Discerning primary and secondary factors responsible for clinical fatigue in multisystem diseases

Research abstract

Fatigue is a common symptom of numerous acute and chronic diseases, including myalgic encephalomyelitis/ chronic fatigue syndrome, multiple sclerosis, heart failure, cancer, and many others. In these multi-system diseases the physiological determinants of enhanced fatigue encompass a combination of metabolic, neurological, and myofibrillar adaptations.

Previous research studies have focused on adaptations specific to skeletal muscle and their role in fatigue. However, most have neglected the contribution of physical inactivity in assessing disease syndromes, which, through deconditioning, likely contributes to symptomatic fatigue.

In this commentary, we briefly review disease-related muscle phenotypes in the context of whether they relate to the primary disease or whether they develop secondary to reduced physical activity. Knowledge of the etiology of the skeletal muscle adaptations in these conditions and their contribution o fatigue symptoms is important for understanding the utility of exercise rehabilitation as an intervention to alleviate the physiological precipitants of fatigue.

From conclusion:

In conclusion, what one sees with chronic disease is a slide into less functionality, with diminished muscle size, strength, and oxidative capacity. As a bulwark against this slide, exercise becomes particularly important for maintaining/ improving muscle size, contractility and oxidative capacity, all of which help to ameliorate fatigue by reducing the amount of fatiguing stimuli.

Where exercise is tolerated, it is beneficial. The only possible exception is ME/CFS, where, as noted above, restorative rest and careful pacing of one’s activities are foremost among the currently recommended therapeutic approaches.

Discerning Primary and Secondary Factors Responsible for Clinical Fatigue in Multisystem Diseases, by D Maughan & M Toth in Biology (Basel), 22 September 2014.

Posted in News | Tagged , | Comments Off on Discerning primary and secondary factors responsible for clinical fatigue in multisystem diseases

Coenzyme Q10 & NADH-potential treatment for fatigue

Research Abstract

Chronic Fatigue Syndrome (CFS) is a chronic and extremely debilitating illness characterized by prolonged fatigue and multiple symptoms with unknown cause, diagnostic test, or universally effective treatment.

Inflammation, oxidative stress, mitochondrial dysfunction, and CoQ10 deficiency have been well documented in CFS.

We conducted an 8-weeks randomized, double-blind, placebo-controlled trial to evaluate the benefits of oral CoQ10 (200 mg/day) plus NADH (20 mg/day) supplementation on fatigue and biochemical parameters in 73 Spanish CFS patients. This study was registered in ClinicalTrials.gov (NCT02063126).

A significant improvement of fatigue showing a reduction in FIS total score (p< 0.05) was reported in treated group vs. placebo. In addition, a recovery of the biochemical parameters was also reported. NAD+/NADH (p< 0.001), CoQ10 (p< 0.05), ATP (p< 0.05) and citrate synthase (p< 0.05) were significantly higher and lipoperoxides (p< 0.05) were significantly lower in blood mononuclear cells (BMCs) of the treated group.

These observations lead to the hypothesis that the oral CoQ10 plus NADH supplementation could confer potential therapeutic benefits on fatigue and biochemical parameters in CFS. Larger sample trials are warranted to confirm these findings.

Does oral Coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in Chronic Fatigue Syndrome?, by Dr. Jesus Castro-Marrero et al,  in Antioxidants & Redox Signaling, Online ahead of editing: November 11, 2014

 

Posted in News | Tagged , | Comments Off on Coenzyme Q10 & NADH-potential treatment for fatigue

CFS: searching for a microbial etiology

Book chapter abstract

Chronic fatigue syndrome [CFS] is a symptom complex of unknown cause which is commonly present in the population, and has been labeled as postinfectious neuromyasthenia for many decades.

A microbial etiology has been considered for this disorder from the outset of its description as a distinct clinical entity. There is strong evidence that female sex and certain personality traits predispose to this condition.

