Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Abstract:

BACKGROUND AND MAIN TEXT: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies.

CONCLUSIONS: This review aims to compile all the studies done so far to investigate various viral agents that could be associated with ME/CFS. Furthermore, we suggest strategies to better design future studies on the role of viral infections in ME/CFS.

Source: Rasa S, Nora-Krukle Z, Henning N, Eliassen E, Shikova E, Harrer T, Scheibenbogen C, Murovska M, Prusty BK6; European Network on ME/CFS (EUROMENE). Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Transl Med. 2018 Oct 1;16(1):268. doi: 10.1186/s12967-018-1644-y. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167797/ (Full article)

No evidence found for an increased risk of long-term fatigue following human papillomavirus vaccination of adolescent girls

Abstract:

INTRODUCTION: In 2013, the Netherlands Pharmacovigilance Center Lareb published an overview of reports of long-lasting fatigue following bivalent HPV-vaccination (2vHPV). After an update of this overview in 2015, concerns regarding the safety of 2vHPV was picked up by the media, which led to further reports of long-lasting fatigue. Therefore, the Dutch National Institute for Public Health and the Environment (RIVM) investigated a possible association between HPV-vaccination and long-term fatigue.

METHODS: In this retrospective cohort study conducted in the Integrated Primary Care Information database, we investigated the occurrence of chronic fatigue syndrome (CFS), fatigue ≥6 months and 3-6 months in all girls born in 1991-2000 during the follow-up period January 1st 2007-December 31st 2014 (2007-2008 pre-vaccination and 2009-2014 post-vaccination). Patients with certain fatigue ≥6 m were asked for consent to link their primary care information with vaccination data. Incidence rates per 10,000 person years (PY) for 12-16-year-old girls were compared between pre- and post-HPV-vaccine era. A self-controlled case series (SCCS) analysis was performed using consenting vaccinated cases. A primary high-risk period of 12 months after each dose was defined.

RESULTS: The cohort consisted of 69,429 12-16-year-old girls accounting for 2758 PY pre-vaccination and 57,214 PY post-vaccination. Differences between pre- and post-vaccination incidences (CFS: 3.6 (95% CI 0.5-25.7)/10,000 PY and 0.9 (0.4-2.1); certain fatigue ≥6 m: 7.3 (1.8-29.0) and 19.4 (16.1-23.4); certain fatigue 3-6 m: 0.0 and 16.6 (13.6-20.3), respectively) were not statistically significant. SCCS analyses in 16 consenting vaccinated cases resulted in an age-adjusted RR of 0.62 (95%CI 0.07-5.49).

CONCLUSIONS: Fatigue ≥6 m and 3-6 m was frequently found among adolescent girls, but CFS was rarely diagnosed. No statistically significant increased incidence rates were found post-vaccination compared to similar age groups of girls pre-vaccination. The SCCS analysis included a low number of cases but revealed no elevated risk of certain fatigue ≥6 m in the high-risk period.

Copyright © 2018 The Authors. Published by Elsevier Ltd. All rights reserved.

Source: Schurink-Van’t Klooster TM, Kemmeren JM, van der Maas NAT, van de Putte EM, Ter Wolbeek M, Nijhof SL, Vanrolleghem A5, van Vliet JA, Sturkenboom M, de Melker HE. No evidence found for an increased risk of long-term fatigue following human papillomavirus vaccination of adolescent girls. Vaccine. 2018 Sep 19. pii: S0264-410X(18)31268-4. doi: 10.1016/j.vaccine.2018.09.019. [Epub ahead of print]  https://www.sciencedirect.com/science/article/pii/S0264410X18312684?via%3Dihub (Full article)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Collaborative Research Center at Harvard, funded by OMF

From Open Medicine Foundation.

