Founder of Health Rising and Phoenix Rising
Jarred Younger of the Neuroinflammation, Pain and Fatigue Lab posted his thoughts on why Rituximab works when it does. He's proposing a very different reason.
Interesting that so far Rituximab gets about the same response rates as LDN. He's not the only one to think that the blood-brain barrier might be involved.Here is my hypothesis (which is different from other researchers) regarding how rituximab improves fatigue. B-cells are immune system cells that are ordinarily found only in the body (and not in the brain). However, when microglia in the brain are activated, they can weaken the blood-brain-barrier and let in the B-cells. Once inside the brain, B-cells cause inflammation that lead to pain and fatigue. Rituximab depletes the B-cells in the body. Because the B-cells are depleted in the body, there are no cells left to reach the brain and cause inflammation.
The response rate was very good, with 64% of participants showing a significant clinical improvement of symptoms. That number is very interesting because it is the same response rate I see when I use low-dose naltrexone (LDN) with fibromyalgia. I am guessing that LDN and rituximab provide two different paths to reaching the same goal: stopping neuroinflammation. LDN gets into the brain and calms down the microglia so that the blood-brain-barrier gates remain strong enough to keep out the B-cells. Rituximab depletes the B-cells so they cannot reach the brain, even if the gates are damaged.
.There are some negative aspects to mention. The study is small, which means we need to see larger replications. It was open-label, meaning that the results are not controlled for placebo effects. There were some adverse events such as upper airway infections, an allergic reaction, and a temporary worsening of symptoms in some participants. Still, the results are encouraging and reinforce what this group has been reporting for the past few years. The technical aspects of the study look good to me, so I will be very interested in seeing what comes up next for this drug.