Carmine Pariante's MRC research award-Persistent fatigue induced by interferon-alpha

[Snow Leopard]

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[Mark]

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[Dolphin]

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Ok, have edited my post like that.

 

[oceanblue]

New MRC info on this study

This study is not as originally described. It is still looking at fatigue in Hepatitis C Virus (HCV) patients treated with Interferon-alpha (IFN-alpha) but instead of looking at the fatigue during treatment, it's actually looking at post-treatment fatigue, which makes it a particularly interesting model for post-infectious CFS.

Technical Summary
We propose to model chronic fatigue syndrome (CFS) by studying patients taking interferon-alpha (IFN-alpha) for chronic viral hepatitis C (HCV) infection. IFN-alpha treatment leads to acute fatigue in the majority of patients. Most importantly, a proportion of patients continue to experience persistent fatigue, together with other CFS-like-symptoms, for many months after the cessation of treatment, that is, in the absence of the pro-inflammatory stimulus. This phenomenon strikingly resembles CFS, which also persists after the viral/immune trigger has been eliminated.

Certainly this ties in with the Dubbos study and theory of an initial cytokine stimulus provoking long-term fatigue.

In order to develop this as a model of CFS, in our three-year project we want to:
1) assess a cohort (n=100) of patients throughout the IFN-alpha treatment and at 6 months after cessation of treatment, and identify the group who develop the persistent post-treatment fatigue (expected n=50 [ie half]);

2) validate this model, by comparing the clinical and biomarkers profiles in patients who experience persistent post-treatment fatigue, patients with CFS (n=50), and healthy controls (n=50);

3) identify the risk factors and the biomarkers trajectories (before and during IFN-alpha treatment) that identify those patients who will later experience persistent post-treatment fatigue.

Perhaps unsurprisingly given the study is based at Kings', they will be looking at psychological risk factors for fatigue too:

We will measure: fatigue, mood, and other CFS-like symptoms; medical and psychiatric history; childhood and recent stressors; social support; illness and treatment perceptions; physical fitness; quality of life; and occupational function. Moreover, we will measure blood biomarkers: serum cytokines; cortisol at awakening and during the day; and leukocytes gene expression. The project will build onto an existing pilot study in HCV patients, an established collaboration with Liver Units across London, and the research-led clinical service for CFS patients at King's College Hospital. "Thus, the project has great chances of success."

As before, this is not studying CFS directly but it could prove an intersting model, that would then need validating in CFS patients. One of the strengths of this approach is that they can collect prospective data on HCV patients pre-IFN-induced-fatige. However, the equivalent data for CFS patients can't be collected in the same way as they are already ill and fatigued so the comparison won't be direct.

Just to expand on the link with ME:

Because it activates the immune system, IFN-alpha also induces fatigue and flu-like symptoms in all patients. Moreover, and of particular relevance for this study, a considerable proportion of patients continue to experience debilitating persistent fatigue, and other symptoms that are similar to CFS, for 6 months or even one year after the cessation of IFN-alpha. This phenomenon strikingly resembles CFS, which, as mentioned above, also persists after the infective/immune trigger has been eliminated. Therefore, we are proposing to use IFN-alpha as a model to understand how an immune trigger induces persistent fatigue even when the initial immune trigger is no longer present. To do this, we will assess these patients throughout the many months of IFN-alpha treatment and at 6 months after cessation of treatment, in order to identify those with persistent "post-IFN-alpha-treatment" fatigue, and understand what biological and clinical changes lead to this outcome.

They will also be looking at cortisol, another favourite of King's College researchers.

 

[WillowJ]

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[Jenny]

Thanks oceanblue. This is interesting to me because my husband is starting a treatment trial at Kings with pegalated interferon and telaprovir for his Hep C in 2 days time. He had interferon (not pegalated) treatment 20 years ago but it failed to deal with the virus. Four years ago his liver failed and he was lucky enough to have a successful transplant, but of course the virus is now attacking his new liver.

The trial he is on is for patients who've had transplants. Treatment for them is more complicated as they are on an immune suppressant drug and the telaprovir will interact with that.