The link with infectious diseases is based on the acute onset of flu-like symptoms, subjective feelings of low grade fever, sore throat, myalgias, arthralgias, or generalized body pain. Various infectious synonyms have been applied to this disorder such as chronic brucellosis, chronic Epstein–Barr virus, and chronic Lyme disease syndromes, but no good evidence to support a causative role has been found. The current understanding of the pathogenesis is discussed and previous investigations to determine an infectious etiology, including studies on coxsackie virus and the murine retrovirus and others.

The cytokines in plasma from these CFS patients was assayed in a multiplex platform, and one of us published findings  showing signatures of infection; that is, significantly high levels of many proinflammatory mediators such as IL-12, MCP-1, IL-8, IP-10, IL-6, TNF-α, and IL-1β  while being low in the critical antiviral cytokine IFN-α. In expanding these results, we  found that subsets of these CFS patients had increased TGF-β and others had increased  IL-9.

We will discuss these and other published results that suggest that chronic  stimulation of the innate immune system is a component of the development and progression of disease in many CFS patients. In chronic diseases the resulting immunodeficiency allows activation and replication of many secondary pathogens. Thus CFS patients can share complex pathogenic complications with patients with HIV AIDS  and HTLV-1 associated myelopathy.

In many CFS patient populations, the presence of several concomitant infections, from Borrelia burgdorferi to reactivated exogenous and  endogenous viruses, chronically dysregulating the immune system, is a major risk factor in the development of pathology. Other risk factors include alterations in microbiota  regulation, mitochondrial toxicity, cognitive dysfunction and impaired methylation pathways. These factors can also increase the risk of others diseases, including cancer, in  some CFS patients.

These results have important implications for the  management of many people with this diagnosis. We will review in this chapter the use of anti-inflammatories, anti-virals and other therapies, as well as discussing how repurposing drugs holds promise in the treatment of patients displaying the immune abnormalities identified in these CFS patients.

Chronic Fatigue Syndrome: Searching for a Microbial Etiology, by  I. W. Fong, in The Role of Microbes in Common Non-Infectious Diseases Emerging Infectious Diseases of the 21st Century Volume 1, 2014, pp 111-128,  08 Aug 2014

Within this Chapter
– Introduction
– Is Chronic Fatigue Syndrome a Psychosocial Disorder?
– Pathobiology of Chronic Fatigue Syndrome
– Infections and Chronic Fatigue Syndrome
– Conclusion
– Future Direction
– References

Posted in News | Tagged , , | Comments Off on CFS: searching for a microbial etiology

MRI shows reaction to the carbohydrate lactulose in IBS

Research abstract

Background:

Postprandial discomfort following intake of poorly absorbable, but fermentable carbohydrates is a common complaint in patients with irritable bowel syndrome (IBS). We used lactulose as a model substance for this group of symptom triggering carbohydrates, aiming to visualize the intestinal response in IBS patients compared to healthy controls.

Methods:

Patients with IBS according to Rome III criteria (n = 52) and healthy controls (n = 16) underwent a lactulose challenge test. By using magnetic resonance imaging, we measured small bowel water content (SBWC), and distension (diameter) of the distal ileum and the colon, both in fasting state and 1 h after ingestion of 10 g lactulose. We recorded symptoms after lactulose ingestion.

Key Results:

Lactulose provoked significantly more symptoms in IBS patients than in healthy controls (p < 0.0001). SBWC increased more in the patient group compared to the control group (p = 0.0005). The postprandial diameter of the terminal ileum was larger in patients with IBS and the postprandial diameter of the ascending colon was smaller in patients with diarrhea-predominant phenotype (IBS-D).
Symptoms were not correlated with change in SBWC (r = 0.05; p = 0.11), nor to the diameters of the terminal ileum or the colon.

Conclusions & Inferences:

Compared to healthy controls, IBS patients developed more symptoms and had an abnormal accumulation of fluid in the small bowel in response to ingestion of the unabsorbable carbohydrate lactulose. This may be due to impaired motor activity of the small intestine or impaired function of the ileocecal segment.

