ME Action blog post, by Darla N, 12 November: Dr. Komaroff’s webinar provides hypothesis, hot research and hope
In a webinar the Solve ME/CFS Initiative hosted on Nov. 10, Dr. Anthony Komaroff presented his hypothesis on ME’s cause and five popular areas of current ME research.
Komaroff, Simcox-Clifford-Higby professor of medicine at Harvard Medical School and senior physician at Brigham and Women’s Hospital, has published at least 240 articles and book chapters, many of them about ME.
He began by confirming there is research-based evidence of biological abnormalities in ME, referring to 2015 Institute of Medicine and 2014 National Institutes of Health reports. “This is not a primary psychological disorder,” he explained.
He hypothesizes ME’s cause is one of several infectious agents that leads to chronic, low-grade brain inflammation, influenced by immune system and gut function. “Several of the agents that have been shown to trigger ME/CFS cannot be fully eradicated by the immune system,” he said.
Komaroff also summarized concepts and findings from five research areas: brain, exercise and post-exertional malaise, immune system, energy metabolism, and epigenetics.
Brain and Exercise Research
Hundreds of studies examining ME patients’ brains have centered on neuroendocrine dysfunction, cognitive impairment not caused by psychiatric disorders, autonomic dysfunction, and “connectivity,”
explained as activation in one region of the brain causing activation in another region. Brain abnormalities in ME have been captured using MRI, SPECT (which measures blood flow and metabolism), PET (which measures neuroinflammation), and EEG (which measures brain waves).
Regarding connectivity, patients have a discoordination between brain regions that should display connectedness.
Recent research has also investigated the cause of post-exertional malaise. Relevant study findings reported during the IACFS/ME conference at the end of October included:
- exercising patients’ characteristic gene expression signature (by Stanford University)
- patients’ difficulty increasing their heart rate on the second consecutive day of exercise testing (by University of the Pacific)
- patients’ blood pressure falling after an exercise challenge (by Georgetown University)
- patients’ higher lactate levels on the second consecutive day of exercise testing when controls’ levels were lower (by Ithaca College and University of Oslo)
Immune System, Energy Metabolism, and Epigenetics Research
Komaroff explained there are immune system abnormalities in ME:
- cytoxic T cells,
- poorly functioning natural killer cells,
- activation of the 2-5A system, and
- increased production of pro-inflammatory cytokines.
One 2015 study by Hornig et al. studied cytokine levels in short-term and long-term ME patients. They found 28 cytokines were at higher-than-normal levels in short-term patients but slightly depressed in long-term patients.
On top of immune system impairment, recent research also indicates impaired cell energy production. Studies reported at the IACFS/ME conference found a specific enzyme connected to energy metabolism deficit in patients (University of Bergen) and found that patients’ peripheral white blood cells produce energy less effectively than those of controls (Newcastle University).
Komaroff defined the final area of research, epigenetics, as the study of normal genes being turned on and off. When this happens at incorrect times, disease can result. Two epigenetic mechanisms involved in ME are microRNAs and abnormalities in gene methylation, which were not explained further.
He concluded by reiterating his hypothesis, which “would unite a lot of the different abnormalities that have been reported in the literature.” Solve ME/CFS Initiative’s next webinar is Dec. 15.
Solve ME/CFS blog post, 16 November 2016: Dr. Anthony Komaroff’s Responses to Follow-Up Webinar Questions – Dr. Komaroff has followed up with his responses to the numerous questions that were unable to be answered during the webinar due to time limitations
#MEAction is an international network of patients empowering each other to fight for health equality for Myalgic Encephalomyelitis… founded with the belief that while we may find it difficult to advocate for ourselves in the physical world, in the virtual world, we can be an unstoppable force.