We are proud to announce the establishment of another ME/CFS Collaborative Research Center. This research initiative, which includes participants from Harvard Medical School (HMS) affiliated hospitals is supported by the Open Medicine Foundation (OMF). The participating HMS Institutions include the Massachusetts General Hospital (MGH), Brigham and Women’s Hospital (BWH), & Beth Israel-Deaconess Medical Center (BIDMC). The new initiative begins with a dozen faculty from the three Harvard Institutions together with critical collaborators from the University of Birmingham, England and University of Nottingham, England, who comprise the MRC-Arthritis Research UK Centre for Musculoskeletal Aging Research, as well as long term highly valued collaborators in the fields of proteomics and metabolism from the Pacific Northwest National Laboratory (PNNL). (Full faculty listing below.)

This new Collaborative Center seeks to conduct basic science mechanistic studies with very high priority. This research focus will discover and understand the multi-omic signature of muscle biopsies of ME/CFS patients during their recovery from mild to moderate muscular stress, by comparison to healthy individuals’ signatures at baseline, during recovery from muscular stress, and during immobilization. Our hypothesis is that the inflammation-related recovery mechanisms in ME/CFS patients are dysregulated, and that this delays recovery from post-muscular stress. In addition to the direct tissue studies, both structural and functional neuroimaging will be conducted at the very advanced MGH/HMS imaging center, the Martinos Center for Biomedical Imaging (www.nmr.mgh.harvard.edu). This will allow testing of hypotheses related to neuro-immune interactions, including exaggerated vagus nerve signaling, microglial activation, and disrupted autonomic and metabolic functioning in the central nervous system.

These clinical research studies are designed to characterize the multi-omic signature (genomic, proteomic, metabolomic, as well as ultrastructural morphology) of ME/CFS patients as compared to those in healthy individuals who are recovering from muscular stress. The proteomic, phosphoproteomic, and metabolomic studies will be conducted at the PNNL. These comparisons will be correlated with the neuroimaging results with the intent to identify biomarkers and suggest drug targets for use in the development of therapeutics for ME/CFS.

This new Collaborative Center also will seek support to develop an infrastructure for rigorous clinical investigations to identify and fast track promising potential treatments through clinical trials. This clinical research center working with the OMF-supported Stanford ME/CFS Collaborative Center also represents a unique opportunity to establish standards and infrastructure for rigorous clinical investigations and trials in ME/CFS. The Center will be designed to evaluate the potential for new ME/CFS therapeutics and to conduct well designed, CRO-supervised, pivotal clinical trials for those novel promising compounds.

Participating Faculty:

The faculty participating in this new collaborative initiative are listed below along with brief introductions to follow.

Stanford University University of Birmingham (U Birmingham)
Ron Davis, PhD Janet Lord, PhD
Massachusetts General Hospital (MGH) University of Nottingham (U Nottingham)
Ronald Tompkins, MD, ScD Philip Atherton, PhD
Wenzhong Xiao, PhD Paul Greenhaff, PhD
Donna Felsenstein, MD
Jonathan Friedstat, MD
Daniel Irimia, MD, PhD Brigham & Women’s Hospital (BWH)
Amel Karaa, MD David Systrom, MD
Michael VanElzakker, PhD Anthony Komaroff, MD
H. Shaw Warren, MD
Yongming Yu, MD, PhD
Andrew Alexander, MBA Pacific Northwest National Laboratory (PNNL)
Richard Smith, PhD
BI Deaconess Medical Center (BIDMC) Jon Jacob, PhD
Janet Mullington, PhD Wei-jun Qian, PhD

Ronald Tompkins, MD, ScD, Sumner M. Redstone Professor of Surgery at HMS and MGH, is a surgeon and scientist who also trained at the Massachusetts Institute of Technology (MIT) receiving a ScD in Chemical Engineering. Dr. Tompkins has been the Chief of the MGH Burn and Trauma Services as well as the Chief of Staff, Shriners Hospitals for Children – Boston for more than 20 years. Dr. Tompkins has been active in medical research supported by more than $200M from the NIGMS in the fields of inflammation and metabolism with emphasis on genomics, proteomics, and small molecule metabolomics. Dr. Tompkins has collaborated for more than two decades with Dr. Ron Davis of the Stanford Genome Technology Center (Department of Biochemistry). Dr. Tompkins has actively participated on the Scientific Advisory Board of OMF since its establishment.

