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

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 ꞵ-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.