Spanish HIV Experts Give Aid to ME/CFS

April 13, 2013

Joel (Snowathlete) talks with Dr Blanco, from IrsiCaixa, about the Spanish AIDS Research Institute‘s latest research on ME/CFS

T-lymphocyte (T-cell)

T-lymphocyte (T-cell)

Back in 2009 when XMRV hit the headlines a number of groups around the world took an interest in ME/CFS for the first time. One of these groups was the AIDS Research Institute IrsiCaixa, in Spain. Then XMRV tripped itself up and ME/CFS became invisible again…Except, it didn’t…

IrsiCaixa were still interested. Dr Blanco and his colleagues had taken a look at ME/CFS in 2010 and spotted a bunch of problems in the immune system. These guys really know their stuff when it comes to immunology and they knew that they were on to something. Here’s what Dr Blanco had to say about it:

“Our preliminary data showed alterations in all lymphocyte subsets analyzed (B, T and NK). However, these preliminary data were generated from patients recruited in one CFS unit. To avoid any bias, we expanded our study by recruiting patients from a different clinical center.

“Patients’ organizations partially funded the initial studies, with many patients contributing with small amounts to fund the research. These studies were aimed at identifying viral (XMRV) and immunological markers in CFS samples. Although the role of XMRV was rapidly ruled out, the researchers felt that the immunological studies were interesting enough to deserve further work. This additional effort was funded by the IrsiCaixa Foundation (a research institute funded by the Catalonian government and “La Caixa” foundation, a Catalonian bank).”

ME/CFS is well understood to have an element of immune dysfunction, and there are many papers on it. The immune system is complex, and contains many different cell types and subtypes which carry out different tasks. The cells most often studied are lymphocytes, the three major types of lymphocytes being T-, B- and natural killer-cells (NK). Within these three groups you have further division of phenotype, so two different T-cells, although related to each other, may possess characteristics that differentiate them, and disease may affect one of these phenotypes but not the other.

The studies that appear to shed the most light on ME/CFS – showing differences from healthy or disease controls – are those which look at the different phenotypes of T-, B- or NK-cells; either their count, or even better, their function. Despite interesting results, some of the immune abnormalities reported in ME/CFS over the years have been contradictory.

Back in 2011, researchers from Bond University in Australia published some very interesting findings in The Journal of Translational Medicine (Ekua W Brenu, et al) showing that the immune system of ME/CFS patients differed in phenotype and function, compared to controls. Now, new findings from Dr Blanco and his colleagues in Spain have been published in the same journal (Marta Curriu, et al) and report an assortment of immune abnormalities, some of which support the earlier findings from Australia.

From left to right: Marta Massanella, Julià Blanco, Jorge Carrillo, Cecilia Cabrera and Marta Curriu. (© IrsiCaixa. Raimon Solà).

From left to right: Marta Massanella, Julià Blanco, Jorge Carrillo, Cecilia Cabrera and Marta Curriu.
© IrsiCaixa. Raimon Solà

In short, what are they reporting?

They have reported that NK-cell phenotype is biased in ME/CFS and some T-cells have been found to be poorly responsive, and these abnormalities clearly identify ME/CFS affected individuals.

Phenotype count

Each cell in our body has one or more special surface molecules which carry out important functions. Each of these different molecules has a name but is also known by a number, called a cluster of differentiation (CD). These differences allow cells, such as lymphocytes, to be subdivided into different populations based on their relative expression of these surface markers.

You have likely heard of them before; they are talked about frequently in immune diseases, and you are probably aware of Rituximab – a potential treatment for ME/CFS – which depletes B-cells possessing the CD20 marker.

In this study Dr Blanco and his colleagues looked at these different markers on T-, B- and NK-cell lymphocytes and compared them to controls. In comparing the absolute count of these phenotypes, they found that some were no different from controls, but others were significantly different.

They found a slightly unbalanced composition of the overall T-cell subset, including higher representation of CD4 T-helper-cells in the CFS group. They also found a significantly lower frequency of cytotoxic T-cells with the CD56 marker, replicating the finding from Klimas, et al, in 2011, and Peterson, et al, in 2011.

cluster of diff

Cluster of differentiation tree showing some of the different markers that differentiate lymphocytes as reported in this study

This signature is also found to occur in Psoriasis, an autoimmune disease. I asked Dr Blanco whether he thought this might suggest ME/CFS is an autoimmune condition? 

“This is a very good question. The autoimmunity link to CFS was among our initial hypotheses. For this reason we deeply analyzed B cells. Contrasting with this hypothesis, we found no differences in B cell subsets between CFS and healthy individuals. In addition, we found (as others) a higher frequency of regulatory T cells in CFS. Considering that one of the main functions of T-regs is to control autoimmune responses, our data suggest that autoimmune responses are under a proper, if not enhanced, control in CFS. This paradox, that may be related to other functions of B cells, remains to be solved.”

