Genome-epigenome interactions associated with ME/CFS

Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, by Santiago Herrera, Wilfred C de Vega, David Ashbrook, Suzanne D Vernon and Patrick O McGowan in Epigenetics 2018 [Published online: 5 Dec 2018]

 

Research abstract:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease of unknown etiology. Multiple studies point to disruptions in immune functioning in ME/CFS patients as well as specific genetic polymorphisms and alterations of the DNA methylome in lymphocytes.

However, potential interactions between DNA methylation and genetic background in relation to ME/CFS have not been examined. In this study we explored this association by characterizing the epigenetic (~480 thousand CpG loci) and genetic (~4.3 million SNPs) variation between cohorts of ME/CFS patients and healthy controls. We found significant associations of DNA methylation states in T-lymphocytes at several CpG loci and regions with ME/CFS phenotype. These methylation anomalies are in close proximity to genes involved with immune function and cellular metabolism. Finally, we found significant correlations of genotypes with methylation modifications associated with ME/CFS.

The findings from this study highlight the role of epigenetic and genetic interactions in complex diseases, and suggest several genetic and epigenetic elements potentially involved in the mechanisms of disease in ME/CFS.

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Prospective biomarkers from plasma metabolomics of ME/CFS implicate redox imbalance in disease symptomatology

Prospective biomarkers from plasma metabolomics of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome implicate Redox imbalance in disease symptomatology, by Arnaud Germain, David Ruppert, Susan M. Levine and Maureen R. Hanson in Metabolites 2018, 8(4), 90 [Published 6 Dec 2018]

 

Research abstract:
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease of enigmatic origin with no established cure. Its constellation of symptoms has silently ruined the lives of millions of people around the world. A plethora of hypotheses have been vainly investigated over the past few decades, so that the biological basis of this debilitating condition remains a mystery.

In this study, we investigate whether there is a disturbance in homeostasis of metabolic networks in the plasma of a female 32-patient cohort compared to 19 healthy female controls.

Extensive analysis of the 832-metabolite dataset generated by Metabolon®, covering eight biological classes, generated important insight into metabolic disruptions that occur in ME/CFS. We report on 14 metabolites with differences in abundance, allowing us to develop a theory of broad redox imbalance in ME/CFS patients, which is consistent with findings of prior work in the ME/CFS field.

Moreover, exploration of enrichment analysis using www.MetaboAnalyst.ca provides information concerning similarities between metabolite disruptions in ME/CFS and those that occur in other diseases, while its biomarker analysis unit yielded prospective plasma biomarkers for ME/CFS. This work contributes key elements to the development of ME/CFS diagnostics, a crucial step required for discovering a therapy for any disease of unknown origin.

Comment: Metabolomics Study Suggests Chronic Fatigue Syndrome May Be Oxidative Stress/Low Oxygen Disease

 

 

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Implementing guided ICBT for chronic pain & fatigue

Implementing guided ICBT for chronic pain and fatigue: A qualitative evaluation among therapists and managers by p in Internet Interventions
Volume 18, December 2019 [doi.org/10.1016/j.invent.2019.100290]

Highlights

  • ICBT for chronic somatic conditions such as pain and fatigue can overcome current barriers to provide patients with evidence-based psychological care
  • Implementing ICBT in mental health care has been found to be challenging on many levels
  • This study uses the Consolidated Framework for Implementation Research to evaluate an implementation project on ICBT for chronic pain and fatigue
  • Therapists and managers were interviewed and provided an extensive overview of key facilitating and hindering factors to adopt ICBT in daily clinical practice
  • Some key factors are “find support from all stakeholders”, “Align goals, expectations and skills”, and “create a feeling of ownership”.

 

Research abstract:

Introduction:
Internet-based cognitive behavioural therapy (ICBT) for chronic pain and chronic fatigue syndrome (CFS) has a high potential to increase the number of patients who can receive an evidence based treatment aimed to reduce symptoms and/or disability and to lower burden on (mental) health care. However, implementing a new behaviour-change intervention, and especially an online intervention, has shown to be a challenge. This study aimed to identify factors influencing the implementation process of ICBT for chronic pain and CFS in mental health care.

