients, the disease has an autoimmune etiology.”

The paper lists six studies where antinuclear antibodies were found in ME and CFS patients, up to 68%, but also points out other studies which found almost none.

Sotzny et al looked at the crossover between ME and autoimmune diseases, giving the example of Hashimoto’s thyroiditis, which occurs around 0.8% in the general population and is found in 17–20% in ME and CFS patients.

The researchers examined genetic varients associated with autoimmunity, saying there are ‘alterations consistent with an autoimmune mechanism’.

Sotzny et al suggest disturbances in metabolic-immune communication may be closely linked with and contribute to autoimmunity.

“A growing body of evidence suggests that energy metabolism is crucial for the maintenance of chronic inflammation, not only in terms of energy supply but also in the control of the immune response through metabolic signals.”

Sotzny et al received support from the European Network on Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (EUROMENE).  Read the full paper.

Immunoadsorption pilot trial
Researchers from Universitätsmedizin Berlin in Germany tested immunoadsorption on 10 people with post-viral Myalgic Encephalomyelitis (Canadian Consensus Criteria), classified as severe by the scientists (from 10-15 on the Bell scale). The researchers state all patients suffered from severe fatigue, post-exertional malaise and impaired concentration, however more than half of them were taking more than 5000 steps a day before the treatment.

‘Immunoadsorption to remove ß2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME‘ by Scheibenbogen et al was published in Plos One in March 2018.

“Immunoadsorption (IA) is an apheresis* procedure to remove specific proteins from a patient’s plasma. The plasma is passed through an absorber which selectively binds IgG and can be regenerated and reloaded during processing of the plasma allowing a highly effective removal of IgG with little side-effects. IA was shown to result in moderate to marked clinical improvement in various types of autoimmune disease including dilatative cardiomyopathy and neurological diseases associated with autoantibodies.”

*Aphersis is the removal of whole blood from a patient. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn and the remaining components are retransfused into the patient. (source)

Scheibenbogen et al observed a rapid improvement of symptoms in seven patients. In four patients, improvement was short and symptoms reoccurred within 1–6 weeks. Two of these patients then improved again for several months following initial worsening. Three patients had a sustained improvement of fatigue and several symptoms for at least 12 months.

“However, none of the patients completely recovered and 5 patients had worsening of fatigue towards the end of treatment despite improvement of other symptoms.”

The daily number of steps shows no dramatic, sustained improvement and in two cases, long-term worsening.

“It provides further evidence that autoantibodies play a role in CFS in line with the results from the Norwegian rituximab trials.”

“Taken together, this pilot study provides evidence that IA can effectively remove ß2 and M3/M4 autoantibodies in CFS/ME and can result in rapid moderate to marked symptom improvement. Larger clinical trials of IA are warranted to obtain more evidence for the efficacy of IA in CFS/ME.”

Read the full paper.