Overall, B-cell phenotype count was found to be similar to controls.

When it came to NK cells, the researchers found that NK-cells expressing the markers CD69 and CD335 (NKp46) were significantly higher than controls and NK cells of the phenotype CD25 were significantly lower in number. A similarly altered NK-cell population has been reported in influenza infection or vaccination.

Phenotype function

Despite the differences found in NK-cell phenotypes, functional tests showed that their overall cytotoxic effect and sensitivity to ex-vivo cell death was similar to controls. This is a bit of a surprise, but Dr Blanco was kind enough to give us his thoughts on this.

“We were also surprised by the lack of differences in NK cell activity. Unfortunately, data from NK cell lytic activity was generated in a subset of patients, thus reducing the statistical power of these data. I think this is the main reason for the apparent lack of difference.”

Overall, as with absolute count, B-cell function was found to be comparable to controls.

The big differences are in the T-cells, where phenotype function was found to be distinctly different to controls. They report an increase in the proportion of CD4 T-cells expressing the PD-1 (CD279) marker, compared to controls. T-cells expressing the PD-1 marker have been reported to correlate with T-cell exhaustion in HIV-infected patients.

CD8 T-cells expressing the CD95 marker (another marker associated with T-cell exhaustion), were also found to be increased in the patient sample when compared to controls.

T-regulatory cells (T-reg) with particular markers (CD4+ CD25++ FOXP3+ or CD4+ CD25++ CD127-) were found to be significantly higher in the CFS sample, in line with a reduced number of CD4 T-cells expressing the Ki67 marker and supporting the earlier findings from Bond University in Australia.

CD8 T-cells expressing the CD5 marker (associated with impaired T-cell response as a result of chronic low level antigen exposure) were higher in the patient sample compared to controls.

And the patient sample demonstrated lower counts of the activation marker CD38 and memory CD8 T-cells displaying the marker CD45RO.

When they tested ex vivo proliferation of T-cells, the CD4 T-cell response was significantly lower in the patient sample. The CD8 proliferation response was not found to be significantly different, compared to controls, and the overall T-cell cell-death test matched controls.

These multiple differences in T-cell function point to an impaired T-cell response in patients with ME/CFS, which the authors describe as “a general hyporesponsiveness”.

How did they do it?

The study was designed in 2010 and so used Fukuda criteria rather than the later 2011 International Criteria that would have allowed selection of defined ME patients. In the paper, the authors show a good understanding and awareness of the potential difference between ME and CFS defined populations and/or subgroups within the disease(s). The majority of the ME/CFS patients in the study were classed as having a mild level of severity, with an approximate 50% reduction in pre-illness activity level, only three of the individuals being moderately severe. No severe cases were represented in the study.

Iriscaixa Lab

Iriscaixa Lab
© IrsiCaixa. Raimon Solà

They took blood samples from 22 ME/CFS patients with an absence of current identified infections, and 30 healthy controls, analyzing the portion of blood containing T-, B- and NK-cells.

Part of the blood drawn was analyzed to ascertain the absolute counts of the different lymphocyte phenotypes. This analysis is called immunophenotyping and was achieved via a process called flow cytometry. This process isn’t new, but it is clever. It involves the introduction of antibodies to the blood which attach to the surface proteins on the lymphocytes. As different phenotypes have different surface proteins, each antibody will only stick to specific cell phenotypes. This acts as a sort of label to identify each of the different cell phenotypes.

These labeled cells are then put through a machine called a flow cytometer, a very complex piece of kit, but the principle behind it is quite simple, it can read all these labeled cells extremely quickly, and give you a count of the different phenotypes.

They used the remaining blood to analyze the function of these different phenotypes by a variety of assays.

Three of the CFS/ME sample group were later excluded from the findings: through the analysis of immune cells, one was found to have B-cell lymphocytosis, another was found to have IgA deficiency and a third was excluded due to sample unavailability. This left a sample size of 19 patients for results.

What does it mean?

We don’t yet know if these lymphocytes are directly involved in the pathophysiology of the disease, or whether they are a secondary effect. Specific NK-cell phenotype profiles have been associated with various viruses in the medical literature and the results may reflect the role of an unknown pathogen, but until such a pathogen is identified (if at all) in ME/CFS, this is merely speculation. Regarding the significant down regulation of T-cell mediated immunity; this characteristic may explain why people with ME/CFS often have various concurrent infections.