Methods
A qualitative study using semi-structured interviews with therapists and managers from twelve mental health care clinics was conducted. Questions and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), covering five domains: (1) the implemented intervention, (2) individual characteristics of the users, (3) the inner setting of implementation, (4) the outer setting, and (5) the implementation process.

Results
In all five domains important facilitators and barriers were found. Key themes were: (1) the quality of the content, its perceived effectiveness and usability, (2) the attitude, self-efficacy and ability to learn new skills among therapists, and motivation to start online treatment among patients, (3) internal communication within a team, existing workload, and top-down support from the management, (4) availability of reimbursement options and marketing strategies, and (5) involvement of all key stakeholders, steering towards independence of the implementation sites during the process and adequate training of therapists.

Conclusions
This study provides insight in the challenge of implementing ICBT for chronic pain and CFS in daily clinical practice. Several lessons can be learned from the interviews with therapists and managers which can also be more broadly applied to (ICBT) implementation projects in general. Development of practical tools to support the implementation process would be a valuable next step to overcome certain challenges at forehand and to properly prepare for those expected to come along.

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Multidimensional comparison of cancer-related fatigue & CFS: the role of psychophysiological markers

Multidimensional comparison of cancer-related fatigue and Chronic Fatigue Syndrome: the role of psychophysiological markers, by Hye Youn Park, Hong Jun Jeon, Young Rong Bang, In-Young Yoon in Psychiatry investigation [Published online: January 7, 2019]

Research abstract:

Objective:
The present study compared cancer-related fatigue (CRF) and chronic fatigue syndrome (CFS) using multidimensional measurements with the aim of better understanding characteristics and exploring markers of two similar fatigue syndromes.

Methods:
Twenty-five patients with CRF and twenty patients with CFS completed questionnaires, including the Fatigue Severity Scale (FSS), Hospital Anxiety Depression Scale (HADS), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Additionally, levels of high sensitivity C-reactive protein (hs-CRP), heart rate variability (HRV), and (EEG) were obtained. Neurocognitive functioning was also evaluated.

Results:
Both groups showed comparable levels of psychological variables, including fatigue. Compared to CFS subjects, CRF patients had significantly higher hs-CRP levels and a reduced HRV-index. The within-group analyses revealed that the FSS score of the CRF group was significantly related to scores on the HADS-anxiety, HADS-depression, and PSQI scales. In the CFS group, FSS scores were significantly associated with scores on the PSS and the absolute delta, theta, and alpha powers in frontal EEG.

Conclusion:
Findings indicate that different pathophysiological mechanisms underlie CFS and CRF. Inflammatory marker and HRV may be potential biomarkers for distinguishing two fatigue syndromes and frontal EEG parameters may be quantitative biomarkers for CFS.

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Hope, disappointment and perseverance: reflections of people with ME/CFS & MS participating in biomedical research

Hope, disappointment and perseverance: Reflections of people with Myalgic encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis participating in biomedical research. A qualitative focus group study, by
Eliana M. Lacerda, Clare McDermott, Caroline C. Kingdon, Jack Butterworth, Jacqueline M Cliff, Luis Nacul in Health Expectations [Preprint January 10, 2019]

 

Research abstract:

Background:
The Clinical Understanding and Research Excellence in ME/CFS group (CureME) at the London School of Hygiene & Tropical Medicine has supported and undertaken studies in immunology, genetics, virology, clinical medicine, epidemiology and disability. It established the UK ME/CFS Biobank (UKMEB), which stores data and samples from three groups: participants with ME/CFS, Multiple Sclerosis (MS) and healthy controls. Patient and public involvement have played a central role from its inception.

Aim:
To explore the views of participants with ME/CFS and MS on CureME research findings, dissemination and future biomedical research priorities.

Method:
Five ME/CFS and MS focus groups were conducted at two UK sites. Discussions were transcribed and analysed thematically.