Abnormal accumulation of intestinal fluid following ingestion of an unabsorbable carbohydrate in patients with irritable bowel syndrome: an MRI study, by R. Undseth, A. Berstad, N.-E. Kløw, K. Arnljot, K. S. Moi and J. Valeur in Neurogastroenterol Motil. 2014 Oct 1

Article in Science Nordic: First image of an irritable bowel

 

 

Posted in News | Tagged , , , , , , | Comments Off on MRI shows reaction to the carbohydrate lactulose in IBS

End ME/CFS project

Cort Johnson on the OMF’s new project:

The Open Medicine Foundation (OMF) has announced it has created and is raising funds for a huge “End ME/CFS” project. They’re looking for five million dollars a year to fund it — about double the NIH’s [National Institutes of Health in US] current annual spending on all ME/CFS research. That’s a really ambitious project. Could they actually pull it off?
“What is needed is a total attack on the problem.” – Ron Davis PhD

I think they could, and the reason why starts with Ron Davis PhD, the originator and leader of the project. Davis has been thinking about producing a high-level consortium to attack Chronic Fatigue Syndrome (ME/CFS) for years. The idea of a consortium immediately came up when I first talked to him about three years ago. His son, Whitney, had introduced us. Whitney was quite ill then, but since then has gotten much worse. He now has one of the worst cases of ME/CFS I’ve heard of.

In order to understand where this project is coming from and why it might work let’s take a look at the man behind it.

Dr. Ron Davis
“He’s a frequent provider of disruptive core technologies.”

Ron Davis PhD has directed the Stanford Genome Technology Center for twenty years. He has a long list of firsts by his name including one – using restriction fragment polymorphisms to construct genetic linkage maps – that helped launch the field of genomics in 1980 and ultimately made the Human Genome project possible.

He’s won numerous awards and prizes (Eli Lilly, Distinguished CIT Alumni and NAS Awards and Dickson , Gruber and Warren Alpert Foundation Prizes). He won the Lifetime Achievement Award from the Genetics Society of America ten years ago. PubMed lists over 500 publications for Dr. Davis – the most I’ve seen for a researcher.  One researcher wrote that Davis’s contributions to the field of genetics are so seminal that it’s impossible to quantify their impact

At the presentation of the Warren Alpert Prize last year Harvard Medical School geneticist Clifford Tabin concluded that Davis’s contributions were so seminal in the world of genetics and disease that it was “impossible to quantify the impact” he and his colleagues had had.

One nominator for Davis’s Gruber Prize stated Davis has “provided the indispensable infrastructure that has driven the astonishing pace of genetic discoveries, as well as provided key technical, intellectual and conceptual contributions to a breathtaking range of genetic problems.”

In 2013 Davis was pegged in an Atlantic Monthly article as one of eight inventors tomorrow’s historians will consider the greatest inventors today. “He’s not just a one-hit wonder,” said Church. “He’s a frequent provider of disruptive core technologies.”

Frequent is the word. Three years ago Dr. Davis talked about the urgent need to assess the role the HLA region of our genome plays in ME/CFS. No one, however, had been able to figure out how to analyze this very complex region of our genome. In the interview below he reports his lab has developed a low cost means of doing that.

It’s safe to say that nobody with this kind of background and reputation has worked in the ME/CFS field before.

The Biggest Challenge
“I really enjoy working on problems that others think are unsolvable.” – Ron Davis

Now Davis is engaged in the biggest challenge of his career: solving Chronic Fatigue Syndrome. He’s best known for his ability to devise creative solutions that clear up technological impasses. He likes nothing better than to attack complex problems. With its diverse population, its many unanswered questions and its lack of funding beating ME/CFS is the biggest challenge of Davis’s career.

He’s got one now and not just at a technological level. The other stuff was easy compared to solving the mystery of a disorder that isn’t well-defined, is mostly ignored by the powers that be, and that has had a spotty record of research.