A biomarker

These findings may allow identification of ME/CFS patients as it is possible to look at their T-cell and NK-cell phenotype signatures, which should stand out when compared to a healthy signature. The authors evaluated the potential for identification of ME/CFS patients based on the reported abnormalities, and found that 8 of these T- and NK-cell phenotype markers, when used in a combination, provided a high sensitivity (100%) but with a moderate false positive rate 5/24 (specificity – 79%). Although the false-positive rate may be seen as problematic, when used in combination with current diagnostic criteria for ME/CFS it is likely that the specificity would be much higher.

Of course, this diagnostic model fits this dataset, and how it would perform against new, unseen data from new patients would be the true test of its efficacy.

This study does confirm some of the findings from Australia in 2011, and other prior studies, and that is fantastic news for us. It suggests that there is a good chance that someone looking at your phenotype profile would find the same signature reported in these two studies. It could be used to diagnose ME/CFS, and to prove what we already know – that we have dysfunctional immune systems, and these immune abnormalities may help focus in on the cause(s) of the illness.

In contrast, some results from this study do not support earlier findings reported by others, including Maes, et al. However the authors suggest that this apparent conflict may just be a result of prior in vitro stimulation which took place in the study by Maes, et al.

Is it a surprise that B-cells were not found to be abnormal?

The work by Mella and Fluge in Norway, using Rituximab, suggests that B-cells in ME/CFS patients may be abnormal and hints at the possibility of autoimmunity. But this new research from Spain found no significant differences in B-cell phenotype, or functions overall. Dr Blanco was good enough to give us his insights on this:

“As I mentioned above, our data suggest that autoimmunity is not a major player in CFS. However, data on Rituximab treatment suggesting a clinical improvement of CFS are clear. To solve this apparent paradox a deep analysis of B cells before and after Rituximab treatment would be very helpful. One possibility to bring together both observations is that the beneficial effect of Rituximab may be indirect, acting by removing B cells that produce cytokines that may contribute to CFS symptoms. This is obviously a hypothesis that requires a proper experimental demonstration.”

A recent study from Bansal, et al, with a sample of 33 patients, suggests a subtle deregulation of B-cells in ME/CFS patients. I asked Dr Blanco how these findings compared to his own observations of B-cells in ME/CFS:

“The paper by Bansal et al suggests abnormalities in B cells from CFS affected individuals. Interestingly some of these alterations seem to fit with our preliminary data. In fact we found a slightly reduced number of antibody producing cells and a low level of circulating IgG in some individuals. Unfortunately in our patients these alterations were not consistent and failed to be useful to identify CFS. However, we still believe that our data could be consistent with alterations in B cell phenotype or function that will be unveiled in larger studies.”

Additionally, as Dr Blanco and his colleagues point out in the paper itself, any B-cell dysfunction in ME/CFS could be present in the tissue rather than in the blood.

Possible causes

XMRV turned out to be contamination, but having taken a closer look at ME/CFS now, I asked Dr Blanco to speculate on what he thinks the potential cause of the illness might be: a retrovirus, virus, bacteria, or something else?

“It can be any of them. What I think is that some infections or other sources of stress may induce chronic unbalance in the inflammatory status. This may fit with some observations made by several authors. This unbalanced inflammatory status may help to explain not only immunological perturbations but also neurocognitive disorders reported in CFS.”

“What do you think of De Meirleir’s and Lombardi’s recent HERV/dendritic cell findings; do you think HERVs could play a role in this disease?”

“This is again a very interesting question. Endogenous retroviruses may play a still undefined role in several human diseases. Interestingly, the expression of HERV genes is controlled or influenced by many inflammatory mediators that activate/repress transcription factors. Thus, the excellent study by De Meirleir and Lombardi on HERV provides an additional piece of information to have a complete picture of CFS.”

What next?

This study adds to the now significant (and still growing) body of evidence showing B-, T-, and NK-cell abnormalities in ME/CFS. This is a relatively small study. A bigger study is now needed to prove that the same signature is consistent in the wider ME/CFS population.

As well as replicating these findings in a larger sample, we also need to know how the ME/CFS profile compares to other diseases with similar symptomology. It may then be possible to diagnose patients by looking at their immune system profile, perhaps in combination with existing diagnosis criteria, allowing a more certain diagnosis of ME/CFS (assuming of course, that an extended study did not show a common profile in other comparable diseases).

One thing that may restrict the usefulness of this reported ME/CFS immune profile is co-infections. This study was careful to exclude patients with identifiable co-infections. This was a good thing, but people with co-infections may present a different profile. So there are still questions to be answered, but we have reason to be optimistic that this area of research will continue to be fruitful.

Having new researchers from different backgrounds working on our illness is exciting and full of promise, and I was delighted when Dr Blanco told us that he and his team plan to continue looking at ME/CFS.