Results:
A total of 28 UKMEB participants took part: 16 with ME/CFS and 12 with MS. Five themes emerged:

(a) Seeking coherence: participants’ reactions to initial research findings;

(b) Seeking acceptance: participants explore issues of stigma and validation;

(c) Seeking a diagnosis: participants explore issues around diagnosis in their lives;

(d) Seeking a better future: participants’ ideas on future research; and

(e) Seeking to share understanding: participants’ views on dissemination. Focus
groups perceived progress in ME/CFS and MS research in terms of ‘putting
together a jigsaw’ of evidence through perseverance and collaboration.

Conclusion:
This study provides insight into the emotional, social and practical importance of research to people with MS and ME/CFS, suggesting a range of research topics for the future.

Findings should inform biomedical research directions in ME/CFS and MS, adding patients’ voices to a call for a more collaborative research culture.

Excerpt from research paper:

4.1 Summary of key results

In recent years, patient perspectives have become increasingly important in informing the is planning, conduct and dissemination of research. In this study, participants with ME/CFS and MS illustrated the importance of research as means of seeking coherence to make sense of their illness (Theme 1), seeking diagnostic clarity (Theme 2) and proof of illness by which they could gain acceptance and from the medical profession and from society (Theme 3). Participants offered ideas on future research priorities (Theme 4) and recommendations for dissemination (Theme 5).

A key aim in this study was to elicit patient views on biomedical research priorities for the future. Overall, the research topics proposed fitted already familiar categories, such as immunological and mitochondrial dysfunction in ME, triggers including viruses, toxins and other pathogens, and biomedical differences between different subgroups. For participants with MS, the search for a cure was viewed as paramount, though participants were also interested in investigating genetic, viral, and immunological factors in triggering the illness. While not unexpected, these findings have value in confirming findings from our previous patient consultation work.2 What this study adds to our understanding is a vivid contextualization of these specific requests, within a wider and more personal understanding of how biomedical confirmation of an illness, or lack of it, can impact the patient’s quality of life, with factors including social acceptance, patient–doctor relationships, self‐confidence and support.

An intriguing finding of the study was the extent to which some of the MS participants reported feeling disbelieved by doctors, employers, or others about their symptoms prior to diagnosis. Their accounts of distress and loss of social confidence resulting from this resonate with the experiences of ME/CFS patients. Within this context, sharing research results was portrayed not only as providing information to medical professionals, families, and others in society, but also as a means of changing attitudes. Participants called for a more collaborative research culture, with greater emphasis on explaining where new knowledge fitted into a wider “jigsaw” of knowledge, and less on apparent “breakthrough” discoveries. Participants expressed pleasure at having played a part in contributing to the current research, tempered with awareness that determination was needed for the research journey ahead.

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Patients’ hopes for recovery from ME/CFS: toward a “recovery in” framework”

Patients’ hopes for recovery from myalgic encephalomyelitis and chronic fatigue syndrome: Toward a “recovery in” framework, by Andrew R Devendorf, Abigail A Brown, Leonard A Jason in Chronic Illness Vol 16, Issue 4, 2020 [First published 6 Dec 2018] doi.org/10.1177/1742395318815965

 

Research abstract:

Objective:

There is no consensus on recovery from myalgic encephalomyelitis and chronic fatigue syndrome, which has spawned debates when interpreting outcome research. Within these debates, the patient voice is often neglected. This study aimed to understand how patients conceptualize recovery – regarding the definition and possibility of recovery.

Method:

We conducted in-depth, semi-structured interviews with 10 older (above age 50) female patients with myalgic encephalomyelitis or chronic fatigue syndrome. Data were analyzed using a deductive thematic analysis.

Results:

Our sample viewed recovery as functioning without fear of relapse, returning to previous roles and identities, and achieving a sustained absence of symptoms. Participants expressed skepticism that reaching recovery from myalgic encephalomyelitis and chronic fatigue syndrome exists but working toward significant improvement through coping is a viable goal. Although many accepted they would never reclaim full functioning, participants continued to experience uncertainty about their future with unclear prognostic goals and limited treatment options.

Discussion:

Recovery is more than just symptom reduction. Outcome research should incorporate well-being measures like identity, meaning and quality of life, and personal empowerment to enhance recovery definitions. When communicating treatment goals, providers might convey cautious optimism for complete symptom remission, while emphasizing that living a fulfilling life through effective coping strategies is possible.