He had mild fatigue and flu-like symptoms for the 9 months he was on the interferon 20 years ago, but could still work full-time. He had no problems once the treatment ended. Hope it's the same this time round as I doubt we could cope with both of us ill with these symptoms!

I'm wondering if he'll be part of the MRC funded study.

I am amazed at the resources they have for dealing with Hep C patients at Kings - he has had tremendous care all along. The contrast with how they treat ME patients is huge.

Jenny

 

[Firestormm]

Thanks Ocean

I'm going to do 'my thang' on the laysummary of this study and figured it was better here than on the general MRC thread (which can be found here: http://forums.phoenixrising.me/show...es-ME-CFS-Research-Projects-Worth-£1-6m/page6).

I don't know if going through it like I do helps anyone else but I often find these days that it's the only way I can try and understand.

Additional information provided by MRC from their website here: http://www.mrc.ac.uk/Ourresearch/ResearchInitiatives/CFSME/index.htm : See MRC-funded Research Projects: or hit this link for a download of the pdf. file: 12 April 2012: http://www.mrc.ac.uk/consumption/id...dID=35295&dDocName=MRC008582&allowInterrupt=1

MR/J002739/1

PI: Dr Carmine Pariante, King's College London

Title: Persistent Fatigue Induced by Interferon-alpha: A New Immunological Model for Chronic Fatigue Syndrome

Start Date: 01/03/2012
End Date: 28/02/2015

Award Amount: 373,075.15

Lay Summary

Chronic fatigue syndrome (CFS) is a medical condition in which patients feel persistently and overwhelmingly tired and run down, both physically and mentally. In addition, they have difficulty with concentration, flu-like symptoms and aches and pains. This condition interferes with daily life activity, and, in some patients, is profoundly disabling. Although many years of research have been conduced on CFS, we still do not know what is causing it.

All true. Of course you could argue (as some are) that 'CFS' ain't 'ME' but for the MRC and NIH they is - at least until such time as a specific and quantifiable difference can be found. And who knows? Perhaps immunological differences will be part of that puzzle-solving.

One biological system that is involved in CFS is the "immune system", that is, the system dedicated to fight infections in our body. Indeed, in many cases CFS is triggered by an infection, but then the symptoms continue even after the infection has been eliminated.

Specifically, infections are always accompanied by acute fatigue and flu-like symptoms, as a consequence of the infection-driven immune activation; however, in patients with CFS the immune activation and the associated fatigue and flu-like symptoms persist for months or years.

Moreover, there is evidence that the immune system is in a state of "hyper-activity" in patients with CFS, as if they were fighting an infective agent, even though they do not have an ongoing infection.

Like the 'Sjorgen's/Not ME' Study on the general thread; here is an explicit acknowledgment that the immune system is in some way affecting/related to the chronic symptoms.

For this to be said (again) from UK researchers who have had their funding approved by the key government agency - is nothing short of bloody miraculous in my humble opine.

Perhaps worth noting here (as I did for the other study) that again the focus is on the immune system and we do hear of people diagnosed with the condition having had a viral infection of course.

Not everyone can remember or was told of a specific viral infection. Not everyone with 'CFS' will know therefore that or if a virus is responsible in some way for the symptoms.

But this research - and the other - are focusing a search on the immune system and it would seem reasonable to assume I think that most people with 'CFS' and experiencing the range of symptoms we endure might have a screwed immune system. Heck everyone might - but with different triggers perhaps?

The mention of the 'hyper-activity' within the immune system (or feelings that the immune system is in hyper-mode) is again interesting to see. The idea that the body is fighting against something that isn't there anymore - and is somehow 'stuck' on 'high' or something.

So it's fighting against the body? Against itself? Permanently or fluctuatingly on 'alert'? Triggered again and again by 'something'? Is the immune system itself revving up and leading us to 'relapse'? Interesting...

I digress

This project aims to understand exactly this process: how the infection and the acute immune activation evolve into CFS, and what are the risk factors that make this process occur in some individuals but not others.

Well there we go

Clearly, trying to study this process in subjects experiencing naturally-acquired infections is very difficult, for the unpredictability of these events.

Ok. I think I understand. They have a clearly-defined patient cohort and trigger. They are going to simulate an immune response with a drug used in this case to treat Hep C.