“Our research team is an immunology group that works in collaboration with the HIV Clinical Unit in the Germans Trias I Pujol Hospital to understand immune damage caused by HIV infection.  Although we found the immunology of CFS is a new exciting area of research, our Hospital lacks a CFS Unit and we perform our work on CFS in collaboration with other Hospitals in Catalonia, limiting sample availability and processing and the design of large studies centralized in our laboratory.

“Despite this, I do think that this collaboration between research teams with a very different background yielded a strongly positive synergy that should be maintained. Therefore, our plans are to bring to the CFS field our ideas in collaboration with the leading research teams in CFS in Barcelona (which have the capacity to recruit larger cohorts) and to contribute to link immunological alterations with other clinical features of CFS.”

“Given your success in collaborating with CFS specialists in Spain, and with other ME/CFS specialists looking at lymphocytes as well, such as Dr Marshall and her colleagues in Australia, might there be an opportunity for your two groups to collaborate on research in this area?”

“It would be great to expand our contribution to CFS immunology in collaboration with leading laboratories worldwide. For instance, in HIV research the establishment of international cohorts has allowed new achievements on therapies and clinical guides. For CFS, the definition of well-defined international cohorts with standardized immunological/neurocognitive/endocrine follow-up and regular blood collection/biobanking might be a valuable tool for research. Again, clinicians that treat CFS should lead this initiative.”

“The ME/CFS community are grateful for your interest in the illness, and are keen to support your efforts. How can the ME/CFS community support your work?”

“The ME/CFS community has strongly supported our work with different fundraising projects. I know that national and international associations work to fund new projects. I would suggest that these projects involve both widely recognized ME/CFS research teams, and groups outside the ME/CFS field to favor synergies and new ideas coming into the field. Attracting new teams will increase the interest of the scientific community for CFS and a dynamic research may be the best weapon to fight the disease.

“I would like to thank you for your interest in our work and I hope that a collection of reliable biomarkers will soon be available for the diagnostic of CFS. This is important for patients, who will benefit from a faster diagnostic, and for health policy makers that will better evaluate the impact of the disease.”

A big thank you from the ME/CFS community to Dr Blanco and his colleagues for their interest in ME/CFS, and their excellent work.

Joel was diagnosed with ME/CFS in 2009 but struggled with the illness for some time prior to this. He loves to write, and hopes to regain enough health to return to the career he loved and have his work published. 

PRIMARY REFERENCE:
Marta Curriu, Jorge Carrillo, Marta Massanella, Josepa Rigau, José Alegre, Jordi Puig, Ana M Garcia-Quintana, Jesus Castro-Marrero, Eugènia Negredo, Bonaventura Clotet, Cecilia Cabrera, and Julià Blanco. Screening NK-, B- and T-cell phenotype and function in patients suffering from Chronic Fatigue Syndrome. J Transl Med. 2013; 11: 68.

OTHER RECENT ARTICLES BY THIS WRITER:

 

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34 comments

{ 34 comments… read them below or add one }

Plum April 13, 2013 at 10:15 am

This is an awesome article. My only issue is that it's a bit hard to understand for someone with pretty bad brain fog! Maybe someone will be kind enough to do a brief summary on the important points?

Angelina LeBaron April 13, 2013 at 10:34 am

Joel, this was a great article! You are a wonderful writer, with a good grasp of the concepts, and enough background to understand the research. Contact me: lebaronangie@yahoo.com.

Sushi April 13, 2013 at 11:55 am

snowathlete

Great article! The writing you are doing is an inspiration (just that you are doing it, let alone the great content) and also gives us peeks into fascinating areas of research that we would not normally have access to. Thanks!

Sushi

Sasha April 13, 2013 at 11:59 am

Great job, Joel – very encouraging to hear that HIV researchers are getting interested in us. It will be interesting to see how these results tie in with the CFI pathogen study (which is of course also a host response study).

Simon April 13, 2013 at 1:12 pm

Thanks, Joel. Always good to have new researchers come in from other fields to CFS – and in that photo they certainlylook like a kick-ass team. This study looks on the small size for any robustconclusions, with only 19 patients, so hopefully they will replicate in a larger sample as they plan. And I do like their idea from HIV research of establishing an international cohort of ME/CFS patients.

carlitos April 13, 2013 at 2:39 pm

Joel

Congratulations for your article! I am a patient in that study, and I was planning to film a documentary on current lines of research of CFS, I am also supporting a signature petition for requesting the Spanish Government to support a bigger study to validate the biomarkers described by Irsi Caixa Team:

https://www.change.org/es/peticiones/ministerio-de-sanidad-financiación-para-la-ampliación-del-estudio-de-investigación-de-irsi-caixa

Which by the way I encourage phoenix rising to support from here…

Joel, how can I contact you? Did you filmed something on any of your former interviews?

