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Naviaux et. al.: Metabolic features of chronic fatigue syndrome

Gingergrrl

Senior Member
Messages
16,171
We are still very early in the game, if this is a game. Personal results will vary. There needs to be more and more patients tested. There needs to be further understanding.

Agreed that it is very early and nothing I am saying is meant as a critique versus my brain trying to understand the info and how is applies to us as patients. I naturally compare it to my own situation (each time something new comes out) to see how it fits or doesn't fit.

I also suspect that I was one of the patients in the Metabolomics study based on the time period that I donated blood at OMI for the Metabolon Test but I am trying to get confirmation of that for my own knowledge. If I was not in the study (which is certainly possible) then I am trying to figure out how (or if) I can I can get the results. I support OMF a million percent and if I cannot ever get the results, it is okay. I am just so curious what the results might show since I did the test.

ETA: I wanted to go back to this post and have learned that I was NOT a part of this study b/c the subjects were all from Gordon Medical Group and not from OMI.
 
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Wolfiness

Activity Level 0
Messages
482
Location
UK
So the 'matched controls' - does this effectively distinguish us vs. healthy people, or us vs. other types of ill people? Do other diseases have this characteristic of hypometabolism - is that what they mean by "related medical disorders like depression and posttraumatic stress disorder" ?

I'm very pleased because it sounds right to me. I've always thought the chronic infection thing was a blind alley and what we really have going on is a smoke-and-mirrors internal dysregulation of some sort.
 
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BruceInOz

Senior Member
Messages
172
Location
Tasmania
There has been much discussion here about cholesterol and the claim is being made that Naviaux found low cholesterol. However, the paper says (page 4)
Total plasma cholesterol, desmosterol, cortisol, and aldosterone were normal in both males and females with CFS.
On the other hand we have (on page 6)
For example, cholesterol, phospholipid, sphingolipid, and
purine metabolism are all decreased in CFS and dauer but are
increased in metabolic syndrome and the stereotyped CDR
For example, cholesterol, phospholipids, and uric acid
are often elevated in the acute CDR and metabolic syndrome, but
these metabolites were decreased in CFS patients.
and there is a section in the supplemental materials titled:
Cholesterol Synthesis through the Lathosterol Pathway was Decreased

Does all this mean that although one metabolic pathway for cholesterol synthesis seems to be reduced, other pathways are picking up the slack and resulting in normal total cholesterol levels? Therefore we cannot read anything into individuals with ME having low or high cholesterol?
 

Gingergrrl

Senior Member
Messages
16,171
The article will be out at 10am this morning, ET -- in an hour, in other words.

@JaimeS, I just read your article and am amazed at the level that you were able to understand and interpret the information! It is very impressive.

I still don't understand the cholesterol part and I think your article supports the idea that PWC's have low cholesterol (but I have very high cholesterol and have all my life even as a child) so would this imply I do not have ME/CFS? I am still not sure myself so am curious.

Also, you explained a possible link between ME/CFS and cancer and I was wondering how the paraneoplastic syndromes (PNS) fit in? For the group or subset (or whatever we are called) with autoantibodies that are linked to specific cancers via a PNS, does this fit with Dr. Naviaux's theory or are the paraneoplastic syndromes/autoantibodies more likely to be part of a different, but yet similar, illness?

I was also curious which factors determine patient severity? Some patients are severely impacted by GI issues and are tube fed, but others can eat literally any food but are bedbound due to fatigue/lack of energy, vs. others have severe POTS/autonomic issues with syncope every time they stand, vs. me who has severe muscle and breathing weakness preventing me from walking, etc? Is there a symptom that all of the severe patients shared or was it based on bloodwork (Ex: someone with 10+ IgM viruses vs. someone with three). I didn't get this part either!
 

Strawberry

Senior Member
Messages
2,109
Location
Seattle, WA USA
I also suspect that I was one of the patients in the Metabolomics study based on the time period that I donated blood at OMI for the Metabolon Test but I am trying to get confirmation of that for my own knowledge. If I was not in the study (which is certainly possible) then I am trying to figure out how (or if) I can I can get the results. I support OMF a million percent and if I cannot ever get the results, it is okay. I am just so curious what the results might show since I did the test.

Please let me know. I also have thought about this, but I haven't contacted Dr K because I assume our information is "randomized" and they might not know. I'd love to know if my blood was in that test also! I never asked what it would be used for.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
I just read your article and am amazed at the level that you were able to understand and interpret the information! It is very impressive.

Thank you very much! I'd actually read up quite a bit on lipid rafts and their relationship to immunity with an eye for ME, or I never would have been able to pull all of that together!