Again it's more likely to result in a success (as well as being more efficient and cheaper) I would imagine than having to screen patients with 'CFS'.

Also as 'CFS' is not diagnosed until after six months it is not always evident what the trigger was - as has been mentioned.

Nonetheless it is disappointing perhaps as I'm sure we'd all like to have seen this - and the other - study looking specifically at 'CFS' patients in the initial phase and not 'merely' as a comparative cohort.

In contrast, we want to model the development of CFS by studying a group of patients that have a pre-existing infection (chronic viral hepatitis C, HCV) and that receive a course of treatment (lasting months) with the immune activator, interferon-alpha (IFN-alpha).

It is interesting that 'CFS' is being viewed as 'something that occurs post-infection to some people' i.e. it is a 'development'. You 'develop' CFS post-infection.

That's their working hypothesis I guess. Fine by me for the purposes of this study. Again - like the other study - we seem to be heading towards an autoimmune disease don't we? And - again like I said on the other thread - maybe this explains why Rituximab achieved such good results?

Anyway...

IFN-alpha is the treatment of choice for HCV infection. Because it activates the immune system, IFN-alpha also induces fatigue and flu-like symptoms in all patients.

Moreover, and of particular relevance for this study, a considerable proportion of patients continue to experience debilitating persistent fatigue, and other symptoms that are similar to CFS, for 6 months or even one year after the cessation of IFN-alpha.

This phenomenon strikingly resembles CFS, which, as mentioned above, also persists after the infective/immune trigger has been eliminated.

Therefore, we are proposing to use IFN-alpha as a model to understand how an immune trigger induces persistent fatigue even when the initial immune trigger is no longer present.

Ocean explains more about IFH-alpha above in the thread, I will need to go back through it I think.

So again they are assuming that the initial infection - the trigger - in Hep C has been treated effectively by IFN-alpha and that this is comparable to whatever the initial trigger was in patients who went on to develop 'CFS'.

Are patients - who have been treated for Hep C with IFN-alpha - candidates then for 'CFS' if the above symptoms post-treatment are observed? I guess they are.

But, again, the reasoning is that they know who had Hep C specifically and they know (or think it's reasonable to assume) that IFN-alpha treatment is leaving patients with 'CFS'-like symptoms: so that's the justification for the simulation.

To do this, we will assess these patients throughout the many months of IFN-alpha treatment and at 6 months after cessation of treatment, in order to identify those with persistent "post-IFN-alpha-treatment" fatigue, and understand what biological and clinical changes lead to this outcome.

A specific and defined cohort. Gotcha. And one that's ready to hand I guess. I suppose any cohort of patients who present with a specific viral infection, are treated and go on to develop the symptoms of CFS would have done; but they can control and observe and have to hand this lot.

And these researchers applied for the funding of course.

Moreover, we will compare these patients with a group of patients with CFS and with a group of healthy individuals, conducting the same biological and clinical assessment.

We will measure changes occurring in blood hormones that are relevant to the immune function, such as "cytokines" and "cortisol".

In addition, we will asses changes in measures of well-being, including physical fitness, concentration, sleep and mood.

Gotcha. Would like some more detail about e.g. patient numbers, criteria and the tests that will be performed but I'm guessing none of them will come as a surprise and all will be consistent with other research enabling comparisons to be made.

We are confident that creating and validating this model of CFS will generate a host of future studies aimed at improving the health of people with CFS.

For example,

1. we will be able to build a check-list of blood measures that could predict who will, and who will not, develop CFS;

2. we will test novel treatments for "post-IFN-alpha-treatment" fatigue, facilitated by the fact that these patients are homogeneous in their clinical background, and then extend these treatments to patients with CFS;

3. and, finally, we will truly understand what happens in the body during the development of CFS, and thus identify novel therapeutic approaches to interrupt this development.

Imagine being able to predict the likelihood of developing 'CFS'. Wow. I mean yes you need to accept that this is based on the hope their model 'works' of course. But imagine.

Ok. 'novel treatments'. Hmm... could be anything I suppose but I am assuming here we are talking about possible drug therapies? Don't know.

And the same with 'novel therapeutic approaches'. I suspect that means non-drug. Any ideas? I guess even they won't know until this initial research is complete and they can get to work on that aspect of it.