Cheers

Carlos

snowathlete April 13, 2013 at 3:05 pm

Thank you for the great feedback everyone. I'm glad people enjoyed the article and found it useful.
Plum – I'll produce a short summary tomorrow. There is rather a lot to take in isn't there and I appreciate that can be difficult when we're foggy!

Sasha – I cannot wait for that CFI study!

Simon – yes the idea of an international cohort is fabulous. One of the major benefits of new researchers is new ideas and experiences brought in from other fields. Invaluable.

snowathlete April 13, 2013 at 3:10 pm
carlitos

Joel

Congratulations for your article! I am a patient in that study, and I was planning to film a documentary on current lines of research of CFS, I am also supporting a signature petition for requesting the Spanish Government to support a bigger study to validate the biomarkers described by Irsi Caixa Team:

https://www.change.org/es/peticione…ón-del-estudio-de-investigación-de-irsi-caixa

Which by the way I encourage phoenix rising to support from here…

Joel, how can I contact you? Did you filmed something on any of your former interviews?

Cheers

Carlos

Thank you Carlos! A documentary sounds like an excellent idea and the petition too! Can anyone vote, or just those in Spain?

I'll send you a PM.

carlitos April 13, 2013 at 5:13 pm

I guess anybody can vote there, to pump up the volume of the petition ;-)

carlitos April 13, 2013 at 5:14 pm

Just say you are in Madrid, Barcelona, Valencia, Bilbao, etc… do not say you are in the US or out of Spain, so that you count as a spanish citizen requesting for public funding

SpecialK82 April 13, 2013 at 6:49 pm

Fantastic news – all this new research is really getting exciting. I wonder if they could collaborate with Mella and Fluge and /or Dr. Kogelnik at the Open Medicine Institute to analyze blood samples before and after Rituximab treatment.

One question – when they selected study participants that had no co-infections, does this mean that they couldn't have HHV-6, CMV, EBV, etc? I would guess that only a small minority of us don't have any of those……

snowathlete April 14, 2013 at 5:26 am
SpecialK82

Fantastic news – all this new research is really getting exciting. I wonder if they could collaborate with Mella and Fluge and /or Dr. Kogelnik at the Open Medicine Institute to analyze blood samples before and after Rituximab treatment.

One question – when they selected study participants that had no co-infections, does this mean that they couldn't have HHV-6, CMV, EBV, etc? I would guess that only a small minority of us don't have any of those……

Good question!
They excluded people with diabetes, hypertension, chronic obstructive pulmonary disease, inflammatory bowel or Crohn's disease, rheumatoid arthritis, Parkinson or Huntington disorders, schizophrenia, organic mental disorders, substance use disorders, multiple sclerosis. People also needed to have CFS for more than 2 years as well those who were pregnant or who had undergone chemotherapy treatment. The bit about co-infections says "absence of current identified infections." I agree that last statement is a bit non-specific, so I'm not really sure what lengths they might have gone to to check for things like HHV6, EBV, CMV, B19, enteroviruses, etc.

In contrast to other studies their inclusion criteria was focused on patients without intercurrent infections. This is quite a different approach to most ME/CFS studies and I guess that shows the different angle that these HIV researchers are approaching the problem.

beaker April 14, 2013 at 6:19 am

Thanks. I appreciate the link to the paper. I can share that w/ my dr.
Interesting read. Good to know we have more researchers on our team !

MeSci April 14, 2013 at 9:06 am

I want to echo the praise for the way you explain the science, Joel. Although I am a scientist, the ME makes it hard for me to take in and work with new info, and you have made it easier – thank you!

Like others, I note that the subjects were mildly affected, and they were presumably well enough to attend a health clinic. This would exclude a lot of people who would be feeling too ill to do so. I think this is important, as post-exertional malaise is likely to feature significant changes in biochemistry.

Erica Verrillo referred to this problem in her excellent article here:

http://blogcritics.org/culture/article/chronic-fatigue-and-immune-dysfunction-who/page-2/

where she says:

"Natelson’s meta-analysis, entitled “Evidence for the Presence of Immune Dysfunction in Chronic Fatigue Syndrome,” examined 79 studies of immune function in CFIDS patients. Natelson found that that there was no consistent immune dysfunction. Some studies indicated that there were increased pro-inflammatory cytokines, others found increased anti-inflammatory cytokines.

Given the fact that one of the hallmarks of CFIDS is waxing and waning symptoms, this should not have come as a surprise. The immune dysfunction that characterizes CFIDS is that it both under- and over-responds."