Davis believes both the field and medicine itself are ripe for breakthroughs. He’s been making the rounds telling everybody that ME/CFS is the field to be in now. This is the place to make big breakthroughs that resonate throughout the medical field. He is convinced that cracking ME/CFS will not just solve ME/CFS, but will provide key insights to the other puzzling neuro-immune disorders that dot the medical field.

Heavyweight Group

The idea is to get experts from inside the field and from outside the field. The ME/CFS experts will lend their deep knowledge of this field. The experts from outside the field will bring a rigor and creative approach to problem solving that has made them experts in much larger fields than ME/CFS.

He’s gathered a group of heavyweight researchers to help him. Thus far Davis been able to gather a group of partners the likes of which we haven’t seen before in ME/CFS. The Scientific Advisory Board includes (and the list will grow over time to include ME/CFS experts and more outside researchers):
Mark Davis PhD – (170+ publications) runs own immune lab (The Mark M. Davis Lab) at Stanford. One of the things he’s doing is characterizing what a normal immune system actually looks like.

Mario Capecchio PhD – (200 + publications) molecular geneticist and Nobel Laureate and Lasker prize winner

Craig Heller PhD (150 + publications) – Stanford exercise physiologist and the inventor of “the glove”, a device that reduces body temperature in order to increase muscle performance.

Baldomero M. Olivera PhD (300+ publications) – a University of Utah neuroscientist focusing on how the ion channels and receptors affect nervous system signaling.

Ron Tompkins MD, ScD – the leader of the sepsis consortium Dr. Davis participated in, Dr. Tompkins (350+ publications) has produced ground-breaking work on the process of inflammation.

Andreas Kogelnik MD, PhD – ME/CFS expert and founder of the Open Medicine Institute.

James Watson PhD – the Nobel Prize laureate who, with Francis Crick, uncovered the structure of DNA.

How many boards boast two Nobel Laureates? No one has ever brought this much brainpower together to study ME/CFS before.

An Emphasis on Rigor
“We wanted the right answer no matter whose theories we destroyed.” – Ron Davis on the Trauma Consortium

Ron Davis is a stickler on scientific rigor. Time and again in our discussions over the years he’s emphasized the need not to be beholden to any preconceived notion – to be open to where the science leads you.

In this process you put everything you know or think you know about ME/CFS at risk. You’re ruthless in your quest for the truth. Instead of trying to prove something is right, your first goal is to find the chinks in a finding’s armor. It’s like looking at a diamond. You hold it up and look at it from every angle to find any flaws. Then you attack the flaws. Anything that makes it through the fire of this kind of rigorous inquiry is rock-solid. You can bank on it. Ruthless analysis and rigorous experimentation allows seminal findings to emerge.

Then you figure out your priorities. If it requires creating new technology (and it will) you do that. You gather a large number of representative patients and focus on them throughout. Then you find the best experimentalists in the field and you have them do the lab work. You gather another large cohort of patients and validate the findings.

At every step you use the best technologies, the best materials, the best study designs, and the best researchers.

This kind of research is the antidote to the recent AHRQ report which eliminated 90% of the studies it gathered up for consideration because of methodological and other problems. It’s about producing findings that stick. It’s about producing seminal insights the field can build on for years.

Expect Surprises
“We discovered that the main theory of trauma taught in medical schools was totally wrong.”

Don’t be surprised if their efforts don’t overturn some ideas regarding ME/CFS. In fact, be surprised if this effort doesn’t yield completely novel ideas about ME/CFS.

It wasn’t as if trauma was an unknown entity when the Tompkins group took it on. It had been studied extensively – just not in the comprehensive manner his group used to look at it. It turned out that lots of the ideas regarding trauma and sepsis were wrong.

By the time this consortium has completed its mission, you can expect a new field to emerge. Expect ME/CFS to be completely redefined. Expect several subsets or perhaps disorders inside of it pop out. Expect them to illuminate numerous pathways that lead to the production of “ME/CFS”.

