Dr. Chia posted a lengthy response to some of the questions asked regarding the last Oxymatrine post. (I added the headers)
Dr. John Chia:
Interferon and Oxymatrine: First of all, oxymatrine or equilibrant is used alone without interferon in almost all of the patients. I only used interferon-alpha 2a to help reducing the muscles pain often worsened by the use of oxymatrine. Interferon was used in patients who had major relapses immediately following discontinuation of this immune modulator and marked increase of myalgia with restart of 1/2 tablet of the herbal product. The use of interferon helped the patient to get back to full doses of oxymatrine within a 2-3 week period. The use of interferon does not increase the overall response to the herbal product.
Fibromyalgia and ME/CFS: Altered Immune Responses – What I have learned from the use of the immune modulator is dose titration. The needs for patients are usually different depending on the symptoms.
The tolerance issue depends on one’s immune response, the tissue viral load and the organs involved. As we have shown with the cytokine gene expression studies, patient with severe fibromyalia actually did not have quite as bad Th2/Th1 imbalance, as comparing to patients with debilitating fatigue without as much myalgia. Conversely, the viral proteins seen in the stomach biopsy are much more abundant in CFS patients than that in fibromyalgia patients (unpublished data). CFS and fibromyalgia are probably the two ends of the same spectrum: one end has much more viruses but little immune response, the other end has few viruses in the tissues but very severe and yet ineffective inflammatory response. I have often seen patients progress from severe CFS to fibromyalgia over several years.
FM and ME/CFS: Dosing – This may be the reason that fibromyalgia patients do not need much more immune stimulation. I use the herbs at very low-doses in these patients hoping the complex immune response can rebalance itself. In my experience, higher doses would only produce more inflammatory symptoms (myalgia etc.) and not better than lower doses.
Autoimmunity and Oxymatrine: (Dr. Chia suggested that patients with autoimmune tendencies should not take Oxymatrine. ) Autoimmune tendency means a strong family history of autoimmune diseases such as rheumatoid arthritis, lupus, autoimmune thyroiditis (especially Grave’s disease), multiple sclerosis, and if the patients have joint pain with positive rheumatoid factor and persistently positive ANA. With the use of other potent Chinese herbs and oxymatrine over the last several years, we have seen two patients develop rheumatoid arthritis (presented at the Reno meeting and London IiME, London meeting).
I believe that the main reason that CFS patients are symptomatic are due to continuing inflammatory response toward viruses living within the cells, enteroviruses in most of the cases I see. The attack is dominated by Th2, which needs to be shifted toward Th1, as is with the use of the herbs. However, an excessive shift toward Th1 in a patient who has autoimmune tendencies could potentially start off an unregulated Th1 response (autoimmune response) that will require immunosuppressant to rebalance the immune response. This is why the herbal product should not be used in patients with autoimmune tendency.
Enteroviruses trigger Autoimmune Responses As Well: We have clearly documented certain enterovirus infections triggering autoimmune responses in some patients that require steroids and other immunosuppressive drugs to control the overreactive and damaging response. Some simple markers for this type of response are high erythrocyte sedimentation rate, c-reactive protein and sometimes high white blood count. Immunosuppressive therapies are detrimental in CFS patients, as I have learned many years ago. Virus-induced immune response can be partly autoimmune in nature, as being argued for type 1 diabetes and chronic viral myocarditis. Steroids and other immunosuppressive drugs are of no benefits, and in fact harmful in these diseases.
Acute rheumatic fever is clearly an autoimmune disease induced by Group A streptococcal throat infections. When the immune response occurs against certain protein sequences of the bacteria (M protein) that are similar to human proteins in the brain, joints and heart, then the patient would develop chorea, carditis and arthritis. The mainstay of treatment is anti-inflammatory drugs for the inflammation, but one has to give antibiotic to kill off streptococcus in the throat. If the inciting pathogen is killed, then the autoimmune response would usually subside within a few months with anti-inflammatory treatment.
Can you imaging how we would feel if there are viruses surviving in our muscles, brains, hearts and gastrointestinal tracts triggering ongoing immune responses?
Lack of Effective Enteroviral Drug: What has been difficult to sort out the dominant role of enterovirus or the immune response is a lack of an effective antiviral drug. If intracellular enteroviruses are attracting and directing (believe it or not) the immune response, then suppression of virus activity will allow cessation of immune response. We clearly have seen this concept proven correct in HIV/AIDS patients. Few years from now, we hope to have drugs to arrest the viruses that are making our immune response angry. Before that happens, the debate on virus or immune response will continue without end.
Interestingly, the use of antibiotics for Mycoplasma has no clear benefit in most patients with CFS/fibromyalgia and GWS. This may mean that Mycoplasma is not important in these diseases. The benefit seen in some patients may be due to the way the antibiotics (doxycycline, zithromax) modulate the immune system rather than the antimicrobial effect, as we have seen in patients with rheumatoid arthritis.
Dig Deeper! Dr. Chia Produces Immunomodulator
Dig Deeper! Enteroviral Foundation Opens – Dr. Chia is a board member of the Enterovirus Foundation