Personal experience helps, too. I was on an azole for a bit and felt like I was on cloud 9: totally recovered. For about a month before my microbiome got too dysregulated to keep on. Looked up mechanism of azoles and found they affect lipid rafts on a hunch. Couldn't have done w/o prior research and personal experience w/the illness. I've got the sick-but-never-sick symptom picture as well. :)

I still don't understand the cholesterol part and I think your article supports the idea that PWC's have low cholesterol (but I have very high cholesterol and have all my life even as a child) so would this imply I do not have ME/CFS? I am still not sure myself so am curious.

[Edit!]

Yes, the article and Naviaux's findings appear to support that a specific pathway of cholesterol generation is impaired, but not necessarily the whole shebang!

Total plasma cholesterol,
desmosterol, cortisol, and aldosterone were normal in both
males and females with CFS. Two pathways are used in mammalian
cells to synthesize cholesterol.
These are the Kandutsch–
Russell (K–R) pathway through lathosterol
[me: the one that's impaired] and the Bloch
pathway through desmosterol (23) [me: which may NOT be impaired, and may even rev up to compensate]. The K–R pathway is preferred
for cholesterol synthesis in the brain, heart, skeletal
muscle, and skin, making up as much as 80% of cholesterol
synthesis in these tissues under baseline conditions (23).

I found it interesting that men seemed far more affected the impairment of this cholesterol synthesis pathway than women. I wonder if one of the compensatory mechanisms is bouncing estrogen back to cholesterol in women. But at this point we're playing 'wild guess'.

Also, you explained a possible link between ME/CFS and cancer and I was wondering how the paraneoplastic syndromes (PNS) fit in? For the group or subset (or whatever we are called) with autoantibodies that are linked to specific cancers via a PNS, does this fit with Dr. Naviaux's theory or are the paraneoplastic syndromes/autoantibodies more likely to be part of a different, but yet similar, illness?

Honestly I can't speak to this bit. I don't know much about PNS, and what I've read quickly doesn't allow me enough understanding to grasp the scope of the question. I'm sorry about that!

Is there a symptom that all of the severe patients shared or was it based on bloodwork

I had trouble getting that information, too, in a specific way. Generally, Naviaux is saying that severity correlates to metabolomic results (which could be obtained through bloodwork), and I presume he means some kind of aggregate score for overall severity of symptoms, but I did not see how severity was measured. As I said in another response, this wasn't what I was looking for, though, so others may be able to answer that better.

-J
 
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JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
There has been much discussion here about cholesterol and the claim is being made that Naviaux found low cholesterol. However, the paper says (page 4)

On the other hand we have (on page 6)


and there is a section in the supplemental materials titled:


Does all this mean that although one metabolic pathway for cholesterol synthesis seems to be reduced, other pathways are picking up the slack and resulting in normal total cholesterol levels? Therefore we cannot read anything into individuals with ME having low or high cholesterol?

I wondered about this as well, BruceInOz.

Before I posted the thing about cholesterol, I read this describing the Figure S4 -- the figure I copied and pasted into one of my previous comments -- the one with the metabolites in green and red, where green shows deficiency and red shows excess:

Figure S4. Cytoscape visualization of metabolite and pathway disturbances in
chronic fatigue syndrome. A. Males, B. Females. The fractional contribution of each
pathway is indicated as a percentage of the total variable importance in projection (VIP)
score in black circles. The smaller circles indicate the measured metabolites in each
pathway, quantified by z-score. Metabolites in red were increased and those in green were
decreased in chronic fatigue syndrome compared to controls
.

I took this to mean that the metabolites were, overall increased or decreased, but perhaps despite the wording it still means that they're increased or decreased only in that particular metabolic position -- at that step. Otherwise, the other statement doesn't make sense. Let me see if cholesterol is listed anyplace else on the chart...

....no, it's not. But perhaps that was the only chart they chose to depict, or the only chart they studied, while knowing that other cholesterol synthesis pathways exist?

...and they chose not to depict them? Ugh. Bothering me now.

Yes, other pathways exist but they aren't depicted! I'll shift that in the article, too.
 

Gingergrrl

Senior Member
Messages
16,171
Please let me know. I also have thought about this, but I haven't contacted Dr K because I assume our information is "randomized" and they might not know. I'd love to know if my blood was in that test also! I never asked what it would be used for.