Mega ME-CFS Project
“I really enjoy working on problems that others think are unsolvable, and I’ve been finding, to my surprise, that the older I get, the easier it is to take on those problems.” – Ron Davis

This is research on a different level than we’re used to. It’s a $5 million a year project. That sounds like a lot of money. For ME/CFS it is a lot of money – about double the federal funding for this disorder – but it’s not a lot of money for the NIH. It’s not a lot of money for medical research, and it’s definitely not a lot of money for an often disabling disorder that affects a million people or more in the United States and many millions more across the world. Community support is needed. Community support is needed.

Still for anyone else, given where ME/CFS is, it might seem like a pipe dream. But this is the man who created the technology that made the Genome Project possible. This is the man named as the most likely person in the medical field to be designated one of the greatest inventors of his time. This is a man whose son has one of the most severe cases of ME/CFS you’ll ever find. If anyone can solve the multitude of puzzles that constitute this disorder, he can.

He’s going to need help. Davis is not a rah-rah kind of guy. He’s an inventor, not a publicist. Give him the tools and I’m confident he can engage the collaborators and invent the technologies we need to crack this disorder, but he needs our support.

This is a long-term effort. Don’t expect answers overnight. New technologies will need to be developed. But give this Consortium the funding and time it needs and it’s hard to imagine it won’t succeed.

To support the project go HERE or contact OMF by email 

Dr. Davis Talks
“The millions of suffering ME/CFS patients are owed an apology and a concerted urgent effort to find effective treatment” Ron Davis

Read more about Ron Davis and the project at: “End ME/CFS” mega CFS project begins

 

 

 

Posted in News | Tagged , , , , , , , , , , | Comments Off on End ME/CFS project

Immune changes in peripheral blood in CFS

Book chapter abstract:
Chronic Fatigue Syndrome (CFS) is recognized by the WHO as an alternative name  for Myalgic Encephalomyelitis, which has been classified as a disease of the central nervous system since 1969.

The concept that chronic microbial infection drives constant activation of the innate immune system through alterations in the production of innate immune cells and accompanied by abnormal production of pro-inflammatory cytokines and chemokines, and that this leads to progressive immune deficiency seen in many CFS patients has only recently been appreciated.

In investigating the distribution of immune cells in the peripheral blood of a cohort of CFS patients who have an antibody recognizing the SFFV envelope protein, we discovered profound alterations in the number and types of cells, particularly in the cells regulating the innate immune system. These changes included chronic activation of monocytes and dendritic cells, and a marked increase in NKT cells and decrease in NK cells.

The cytokines in plasma from these CFS patients was assayed in a multiplex platform, and one of us published findings showing signatures of infection; that is, significantly high levels of many proinflammatory mediators such as IL-12, MCP-1, IL-8, IP-10, IL-6, TNF-α, and IL-1β while being low in the critical antiviral cytokine IFN-α. In expanding these results, we found that subsets of these CFS patients had increased TGF-β and others had increased
IL-9.

We will discuss these and other published results that suggest that chronic
stimulation of the innate immune system is a component of the development and progression of disease in many CFS patients. In chronic diseases the resulting immunodeficiency allows activation and replication of many secondary pathogens. Thus CFS patients can share complex pathogenic complications with patients with HIV AIDS and HTLV-1 associated myelopathy.

In many CFS patient populations, the presence of several concomitant infections, from Borrelia burgdorferi to reactivated exogenous and endogenous viruses, chronically dysregulating the immune system, is a major risk factor in the development of pathology. Other risk factors include alterations in microbiota regulation, mitochondrial toxicity, cognitive dysfunction and impaired methylation pathways. These factors can also increase the risk of others diseases, including cancer, in some CFS patients.

These results have important implications for the management of many people with this diagnosis. We will review in this chapter the use of anti inflammatories, anti-virals and other therapies, as well as discussing how repurposing drugs holds promise in the treatment of patients displaying the immune abnormalities identified in these CFS patients.

Innate Immune Changes in the Peripheral Blood of Chronic Fatigue Syndrome Patients: Risk Factors for Disease Progression and Management, by Deborah L.S Goetz, Judy A. Mikovits, Jamie Deckoff-Jones, Francis W. Ruscetti. Chapter 6 in Chronic Fatigue Syndrome, edited by Connor Hudson, pp. 91-130.

