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CFS with normal NK cell function

msf

Senior Member
Messages
3,650
what do you make of these EBV results? I'm not sure that I undestand the concept of ongoing infection.. The literal meaning is that the patient is out of the acute phase of the infection - that's clear.. However, my results are chronically high, and subjectively, I feel like I constantly have anywhere between 20 - 90% of the flu, so these results make sense to me (3 of 4 EBV tests consistently "High")
  1. EA-IgG = 2.98 High
    • < or = 0.9 is negative"
  2. EBNA-IgG = > 5.00 High
    • < or = 0.9 is negative
  3. VCA-IgG = > 5.00 High
    • < or = 0.9 is negative
  4. VCA-IgM = < or = 0.9
    • < or = 0.9 is negative

According to Lerner, high IgG to EA was a sign of reactivation.

This seems to be the case in some other diseases, such as SLE: http://www.ncbi.nlm.nih.gov/pubmed/25562120

´The amplified humoral responses to EBV EA/D and CMV pp52 in our SLE patient cohort probably reflect aberrant control of EBV and CMV reactivation.´
 

user9876

Senior Member
Messages
4,556
When I say the NK function deficit has not been replicable I amanita talking about cohorts that do not have ME/CFS. The researchers I know who have been unable to replicate the finding use as strict criteria as the original studies. The argument that studies are no good because they have the wrong patients I simply do not buy. And I see no reason to insult researchers with terms like piss poor cohorts when you have no knowledge of who the researchers are or what criteria they use. The study underway with NIH funding in London at present is as rigorous as any in terms of cohort selection. It will be interesting to see if they can replicate the NK function deficit.

Is there just something about all the cohorts being quite small. If there was a relatively small effect on NK function (i.e. with heavily overlapping distributions) then I would have thought that could explain quite variable results. Also there are potential subgroup problems? Don't we need some sort of larger scale trial (with a general cohort) to get a good understanding of the issue? Or maybe I'm misunderstanding the size of the trials done on NK cells.

I've also wondered whether there is something about stability and variability of NK populations could for example the depend on levels of exertion and PEM. I guess it depends on the typical lifetime and refresh rates for NK cells?
 

ebethc

Senior Member
Messages
1,901
Judging from the website Quest is a private commercial set up. I am not sure what mainstream means in that context - maybe successful at selling stuff? A lab that sells a 'Th1/Th2 balance' test is happy to sell meaningless nonsense so I would personally be sceptical about any of their results. Sadly I think there are huge businesses selling this sort of stuff to peopler easy to buy.

by mainstream, I mean that most doctors I've seen use Quest of Labcorp.. Combined, these 2 cos. own 21% of the american medical testing market *. The docs that I've seen are part of bigger health groups like Palo Alto Medical Foundation & California Pacific Medical Center, and also one independent doctor.. These labs are by no means a fringe or fly-by-night operation in the U.S.
* per forbes, 2011... Hospitals = 55%, and the remainder are small, independent labs ..

I know that the NK cell & HHV tests are in the "playbooks" used by OMI (Drs Kogelnik & Kaufman) and Montoya's Clinic @ Stanford.
 

ebethc

Senior Member
Messages
1,901
According to Lerner, high IgG to EA was a sign of reactivation.

This seems to be the case in some other diseases, such as SLE: http://www.ncbi.nlm.nih.gov/pubmed/25562120

´The amplified humoral responses to EBV EA/D and CMV pp52 in our SLE patient cohort probably reflect aberrant control of EBV and CMV reactivation.´


what do you mean by "high IgG to EA" .. is that a ratio? My results are not reported like that.. i.e., IgG & EA are in the same line item.. sorry, foggy today, so I'm probably missing something.

What do you mean by aberrant control of reactivation?
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Is there just something about all the cohorts being quite small. If there was a relatively small effect on NK function (i.e. with heavily overlapping distributions) then I would have thought that could explain quite variable results. Also there are potential subgroup problems? Don't we need some sort of larger scale trial (with a general cohort) to get a good understanding of the issue? Or maybe I'm misunderstanding the size of the trials done on NK cells.

I've also wondered whether there is something about stability and variability of NK populations could for example the depend on levels of exertion and PEM. I guess it depends on the typical lifetime and refresh rates for NK cells?

If small cohorts make a big difference to whether or not there is a statistically significant difference I think that just emphasises the fact that what is being looked at is merely a statistical difference between populations. In other words it cannot possibly be of any relevance to the management of individual cases. For test differences to be relevant to individual cases you would need to have a nearly black and white difference between disease and control populations, detectable in small cohorts - as for rheumatoid factor in RA or blood sugar in diabetes etc.