Wenzhong Xiao, PhD, Associate Professor of Surgery (Bioinformatics) at HMS and MGH, directs the MGH Inflammation & Metabolism Computational Center and leads the Computational Genomics Group at Stanford Genome Technology Center. Dr. Xiao received his PhD from the University of California Berkeley. Dr. Xiao develops bioinformatic and statistical tools for use in understanding human diseases, especially in studies of immuno-metabolic response. He focuses on integrative analysis and interpretation of multi-dimensional molecular, cellular, and clinical data of many types of patients, including those with ME/CFS. Dr. Xiao’s expertise will be essential for the interpretation of the massive data sets that will be collected in this project.

Donna Felsenstein, MD, Physician in Medicine and Assistant Professor of Medicine at HMS and MGH, is a senior attending in the Infectious Disease Unit at MGH. She has been diagnosing and caring for patients with ME/CFS since 1979. She has a large number of ME/CFS in her clinical practice, some of whom she has followed for more than 20 years. Dr. Felsenstein has participated in several clinical research studies on ME/CFS. Her clinical expertise in evaluating, diagnosing and treating patients with ME/CFS will be highly valued in the new OMF Center.

Jonathan Friedstat, MD, Assistant Professor of Surgery at HMS and MGH, is an plastic surgeon who has been well-trained in clinical trial protocols and research. His expertise and competence will be essential for proper conduct of the muscle biopsies.

Daniel Irimia, MD, PhD, Associate Professor of Surgery at HMS and MGH, is a longtime collaborator whose primary interest is in the role of neutrophils in sepsis. Daniel has developed an assay using neutrophil behavior within a microfluidic circuit that predicts sepsis with a high degree of precision (Nature Biomedical Engineering 2:207–214, 2018). Daniel’s expertise in neutrophils and neutrophil extracellular traps (NETs) will be important to clinical research in ME/CFS going forward.

Amel Karaa, MD, Assistant Professor of Pediatrics at HMS and MGH, is a board-certified pediatrician with specialty in medical genetics. This is an expertise that is very much needed in our MECFS research for many reasons but particularly because many mutations are and have been discovered but there is little medical expertise to assist us to better understand the medical implications of these mutations. She treats many ME/CFS patients in the MGH Mitochondrial Disorders Clinic will be critical to coordinate and recruit patients as well as interpret the multiple genomic findings in patients. In addition, she is critical to coordination with the mitochondrial genomic specialists at the MGH Center for Genomic Medicine.

Michael VanElzakker, PhD, Research Fellow at the MGH and HMS Martinos Center for Biomedical Imaging in the Neurotherapeutics Division, and lecturer at Tufts University. As a graduate student, Dr. VanElzakker wrote an influential hypothesis paper on the potential role of the vagus nerve in ME/CFS that has now been downloaded more than 10,000 times. Dr. VanElzakker’s expertise in neuroscience is focused on identifying abnormal patterns in brain metabolism, inflammation, structure, and function in this condition. He has enthusiastically engaged the ME/CFS community as both a scientist and patient advocate. Dr. VanElzakker will be critical to develop and conduct the neuroimaging clinical studies with the Martinos Center, which is one of the most advanced neuroimaging centers in the world.

H. Shaw Warren, MD, Physician and Pediatrician at MGH and Associate Professor of Pediatrics at HMS, is an internal medicine physician with expertise in pediatric infectious disease. His role follows his extensive experience in research in inflammation, endotoxemia, and genomics. He currently directs a DARPA funded project entitled SPIRIT, which probes the differences in the host’s responses to infectious agents in multiple mammalian species. His research competence in these fields together with his clinical experience with ME/CFS patients will make a tremendous contribution to the new initiative.

Yong Ming Yu, MD, PhD, Associate Professor of Surgery at MGH and HMS, is classically trained in nutritional biochemistry at the Massachusetts Institute of Technology (MIT). He is highly experienced in the in metabolism following the severe stress of injury and inflammation, prolonged fasting or nutritional depletion, and immobilization. His understanding of metabolism will be essential to understand the metabolic findings seen in ME/CFS patients.

