{"id":16704,"date":"2018-06-19T06:32:01","date_gmt":"2018-06-19T06:32:01","guid":{"rendered":"http:\/\/wames.org.uk\/cms-english\/?p=16704"},"modified":"2018-06-19T06:32:01","modified_gmt":"2018-06-19T06:32:01","slug":"c-reactive-protein-response-in-patients-with-post-treatment-lyme-disease-symptoms-versus-those-with-me-cfs","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/c-reactive-protein-response-in-patients-with-post-treatment-lyme-disease-symptoms-versus-those-with-me-cfs\/","title":{"rendered":"C-Reactive protein response in patients with Post-Treatment Lyme Disease symptoms versus those with ME\/CFS"},"content":{"rendered":"

Research letter:<\/strong><\/h3>\n

C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome<\/a>, by Melanie\u00a0Uhde,\u00a0Alyssa\u00a0Indart,\u00a0Brian A Fallon,\u00a0Gary P Wormser,\u00a0Adriana\u00a0R Marques,\u00a0Suzanne D Vernon,\u00a0and Armin\u00a0Alaedini in<\/span> Clinical Infectious diseases<\/em>,\u00a02018;XX(00):2\u20132<\/p>\n

To the Editor\u2014There is substantial\u00a0overlap in symptoms, including fatigue,\u00a0muscle and joint pain, and cognitive and\u00a0memory deficits, between post-treatment\u00a0Lyme disease syndrome (PTLDS) and\u00a0myalgic encephalomyelitis\/chronic fatigue\u00a0syndrome (ME\/CFS) [1]. Increasing evidence\u00a0suggests a role for immunologic\u00a0and inflammatory pathways in both\u00a0PTLDS and ME\/CFS [2\u20134]. However, in\u00a0part owing to their etiologic complexity\u00a0and the lack of established biomarkers, our\u00a0understanding of the pathways involved\u00a0and potential mechanistic differences\u00a0between the 2 conditions is very limited.<\/p>\n

\"\"In a 2016 study published in Clinical\u00a0Infectious Diseases, Uhde et al [5] examined\u00a0the concentrations of acute-phase\u00a0response proteins, including C-reactive\u00a0protein (CRP), in individuals with\u00a0PTLDS. CRP is a highly sensitive marker\u00a0of infection and inflammation that binds\u00a0a variety of ligands present on the surface\u00a0of pathogens or exposed during\u00a0autologous cell stress or death, exerting\u00a0its effect through opsonin deposition\u00a0and activation of the complement pathway,\u00a0in addition to direct interaction\u00a0with phagocytic cells [6].<\/p>\n

We found that\u00a0the circulating levels of CRP, as well as\u00a0the frequency of concentrations >3 mg\/\u00a0mL (generally considered to represent\u00a0some degree of inflammation [7]) to be\u00a0significantly higher in the PTLDS cohort\u00a0than in a control group of subjects who\u00a0had a history of Lyme disease but without\u00a0persistent symptoms (both P < .001).<\/p>\n

The data provided evidence for increased\u00a0expression of an objective marker of\u00a0inflammation in PTLDS but suggested\u00a0a mechanism of activation distinct from\u00a0that in active infection, as previously discussed\u00a0[5].<\/p>\n

Using the same methods [5] in a new\u00a0study, we screened plasma samples from\u00a0131 patients with ME\/CFS (89 female;\u00a0mean age [standard deviation], 50.0\u00a0[11.4] years; mean body mass index\u00a0(BMI), 26.0 [5.5]) and 86 healthy controls\u00a0(68 female; mean age, 50.0 [12.8] years;\u00a0mean BMI, 26.5 [6.8]), provided by the\u00a0SolveCFS BioBank [8]. Patients with ME\/\u00a0CFS met the criteria of Fukuda et al [9]\u00a0and the Canadian criteria [10] for this\u00a0condition [9, 10].<\/p>\n

Screening questionnaires\u00a0were used to evaluate the general\u00a0health of the unaffected controls and to\u00a0confirm that they did not meet ME\/CFS\u00a0case definition criteria. The ME\/CFS\u00a0and control sample sizes provided >95%\u00a0power, with an \u03b1 value <.05, to detect\u00a0the same increase in CRP response as\u00a0in the patients with PTLDS [5].<\/p>\n

Group\u00a0differences were assessed by the analysis\u00a0of covariance, using the general linear\u00a0model, to account for the potential confounding\u00a0effect of age, sex, and BMI. This\u00a0study was approved by the Institutional\u00a0Review Board of Columbia University.<\/p>\n

In contrast to data from patients with\u00a0PTLDS [5], we did not find a statistically\u00a0significant difference in the circulating\u00a0levels of CRP (Figure 1) or the frequency\u00a0of CRP levels >3 mg\/L (33 of 131 [25.2%]\u00a0vs 22 of 86 [25.6%], respectively) between\u00a0patients with ME\/CFS and controls.<\/p>\n

These data provide evidence for the\u00a0likely existence of distinct inflammatory\u00a0mechanisms in ME\/CFS versus PTLDS,\u00a0which may be driven in part by the potentially\u00a0more heterogeneous etiology of\u00a0ME\/CFS symptoms in comparison with\u00a0PTLDS. The absence of a significantly\u00a0enhanced CRP response in ME\/CFS, despite\u00a0published data suggesting activation\u00a0of various inflammatory pathways, warrants\u00a0further examination.<\/p>\n","protected":false},"excerpt":{"rendered":"

Research letter: C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome, by Melanie\u00a0Uhde,\u00a0Alyssa\u00a0Indart,\u00a0Brian A Fallon,\u00a0Gary P Wormser,\u00a0Adriana\u00a0R Marques,\u00a0Suzanne D Vernon,\u00a0and Armin\u00a0Alaedini in Clinical Infectious diseases,\u00a02018;XX(00):2\u20132 To the Editor\u2014There is substantial\u00a0overlap in symptoms, … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[3268,4469,4466,4301,4467,535,35,4468,773,4297,3006],"class_list":["post-16704","post","type-post","status-publish","format-standard","hentry","category-news","tag-activated-immune-inflammatory-pathways","tag-adriana-r-marques","tag-alyssa-indart","tag-armin-alaedini","tag-brian-a-fallon","tag-c-reactive-protein","tag-dr-suzanne-vernon","tag-gary-p-wormser","tag-lyme-disease","tag-melanie-uhde","tag-post-treatment-lyme-disease-syndrome"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-4lq","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/16704","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=16704"}],"version-history":[{"count":3,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/16704\/revisions"}],"predecessor-version":[{"id":16898,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/16704\/revisions\/16898"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=16704"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=16704"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=16704"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}