If sample size matters then the NK function issue can only be an indirect clue to some other physiological disturbance - not a necessary step in causation. Even if it were a necessary step in a subgroup one would expect there to be a bimodal distribution that is likely to show up even if the subpopulation size varies.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
what do you mean by "high IgG to EA" .. is that a ratio? My results are not reported like that.. i.e., IgG & EA are in the same line item.. sorry, foggy today, so I'm probably missing something.

What do you mean by aberrant control of reactivation?

High IgG to EA means specifically a high IgG antibody level to the 'early antigen'. At one time it was thought that high IgG antibodies to early antigen might be indicative of recent active infection but subsequently it turned out to be unreliable. Basically IgG antibodies show that there has been an encounter with the virus in the past. IgM antibodies suggest that infection was active recently or may still be active.

I don't think abnormal antibody levels in SLE reflect anything special about control of viral reactivation. The central feature of SLE is an inability of the immune system to distinguish auto antigens from foreign antigens so antibody levels to almost anything are all over the shop. SLE patients have antibodies to drugs like rituximab even before they are given them - their antibodies are just all over the shop.
 

duncan

Senior Member
Messages
2,240
If small cohorts make a big difference to whether or not there is a statistically significant difference I think that just emphasises the fact that what is being looked at is merely a statistical difference between populations. In other words it cannot possibly be of any relevance to the management of individual cases. For test differences to be relevant to individual cases you would need to have a nearly black and white difference between disease and control populations, detectable in small cohorts - as for rheumatoid factor in RA or blood sugar in diabetes etc.
If sample size matters then the NK function issue can only be an indirect clue to some other physiological disturbance - not a necessary step in causation. Even if it were a necessary step in a subgroup one would expect there to be a bimodal distribution that is likely to show up even if the subpopulation size varies.

I don't think the main idea behind low NK cell values is one of causation, anymore than the bulls-eye rash causes Lyme. I think most assume it is a downstream affect of a variable that plays some role in ME/CFS. Lower NK cell function values are symptomatic or indicative of something that is associated with ME/CFS. Maybe. But if research bears that premise out, we are one step closer to a biomarker for at least a subset.
 

msf

Senior Member
Messages
3,650
what do you make of these EBV results? I'm not sure that I undestand the concept of ongoing infection.. The literal meaning is that the patient is out of the acute phase of the infection - that's clear.. However, my results are chronically high, and subjectively, I feel like I constantly have anywhere between 20 - 90% of the flu, so these results make sense to me (3 of 4 EBV tests consistently "High")
  1. EA-IgG = 2.98 High
    • < or = 0.9 is negative"
  2. EBNA-IgG = > 5.00 High
    • < or = 0.9 is negative
  3. VCA-IgG = > 5.00 High
    • < or = 0.9 is negative
  4. VCA-IgM = < or = 0.9
    • < or = 0.9 is negative
what do you mean by "high IgG to EA" .. is that a ratio? My results are not reported like that.. i.e., IgG & EA are in the same line item.. sorry, foggy today, so I'm probably missing something.

What do you mean by aberrant control of reactivation?

EA is the name of the antibody, IgG is the kind of antibody.

The quote was from the paper I linked to. I guess they mean that, for some reason, the immune system does not suppress reactivation like it does in healthy people.
 

msf

Senior Member
Messages
3,650
High IgG to EA means specifically a high IgG antibody level to the 'early antigen'. At one time it was thought that high IgG antibodies to early antigen might be indicative of recent active infection but subsequently it turned out to be unreliable. Basically IgG antibodies show that there has been an encounter with the virus in the past. IgM antibodies suggest that infection was active recently or may still be active.

I don't think abnormal antibody levels in SLE reflect anything special about control of viral reactivation. The central feature of SLE is an inability of the immune system to distinguish auto antigens from foreign antigens so antibody levels to almost anything are all over the shop. SLE patients have antibodies to drugs like rituximab even before they are given them - their antibodies are just all over the shop.

There is a lot of research into EA in nasal pharygneal carcinoma. I thought the SLE example might be a troublesome one. I didn´t realise that people produce antibodies to Rituximab - I guess those are antibodies to an antibody?
 

msf

Senior Member
Messages
3,650
In this RA study, EA, EBNA-1, and viral load were higher in patients than in controls.
 

ebethc

Senior Member
Messages
1,901
High IgG to EA means specifically a high IgG antibody level to the 'early antigen'. At one time it was thought that high IgG antibodies to early antigen might be indicative of recent active infection but subsequently it turned out to be unreliable. Basically IgG antibodies show that there has been an encounter with the virus in the past. IgM antibodies suggest that infection was active recently or may still be active.

so, basically, my results are "normal" ..i.e., if ~90% of adults have EBV, then most adults would have results that look like mine.. (high IgG, and normal IgM)?
 