David Systrom, MD, Assistant Professor of Medicine at BWH and HMS, is a internal medicine and pulmonary disease physician with certification in critical care medicine. Dr. Systrom’s expertise focuses on cardiopulmonary function resulting in highly specific phenotype characterization of ME/CFS patients particularly those with POTS syndrome. His research involving ME/CFS particularly seeks to discover the link between small fiber polyneuropathy (nerve damage) and exertional intolerance. His participation in this new initiative has tremendous value to more precisely characterize ME/CFS patients with their ME/CFS disease characteristics and to study these well-characterized patients in clinical trials.

Anthony Komaroff, MD, Distinguished Simcox-Clifford-Higby Professor of Medicine at HMS, and Senior Physician at BWH. He served for 15 years as Director of the Division of General Medicine and Primary Care at BWH. Dr. Komaroff’s contributions to ME/CFS include his pioneering work in the definition of, epidemiologic studies of the prevalence of the illness, and assessment of the biological changes present in chronic fatigue syndrome. He will be a consultant to the new OMF Center and he currently leads the human studies core at the Columbia NIH-funded ME/CFS Collaborative Center.

Janet Mullington, PhD, Professor of Neurology at HMS and BIDMC, is Director of the BIDMC Clinical Research Center and directs the HMS Human Sleep and Inflammatory Systems Laboratory. Dr. Mullington is a well-respected expert in the physiological and neurobehavioral effects of insufficient and/or inadequate quality sleep including autonomic, metabolic and inflammatory system consequences of sleep loss. Her perspective and participation will be extremely helpful for our new initiative particularly as issues relate to the very common symptoms of non-restorative sleep and sleep disorders in ME/CFS patients.

Janet Lord, PhD, Professor of Immunology, University of Birmingham, and Chair of Immunology. Dr. Lord directs the Institute of Inflammation and Ageing and the MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research. Dr. Lord brings together fundamental scientists and clinicians to translate the understanding of inflammation to new treatments for chronic age-related inflammatory diseases. Her research focuses on the dysregulation of immunity in old age, and in particular, the decline in neutrophil function and how this compromises the response to infection and tissue injury. Her knowledge and leadership in the natural findings of inflammation upon tissues will be critical to understand many of the findings that are discovered in ME/CFS patients in this new initiative. She brings two essential colleagues to the new OMF Center, Drs. Paul Greenhaff and Philip Atherton.

Paul Greenhaff, PhD, Professor of Muscle Metabolism, University of Nottingham, is a physiologist and the Deputy Director of the MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research (Nottingham). Dr. Greenhaff is also an active member of the ARUK Centre for Sport, Exercise and Osteoarthritis and the Musculoskeletal Disease theme of the Nottingham NIHR Biomedical Research Centre. He is classically trained in the field of muscle metabolism with research interests centered on the loss of muscle mass and the dysregulation of metabolism in ageing, inactivity, inflammation, trauma and disease, and strategies to offset these pathophysiological events. His expertise will be critical to understand what the nutritional and sedentary effects are contributing to patients with ME/CFS in the new initiative.

Philip Atherton, PhD, Professor of Clinical, Metabolic & Molecular Physiology, University of Nottingham is classically trained in stable isotope nutritional biochemistry, providing tremendous experience in the inflammation and metabolism fields. His laboratory is in the Royal Derby Hospital under the auspices of our UK Medical Research Council/Arthritis Research UK Centre of Excellence for musculoskeletal ageing research and the newly awarded NIHR Biomedical Research Centre (BRC) under a clinical musculoskeletal theme. His research seeks identification of central mechanisms regulating metabolism in human musculoskeletal tissues. These interests and expertise will be critical to the new OMF Center.

Richard Smith, PhD, Battelle Fellow and Director of Proteome Research at PNNL, is also the Director of the NIGMS Biomedical Technology Research Resource for Proteomic Integrative Biology and the DOE ‘Pan-omics’ Program at PNNL. He is a pioneer in mass spectroscopy and proteomics technologies, is a long term collaborator with the faculty at MGH, and is the author or co-author of more than 1,000 peer-reviewed publications and more than 50 US patents. His continued development and application of innovative mass spectrometry technologies will be critical in identifying the proteomic and metabolic signatures of patients with ME/CFS in the new initiative.

