Review of potential causes of muscle dysfunction in ME/CFS

Review abstract:

Purpose of Review:
Here, we review potential causes of muscle dysfunction seen in many patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) such as the effects of oxidative and nitrosative stress (O&NS) and mitochondrial impairments together with reduced heat shock protein production and a range of metabolic abnormalities.

Recent Findings:
Several studies published in the last few years have highlighted the existence of chronic O&NS, inflammation, impaired mitochondrial function and reduced heat shock protein production in many patients with ME/CFS.

These studies have also highlighted the detrimental effects of chronically elevated O&NS on muscle functions such as reducing the time to muscle fatigue during exercise and impairing muscle contractility. Mechanisms have also been revealed by which chronic O&NS and or impaired heat shock production may impair muscle repair following exercise and indeed the adaptive responses in the striated muscle to acute and chronic increases in physical activity.

Summary:
The presence of chronic O&NS, low-grade inflammation and impaired heat shock protein production may well explain the objective findings of increased muscle fatigue, impaired contractility and multiple dimensions of exercise intolerance in many patients with ME/CFS.

Mechanisms explaining muscle fatigue and muscle pain in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a review of recent findings, by Morris Gerwyn, Michael Maes in Current Rheumatology Reports, January 2017, 19:1 [published online 23 Jan 2017]

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International wheelchair day 1 March 2017

Celebrate your wheelchair on International Wheelchair day

an annual day of events and activities which take place around the World when wheelchair users celebrate the positive impact a wheelchair has on their lives.

International wheelchair day website

 

Euan’s guide: Euan’s Guide features disabled access reviews from disabled people and their friends and families

“The aim of Euan’s Guide is to empower disabled people by providing information that will give confidence and choices for getting out and about.”

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Brain & spinal fluid abnormalities in CFS are not affected by psychiatric comorbidity

Research highlights:

  • As a group, CFS patients have higher brain ventricular lactate, more abnormal spinal fluid results, lower brain GSH, and reduced cerebral blood flow relative to healthy sedentary controls
  • Psychiatric comorbidity does not influence any of these potential biological markers of CFS
  • 50% of the patients had more than one of these abnormalities
  • The subgroup of patients with brain abnormalities may have an underlying encephalopathy producing their illness

Research abstract:

The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH).

The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS.

Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls.

Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables. These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS.

These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS.

Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity by Benjamin H Natelson, Xiangling Mao, Aaron J Stegner, Gudrun Lange, Diana Vu, Michelle Blate, Guoxin Kang, Eli Soto, Tolga Kapusuz, Dikoma C Shungu in Journal of the Neurological Sciences April 15, 2017 Vol 375, pp 411–416 [Published online Feb 2017]

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Effectiveness of long-term Doxycycline treatment & CBT on fatigue severity in patients with Q Fever Fatigue Syndrome

Research abstract:

Background: Approximately 20% of patients with acute Q fever will develop chronic fatigue, referred to as Q fever fatigue syndrome (QFS). The objective of this randomized controlled clinical trial was to assess the efficacy of either long-term treatment with doxycycline or cognitive-behavioral therapy (CBT) in reducing fatigue severity in patients with QFS.

Methods: Adult patients were included who met the QFS criteria according to the Dutch guideline: a new onset of severe fatigue lasting ≥6 months with significant disabilities, related to an acute Q fever infection, without other somatic or psychiatric comorbidity explaining the fatigue. Using block randomization, patients were randomized between oral study medication and CBT (2:1) for 24 weeks.

Second, a double-blind randomization between doxycycline (200 mg/day, once daily) and placebo was performed in the medication group. Primary outcome was fatigue severity at end of treatment (EOT; week 26), assessed with the Checklist Individual Strength subscale Fatigue Severity.

Results: Of 155 patients randomized, 154 were included in the intention-to-treat analysis (doxycycline, 52; placebo, 52; CBT, 50).

At EOT, fatigue severity was similar between doxycycline (40.8 [95% confidence interval {CI}, 37.3-44.3]) and placebo (37.8 [95% CI, 34.3-41.2]; difference, doxycycline vs placebo, -3.0 [97.5% CI, -8.7 to 2.6]; P = .45). Fatigue severity was significantly lower after CBT

(31.6 [95% CI, 28.0-35.1]) than after placebo (difference, CBT vs placebo, 6.2 [97.5% CI, .5-11.9]; P = .03).