Have left the 'techy' stuff to Ocean

 

[oceanblue]

Thanks Ocean

Ok. I think I understand. They have a clearly-defined patient cohort and trigger. They are going to simulate an immune response with a drug used in this case to treat Hep C...

So again they are assuming that the initial infection - the trigger - in Hep C has been treated effectively by IFN-alpha and that this is comparable to whatever the initial trigger was in patients who went on to develop 'CFS'.

Are patients - who have been treated for Hep C with IFN-alpha - candidates then for 'CFS' if the above symptoms post-treatment are observed? I guess they are.

But, again, the reasoning is that they know who had Hep C specifically and they know (or think it's reasonable to assume) that IFN-alpha treatment is leaving patients with 'CFS'-like symptoms: so that's the justification for the simulation.

cheers, Firestormm

You probably realise this already, but just to clarify: the Hep C in this case isn't the trigger, the trigger is the IFN-alpha that creates an immune response comparable (in theory) to that seen in an infection. (See Dubbo studies on this.)

Why use Hepatitis C (HCV) patients?
HCV patients are a conveniently available, usually non-fatigued cohort receiving IFN-alpha. HCV is often unsymptomatic at first, it just quietly destroys your liver - IFN-a is there to boost the hosts immune reaction. It would be more interesting to treat healthy volunteers with IFN-a for 6 months, but this would be unethical due to the nasty side effects such as fatigue and depression.

As for tests for CFS and 'novel therapeutic approaches', I think that's just pie-in-the-sky that researchers seem to throw in to persuade funders to award grants. Don't hold your breath. But if they gain an insight into how immune activation can trigger long-term fatigue, that would be quite something.

 

[oceanblue]

Thanks oceanblue. This is interesting to me because my husband is starting a treatment trial at Kings with pegalated interferon and telaprovir for his Hep C in 2 days time. He had interferon (not pegalated) treatment 20 years ago but it failed to deal with the virus. Four years ago his liver failed and he was lucky enough to have a successful transplant, but of course the virus is now attacking his new liver.

The trial he is on is for patients who've had transplants. Treatment for them is more complicated as they are on an immune suppressant drug and the telaprovir will interact with that.

He had mild fatigue and flu-like symptoms for the 9 months he was on the interferon 20 years ago, but could still work full-time. He had no problems once the treatment ended. Hope it's the same this time round as I doubt we could cope with both of us ill with these symptoms!

I'm wondering if he'll be part of the MRC funded study.

I am amazed at the resources they have for dealing with Hep C patients at Kings - he has had tremendous care all along. The contrast with how they treat ME patients is huge.

hi Jenny, hope the treatment goes well. It seems cruel that your husband should be lucky enough to get a transplant only for it to be attacked by HCV again.

Normally studies like these like 'standard' patients with standard treatment so maybe your husband won't be in the Pariente trial - though it would be amazing if his treatment helped lead to a breakthrough in CFS. It is interesting how if you have the 'right' illness resources are more readily available.

 

[Ember]

Again it's more likely to result in a success (as well as being more efficient and cheaper) I would imagine than having to screen patients with 'CFS'.

The mechanism they've chosen to study in a considerable proportion of these patients seems to resolve itself within six months to a year:

Of particular relevance for this study, a considerable proportion of patients continue to experience debilitating persistent fatigue, and other symptoms that are similar to CFS, for 6 months or even one year after the cessation of IFN-alpha.

What success will they have in finding here the keys to our house?

 

[Wildcat]

.
"Of particular relevance for this study, a considerable proportion of patients continue to experience debilitating persistent fatigue, and other symptoms that are similar to CFS"
.
Oh Really?? 'Persistent fatigue'. Back to 'Fatigue' again.

No progress for Myalgic Encephalomeyelitis (WHO ICD ME) research, then.

 

[Snow Leopard]

Given the background of Carmine Pariante/King's College what's a fair bet that this study won't find anything useful for Hep C patients, but try to blame it on psychological factors?

Another psychiatrist claiming to study immunity...

 

[Firestormm]

The mechanism they've chosen to study in a considerable proportion of these patients seems to resolve itself within six months to a year:

What success will they have in finding here the keys to our house?