Jon Jacobs, PhD, Senior Research Scientist at PNNL, is currently the associate director of the NIGMS Biomedical Technology Research Resource for Proteomic Integrative Biology and the collaborative analytical support for the MGH lead DARPA project SPIRIT. His expertise lies in the development and application of advanced proteomic analysis techniques, specifically in the context of clinical studies focusing on complex disease signatures including inflammatory responses and chronic liver disease. Dr. Jacobs has a history of productive long term collaborations with MGH faculty through the application of proteomic approaches. His role will be to accurately direct the application of the advanced analytical technologies at PNNL towards the ME/CFS patient clinical samples for signature characterization.

Wei-Jun Qian, PhD, is a bioanalytical chemist whose research centers primarily on global and targeted quantification of proteins and post-translational modifications (PTMs), particularly redox modifications and phosphorylation. Dr. Qian is currently a Senior Staff Scientist and the Team Lead for Proteomics at PNNL, and has been the recipient of the NIH Director’s New Innovator Award and the Presidential Early Career Award for Scientists and Engineers (PECASE). Dr. Qian’s team has significantly advanced the sensitivity and robustness of selected reaction monitoring (SRM)-based targeted quantification, thus enabling the direct quantification of extremely low-abundance proteins, protein isoforms, and PTMs for broad biomedical applications. Dr. Qian’s expertise in PTM and SRM efforts will directly benefit analysis of ME/CFS patient samples.

Immunosignature Analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Abstract:

A random-sequence peptide microarray can interrogate serum antibodies in a broad, unbiased fashion to generate disease-specific immunosignatures. This approach has been applied to cancer detection, diagnosis of infections, and interrogation of vaccine response. We hypothesized that there is an immunosignature specific to ME/CFS and that this could aid in the diagnosis.

We studied two subject groups meeting the Canadian Consensus Definition of ME/CFS. ME/CFS (n = 25) and matched control (n = 25) sera were obtained from a Canadian study. ME/CFS (n = 25) sera were obtained from phase 1/2 Norwegian trials (NCT01156909). Sera from six healthy controls from the USA were included in the analysis. Canadian cases and controls were tested for a disease immunosignature.

By combining results from unsupervised and supervised analyses, a candidate immunosignature with 654 peptides was able to differentiate ME/CFS from controls. The immunosignature was tested and further refined using the Norwegian and USA samples. This resulted in a 256-peptide immunosignature with the ability to separate ME/CFS cases from controls in the international data sets.

We were able to identify a 256-peptide signature that separates ME/CFS samples from healthy controls, suggesting that the hit-and-run hypothesis of immune dysfunction merits further investigation. By extending testing of both our signature and one previously reported in the literature to larger cohorts, and further interrogating the specific peptides we and others have identified, we may deepen our understanding of the origins of ME/CFS and work towards a clinically meaningful diagnostic biomarker.

Source: Günther, O.P., Gardy, J.L., Stafford, P. et al. Immunosignature Analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Mol Neurobiol (2018). https://doi.org/10.1007/s12035-018-1354-8  https://link.springer.com/article/10.1007%2Fs12035-018-1354-8 (Full article)

Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: a prospective cohort study

Abstract:

INTRODUCTION: Acute Epstein-Barr virus (EBV) infection is a trigger of chronic fatigue and Chronic Fatigue Syndrome (CFS). This study investigated baseline predictors of chronic fatigue six months after an acute EBV infection.

MATERIALS AND METHODS: A total of 200 adolescents (12-20 years old) with acute EBV infection were assessed for 149 possible baseline predictors and followed prospectively. We performed linear regression to assess possible associations between baseline predictors and fatigue (Chalder Fatigue Questionnaire total score) six months after the acute EBV infection. A total of 70 healthy controls were included for cross-sectional reference. This study is part of the CEBA-project (Chronic fatigue following acute Epstein-Barr virus infection in adolescents).

