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Mestinon
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==ME/CFS== In 2015, a large [[Germany|German]] study found 29% of [[ME/CFS]] patients had elevated [[Autoantibody|autoantibodies]] to M3 and M4 [[muscarinic acetylcholine receptor]]s.<ref>{{Cite journal | last = Loebel|first = Madlen | last2 = Grabowski | first2 = Patricia | last3 = Heidecke | first3 = Harald | last4 = Bauer | first4 = Sandra | last5 = Hanitsch | first5 = Leif G. | last6 = Wittke | first6 = Kirsten | last7 = Meisel | first7 = Christian | last8 = Reinke | first8 = Petra | last9 = Volk | first9 = Hans-Dieter | date = Feb 2016 | title = Antibodies to β adrenergic and muscarinic cholinergic receptors in patients with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/26399744|journal=Brain, Behavior, and Immunity|volume=52|pages=32–39|doi=10.1016/j.bbi.2015.09.013|issn=1090-2139|pmid=26399744}}</ref><ref>{{Cite web|url=http://www.meaction.net/2015/09/26/antibodies-found-in-subset-of-cfs-patients/ | title = Autoantibodies found in subset of CFS patients {{!}} #MEAction|website = [[The MEAction Network]]|language=en-US|access-date=2018-08-10}}</ref> A 2016 [[Australia|Australian]] study found that ME/CFS patients had significantly greater numbers of [[single nucleotide polymorphism]]s associated with the gene encoding for M3 muscarinic acetylcholine receptors. While these findings suggests some ME patients could benefit from Mestinon, anecdotal patient reports of Mestinon are mixed.<ref>{{Cite news | url=http://www.healthrising.org/blog/2016/06/17/mestinon-chronic-fatigue-vagus-nerve-stimulation-exercise/ | title = A Mestinon Miracle: Vagus Nerve Stimulating Drug Helps Long Time ME/CFS Patient Exercise - Health Rising | last = Johnson | first =Cort | date = 2016-06-17|work=Health Rising|access-date=2018-08-26|archive-url=|archive-date=|url-status=|language=en-US}}</ref> A work in progress study of [[exercise intolerance]] in [[preload failure]] found that Mestinon improved exercise tolerance, but the study has not yet been published and there are no clinical trials of Mestinon in ME/CFS.<ref>{{Cite journal | last = Oliveira | first = R.K. | date = 2016 | title=Pyridostigmine for Exercise Intolerance Treatment in Preload Failure|url=https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A5664|journal=American Journal of Respiratory and Critical Care Medicine|volume=|pages=|via=}}</ref> Case reports from just 3 patients with chronic fatigue syndrome showed all three either significantly improved or were able to exercise again without experiencing [[post-exertional malaise]] (PEM).<ref name="Kawamura2003" />
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