I haven't read your whole article yet. I've also had an incomplete look at the Brenu et al paper. Hope to take it all in eventually!

I still have a strong sense that many/most people with ME have an autoimmune condition, quite likely to be related to/resulting from colonic acidity/lactic acid in many/most cases. The evidence for that seems strong.

I'd like to see stronger, less-equivocal biochemical evidence though.

SpecialK82 April 14, 2013 at 10:36 am
MeSci

"Natelson’s meta-analysis, entitled “Evidence for the Presence of Immune Dysfunction in Chronic Fatigue Syndrome,” examined 79 studies of immune function in CFIDS patients. Natelson found that that there was no consistent immune dysfunction. Some studies indicated that there were increased pro-inflammatory cytokines, others found increased anti-inflammatory cytokines.

Given the fact that one of the hallmarks of CFIDS is waxing and waning symptoms, this should not have come as a surprise. The immune dysfunction that characterizes CFIDS is that it both under- and over-responds."

I wonder also if the blood samples would show a difference before and after exercise – basically without PEM and with PEM……..

kauri April 14, 2013 at 10:39 am

Thank you for bringing this so interestingly and clearly to our attention. You summed it up so well and drew connections with other research to set it in context beautifully. I liked the photo too, nice to see the people involved, people working to help us.
I find it striking that a team very familiar with HIV infection should summarize the impression given by the findings as not that of an autoimmune disorder. The signs of T-cell exhaustion being reminiscent of HIV infection,and their finding of higher T-reg (higher T-cells regulatiory cells is a replication of the Bond U. study, as you mentioned.
Now I'm curious what the immune state of severe, long term cases (like mine) would look like.
Thanks again, much appreciated.

snowathlete April 14, 2013 at 12:00 pm
MeSci

I want to echo the praise for the way you explain the science, Joel. Although I am a scientist, the ME makes it hard for me to take in and work with new info, and you have made it easier – thank you!

Thanks MeSci.

MeSci

Like others, I note that the subjects were mildly affected, and they were presumably well enough to attend a health clinic. This would exclude a lot of people who would be feeling too ill to do so. I think this is important, as post-exertional malaise is likely to feature significant changes in biochemistry.

Yes, you're right, there are several factors that influence results, and one of those is undoubtably PEM. I'm looking forward to the PEM research results from Mt. Sinai which is looking at a whole bunch of stuff before and after exercise.

Sasha April 14, 2013 at 12:13 pm
snowathlete

I'm looking forward to the PEM research results from Mt. Sinai which is looking at a whole bunch of stuff before and after exercise.

Do you know what other major research results we can expect this year? Anything big expected in the next 6 months? I think there's some early CFI 'pathogen study' stuff expected but apart from that, I don't know what's on the calendar and it's nice to have something to look forward to. :)

Dreambirdie April 14, 2013 at 12:22 pm

Thanks Joel for your work on this. You did a great job explaining the findings.

Like others here, I have an issue with this part of the research:

"The study was designed in 2010 and so used Fukuda criteria rather than the later 2011 International Criteria that would have allowed selection of defined ME patients. In the paper, the authors show a good understanding and awareness of the potential difference between ME and CFS defined populations and/or subgroups within the disease(s). The majority of the ME/CFS patients in the study were classed as having a mild level of severity, with an approximate 50% reduction in pre-illness activity level, only three of the individuals being moderately severe. No severe cases were represented in the study."

WHY couldn't they make an effort to use the Canadian Consensus Criteria, or maybe even scrapped what they had and done the study over using the MEICC? And more importantly why didn't they gather blood samples from those who are severely stricken? The most important part of a study is the cohort. It bugs me that they weren't more discriminating about this.

snowathlete April 14, 2013 at 12:34 pm
Plum

This is an awesome article. My only issue is that it's a bit hard to understand for someone with pretty bad brain fog! Maybe someone will be kind enough to do a brief summary on the important points?

OK, here is a short summary of the key points for those of us who arent at our best at the moment:

Researchers from Spain who usually look at the immune systems of HIV patients took a look at a group of ME/CFS patients. They looked at the different types of white blood cells in our blood and compared what they found with a group of healthy controls.

They found that some types of white blood cell counts were higher than they should be, while some others were lower the normal. Additionally, they found that some of these cells didn't respond as they normally would. Overall this suggests that we have some immune impairment, which may explain why we get co-infections like herpes, etc.

Some of these findings were very similar to previous findings in ME/CFS by researchers in Australia.

These immune cell differences were strong and consisitant enough that if you put an ME/CFS patient's results next to a healthy person's results, you could identify which was the ME/CFS patient. So, it could be possible to diagnose ME/CFS with these markers – we'd have a blood test for ME/CFS. But it is an early stage in the research, so it has real promise, but we need more checks yet before we know this would work in the general ME/CFS population.