Conclusions: CBT is effective in reducing fatigue severity in QFS patients. Long-term treatment with doxycycline does not reduce fatigue severity in QFS patients compared to placebo.

Effectiveness of Long-term Doxycycline Treatment and Cognitive-Behavioral Therapy on Fatigue Severity in Patients with Q Fever Fatigue Syndrome (Qure Study): A Randomized Controlled Trial, by Keijmel SP, Delsing CE, Bleijenberg G, van der Meer JW, Donders RT, Leclercq M, Kampschreur LM, van den Berg M, Sprong T, Nabuurs-Franssen MH, Knoop H, Bleeker-Rovers CP in Clin Infect Dis. 2017 Feb 27

Note: protocol for the Qure study

Clinical Trials Registration.: NCT01318356

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Epigenetic modifications & glucocorticoid sensitivity in ME/CFS

Research abstract:

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

(ME/CFS) is a debilitating idiopathic disease characterized by unexplained fatigue that fails to resolve with sufficient rest.

Diagnosis is based on a list of symptoms and exclusion of other fatigue-related health conditions. Despite a heterogeneous patient population, immune and hypothalamic-pituitary-adrenal (HPA) axis function differences, such as enhanced negative feedback to glucocorticoids, are recurring findings in ME/CFS studies. Epigenetic modifications, such as CpG methylation, are known to regulate long-term phenotypic differences and previous work by our group found DNA methylome differences in ME/CFS, however the relationship between DNA methylome modifications, clinical and functional characteristics associated with ME/CFS has not been examined.

Methods: We examined the DNA methylome in peripheral blood mononuclear cells (PBMCs) of a larger cohort of female ME/CFS patients using the Illumina HumanMethylation450 BeadChip Array. In parallel to the DNA methylome analysis, we investigated in vitro glucocorticoid sensitivity differences by stimulating PBMCs with phytohaemagglutinin and suppressed growth with dexamethasone.

We explored DNA methylation differences using bisulfite pyrosequencing and statistical permutation. Linear regression was implemented to discover epigenomic regions associated with self-reported quality of life and network analysis of gene ontology terms to biologically contextualize results.

Results: We detected 12,608 differentially methylated sites between ME/CFS patients and healthy controls predominantly localized to cellular metabolism genes, some of which were also related to self-reported quality of life health scores. Among ME/CFS patients, glucocorticoid sensitivity was associated with differential methylation at 13 loci.

Conclusions: Our results indicate DNA methylation modifications in cellular metabolism in ME/CFS despite a heterogeneous patient population, implicating these processes in immune and HPA axis dysfunction in ME/CFS. Modifications to epigenetic loci associated with differences in glucocorticoid sensitivity may be important as biomarkers for future clinical testing. Overall, these findings align with recent ME/CFS work that point towards impairment in cellular energy production in this patient population.

Epigenetic modifications and glucocorticoid sensitivity in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) by Wilfred C. de Vega, Santiago Herrera, Suzanne D. Vernon and Patrick O. McGowan in BMC Medical Genomics 2017 10:11 [Published: 23 February 2017]

University of Toronto news, by Don Campbell,  4 April 2017: University of Toronto study offers hope to sufferers of chronic fatigue syndrome

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People with ME in South Africa share their stories

Carte Blanche blog post, 19 February 2017: Living With Chronic Fatigue Syndrome

The effects of ME/CFS are very real and can change a patient’s life in a dramatic way. Three South African women share their stories on living with this condition: Retha, Rika and Nathalie  Read more

Nathalie & Retha

Nathalie Williams says:

Please share this video to help raise awareness of Myalgic Encephalomyelitis (ME), also referred to as Chronic Fatigue Syndrome (CFS).

To share this video on other platforms, here’s the link: https://www.facebook.com/NathalieHWilliams/videos/10156004031092619/

or watch it on the ME Association website:

A 10-film on M.E. was shown on Carte Blanche, South Africa’s longest-running TV investigation show, on 20 February 2017. It has won plaudits round the world for its straight talking about this illness, and choice of interview subjects – particularly Dr Ron Davis and David Tuller. Nathalie Williams is featured in the film  Watch video

ME/CFS Foundation South Africa

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Neuro inflammatory etiopathology of ME/CFS

Article abstract:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating multi-systemic chronic illness of unknown etiology, classified as a neurological disorder by the World Health Organization (WHO).

The symptomatology of the condition appears to emanate from a variety of sources of chronic neurological disturbance and associated distortions, and chronicity, in noxious sensory signaling and neuroimmune activation.

