Download PDF
Horm Metab Res 2024; 56(12): 869-874
DOI: 10.1055/a-2445-8593
Original Article: Endocrine Care

A Single-Center Pilot Study of Therapeutic Apheresis in Patients with Severe Post-COVID Syndrome

Johannes Korth
1   Apherese-Zentrum am Kortumpark, Bochum, Germany
,
Charlotte Steenblock 
2   Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Romy Walther
2   Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Mahmoud Barbir
2   Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
3   Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust Hospital, Harefield, United Kingdom of Great Britain and Northern Ireland
,
Michael Husung
4   MedSelect GmbH, Lüdenscheid, Germany
,
Ansgar Velthof
1   Apherese-Zentrum am Kortumpark, Bochum, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

After the COVID-19 pandemic, many patients have reported chronic fatigue and severe post-exertional malaise, with symptoms similar to those of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The accumulation of agonistic receptor autoantibodies targeting beta-adrenergic (β1 and β2) and muscarinic (M3 and M4) neurotransmitter receptors may play a crucial role in the pathomechanism of both ME/CFS and post-COVID conditions. Therapeutic apheresis has been suggested as an effective treatment option for alleviating and mitigating symptoms in this desperate group of patients. In this single-center pilot study, we analyzed autoantibodies in a cohort of 20 post-COVID patients before and after therapeutic apheresis. Apheresis resulted in a decline of β1 or β2 adrenergic receptor antibodies in all patients. Additionally, the majority of patients experienced a concurrent reduction in symptoms such as fatigue, physical activity restrictions, myalgia, post-exertional malaise, and concentration disorders. This study clearly demonstrates an association between autoantibodies and the clinical improvement of post-COVID patients. Even if future sham-controlled trials do not show a positive outcome, extracorporeal apheresis may still be valuable for this patient group by temporarily improving microperfusion and symptoms. Success in restoring patients to work and normal life, as observed in many individuals after therapeutic apheresis, should be recognized. Therefore, we believe that extracorporeal therapeutic apheresis, as part of a multimodal treatment, should be considered an early intervention for postinfectious syndromes in selected patients.

Keywords

apheresis - long-COVID - post-COVID - chronic fatigue - neurotransmitter - immunity - autoantibodies