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Evidence of widespread metabolite abnormalities in ME/CFS: assessment with whole-brain magnetic resonance spectroscopy

Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy, by Christina Mueller, Joanne C Lin, Sulaiman Sheriff, Andrew A Maudsley, Jarred W. Younger in Brain Imaging and Behavior 2019: pp 1–11 [First Online: 07 January 2019]

 

Research abstract:

Previous neuroimaging studies have detected markers of neuroinflammation in patients with Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS). Magnetic Resonance Spectroscopy (MRS) is suitable for measuring brain metabolites linked to inflammation, but has only been applied to discrete regions of interest in ME/CFS.

We extended the MRS analysis of ME/CFS by capturing multi-voxel information across the entire brain. Additionally, we tested whether MRS-derived brain temperature is elevated in ME/CFS patients.

Fifteen women with ME/CFS and 15 age- and gender-matched healthy controls completed fatigue and mood symptom questionnaires and whole-brain echo-planar spectroscopic imaging (EPSI). Choline (CHO), myo-inositol (MI), lactate (LAC), and N-acetylaspartate (NAA) were quantified in 47 regions, expressed as ratios over creatine (CR), and compared between ME/CFS patients and controls using independent-samples t-tests. Brain
temperature was similarly tested between groups.

Significant between-group differences were detected in several regions, most notably elevated CHO/CR in the left anterior cingulate (p < 0.001). Metabolite ratios in seven regions were correlated with fatigue (p <0.05). ME/CFS patients had increased temperature in the right insula, putamen, frontal cortex, thalamus, and the cerebellum (all p < 0.05), which was not attributable to increased body temperature or differences in cerebral perfusion. Brain temperature increases converged with elevated LAC/CR in the right insula, right thalamus, and cerebellum (all p < 0.05).

We report metabolite and temperature abnormalities in ME/CFS patients in widely distributed regions. Our findings may indicate that ME/CFS involves neuroinflammation.

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“It’s not one size fits all”; the use of videoconferencing for delivering therapy in a Specialist Paediatric CFS Service

“It’s not one size fits all”; the use of videoconferencing for delivering therapy in a Specialist Paediatric Chronic Fatigue Service by Andrew Haig-Ferguson, Maria Loades, Charlotte Whittle, Rebecca Read, Nina Higson-Sweeney, Lucy Beasant, Jennifer Starbuck, Esther Crawley in Internet Interventions Volume 15, March 2019, Pages 43-51 [Available online 23 Dec 2018]

 

Research abstract:

Background:
There are few specialist paediatric Chronic Fatigue Syndrome (CFS/ME) services in the UK. Therefore, the distance some families have to travel to reach these services can be a barrier to accessing evidence-based treatment. Videoconferencing technology such as Skype provides a means of delivering sessions remotely. This study aimed to explore the views of children and young people, their parents, and healthcare professionals of treatment delivered by videoconferencing in a specialist paediatric CFS/ME team.

Method:
To explore the experiences of the participants, a qualitative design was selected. Twelve young people (age 9–18), and 6 parents were interviewed about their experience of treatment sessions delivered via videoconferencing within a specialist CFS/ME service. A focus group explored the views of healthcare professionals (N = 9) from the service. Thematic analysis was used.

Results:
Three themes were identified from the data: “Challenges and concerns”, “Benefits” and “Treatment provision”. Challenges and concerns that participants identified were; difficulties experienced with technology; a sense of a part of communication being lost with virtual connections; privacy issues with communicating online and feeling anxious on a screen. Participants felt that benefits of videoconferencing were; improving access to the chronic fatigue service; convenience and flexibility of treatment provision; a sense of being more open online and being in the comfort of their own home. In terms of treatment provision participants talked about videoconferencing as a part of a hierarchy of communication; the function of videoconferencing within the context of the chronic fatigue service; additional preparation needed to utilise videoconferencing and an assumption that videoconferencing is “part of young people’s lives”.

Conclusions:
Although the experience of sessions provided by videoconferencing was different to sessions attended in person, participants tended to be positive about videoconferencing as an alternative means of accessing treatment, despite some barriers. Videoconferencing could be an additional option within an individualised care plan, but should not be an alternative to face to face support.