@Strawberry I am trying to get this info (only pertaining to myself of course!) and it is true that the Metabolon tests may have been randomized and no one knows the answer. In another thread, it was mentioned that there were subjects from Gordon Medical Group (and I have never been a patient there) so if that is the case, then I am definitely not a part of the study as my Metabolon test was done at OMI. If I can confirm that I was not in the study, then I am hoping that I can obtain my results (and of course pay whatever they cost) and that these might be useful in my treatment-- even if not now, but as the science advances, they might be useful to have in the future. I will let you know via PM what I find out.

Thank you very much! I'd actually read up quite a bit on lipid rafts and their relationship to immunity with an eye for ME, or I never would have been able to pull all of that together!

Yes, your article was phenomenal and am glad you had been reading up on those topics, it was meant to be! For someone like me with no background, how would you explain "lipid rafts"? Last night you guys explained "Dauer" to me and I totally get it now so hoping you or someone can explain lipid rafts.

Yes, the article and Naviaux's findings appear to support that, overall, PWME have lower cholesterol production. I would think that, if you've had high cholesterol all your life, it might have lowered when you contracted ME but still technically be high. I'm throwing this out there, but if everyone is sequestering cholesterol for lipid rafts or limiting cholesterol production (or both) as part of a defense mechanism, all this would mean is that you would have lower cholesterol than before, not that your cholesterol levels would dip below normal.

That makes sense and as a child my cholesterol was off the charts high and now it is still high but not at the same level as it was back then. So maybe it is a fraction lower b/c of this mechanism (or maybe it is random and not connected, I have no idea)!

Also are SED rates and cholesterol connected? My SED rate is six and was never as low as many PWC's report.

Honestly I can't speak to this bit. I don't know much about PNS, and what I've read quickly doesn't allow me enough understanding to grasp the scope of the question. I'm sorry about that!

No worries and I know this research study and article were not about autoantibodies or paraneoplastic syndromes. I am just so curious how (or if) they relate to each other. We know that PWC's get certain cancers at a high rate but no one has linked them to autoantibodies or PNS yet. I feel there is a connection but I lack the skills to explain how.

I had trouble getting that information, too, in a specific way. Generally, Naviaux is saying that severity correlates to bloodwork, and I presume he means overall severity of symptoms, but I did not see how severity was measured. As I said in another response, this wasn't what I was looking for, though, so others may be able to answer that better.

Thanks and I was not sure if he was saying the level of severity correlated with blood work or symptoms? My initial blood work was very high for IgM of EBV (for 2-3 years) but my current IgM for EBV is negative. I have always been negative for CMV, HHV-6, Lyme/TBD and some of the other high risk culprits. But my symptoms are severe in the sense that I have pretty profound breathing and muscle weakness and now some weird autoantibodies. My MCAS was also very severe (near death last summer) but now virtually gone after two IVIG infusions. So I don't know where I would fit in on the severity scale?

I cannot walk or drive and require caregiver assistance but yet I am never "sick" and never feel fatigued or match with the descriptions of PEM. Every day is the same for me and if I am careful, I am okay and can go out in wheelchair and do activities all week back to back. But if I cross the line (standing/walking more than a few minutes), I can have hours of dyspnea and chest pain but it is immediate and never delayed. So was curious how Dr. Naviaux labeled his subjects as "Severely ill" or if they all shared a certain commonality?
 
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M Paine

Senior Member
Messages
341
Location
Auckland, New Zealand
I never thought I would live to see all this good research come together!

Yes, I hope that this trend continues. We still have CD20+ B-Cell depletion, Lowered NK Cytotoxicity/detectable kinase activity, and probably many other noteworthy leads which hopefully can be brought into context with hypometabolism. B-cells seem like they must be directly involved in the epigenetic signalling which must occur as part of the regulation of human hypometabolism.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
lipid rafts.

Alrighty. I tried in the article; I hope you won't consider me lazy if I cut and paste a little. :)

At one time, it was believed that membrane proteins and fats were always scattered haphazardly throughout the lipid bilayer that makes up the cell membrane. The cell membrane surrounds all animal cells, and is generally made up of phospholipids (phosphates, PO4^3-, and lipids -- tiny fatty bits). These float around like little beachballs in a vast and sedate ocean:

lipid-bilayer.jpg

What you’ve seen in every Biology textbook ever

The phospholipids are the brown bouncy bits.

Now, throughout the cell membrane are also proteins. Those are the blue guys. They let bigger molecules in and out of the cell. The carbohydrates that stick up (see the glycoprotein and glycolipid) help with cell recognition, which keeps you from attacking yourself. These are all in all your cells all the time: a vast sea of floaty things with cell bits -- mitochondria, nucleus, Golgi -- at the creamy center.