Publication History

Received: 06 September 2024

Accepted after revision: 12 October 2024

Article published online:
09 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Park JW, Park BJ, Lee JS. et al. Systematic review of fatigue severity in ME/CFS patients: insights from randomized controlled trials. J Transl Med 2024; 22: 529
    CrossrefPubMedSearch in Google Scholar
  • 2 Scheibenbogen C, Loebel M, Freitag H. et al. Immunoadsorption to remove ss2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME. PLoS One 2018; 13: e0193672
    CrossrefPubMedSearch in Google Scholar
  • 3 Bornstein SR, Voit-Bak K, Donate T. et al. Chronic post-COVID-19 syndrome and chronic fatigue syndrome: is there a role for extracorporeal apheresis?. Mol Psychiatry 2022; 27: 34-37
    CrossrefPubMedSearch in Google Scholar
  • 4 Seibert FS, Stervbo U, Wiemers L. et al. Severity of neurological Long-COVID symptoms correlates with increased level of autoantibodies targeting vasoregulatory and autonomic nervous system receptors. Autoimmun Rev 2023; 22: 103445
    CrossrefPubMedSearch in Google Scholar
  • 5 Steenblock C, Toepfner N, Kok YP. et al. A multimodal approach for treating post-acute infectious syndrome. Brain Med 2024; 1: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 6 Chen C, Haupert SR, Zimmermann L. et al. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a meta-analysis and systematic review. J Infect Dis 2022; 226: 1593-1607
    CrossrefPubMedSearch in Google Scholar
  • 7 Steenblock C, Walther R, Tselmin S. et al. Post COVID and apheresis – where are we standing?. Horm Metab Res 2022; 54: 715-720
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Davis HE, Assaf GS, McCorkell L. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 2021; 38: 101019
    CrossrefPubMedSearch in Google Scholar
  • 9 Loebel M, Grabowski P, Heidecke H. et al. Antibodies to beta adrenergic and muscarinic cholinergic receptors in patients with chronic fatigue syndrome. Brain Behav Immun 2016; 52: 32-39
    CrossrefPubMedSearch in Google Scholar
  • 10 Sotzny F, Blanco J, Capelli E. et al. Myalgic encephalomyelitis/chronic fatigue syndrome – evidence for an autoimmune disease. Autoimmun Rev 2018; 17: 601-609
    CrossrefPubMedSearch in Google Scholar
  • 11 Asadi-Pooya AA, Akbari A, Emami A. et al. Risk factors associated with long COVID syndrome: a retrospective study. Iran J Med Sci 2021; 46: 428-436
    PubMedSearch in Google Scholar
  • 12 Ohkubo A, Okado T. Selective plasma exchange. Transfus Apher Sci 2017; 56: 657-660
    CrossrefPubMedSearch in Google Scholar
  • 13 Fluge Ø, Risa K, Lunde S. et al. B-Lymphocyte depletion in myalgic encephalopathy/chronic fatigue syndrome. An open-label phase II study with rituximab maintenance treatment. PLoS One 2015; 10: e0129898
    CrossrefPubMedSearch in Google Scholar
  • 14 Carruthers BM, van de Sande MI, De Meirleir KL. et al. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med 2011; 270: 327-338
    CrossrefPubMedSearch in Google Scholar
  • 15 Achleitner M, Steenblock C, Danhardt J. et al. Clinical improvement of long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis. Mol Psychiatry 2023; 28: 2872-2877
    CrossrefPubMedSearch in Google Scholar
  • 16 Giszas B, Reuken PA, Katzer K. et al. Immunoadsorption to treat patients with severe post-COVID syndrome. Ther Apher Dial 2023; 27: 790-801
    CrossrefPubMedSearch in Google Scholar
  • 17 Tolle M, Freitag H, Antelmann M. et al. Myalgic encephalomyelitis/chronic fatigue syndrome: efficacy of repeat immunoadsorption. J Clin Med 2020; 9: 2443
    CrossrefPubMedSearch in Google Scholar
  • 18 Stein E, Heindrich C, Wittke K. et al. Observational study of repeat Immunoadsorption (RIA) in post-COVID ME/CFS patients with elevated ss2-adrenergic receptor autoantibodies – an interim report. J Clin Med 2023; 12: 6428
    CrossrefPubMedSearch in Google Scholar
  • 19 Stein E, Heindrich C, Wittke K. et al. Efficacy of repeat immunoadsorption in post-COVID ME/CFS patients with elevated Β2-adrenergic receptor autoantibodies: a prospective cohort study https://ssrncom/abstract=4911576 2024
    PubMed
  • 20 Lai YJ, Liu SH, Manachevakul S. et al. Biomarkers in long COVID-19: a systematic review. Front Med (Lausanne) 2023; 10: 1085988
    CrossrefPubMedSearch in Google Scholar
  • 21 Tsilingiris D, Vallianou NG, Karampela I. et al. Laboratory findings and biomarkers in long COVID: what do we know so far? Insights into epidemiology, pathogenesis, therapeutic perspectives and challenges. Int J Mol Sci 2023; 24: 10458
    CrossrefPubMedSearch in Google Scholar
  • 22 Yin JX, Agbana YL, Sun ZS. et al. Increased interleukin-6 is associated with long COVID-19: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12: 43
    CrossrefPubMedSearch in Google Scholar
  • 23 Hatano Y, Katagiri K, Arakawa S. et al. Successful treatment by double-filtration plasmapheresis of a patient with bullous pemphigoid: effects in vivo on transcripts of several genes for chemokines and cytokines in peripheral blood mononuclear cells. Br J Dermatol 2003; 148: 573-579
    CrossrefPubMedSearch in Google Scholar
  • 24 Bensing J. Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Couns 2000; 39: 17-25
    PubMedSearch in Google Scholar