Posted in News | Tagged , , , , , | Comments Off on Immune changes in peripheral blood in CFS

Low-level laser therapy as a treatment for chronic pain

Opinion article

Chronic pain is defined as pain that persists for greater than 12 weeks (Task-Force, 1994) and currently affects roughly 30% of the population in the United States (Johannes et al., 2010).

The most common method for managing chronic pain has traditionally been pharmacological (Nalamachu, 2013). These treatments often include non-steroidal anti-inflammatory drugs (NSAIDS), opioids, acetaminophen, and anticonvulsants (Nalamachu, 2013).

Alternative medicine is now also being used more frequently to treat chronic pain and may consist of acupuncture (McKee et al., 2013), Tai Chi (Wang et al., 2010; Wang, 2012), and low-level laser therapy (LLLT) (Enwemeka et al., 2004; Ay et al., 2010).

The focus of this manuscript is to highlight the physiological aspects of LLLT, and to discuss its application for those suffering from chronic pain, alone and in combination with exercise. It will also provide justification for the use of LLLT using specific data and case studies from the existing literature which have resulted in positive outcomes for those suffering from chronic pain.

Low-level laser therapy as a treatment for chronic pain, by  J. Derek Kingsley, Timothy Demchak and Reed Mathis in  Front. Physiol., 19 August 2014

 

Posted in News | Tagged , , , | Comments Off on Low-level laser therapy as a treatment for chronic pain

Viruses and cytokines in ME

Research abstract

Myalgic encephalomyelitis (ME) is a polymorphic clinical entity. In some patients, chronic infection with Epstein–Barr virus (EBV), human herpesvirus 6 (HHV-6), and human herpesvirus 7 (HHV-7) is regarded as an important pathogenetic factor that contributes to chronic neuroinflammation.

We determined a relationship between EBV, HHV-6 and HHV-7 viral load in the saliva and serum levels of pro-inflammatory cytokines (IFNalpha, IFNgamma, IL-1, IL-2) in a group of ME patients.

Viral load and T-helper-1-cell cytokines in myalgic encephalomyelitis, by Irina Malashenkova, Sergey Krynskiy, Daniil Ogurtsov, Nikita Hailov, Galina Kazanova, Olga Gurskaya, Maria Jarova, Igor Zuikov, Elvira Domonova, O.yu Silveystrova, Nikolay Didkovskiy in Journal of Neuroimmunology Volume 275, Issues 1-2, Pages 78–79, October 15, 2014

Posted in News | Tagged , , , | Comments Off on Viruses and cytokines in ME

High isoflavone diet is possible treatment for CFS

Research abstract (provisional)

Background

Chronic Fatigue Syndrome (CFS) is a neuroimmunoendocrine disease affecting about 1% of the US population, mostly women. It is characterized by debilitating fatigue for six or more months in the absence of cancer or other systemic diseases.

Many CFS patients also have fibromyalgia and skin hypersensitivity that worsen with stress. Corticotropin-releasing hormone (CRH) and neurotensin (NT), secreted under stress, activate mast cells (MC) necessary for allergic reactions to release inflammatory mediators that could contribute to CFS symptoms.

Objective

To investigate the effect of isoflavones on the action of polyinosinic:polycytidylic acid (poly(I:C)), with or without swim stress, on mouse locomotor activity and inflammatory mediator expression, as well as on human MC activation.

Methods

Female C57BL/6 mice were randomly divided into four groups: (a) control/no-swim, (b) control/swim, (c) poly(I:C)/no swim, and (d) poly(I:C)/swim. Mice were provided with chow low or high in isoflavones for 2?weeks prior to ip injection with 20?mg/kg poly(I:C) followed or not by swim stress for 15?minutes.

Locomotor activity was monitored overnight and animals were sacrificed the following day. Brain and skin gene expression, as well as serum levels, of inflammatory mediators were measured. Data were analyzed using the non-parametric Mann-Whitney U-test.