This article incorporates a summary review and discussion of biomedical research considered relevant to this essential conception perspective. It is intended to provide stakeholders with a concise, integrated outline disease model in order to help demystify this major public health problem.

The primary etiopathological factors presented are:

  • (A) Postural/biomechanical pain signaling, affecting adverse neuroexcitation, in the context of compression, constriction, strain, or damage of vertebral-regional bone and neuromuscular tissues;
  • (B) Immune mediated inflammatory sequelae, in the context of prolonged immunotropic neurotrophic infection—with lymphotropic/gliotropic/glio-toxic varieties implicated in particular;
  • (C) A combination of factors A and B. Sustained glial activation under such conditions is associated with oxidative and nitrosative stress, neuroinflammation, and neural sensitivity.

These processes collectively enhance the potential for multi-systemic disarray involving endocrine pathway aberration, immune and mitochondrial dysfunction, and neurodegeneration, and tend toward still more intractable synergistic neuro-glial dysfunction (gliopathy), autoimmunity, and central neuronal sensitization.

The Neuroinflammatory Etiopathology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), by Independent Health Researcher and Consultant, Julian AG Glassford, from Shrewsbury in Front. Physiol., 17 February 2017

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The UK ME/CFS Biobank for biomedical research on ME/CFS & MS

Overview of a UK bioresource:

The UK ME/CFS Biobank was launched in August 2011 following extensive consultation with professionals and patient representatives. The bioresource aims to enhance research on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), related to pathophysiology, biomarkers and therapeutic approaches.

The cohort includes 18–60 year olds, encompassing 284 clinically-confirmed ME/CFS cases, 60 neurologist-diagnosed multiple sclerosis (MS) cases, and 135 healthy individuals.

The Biobank contains blood samples, aliquoted into serum, plasma, peripheral blood mononuclear cells (PBMC), red blood cells/granulocyte pellet, whole blood, and RNA (totalling 29,863 aliquots). Extensive dataset (700 clinical and socio-demographic variables/participant) enables comprehensive phenotyping. Potential reuse is conditional to ethical approval.

More info:
The UK ME/CFS Biobank for biomedical research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis, by Eliana M Lacerda , Erinna W Bowman, Jacqueline M Cliff, Caroline C Kingdon, Elizabeth C King, Ji-Sook Lee, Taane G Clark, Hazel M Dockrell, Eleanor M Riley, Hayley Curran, Luis Nacul in Open Journal of Bioresources 4(1), p.4 [Published on 20 Feb 2017]

 

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Vitamin D could boost the immune system

Recent news reports of research claiming vitamin D supplements can boost the immune system as well as the health of bones, has raised questions for how people with ME can obtain enough of this vital nutrient.

Get vitamin D from:

  • sunshine, but not through glass or sun creams
  • oily fish e.g. fresh salmon, tuna, mackerel – tinned tuna and some tinned salmon doesn’t contain much, if any
  • fortified foods – some bread, spreads and cereals have vitamin D added
  • egg yolks
  • beef liver
  • supplements

More info about the recent research:

BBC news report, by James Gallagher, 16 Feb 2017: Vitamin D pills ‘could stop colds or flu’

Vitamin D supplements could spare more than three million people from colds or flu in the UK each year, researchers claim. The sunshine vitamin is vital for healthy bones, but also has a role in the immune system.

The analysis, published in the British Medical Journal, argues food should be fortified with the vitamin.

But Public Health England (PHE) says the infections data is not conclusive, although it does recommend supplements. These, it says, should be taken for improved bone and muscle health.    Read more

Independent: Vitamin D supplements ‘the key to beating colds and flu’, study finds

ITV news: Vitamin D pills ‘key to beating colds and flu’ says study

Guardian: Vitamin D ‘proved to cut risk of colds and flu’

ME Association: Vitamin D supplements may help to prevent viral and bacterial infections

More info about Vitamin D and other supplements:

Independent: Five ways to boost your Vitamin D levels

Dr Lapp’s Recommendations on Supplements

Independent: Can you get a suntan and absorb vitamin D through a window?

 

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Citric Acid Cycle is deficient in people with ME/CFS

MEAction blog post, by Adrianne Tillman, 22 Feb 2017: Stanford team announces breakthrough in ME/CFS research

A research team at Stanford announced yesterday that it has made some breakthroughs in understanding the metabolic cycles that are not working properly in people with ME/CFS that might be at the heart of the disease.