RESULTS: In the final multiple linear regression model, fatigue six months after acute EBV infection was significantly and independently predicted by the following baseline variables (regression coefficient B[95% CI]): Sensory sensitivity (0.8[0.09 to 1.6]), pain severity (0.2[0.02 to 0.3]), functional impairment (1000 steps/day) (-0.3[-0.5 to -0.08]), negative emotions (anxiety) (0.4[0.2 to 0.6]), verbal memory (correct word recognition) (1.7[0.1 to 3.3]), plasma C-reactive protein (2.8[1.1 to 4.4] for CRP values >0.86) and plasma Vitamin B12 (-0.005[-0.01 to -0.001]).

CONCLUSIONS: Development of fatigue after acute EBV infection is to a larger extent predicted by baseline variables related to symptoms and functions than to baseline variables reflecting infectious and immune processes.

TRIAL REGISTRATION: ClinicalTrials, ID: NCT02335437, ttps://clinicaltrials.gov/ct2/show/NCT02335437.

Copyright © 2018. Published by Elsevier Inc.

Source: Pedersen M, Asprusten TT, Godang K, Leegaard TM, Osnes LT, Skovlund E, Tjade T, Øie MG, Wyller VBB. Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: a prospective cohort study. Brain Behav Immun. 2018 Sep 24. pii: S0889-1591(18)30625-1. doi: 10.1016/j.bbi.2018.09.023. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30261303

CD24 expression and B cell maturation shows a novel link with energy metabolism: potential implications for patients with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Abstract:

CD24 expression on pro-B cells plays a role in B cell selection and development in the bone marrow. We previously detected higher CD24 expression and frequency within IgD+ naïve and memory B cells in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) compared with age-matched healthy controls (HC). Here, we investigated the relationship between CD24 expression and B cell maturation.

In vitro stimulation of isolated B cells in response to conventional agonists were used to follow the dynamics of CD24 positivity during proliferation and differentiation (or maturation). The relationship between CD24 expression to cycles of proliferation and metabolism in purified B cells from HC was also investigated using phospho-flow (phosphorylation of AMPK-pAMPK), 1proton nuclear magnetic resonance and Mitotracker Far-red (Mitochondrial mass-MM).

In vitro, in the absence of stimulation, there was an increased percentage of CD24+ viable B cells in ME/CFS patients compared to HC (p< 0.05) following 5 days culture. Following stimulation with B cell agonists, percentage of CD24+B cells in both naïve and memory B cell populations decreased. p< 0.01). There was a negative relationship between percentage of CD24+B cells with MM (R2=0.76; p< 0.01), which was subsequently lost over sequential cycles of proliferation. There was a significant correlation between CD24 expression on B cells and the usage of glucose and secretion of lactate in vitro. Short term ligation of the B cell receptor with anti-IgM antibody significantly reduced the viability of CD24+ memory B cells compared to those cross-linked by anti-IgD or anti-IgG antibody.

A clear difference was found between naïve and memory B cells with respect to CD24 expression and pAMPK, most notably a strong positive association in IgD+IgM+ memory B cells. In vitro findings confirmed dysregulation of CD24-expressing B cells from ME/CFS patients previously suggested by immunophenotype studies of B cells from peripheral blood. CD24-negative B cells underwent productive proliferation whereas CD24+ B cells were either unresponsive or susceptible to cell death upon BCR-engagement alone. We suggest that CD24 expression may reflect variations in energy metabolism on different B cell subsets.

Source: Fane K. Mensah, Christopher W. Armstrong, Venkat Reddy, Amolak S. Bansal, Saul Berkovitz, Maria Leandro and Geraldine Cambridge. CD24 expression and B cell maturation shows a novel link with energy metabolism: potential implications for patients with Myalgic
Encephalomyelitis / Chronic Fatigue Syndrome. Front. Immunol. | doi: 10.3389/fimmu.2018.02421 https://www.frontiersin.org/articles/10.3389/fimmu.2018.02421/abstract

Research teams find widespread inflammation in the brains of fibromyalgia patients