I know what you are saying Ember (I think), but the point is that in this model, treatment of the acute viral infection HPV with IFN-aplha stimulates an immune response that is believed to be comparable with 'CFS' - in so far as the immune system activation and the chronic symptomology.

'CFS' is diagnosed at the six-month stage and those who go on to develop 'CFS-like' symptoms following IFN-alpha do so at this point too - at least.

So the model is that 'Hey we can observe more readily what is happening in our patients post-IFN-alpha' and see if the immune stimulation is not only resulting, causing, the 'CFS-like' symptoms (which they believe it is) but biologically try and prove it as well as actually observing it.

And not only that, but biologically compare this profile with those patients otherwise diagnosed with 'CFS' and see if the two resemble one another.

One of the results of 'stimulation' of the immune system (whether by a virus or - in this case - IFN-alpha) is more generally known as 'inflammation' (hence the cytokine involvement).

And as you know it has long-been suggested that 'inflammation' plays another key role in 'CFS' (however you like to define it).

If they do - even in a small sub-set of patients* - then treatments post-treatment for IFN-alpha-induced 'CFS-like' symptoms could be applied similarly.

And a biomarker could be established. An immune biomarker. One that could also help predict patients who are in some way susceptible to post-viral infection 'CFS'.

The length of time a person who has been treated with IFN-alpha has the chronic effects is not really relevant. At least not to this model. And that's all it is - a model.

(*I actually think they will employ Fukuda and CCC as well as screening pre-study for immune-system abnormalities or at least to establish a base-line (cytokines and cortisol). Only a hunch mind but as well as applying and monitoring (and employing the other checks and balances mentioned in the Technical notes from Ocean), they will want to ensure that the 'CFS' cohort is as relevant as it can possibly be to the Hep C-treated cohorts.)

 

[oceanblue]

Given the background of Carmine Pariante/King's College what's a fair bet that this study won't find anything useful for Hep C patients, but try to blame it on psychological factors?

Another psychiatrist claiming to study immunity...

Note that the study isn't intended to help Hep C patients, beyond the IFN-alpha treatment itself. The aim is to use it as a model of CFS to gain insights, then try to see if that model really does apply to CFS patients (though they won't be able to do that fully in this study).

Psychologists e.g. Ute Vollmer-Conna have done very interesting work on the role of immunity in CFS as part of the Dubbo studies.

However, this study is clearly looking at psychological factors, including: "psychiatric history; childhood and recent stressors; social support; illness and treatment perceptions", as well as immune markers such as cytokines.

This would tie in with the view of Wessely & Harvey (of King's), expressed in their paper Chronic fatigue syndrome: identifying zebras amongst the horses, that fatigue across a range of illnesses including MS, cancer and HIV/AIDS has a strong psychological basis and behavioural treatment is the answer. (Needless, to say, the references they quote to make this case don't really back up their argument.) Rona Moss Morris, now also at King's/Institute of Psychiatry, published a study claiming that developing CFS post glandular fever is down to psychological factors. It's a deeply flawed study.

So, cause for concern, but the study might also find that it's the severity of the symptoms (in response to IFN-alpha therapy) that determines the likelihood of post IFN-a fatigue, rather than psychological factors (Dubbo found acute illness severity, not psychological factors predicted CFS post EBV and other infections). Also, whatever he findings are, they will apply to IFN-a treatment and will then need confirming in CFS.

I am concerned at where this study is stabled, given King's/IoP's track record in this area, but I also think it's a very interesting model and well worth pursuing.

 

[Ember]

I know what you are saying Ember (I think), but the point is that in this model, treatment of the acute viral infection HPV with IFN-aplha stimulates an immune response that is believed to be comparable with 'CFS' - in so far as the immune system activation and the chronic symptomology.

'CFS' is diagnosed at the six-month stage and those who go on to develop 'CFS-like' symptoms following IFN-alpha do so at this point too - at least.

ME (ICC) neither requires six months to diagnose nor is it likely to resolve in six months to a year:

Myalgic encephalomyelitis (ME), also referred to in the literature as chronic fatigue syndrome (CFS), is a complex disease involving profound dysregulation of the central nervous system (CNS) [13] and immune system [48], dysfunction of cellular energy metabolism and ion transport [911] and cardiovascular abnormalities [1214] (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full).