Sasha April 14, 2013 at 12:51 pm
carlitos

Just say you are in Madrid, Barcelona, Valencia, Bilbao, etc… do not say you are in the US or out of Spain, so that you count as a spanish citizen requesting for public funding

Hi carlitos – I think it's great that you're encouraging people to support the petition but it's possible that the polling software can see the location of people (IP address, maybe) and would throw out any votes from those not from Spain. 'm concerned that this might undermine the legitimacy of the petition. If the government see that many people are voting from outside Spain, they may consider the results to be meaningless.

maryb April 14, 2013 at 2:03 pm

I have signed from the UK – I hadn't seen this thread – wonder if it matters? If enough people from around the world are supporting it too doesn't that make it as valuable?

Just thought is it like the govt petitions here where you have to be a UK citizen to sign.

Andrew April 14, 2013 at 3:36 pm

I'm glad their curiosity was stimulate enough to investigate further, and I'm glad they were able to arrange funding. Others have been down this same path of research. I hope their research is more fruitful than the others.

snowathlete April 14, 2013 at 3:39 pm
Sasha

Do you know what other major research results we can expect this year? Anything big expected in the next 6 months? I think there's some early CFI 'pathogen study' stuff expected but apart from that, I don't know what's on the calendar and it's nice to have something to look forward to. :)

One thing that really encourages me is that there is actually a whole load of research going on. Sure, we dont get much govt. funding but we still have a surprising number of studies occuring and lots and lots of doctors working on the illness. More than you would think, because some of it doesnt get much publicity. One of the problems I have at the moment is chosing what to write about, or more specifically: what not to write about.
Some studies come out of nowhere and even those we know about are moving targets, because they rarely finish and get published at the date originally thought.
We're going to have more interviews, like the recent one with Dr Enlander, and we'll be asking each time about current and future studies so readers should get more visability of what is coming up in advance.

As well as the big CFI pathogen study, there's more to come from De Meirleir and Lombardi, I think there are three different groups looking at spinal fluid: Natelson, Peterson and Baraniuk. I dont know if they are all finishing this year, but im looking forward to those. The CFIDS Association's drug repurposing study should be finishing this year too. I know there is more, I just can't remember it of hand!

heapsreal April 14, 2013 at 3:40 pm

The aussie scientists mentioned about their nk study are undergoing another now, so hopefully the more of these studies produced the closer they will get to having a test for cfs/me, i dont think they are far off. Once this is done hopefully then more people will be looking into treatments??

Plum April 14, 2013 at 3:46 pm
snowathlete

OK, here is a short summary of the key points for those of us who arent at our best at the moment:

Researchers from Spain who usually look at the immune systems of HIV patients took a look at a group of ME/CFS patients. They looked at the different types of white blood cells in our blood and compared what they found with a group of healthy controls.

They found that some types of white blood cell counts were higher than they should be, while some others were lower the normal. Additionally, they found that some of these cells didn't respond as they normally would. Overall this suggests that we have some immune impairment, which may explain why we get co-infections like herpes, etc.

Some of these findings were very similar to previous findings in ME/CFS by researchers in Australia.

These immune cell differences were strong and consisitant enough that if you put an ME/CFS patient's results next to a healthy person's results, you could identify which was the ME/CFS patient. So, it could be possible to diagnose ME/CFS with these markers – we'd have a blood test for ME/CFS. But it is an early stage in the research, so it has real promise, but we need more checks yet before we know this would work in the general ME/CFS population.

Thank you so much for the summary :) I will go through the longer post when I have time and am less brain fogged as it is awesome but it's nice for now to have an understanding of it. Thanks for taking the time to do this.

GcMAF Australia April 14, 2013 at 4:37 pm

is good
Some comments,

they found low CD57 counts and Low CD57 is found in Lyme disease.
Lyme Disease is rife in much of Europe. These people would not have been tested for many bacterial infections.
GcMAF is being used for CFS/ME, Lyme and i beleive HIV. This indicates a possible common underlyng cause. More information should come out of the first GcMAF conference this next weekend.
and also
Excluding diseases such as diabetes, hypertension, chronic obstructive pulmonary disease, inflammatory bowel or Crohn’s disease, rheumatoid arthritis, Parkinson or Huntington disorders, schizophrenia, organic mental disorders, substance use disorders, multiple sclerosis
maybe a moot point as diagnosis may be false. Many Lyme patients have been falsely diagnosed.

SpecialK82 April 15, 2013 at 7:39 am
snowathlete

We're going to have more interviews, like the recent one with Dr Enlander, and we'll be asking each time about current and future studies so readers should get more visability of what is coming up in advance.