A study by Massachusetts General Hospital (MGH) researchers – collaborating with a team at the Karolinska Institutet in Sweden – has documented for the first time widespread inflammation in the brains of patients with the poorly understood condition called fibromyalgia. Their report has been published online in the journal Brain, Behavior and Immunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” says Marco Loggia, PhD, of the MGH-based Martinos Center for Biomedical Imaging, co-senior author of the report. “And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

Characterized by symptoms including chronic widespread pain, sleep problems, fatigue, and problems with thinking and memory, fibromyalgia affects around 4 million adults in the U.S., according to the Centers for Disease Control and Prevention. Previous research from the Karolinska group led by Eva Kosek, MD, PhD, co-senior author of the current study, suggested a potential role for neuroinflammation in the condition – including elevated levels of inflammatory proteins in the cerebrospinal fluid – but no previous study has directly visualized neuroinflammation in fibromyalgia patients.

2015 study by Loggia’s team used combined MR/PET scanning to document neuroinflammation – specifically activation of glial cells – in the brains of patients with chronic back pain. Hypothesizing that similar glial activation might be found in fibromyalgia patients as well, his team used the same PET radiopharmaceutical, which binds to the translocator protein (TSPO) that is overexpressed by activated glial cells, in their study enrolling 20 fibromyalgia patients and 14 control volunteers.

At the same time, Kosek’s team at Karolinska had enrolled a group of 11 patients and an equal number of control participants for a similar study with the TSPO-binding PET tracer. Since that radiopharmaceutical binds to two types of glial cells – microglia and astrocytes – they also imaged 11 patients, 6 who had the TSPO imaging and 5 others, and another 11 controls with a PET tracer that is thought to bind preferentially to astrocytes and not to microglia. At both centers, participants with fibromyalgia completed questionnaires to assess their symptoms. When the MGH team became aware of the similar investigation the Karolinska group had underway, the teams decided to combine their data into a single study.

The results from both centers found that glial activation in several regions of the brains of fibromyalgia patients was significantly greater than it was in control participants. Compared to the MGH team’s chronic back pain study, TSPO elevations were more widespread throughout the brain, which Loggia indicates corresponds to the more complex symptom patterns of fibromyalgia. TSPO levels in a structure called the cingulate gyrus – an area associated with emotional processing where neuroinflammation has been reported in patients with chronic fatigue syndrome – corresponded with patients reported levels of fatigue. The Karolinska team’s studies with the astrocyte-binding tracer found little difference between patients and controls, suggesting that microglia were primarily responsible for the increased neuro-inflammation in fibromyalgia patients.

“The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue,” says Loggia, an assistant professor of Radiology at Harvard Medical School. “The ability to join forces with our colleagues at Karolinska was fantastic, because combining our data and seeing similar results at both sites gives confidence to the reliability of our results.”

###

The co-lead authors of the Brain, Behavior and Immunity report are Daniel Albrecht, PhD, MGH Martinos Center and Department of Radiology, and Anton Forsberg, PhD, Karolinska Institutet. Support for the study includes U.S. Department of Defense grant W81XWH-14-1-0543; National Institutes of Health grants R01 NS094306-01A1, R01 NS095937-01A1 and R21 NS087472-01A1; an International Association for the Study of Pain Early Career Award, and funding from the Stockholm County Council the Swedish Research Council, the Swedish Rheumatism Association and the Fibromyalgia Association of Sweden.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of “America’s Best Hospitals.”

Open Medicine Foundation Sponsors Second Annual Community Symposium on the Molecular Basis of ME/CFS at Stanford University

LOS ANGELES, Sept. 20, 2018 /PRNewswire/ — Open Medicine Foundation (OMF), the premier nonprofit organization investing in research to cure myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), sponsors the Second Annual Community Symposium on the Molecular Basis of ME/CFS on September 29, 2018, at Stanford University. This event is expected to draw more than 300 scientists, clinicians, patients, and caregivers as well as over 3,000 attendees globally via livestream.

OMF is working to put an end to ME/CFS – estimated to afflict 20 million globally — by funding a global research effort to identify diagnostic biomarkers, effective treatments, and ultimately a cure. As part of its efforts to foster open, collaborative research, OMF is funding a three-day scientific working group meeting in which over 50 world-class scientists with diverse expertise will share their latest results and chart a path forward, followed by the Community Symposium, at which highlights of these results will be shared with the public.