 

[Firestormm]

I know Ember and it is but one of the concerns I personally have with the ICCME. If CFS and ME are triggered by some insult to the immune system - or maybe even if some of the predominate symptoms are the results of an immune-system insult - how can they diagnose 'ME' at ground zero?

I get a viral infection. I get treated. My symptoms don't clear up in the expected time-frame. Indeed they become chronic. I am diagnosed with PVFS.

Or in the above example. I have Hep C. I am treated. That treatment stimulates my immune-system (in the way that a virus might only it exaggerates the reaction) and instead of recovering, I develop chronic symptoms comparable to those primarily seen in CFS or ME.

Indeed, as I speculated above, someone who has been treated for Hep C with IFN-alpha could then be diagnosed with CFS or ME or PVFS. It's just that in this model they believe they know the cause can be seen and as a result can observe the immune system interactions and effects.

You need a demarcation line. A point in the sand. If only to rule out anything else. And how do you determine exactly WHEN the specific (?) symptoms for 'ME' or 'CFS' actually occurred?

One of the things that might be possible following the above study perhaps because - if things pan-out as they hope - then they could be able to predict those patients whose immune systems are more likely to go on to develop CFS or ME.

If they are able to predict onset THEN you might be able to have a criteria with an immediate ability to diagnose. I just can't see it myself but there we go.

Whether or not CFS/ME clears-up after six months is debatable isn't it? And this study isn't looking at that.

If it does work though it might throw some light on the reasons why some people are debilitated far longer than others.

It might also serve to explain (I'm stretching) why relapses and remittances are occurring. Are we in some way more susceptible to viral insults once our immune systems have been knocked off-kilter in some way?

Do our immune systems react perhaps more slowly in coming down off the ceiling but are more twitchy and determined to get back up there again at the first sign of 'danger'?

I think it's all about being able to apply a model and once (and if) that model can be applied to people diagnosed with CFS/ME then we might have a biomarker that can be used to help explain more in terms of duration. Hell they might one day be able to predict how long we are likely to remain in such a state!

Wouldn't that be something.

 

[Marco]

Sorry to come in so late in this discussion but I've been a little tied up lately.

Plus points (point).

Less likely to be a heterogenous population with at least the presence of objective biomarkers.

Negative points.

The emphasis on fatigue.

Fatigue is a common symptom associated with a wide range of illnesses or resulting from treatments that modulate the immune system (interferon alpha or some chemotherapy regimes). There is no mystery here. Fatigue is one element of 'sickness behaviour' resulting from inflammation :

In the clinic, symptoms of sickness (for example, fatigue, reduced appetite, sleep disorders, altered mood and cognition) are well known to have a negative impact on the quality of life of patients with chronic inflammatory disorders

and Danzer and colleagues have proposed a standard list of inflammatory markers to improve consistency in identifying inflammatory disorders that lead to such 'sickness behaviour' :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/

What does appear to distinguish ME/CFS from other fatigue states is PEM although similar adverse responses to exercise (or other stressors) also occur in mitochondrial diseases and mastocytosis (resulting from mitochondrial disorder and mast cell proliferation respectively).

Even with a relatively unique symptom such as PEM, the underlying mechanisms may be very different.

Perhaps all these states lead to oxidative stress/cytokine induced 'fatigue' but I don't see how this advances our knowledge any?

More generally as regards this MRC funded tranche of projects, I really don't see anything particularly new there.

Perhaps the best I can say for them is that the MRC may have been suffering from 'not invented here' syndrome and they may look more favourably on any positive results that they funded. At least they can't write them off due to poor methodology.

 

[Firestormm]

Marco I think you are missing the point (or I am).

The difference here is that there are no biological markers that can be applied to a patient cohort with 'fatigue' and other predominant 'CFS-like' symptoms within a CFS/ME cohort of patients that are clearly defined and readily available.

If they can identify such markers in the Hep C contingent and apply the same model to patients with 'CFS' then we have a comparable marker or set of markers but something tangible.