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The link between idiopathic intracranial hypertension, FM, & CFS: exploration of a shared pathophysiology

The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology, by Mieke Hulens, Ricky Rasschaert, Greet Vansant, Ingeborg Stalmans, Frans Bruyninckx, Wim Dankaerts in Journal of Pain Research Vol 2018:11 Pages 3129—3140 [Published 10 December 2018]

 

Abstract:

Purpose: Idiopathic intracranial hypertension (IICH) is a condition characterized by raised intracranial pressure (ICP), and its diagnosis is established when the opening pressure measured during a lumbar puncture is elevated >20 cm H2O in nonobese patients or >25 cm H2O in obese patients. Papilledema is caused by forced filling of the optic nerve sheath with cerebrospinal fluid (CSF). Other common but underappreciated symptoms of IICH are neck pain, back pain, and radicular pain in the arms and legs resulting from associated increased spinal pressure and forced filling of the spinal nerves with CSF.

Widespread pain and also several other characteristics of IICH share notable similarities with characteristics of fibromyalgia (FM) and chronic fatigue syndrome (CFS), two overlapping chronic pain conditions. The aim of this review was to compare literature data regarding the characteristics of IICH, FM, and CFS and to link the shared data to an apparent underlying physiopathology, that is, increased ICP.

Methods: Data in the literature regarding these three conditions were compared and linked to the hypothesis of the shared underlying physiopathology of increased cerebrospinal pressure.

Results: The shared characteristics of IICH, FM, and CFS that can be caused by increased ICP include headaches, fatigue, cognitive impairment, loss of gray matter, involvement of cranial nerves, and overload of the lymphatic olfactory pathway. Increased pressure in the spinal canal and in peripheral nerve root sheaths causes widespread pain, weakness in the arms and legs, walking difficulties (ataxia), and bladder, bowel, and sphincter symptoms. Additionally, IICH, FM, and CFS are frequently associated with sympathetic overactivity symptoms and obesity. These conditions share a strong female predominance and are frequently associated with Ehlers-Danlos syndrome.

Conclusion: IICH, FM, and CFS share a large variety of symptoms that might all be explained by the same pathophysiology of increased cerebrospinal pressure.

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A systematic review of enteric dysbiosis in CFS/ME

A systematic review of enteric dysbiosis in chronic fatigue syndrome/myalgic encephalomyelitis, by S Du Preez, M Corbitt, H Cabanas, N Eaton, D Staines and S Marshall-Gradisnik in Systematic Reviews 2018 7:241 [Published: 20 December 2018]

Review abstract:

Background:
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is an illness characterised by profound and pervasive fatigue in addition to a heterogeneous constellation of symptoms. The aetiology of this condition remains unknown; however, it has been previously suggested that enteric dysbiosis is implicated in the pathogenesis of CFS/ME.

This review examines the evidence currently available for the presence of abnormal microbial ecology in CFS/ME in comparison to healthy controls, with one exception being probiotic-supplemented CFS/ME patients, and whether the composition of the microbiome plays a role in symptom causation.

Methods:
EMBASE, Medline (via EBSCOhost), Pubmed and Scopus were systematically searched from 1994 to March 2018. All studies that investigated the gut microbiome composition of CFS/ME patients were initially included prior to the application of specific exclusion criteria. The association between these findings and patient-centred outcomes (fatigue, quality of life, gastrointestinal symptoms, psychological wellbeing) are also reported.

Results:
Seven studies that met the inclusion criteria were included in the review. The microbiome composition of CFS/ME patients was compared with healthy controls, with the exception of one study that compared to probiotic-supplemented CFS/ME patients. Differences were reported in each study; however, only three were considered statistically significant, and the findings across all studies were inconsistent. The quality of the studies included in this review scored between poor (< 54%), fair (54–72%) and good (94–100%) using the Downs and Black checklist.

Conclusions:
There is currently insufficient evidence for enteric dysbiosis playing a significant role in the pathomechanism of CFS/ME. Recommendations for future research in this field include the use of consistent criteria for the diagnosis of CFS/ME, reduction of confounding variables by controlling factors that influence microbiome composition prior to sample collection and including more severe cases of CFS/ME.

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