Linda Tannenbaum, OMF founder and CEO/President, will welcome guests at this year’s symposium and highlight the importance of open collaboration to fast track solutions. The keynote address will be delivered by Oystein Fluge, MD, PhD, of Norway. Additional scientists speaking include the Symposium Chair Ronald Davis, PhD; the Symposium Moderator Raeka Aiyar, PhD; Maureen Hanson, PhD; Jonas Bergquist, MD, PhD; Wenzhong Xiao, PhD; Alain Moreau, PhD; Ronald Tompkins, MD, ScD; Jared Younger, PhD; Michael Sikora, graduate student; and Rob Phair, PhD, who will speak about the new metabolic trap hypothesis.

OMF currently funds ME/CFS Collaborative Research Centers at Stanford and Harvard. Scientists from both centers will present their research at this year’s symposium.

To register for the symposium Livestream, click here.

About OMF

Founded as a nonprofit in 2012, OMF has raised over $15 million to fund research and increase public awareness with the patient and medical communities. OMF’s funded research is overseen by a renowned Scientific Advisory Board, including three Nobel laureates and six members of the National Academy of Sciences, directed by Ronald W. Davis, PhD, Director of the Stanford Genome Technology Center. www.omf.ngo

SOURCE Open Medicine Foundation

Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England

Abstract:

OBJECTIVES:
To define the prevalence of severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and its clinical characteristics in a geographically defined area of Northern England. To understand the feasibility of a community-based research study in the severely affected CFS/ME group.

DESIGN: A two-phase clinical cohort study to pilot a series of investigations in participants own homes.

SETTING: Participants were community living from the area defined by the Northern clinical network of the UK.

PARTICIPANTS: Adults with either a medical or a self-reported diagnosis of CFS/ME. Phase 1 involved the creation of a database. Phase 2: five participants were selected from database, dependent on their proximity to Newcastle.

INTERVENTIONS: The De Paul fatigue questionnaire itemised symptoms of CFS/ME, the Barthel Functional Outcome Measure and demographic questions were collected via postal return. For phase 2, five participants were subsequently invited to participate in the pilot study.

RESULTS: 483 questionnaire packs were requested, 63 were returned in various stages of completion. 56 De Paul fatigue questionnaires were returned: all but 12 met one of the CFS/ME criteria, but 12 or 22% of individuals did not fulfil the Fukuda nor the Clinical Canadian Criteria CFS/ME diagnostic criteria but 6 of them indicated that their fatigue was related to other causes and they barely had any symptoms. The five pilot participants completed 60% of the planned visits.

CONCLUSIONS: Severely affected CFS/ME individuals are keen to participate in research, however, their symptom burden is great and quality of life is poor. These factors must be considered when planning research and methods of engaging with such a cohort.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Source: Strassheim VJ, Sunnquist M, Jason LA, Newton JL. Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England. BMJ Open. 2018 Sep 19;8(9):e020775. doi: 10.1136/bmjopen-2017-020775. https://bmjopen.bmj.com/content/8/9/e020775.long (Full article)

School Nurses Can Improve the Lives of Students With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic illness that is defined and diagnosed by its symptoms: extreme fatigue made worse by physical and mental activity, pain and decreased mental stamina, among others. A long-held, erroneous belief that ME/CFS is not a physiological illness has persisted among some clinicians, leading to the denial of a patient’s physical illness and attributing the symptoms to other causes.

The debilitating effects of ME/CFS in the pediatric population can affect all aspects of academic, social, emotional, and physical development. ME/CFS has been diagnosed in children younger than 10 years. Therefore, the school nurse is likely to encounter one or more students in the various stages of this disease, putting the school nurse in a position to ameliorate the impact of this potentially devastating chronic condition.

Source: Friedman KJ, Mattey B, Newton F. School Nurses Can Improve the Lives of Students With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. NASN Sch Nurse. 2018 Sep 15:1942602X18795299. doi: 10.1177/1942602X18795299. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30222036