Nobody is doubting that 'fatigue' all on it's own isn't a common symptom across the board. But in this Hep C (or rather IFN-alpha-treated cohort) they specifically go on to develop 'CFS-like' debilitation including severe fatigue as a result (or the majority appear to).

And 'fatigue' IF it is the result of immune system dysfunction; IF this study is able to apply the model to 'CFS' - it may also apply to other conditions too e.g. Multiple Sclerosis.

CFS is an amalgam of many different 'triggers' and some folk in the 'pot' may not even have anything like an immune profile developed by this model. Some may well do - and that's the hypothesis being worked on here:

That primarily any Viral Trigger leads in some cases post-resolution to CFS and that in HPV following treatment by a naturally occurring Immune Trigger (same as is triggered by a viral infection but to a more significant effect i.e. a stimulant) i.e. IFN-aplha leads to CFS-like symptoms INCLUDING fatigue.

If specifically it is shown that IFN-alpha is causing those symptoms or the interaction of this stimulant with other parts of the immune system this model should be able to demonstrate that. But they felt unable to use 'CFS' patients specifically - for the reasons you mention.

If they can model the Hep C-lot and match it to the CFS-lot then they might be able to see what is leading to the symptoms (at least in so far as immune-system contribution) and that includes inflammation i.e. cell inflammation including neurological inflammation.

Of course both studies are equated ME with CFS synonymously because in so far as the MRC/NICE and for that matter the NIH are concerned they are the same condition.

These studies COULD help us to quantify significant differences in the general population currently and in the future diagnosed with 'CFS'. Isn't that something we would all welcome? Might it not lead to more targeted and effective treatments?

When the MRC announced it was setting aside 'ring-fenced'/'specific' funding for research into CFS/ME it asked for research applications. Of the applications it received the interest was such and the quality judged to be such that they increased the allocation of funds.

Not one of the grants was for e.g. 'Quantification of the differences between ME and CFS' and I don't recall the MRC requesting applications for such. And yet some people seem to think these studies are crap because they are not focusing on their own preferred 'ME' as being somehow different to CFS/ME.

If all this funding were spent in trying (again) to define a cohort of 'ME' and then to look at the cause of all those symptoms (presuming they are fundamentally different to 'CFS') - it would not be sufficient to get anywhere near the MRC's objectives.

I have yet to really look at the other studies Marco but there is one (?) looking into mitochodria. That might be the one that considers best the PEM and muscle weakness we all experience. I think though it is beyond the remit of these two studies (Hep C and Sjorgen's) that appear most controversial.

 

[Marco]

Hi Firestorm

I wouldn't rule out me missing the point.

I'm still a little tied up at the mo' so haven't looked at this in sufficient detail and can't respond as fully as I would like.

Having said that, I now conceded that the literature notes that 'exercise intolerance' is associated with IFN a treatment (which may equate to PEM) and some of the effects of IFN a treatment with HIV are also suggestive (endothelial dysfunction, cardiac arhythmias etc).

My concern is that immune markers in ME/CFS are inconsistent even using a cohort elected by 'tight' criteria such as the CCC. What does appear to be consistent is the finding of low grade inflammation/oxidative stress.

My intuition, for what its worth is that ME/CFS is a 'state' with many and various triggers which may include a viral etiology.

Lets suppose they identify an immune signature associated with IFN a treatment (like raised IFN a?) and search for this signature in a ME/CFS cohort.

They may find this signature in say 25% of the cohort.

How should this be interpreted?

That this immune pattern is not strongly associated with ME/CFS as its only detected in one quarter of the cohort (the usual argument against pathogens in ME/CFS)?

That 25% of the cohort only have ME/CFS and the remainder are ideopathic fatigue?

That the 25% are a subset associated with a viral onset (fair enough - I've no problem with splitting)? and the remainder do have ME/CFS but not of viral onset origin?

In which case, what value is the IFN a associated immune marker if other routes can lead to the same state of low grade inflammation/oxidative stress.

What additional diagnostic value or treatment options would this offer?


It would have been nice to have seen an expanded rationale for this and the other studies beyond even the additional information provided which might better answer questions such as these.

As it stands, you may be right about its potential but its hard to tell.

Cheers

Marco