Kati

Patient in training
Messages
5,497
@Jonathan Edwards, the Australian group have done a lot of research on NK cell function. Here are a few:

Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/24343819

Killer Cell Immunoglobulin-like Receptor Genotype and Haplotype Investigation of Natural Killer Cells from an Australian Population of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients.
http://www.ncbi.nlm.nih.gov/pubmed/27346947

Natural killer cells in patients with severe chronic fatigue syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/26000145

Longitudinal investigation of natural killer cells and cytokines in chronic fatigue syndrome/myalgic encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/22571715

Immunological abnormalities as potential biomarkers in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/21619669
 

Jonathan Edwards

"Gibberish"
Messages
5,256
@Jonathan Edwards, the Australian group have done a lot of research on NK cell function. Here are a few:

Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/24343819

Killer Cell Immunoglobulin-like Receptor Genotype and Haplotype Investigation of Natural Killer Cells from an Australian Population of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients.
http://www.ncbi.nlm.nih.gov/pubmed/27346947

Natural killer cells in patients with severe chronic fatigue syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/26000145

Longitudinal investigation of natural killer cells and cytokines in chronic fatigue syndrome/myalgic encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/22571715

Immunological abnormalities as potential biomarkers in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
http://www.ncbi.nlm.nih.gov/pubmed/21619669

Yes,I am aware of those studies, @Kati. But it is not the number of studies that matters - there are always lots of studies if something gets fashionable. What matters is that the study results all fit together in a way that makes sense (as in the crossword analogy). So far I do not see these studies fitting into a clear story and other groups have failed to find functional defects.
 

duncan

Senior Member
Messages
2,240
Yes,I am aware of those studies, @Kati. But it is not the number of studies that matters - there are always lots of studies if something gets fashionable. What matters is that the study results all fit together in a way that makes sense (as in the crossword analogy). So far I do not see these studies fitting into a clear story and other groups have failed to find functional defects.

So far.

The idea, though, is low NK cell function values reflect an immune anomaly. Much in the same way, I suppose, erythema migrans represent immune anomalies. What is the functional defect of an EM besides its presence? Its presence is an immune response. Low NK cell function values could be an immune response. Neither has to be characterized by functional defects.

Again, this is an area that may be worthy of additional and larger research efforts.
 

Research 1st

Severe ME, POTS & MCAS.
Messages
768
NK cells are the most consistent test I've had over a long time period, so I like using these tests to 'prove' I am ill, when doctors remind me ''you don't have a temperature''. (One of the first signs of ME/Chronic Lyme in many, is the loss of normal fevers - that raise core temperature and kill pathogens). What do most PWME CFS have? Lower body core temperature....infections love that.

I also point out my Interferon Gamma (IFN-g) is many times elevated and the IFN-a is reduced (antiviral) Combined, this implies chronic infection especially if you go even more complicated (as I like to) and see I lack antibodies to common infections I should have, that I don't because my immune system 'forgot' - this phenomena is seen in some immunosupressive disorders.

This then makes some sense if we look at Science.........and then link to LPS and LPS to ME CFS/Lyme...

The generation of IFN-gamma by PBMC after treatment with LPS strongly suggests that the enhancement of NK cell activity may be indirectly due to IFN production.

Source:
Immunology. 1991 Aug;73(4):450-6.
Activation of human natural killer cells by lipopolysaccharide and generation of interleukin-1 alpha, beta, tumour necrosis factor and interleukin-6. Effect of IL-1 receptor antagonist.
Conti P1, Dempsey RA, Reale M, Barbacane RC, Panara MR, Bongrazio M, Mier JW.

11 years later...... they comment that Cytokines regulate LPS and IFN....

NK cells and NKT cells are the most abundant IFN-gamma-producing cells in the mouse spleen after LPS challenge and that IL-10 and IL-12 are key functional regulators of LPS-induced IFN-gamma production.

Source:
Clin Diagn Lab Immunol. 2002 May;9(3):530-43.
Endotoxin-induced gamma interferon production: contributing cell types and key regulatory factors.
Varma TK1, Lin CY, Toliver-Kinsky TE, Sherwood ER.

And my Cytokines are also very high....again, consistently and mine don't vanish after 3 years.

The reality is ME can lead to serious other secondary disorders like Cancer, life threatening allergic reactions and heart failure and isn't a syndrome of 'fatigue'. So we need to really ignore this issue and focus on actual patients with ME rather than patients who met criteria for 'fatigue' (as it won't get us anywhere and never has in 25 years).