Ronald W. Davis, PhD, made the announcement via YouTube. Davis directs the CFS Research Center team at the Stanford Genome Technology Center (SGTC).

You tube video: Problems with metabolic cycles (18 mins)

The team’s metabolomics tests on severely-ill patients revealed problems with the citric acid cycle. Participants’ blood work showed that some of the chemicals involved in the citric acid cycle are very low, making it difficult for the patient to generate the chemicals we use for energy. Several chemicals were found to be two standard deviations away from those of healthy controls, which is serious, according to Davis.

Recent research by Fluge and Mella has also suggested that pyruvate dehydrogenase, the enzyme that helps glycolysis transition into the citric acid cycle, may be blocked.

“We have not investigated that, but it is consistent with glycolysis being shut down,” Davis said. “We also think that pyruvate kinase might be shut down. Those are not inconsistent and it is possible there are blocks in both of them.”

The problem with NIH
Davis and his team applied for federal funding from the National Institute of Health (NIH) for the research that led to the data showing the dysfunctional citric acid cycle in people with ME/CFS. The NIH turned down both of his grants “because we were trying to do discovery, and they wanted us to only do hypothesis testing,” Davis said.

“I said to them: the scientific method is first observation, then hypothesis. And if you have virtually no observations you can’t generate a good hypothesis. I think one of the big problems we have is that we do not know enough at the molecular level to generate hypotheses.”

Technology to screen drugs without using patients
Davis also announced a device that the Stanford team has developed to test metabolic functions, which will enable them to do mass screenings of drugs without the time and cost restraints of using patients.

The device is about the size of a computer chip. It has a small channel in it to accommodate a tenth-of-a-drop of blood, all that is needed for this assay. It has 2500 electrodes in it, and each electrode is sampled 200 times a second. This generates a massive amount of data.

Davis explains how the device works:

“What we have noticed from this device is that if we put bacterial population into this, we will get a certain electrical impedance signal. If we then add an antibiotic that kills the bacteria, the electrical impedance will rapidly increase. If the bacteria are resistant to the antibiotic, we see no change.

“So, if we put healthy cells and their serum into the device, it is pretty stable and does not change. If we put in ME/CFS cells and their serum, it doesn’t change. However, if we put a demand on the cells, we require them to consume energy, and that demand is seen in this graph where there is a slight dip in the healthy controls – but they handle that demand quite well and don’t change after that – however the cells from the ME/CFS patient shows a rapid increase in impedance. And that has been shown for every patient we have looked at, and also every healthy control is the same.”

Most importantly, the device provides a way for Davis and his team to test drugs on ME/CFS cells and serum to see the effect.

Davis noted that the rapid rise in impedance is caused by the serum, not the cell, which means that there is something being released into the serum that may be causing or contributing to symptoms.

“If it is in the serum, we probably can find it,” Davis said. “And that is what we’re trying to do now, which is find the component or components – most likely plural – that is causing this effect… Now this a good hypothesis, and we are now testing it.”

Davis said that the next step is to use the device to test the effects of various drugs on the cells and serum of ME/CFS patients. For example, Davis’ team found that adding ATP to unhealthy ME/CFS cells and serum made the cells respond normally. The team also plans to test drugs that many ME/CFS patients have reported helpful using this device, such as Valcyte and Rituximab.

If the device turns out to be a good diagnostic test for ME/CFS, Davis said his team will disseminate information to doctors’ offices.

This device may be applicable to other diseases as well, including Lyme and Fibromyalgia.

The magnetic levitation device
Davis and his team have also developed a magnetic levitation device which separates cells based on their magnetic properties. The device is small and can fit onto an iPhone.  This device can be used to separate and examine cells with differing properties, which has broad applications, including examining specific cell types in ME/CFS patients.  The magnetic levitation device costs 5 cents per assay.

“We’re accumulating a list of things that we are trying with this device,” Davis said.

“One of our focuses is on developing engineered biosensors and devices. We also have a synthetic biology core that is used to develop new ways to do production of drugs and test drugs… So we have a heavy focus on how to reduce cost of tests and simplicity of those tests and portability,” Davis said.

The Open Medicine Foundation (OMF) is helping fund the work of Dr. Davis’ CFS Research Center team at SGTC. So far, their breakthroughs have been achieved by doing one experiment at a time, week-by-week. At this point, the team is ready to ramp up the project in order to carry out multiple parallel investigations to get answers as fast as possible. However, substantially more funding is needed for this to happen.

Opportunity to donate to Stanford’s research

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