As well as the big CFI pathogen study, there's more to come from De Meirleir and Lombardi, I think there are three different groups looking at spinal fluid: Natelson, Peterson and Baraniuk. I dont know if they are all finishing this year, but im looking forward to those. The CFIDS Association's drug repurposing study should be finishing this year too. I know there is more, I just can't remember it of hand!

Thanks for this listing of coming research. I've often thought that it would be terrific if we could maintain a Master List, (maybe right here on PR?) that would show all, or most, research studies that are planned or underway, give an estimated completion date and publication date so that we as a community can look forward to these events, and also so that we would know what studies are in need of funding, etc. We would also be able to follow-up with groups who have gone over the projected time-frame and find out if there are problems.

This is easier said then done of course ;), but if a list is set-up, maybe the whole community could submit research studies as they come across them and it wouldn't be a big burden on any one or two individuals. This might be a good project for the proposed PR Advocacy team to handle ——–after all, if a research study can't continue due to lack of funds, an Advocacy team might be able to raise awareness about it.

snowathlete April 15, 2013 at 3:00 pm
Dreambirdie

Thanks Joel for your work on this. You did a great job explaining the findings.

Like others here, I have an issue with this part of the research:

"The study was designed in 2010 and so used Fukuda criteria rather than the later 2011 International Criteria that would have allowed selection of defined ME patients. In the paper, the authors show a good understanding and awareness of the potential difference between ME and CFS defined populations and/or subgroups within the disease(s). The majority of the ME/CFS patients in the study were classed as having a mild level of severity, with an approximate 50% reduction in pre-illness activity level, only three of the individuals being moderately severe. No severe cases were represented in the study."

WHY couldn't they make an effort to use the Canadian Consensus Criteria, or maybe even scrapped what they had and done the study over using the MEICC? And more importantly why didn't they gather blood samples from those who are severely stricken? The most important part of a study is the cohort. It bugs me that they weren't more discriminating about this.

Thanks Dreambirdie.

Good question about the Canadian consensus, which was available of course. I think scrapping the work and re-doing it under MEICC wouldn't have been realistic though, because of the costs involved with starting again.
I suspect that not using severe cases was a consequence of the studies design to exclude people with known co-infections.

elbosque April 16, 2013 at 9:08 am
Plum

Thank you so much for the summary :) I will go through the longer post when I have time and am less brain fogged as it is awesome but it's nice for now to have an understanding of it. Thanks for taking the time to do this.

I echo this gratitude of a simple explanation. What i did understand is one of the things my ME/CFS doctor used to help confirm my diagnosis of ME/CFS two years ago. Back then my MD said my CD4 / CD8 ratio showed that my immune system was chronically activated. In successive tests after immune modulation treatment, it has stayed the same. Actually, one of the immune modulators was Imunovir which was originally an HIV/AIDS drug. My point is that my doctor and now the researchers I am seeing have been saying for quite some time that ME/CFS is an immune system disease. So this study is just confirming what other studies have show, right? Or is there something new from this study that I have missed understanding from the article?

Daffodil April 17, 2013 at 7:45 am

sorry bad brain fog….so this spanish research suggests that CFS is in fact not autoimmune?

snowathlete April 17, 2013 at 1:02 pm
elbosque

So this study is just confirming what other studies have show, right? Or is there something new from this study that I have missed understanding from the article?

Not quite. Their findings did support some previous research by another group, but they also came up with a model based on these abnormalities which perhaps could be used to diagnose ME/CFS in patients. In this sample, their model was able to distinguished between patients and controls. Its important to note however that the model would need to be tested against a new set of patients before we would know for sure if it would work as a diagnosis tool, or not.

Daffodil

sorry bad brain fog….so this spanish research suggests that CFS is in fact not autoimmune?

Well, these researchers who spend a lot of time looking at the immune system thought that if CFS/ME was an autoimmune condition then differences in the B cells would likely show up, and when they took an initial look at the illness when XMRV was happening, they saw some evidence to support that, but when they did a formal study they didnt really find the expected B cell abnormalites, and in contrast they found T-regs were up regulated which suggests we might have enhanced protection against autoimmunity. But I dont think they have completley ruled out autoimmunity, because there are some reasons still to think it may be autoimmune and there is not enough data yet to rule it out, but their study does not seem to support the autoimmune hypothesis.

heapsreal April 17, 2013 at 2:52 pm

The equivilant australian study showed that nk and cd8 t cells dont work well, so maybe its a combo of immune defincey/auto-immune issue. Explains why we pick up different bugs as well as unable to find 'one' particular infectious cause od cfs/me.

leela April 17, 2013 at 3:07 pm

thank you so much, joel. very well done, and very inspiring.

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