This requires chronic immune activation, inflammation likely driven by autoimmunity (from infection) - never looked at, due to the CDC creating CFS and focusing on fatigue, never researching severe cohorts, sick for years and years with all this co-morbidity that leads to removal from from CFS research - that's how you hide ME.

So regarding ME and researching ME....there is some ideas
that via Lyme, some forms of Autism is linked to a chronic low grade sepsis (blood poisoning), naturally not acute or the patients would be dead within a day. Something, 'novel' then, but what? (NB: Inflammatory profiles in some cases of Autism appear to be identical to CFS).

From looking at Kenny De Meirleir's research (and others regarding LPS in CFS) it looks like we might be getting 'translocation' of bacteria from the stomach to other organs, maybe even our CNS and likely our lymphatic system. This would then make sense why you find in ME, not CDC Syndrome, such high Cytokines and it would make even more sense when you exercise, these Cytokines will go crazy (as shown by Dr Nancy Klimas) when patients are on exercise bikes who are moderately affected but biologically ill.

Ergo GET and CBT is not only fradulent (PACE trial) it's potentially DANGEROUS to exercise when infected, IF, the heart muscle is involved.

If research can demonstrate what is special about LPS in ME CFS (e.g. from Bartonella etc), which by the way infects endothelium (VEGF and TGF-B1 can be elevated in ME/Lyme patients). VEGF is a growth factor associated to this part of the body (blood vessels), then it may be a big breakthrough to then tie this to Dr Ron Davis's work (and his team) because we already know from Jonas Blomberg, that Mitochondria is affected by infection (antibodies to heat shock proteins) - mitochondrial by Chlamydia Pneumoniae (Lyme co infection) in almost 1 in 4 of the ME sufferers tested.

IgM to specific cross-reactive epitopes of human and microbial HSP60 occurs in a subset of ME, compatible with infection-induced autoimmunity.
Source:
PLoS One. 2013 Nov 28;8(11):e81155. doi: 10.1371/journal.pone.0081155. eCollection 2013.
Epitopes of microbial and human heat shock protein 60 and their recognition in myalgic encephalomyelitis.
Elfaitouri A1, Herrmann B, Bölin-Wiener A, Wang Y, Gottfries CG, Zachrisson O, Pipkorn R, Rönnblom L, Blomberg J.

And it would then make potential sense this all ties in with NK Cells 'phenomena' in ME CFS and would help create subsets of infected autoimmune patients who have 'it' and who don't, and if they don't, there is another reason and that can be researched or explained by another pathway. So everyone would benefit from subgrouping.
 

ebethc

Senior Member
Messages
1,901
NK cells are the most consistent test I've had over a long time period, so I like using these tests to 'prove' I am ill, when doctors remind me ''you don't have a temperature''. (One of the first signs of ME/Chronic Lyme in many, is the loss of normal fevers - that raise core temperature and kill pathogens). What do most PWME CFS have? Lower body core temperature....infections love that.

1. which nk cell tests (and related tests, if any) do you get?

...Re the fever.. makes sense... I never get fevers, even before I was hypothyroid

I also point out my Interferon Gamma (IFN-g) is many times elevated and the IFN-a is reduced (antiviral) Combined, this implies chronic infection especially if you go even more complicated (as I like to) and see I lack antibodies to common infections I should have, that I don't because my immune system 'forgot' - this phenomena is seen in some immunosupressive disorders.

2. does this mean that your body can't make antibodies properly?
I don't think that my body can make antibodies (or enough of them) and I would love to find a way to verify this:
  • I had severe mono in 2001, and my doctor said that I didn't have antibodies, but he had had seen enough cases of mono to diagnose me w mono...
  • I have hypothyroidism, and I think it's hashimoto's, but I never get results w the antibodies showing up
  • allergy tests come up negative, even though I'm miserable in allergy season...I have a mast cell problem, so this is a grey area.
  • etc, etc... There's more, but I"m too tired to think of more examples.

3. What is IFN, and how does it influence NK activity/production?
4. How does LPS influence NK activity/production?

5. What are GET and CBT?

6. How are you measuring cytokines? crp & sed rate?

And it would then make potential sense this all ties in with NK Cells 'phenomena' in ME CFS and would help create subsets of infected autoimmune patients who have 'it' and who don't, and if they don't, there is another reason and that can be researched or explained by another pathway. So everyone would benefit from subgrouping.