Results

Poly(I:C)-treated mice had decreased locomotor activity over 24? hours, and increased serum levels of TNF-?, IL-6, KC (IL-8/CXCL8 murine homolog), CCL2,3,4,5, CXCL10, as well as brain and skin gene expression of TNF, IL-6, KC (Cxcl1, IL8 murine homolog), CCL2, CCL4, CCL5 and CXCL10. Histidine decarboxylase (HDC) and NT expression were also increased, but only in the skin, over the same period. High isoflavone diet reversed these effects.

Conclusion

Poly(I:C) treatment decreased mouse locomotor activity and increased serum levels and brain and skin gene expression of inflammatory mediators. These effects were inhibited by isoflavones that may prove useful in CFS.

Isoflavones inhibit poly(I:C)-induced serum, brain, and skin inflammatory mediators – relevance to chronic fatigue syndrome, by Magdalini Vasiadi, Jennifer Newman and Theoharis C Theoharides in Journal of Neuroinflammation 2014, 11:168     Published: 31 October 2014

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

NB   Isoflavones are found abundantly in soy products. Much controversy surrounds consumption of high levels of isoflavones, as the efficacy and safety of soy isoflavones have not yet been established. But foods that contain isoflavones are beneficial as they are high in polyunsaturated fat, fibre, vitamins and minerals.

Posted in News | Tagged , , , | Comments Off on High isoflavone diet is possible treatment for CFS

Serum cytokine levels vary in moderate and severe CFS/ME patients

Volume 70, Issue 1, November 2014, Pages 45

Research aims
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a disabling illness with an unknown aetiology and diagnosis is based on symptom-specific criteria. Immunological dysregulation and cytokine abnormalities are consistent in CFS/ME.

As recent studies have highlighted the importance of assessing severity subgroups in the illness, the purpose of this study was to further examine the relationship between severity subgroups in CFS/ME, assessing Th1/Th2/Th17 and inflammatory cytokines in severe (housebound) and moderate (mobile) CFS/ME patients.

Methods
The Centres for Disease Prevention and Control (1994 CDC) Criteria for CFS/ME was used to define CFS/ME participants and severity scales such as the Fatigue Severity Scale (FSS), Dr. Bell’s Disability Scale, the FibroFatigue Scale and the Karnofsky Performance Scale (KPS) were used to confirm CFS/ME subgroups as moderate/mobile or severe/housebound.

Participants included healthy controls (n   = 22, age = 40.14 + 2.38), moderate/mobile (n   = 22; age = 42.09 + 2.72) and severe/housebound (n   = 19; age = 40.21 + 1.57) CFS/ME patients. Serum samples were assessed using Bio-Plex Assays for cytokines analyses. Cytokines measured included IL-1β, IL-1ra, IL-2, IL-7, IL-10, IL-17, TNF-α and IFNγ.

Results
The results found IL-1β was significantly reduced in severe CFS/ME compared to moderate patients (p   = 0.002). IL-7 was significantly increased in the severe group compared to controls and moderate CFS/ME (p   = 0.000, 0.000 respectively). IFN-γ was also increased in severe CFS/ME compared to moderate CFS/ME (p = 0.025).

Conclusion
This is the first study to show variations in cytokines in moderate and severe CFS/ME patients with all significant differences being between CFS/ME severity groups. This study supports the notion that it seems necessary for CFS/ME patient severity subgroups to be classified and identified in both research and clinical settings.

Serum cytokines in patients with moderate and severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), by  Sharni L. Hardcastle, Ekua Brenu, Naomi Wong, Samantha Johnston, Thao Nguyen, Teilah Huth, Ally Hawthorn, Rachel Passmore, Sandra Ramos, Ali Salajegheh, Don Staines, Sonya Marshall-Gradisnik

in Science Direct Vol 70, Issue 1, November 2014
 

Posted in News | Tagged , , | Comments Off on Serum cytokine levels vary in moderate and severe CFS/ME patients