However, now there is a theory that there are fatty areas of the membrane, full of glycosphingolipids (sugar-amino alcohol-fatty bits), cholesterol, gangliosides, and proteins. These exist as little ‘pockets’ that go through the cell membrane, but they may be linear as well; and they tend to cluster together when the cell is stressed. Stress here signifies anything that has the potential to cause cell damage, rather than to intimate that these cells are frightened or upset. (Last we checked, cells didn’t get very emotional.)

It's actually really fascinating the way it goes down. Actin -- which you may remember from studying muscle fibers -- actually yanks and drags proteins and fatty bits into place until there's like this little fatty warrior ready to do battle with any pathogen that tries to get past. There's a certain simple chemical barrier: it's hard to get past an oil slick. At the same time, lipid rafts are essential to signalling the cell to alert other cells to danger:

An interesting manner that allows pathogens to
evade the immune system is through membrane
microdomains. As signalling for the innate and
adaptative immune responses is initiated in rafts,
some pathogens have evolved mechanisms to subvert
this signalling by co-opting raft-associated pathways
(Ma˜ nes et al., 2003). Different pathogens, such as
viruses, bacteria and protozoa, can use the host-cell
lipid rafts to secure their entrance and maintenance
inside target cells.

From the excellent review article Host-cell lipid rafts: a safe door for micro-organisms? Did not find this one while writing the article but apparently prions do this too guys.

So in order to defend the cell, lipid rafts aggregate, making it more challenging for a pathogen to enter both by simple polar (watery) vs nonpolar (fatty) inhibition at its most basic, as well as via some more complex immune mechanisms.

However, some bacterial and viral pathogens have evolved to not only get around this defense technique, but exploit it. By ‘sneaking in’ the cellular back-door, these pathogens also escape being sent to the lysosome for disposal, and may therefore survive longer than their traditionally-infectious counterparts.

When you look at a list of which pathogens use the lipid raft more like the secret entrance to the hidden underground lair of your cell... whaddaya know, all the usual ME pathogens are present and accounted for.

Now you can read about this in college-level textbooks, but as recently as the 2000-2010s, the existence of lipid rafts was hotly debated in cellular metabolic circles, and lingering traces of butthurt still linger.

This torrent of research notwithstanding, there remains heated discussion concerning matters as fundamental as what lipid domains look like—a discussion that peaked but reached little in the way of resolution at a recent conference (Euroconference on Microdomains, Lipid Rafts, and Caveolae; Tomar, Portugal, May 17–22, 2003).

WHAT HAPPENED, CELLULAR FOLK. THE INTERNET WANTS TO KNOW.

And

Despite all of the work published on lipid rafts, it is not clear whether everybody is studying the same thing or even studying what they intend to study.

Does it sound familiar?

Just goes to show that no branch of science is without its hotly debated madness. At least the article I'm citing was produced 10+ years ago: now lipid rafts are a much more respectable field of research than once they were.

-J

P.S. I attached a cool article on lipid rafts and pathogens.
 

Attachments

  • Microrg&Rafts.pdf
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Gingergrrl

Senior Member
Messages
16,171
Alrighty. I tried in the article; I hope you won't consider me lazy if I cut and paste a little. :)

Absolutely not and I just wasn't sure if I was getting it. So the lipids sort of form a little raft vs. floating around all randomly in the body? Is this a good thing or bad thing? I need to read it again when I am more alert and don't spend any more time trying to explain it to me!
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
Y'know I just thought of them as a tar pit used to trap pathogens. It's a simple metaphor but it really works.

One a lipopolysaccharide (bacteria) hits those little suckers,

"when
the human monocytic cell line THP-1 was stimulated
with LPS, there was a mobilization of TLR4
and HSP70 into the lipid raft."

Those are things that would kill the pathogen. The cell literally sets a trap and then kills its prey.

Whoa.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
Absolutely not and I just wasn't sure if I was getting it. So the lipids sort of form a little raft vs. floating around all randomly in the body? Is this a good thing or bad thing? I need to read it again when I am more alert and don't spend any more time trying to explain it to me!

It's not free in the body versus in the cell... it's

1) Floating around within the cell membrane

OR

2) Aggregating / clumping together in the cell membrane
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
There are many ways the borrelia can enter cells. I think lipid rafts might be one of them.

I found some evidence of Borrelia utilizing lipid rafts, but I didn't feel secure enough in it. I think it's easy to get carried away!

You might want to check out this one, though, I know it discusses Borrelia and lipid metabolism: http://www.ncbi.nlm.nih.gov/pubmed/27337282