I think you're on to something here.. I believe that CFS will eventually be broken out into multiple, disparate or overlapping illnesses.... The HHV/NK Cell path (combined w gut health) seem like the right focus for me now... High dose Olive Leaf Extract has been a game changer for me

=

thanks for taking the time to write all this out! I think it's very pertinent for me personally, and I appreciate all the info... I'm saving the whole thing into evernote ..
 
Last edited:
Messages
6
@ebethc wrote Quest, along with Labcorp have 21% or the lab testing market. Yup, couldn't agree more. They expanded beyond clinical chemistry when they bought Nichols Institute a long time ago. They were well positioned to expand esoteric testing when molecular testing came along. That's not just mainstream, that's cutting edge.

I looked for a "TH1/TH2 Balance test one their web sight and did not find one, so that part of @Edward jones comment leaves me confused.

Of course like all companies, they try to grow. Perhaps it was a misstep to enter the direct to consumer testing market, but there was demand for those services. That may be a thing of the past though, in that I don't see anything like that on their website.
 

Daffodil

Senior Member
Messages
5,875
Hello,
This is my first post here. I'm suffering from symptoms that resemble cfs for almost 3 years. I've done a ton of tests and everything is fine. One doctor eventually diagnosed me with cfs, but he didn't do anything about it.

I read that low nk cell function may be used as a biomarker, so I found a lab that do this test.

The results are following:
NK function: 33.9%(Ref. range 20-40)
NK lymphocyte number: 0.32(Ref. range 0.29-0.60)

I also did Th1/Th2 profile, and the results are:
INFγ: 26950 pg/ml(Ref. range 3160-22534)
Interleukin-4: 130 pg/mL(Ref. range 27-123)
Th1/Th2: 226.9(Ref. range 80.9-226.4)

I also did antibody tests for EBV and CMV:
CMV IgG: 280.2 U/mL(Ref. range 0-1)
CMV IgM: 0.336 COI(Ref. range 0-1)
EBV VCA IgG: 11.6(Ref. range 0-1.1)
EBV VCA IgM: 0.145(Ref. range 0-1.1)

Can I have CFS with this results? Has anyone with CFS have similar results?

Here is one study that connects CFS with low NK cell function:
http://www.ncbi.nlm.nih.gov/pubmed/8148445

The problem is that in that study the unit of measure are LU and not percentage, so I cannot compare those results with mine. However, the ref. range is 20-250 LU and nobody with CFS had >100. However, results in healthy controls are not evenly distributed. So, I don't know what to make of my results...


yea I think you have to get the other test :

http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=34184X&labCode=QDV

normal people typically have 60 - 80 but if yours is normal, it could just mean you are early on in the disease.

xo
 

Research 1st

Severe ME, POTS & MCAS.
Messages
768
This was out yesterday regarding NK Function in severe CFS ME and Protein Kinase genes:

Gene Regul Syst Bio. 2016 Aug 28;10:85-93. doi: 10.4137/GRSB.S40036. eCollection 2016.
Dysregulation of Protein Kinase Gene Expression in NK Cells from Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients.
Chacko A1, Staines DR2, Johnston SC1, Marshall-Gradisnik SM1.


Author information
Abstract

BACKGROUND:
The etiology and pathomechanism of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) are unknown. However, natural killer (NK) cell dysfunction, in particular reduced NK cytotoxic activity, is a consistent finding in CFS/ME patients. Previous research has reported significant changes in intracellular mitogen-activated protein kinase pathways from isolated NK cells. The purpose of this present investigation was to examine whether protein kinase genes have a role in abnormal NK cell intracellular signaling in CFS/ME.

METHOD:
Messenger RNA (mRNA) expression of 528 protein kinase genes in isolated NK cells was analyzed (nCounter GX Human Kinase Kit v2 (XT); NanoString Technologies) from moderate (n = 11; age, 54.9 ± 10.3 years) and severe (n = 12; age, 47.5 ± 8.0 years) CFS/ME patients (classified by the 2011 International Consensus Criteria) and nonfatigued controls (n = 11; age, 50.0 ± 12.3 years).

RESULTS:
The expression of 92 protein kinase genes was significantly different in the severe CFS/ME group compared with nonfatigued controls. Among these, 37 genes were significantly upregulated and 55 genes were significantly downregulated in severe CFS/ME patients compared with nonfatigued controls.

CONCLUSIONS:
In severe CFS/ME patients, dysfunction in protein kinase genes may contribute to impairments in NK cell intracellular signaling and effector function. Similar changes in protein kinase genes may be present in other cells, potentially contributing to the pathomechanism of this illness.

source: http://www.ncbi.nlm.nih.gov/pubmed/27594784