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Dr. Bateman: Global Progress Report Nov 2nd

RL_sparky

Senior Member
Messages
379
Location
California
I spent almost all of October on the road, traveling from DC, to Sweden, then Florida, connecting with hundreds of scientists, physicians, professionals, and patients and I am encouraged! Encouraged by all the good science being done and the progress being made. I can't wait to tell you all about it. Please tune in, I'd love to have you join us.


Global Report of Progress
with Lucinda Bateman, M.D.


Wednesday, November 2, 2016
7pm Mountain/8pm Central



Watch LIVE at
http://www.youtube.com/c/OfferutahOrg/live
No registration required. Come as you are - tune in from anywhere!
 

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
I only heard the end, so not much to report, but they did record the session and it will be available for viewing later.
 

ZeroGravitas

Senior Member
Messages
141
Location
UK
OK, so I was fairly keen to find out any more insights from the IACFS/ME conference (of which there wasn't tooo much detail here, I guess there was a lot on show there to cover) and so I thought I'd watch through and make some notes. It ended up being a little more thorough than intended, with YouTube video times indexed, to perhaps let people skip to the bits they want to hear about directly.
The slides had a problem and did not show, so links and names are what I've looked up myself. Maybe they will post the original slides up some time too. Feel free to quote or repost this where appropriate.
-----------
1:20 - How things have changed with our federal agencies (US):
[7:14:06 on in-video clock]


Thinks it's time to forgive and forget, as they are now starting to ramp up support dramatically.

+ CDC (Centre for Disease Control) - now running a multi-site clinical assessment (MCAM).

- Involving 7 CFS specialist clinics around the country, including theirs. 470 patients in 2013. Questionnaires, physical exam, NASA lean test, neurological, exercise, cognitive testing, biological samples. Adding paediatric, early onset, home-bound groups plus chronic illness controls (from other diseases). Will be studying NK cell function.

First publication coming soon describing the methods. Good longitudinal data and will enable many studies using this.

+ 4:00 - CFSAC (Committee to the secretary of health) https://www.hhs.gov/ash/advisory-committees/cfsac/index.html

Been meeting for years, but it's been ignored. Now functioning more as intended. 13 members, including biomed science, pub/private health care delivery, carers, etc.

[Trying to fix issues with slides.]

6:39 [continues] - an active group making recommendations to the secretary and NIH. Representatives from each major agency of federal government. So check them out.

+ 7:18 - IOM (Institute of medicine) report [10 Feb 2015], was very pivotal. Federally funded but outsourced for neutrality. Year long review to come up with new clinical criteria for diagnosis. A subtle change, but evidence based report is respected by all of medicine and academia, taken note of, opening doors.
http://nationalacademies.org/hmd/reports/2015/me-cfs.aspx (Including PDF downloads.)

+ 8:30 - P2P (Pathways to Prevention) report - another evidence based review within NIH, done in in parallel.
https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/me-cfs

+ 8:58 - Director of NIH released a statement a year ago, stating they were going to take ME/CFS seriously. A huge change.

Explaining what the NIH is, it's structure. They do basic research in house plus fund other researches inside and outside the US in some cases.
https://www.nih.gov/about-nih
https://en.wikipedia.org/wiki/National_Institutes_of_Health

Now there is an inter-agency collaborative (within health and human services):

+ Trans-NIH working group: https://www.nih.gov/research-training/medical-research-initiatives/mecfs

Headed by Dr Koroshetz, director of NINDS, and Vicky Whittemore (amazing person and catalyst), also a member - NIH representative in CFSAC.

They can review grant applications, and send worthy projects to the best place for funding. Their overall goals - to advance, encourage and communicate ME/CFS research.

+ 12:34 - NIH intramural study - http://mecfs.ctss.nih.gov/

Planning a protocol, bringing patients in for extensive testing [Autumn 2016]. The best you could hope for. Looking specifically for patients with viral onset, well evaluated and sick less than 5 years. Looking at the illness from an earlier window.

Announced (notice of intent) funding of 2 opportunities:
1) For collaborative ME/CFS research centres.
2) Data management and co-ordinating centre.

Doing things the way they should have been from the beginning. We're hoping this will come before the end of January, with directors of agencies being changed after an election.


15:03 - What do we already know about ME/CFS?:

- Function impaired systemically. Characterised by PEM.

- CNS and autonomic involvement (from sleep, cognitive, pain, orthostatic intolerance). Many supporting studies came out after the IOM report and for P2P, including imaging, cerebrospinal fluid, tilt testing and lean test.

- Immune disturbances, including NK cells and cytokines. Phases of diseases presenting differently.

- No new name can be decided.

- Case definitions don't work well.

- Similar symptom overlap with FM and POTS.

- Not been able to produce good biomarkers.

- pwME/CFS have been suffering without good support for decades.


* 18:00 - What did she learn in October in Sweden and at IACFS?:
http://iacfsme.org/ [Massive PDF listing speakers, posters, etc, summarising content.]
[PR thread on the Swedish conference. Full day video (partly in English).]

Scientific research clearly and definitely supports it is a biological disease. We're not going back and research will now advance exponentially. Clinical medicine is totally unprepared for what's going to happen.

18:50 - From specific presentations (diagnostics available now):

- From Romberg and lean tests you can pick out persons with abnormalities, with correlation between the results from each.

- 10 minute NASA lean test comparable to tilt-table (which is hard to get, so good alternative).

- Cognitive testing tailored for ME CFS are coming soon, narrowing it down. They've previously been long and difficult to get.

- Tests for small fibre Polyneuropathy.

* 21:05 More possible treatments and tools:

- Dr Jarred Younger - Low dose Naltrexone (LDN) works better than opioid in FM patients.

- Dr Peter Rowe - treatments for orthostatic intolerance and POTS. Just need doctors to recognise this problems separately.

- Dr Jon Kaiser - pushing through FDA approval for one of the first treatments: methylphenidate [Ritalin] micronutrient supplement. Once first drugs are validated it would also validate the illness.

- (23:00) Rituximab (used for non-hodgkins lymphoma and rheumatoid arthritis) - makes CFS/ME responders able to return to work. Very slow effect. Culls B-cells, reduction in whatever auto-immune process, B-Cells grow back and illness recurs.

- Dikoma Shungu - proton magnetic resonance spectroscopy (MRS) research. A way of imaging chemicals in the brain. Previously shown increased lactate and reduced glutathione.
https://en.wikipedia.org/wiki/In_vivo_magnetic_resonance_spectroscopy

Administered N-Acetylcysteiene (NAC, as given in emergency for tylenol overdose), showed with imaging that glutathione was restored and that symptoms improved.

Note taking them orally won't necessarily get the NAC to the cells where it's needed.

* 25:12 - New objective biomarkers upcoming:

- Dr Jose Montoya's group (at Stanford) - cytokines in blood are different from controls after an exercise challenge. Also, more cytokines = sicker. Genomics showed pattern consistent with systemic inflammatory response.

- (26:33) Microbiome - intense interest in all fields. Reduced bacterial diversity, changes in the virome too. Starting to look at it as a diagnostic, also understand the physiology.

- (27:30) Metabolomics - 2 unpublished papers showed a specific signature in the blood.

- Mitochondria, and how they relate to the illness.

- Cardiopulmonary test, the lactate in the blood rises more and more quickly, possible marker. There is a low anaerobic threshold.

* 28:38 - Some general themes:

ME/CFS is a hypometabolic state, on a cellular level, from metabolites.

(29:37) Maureen Hanson - study (unpublished), it look most like over-training syndrome (in athletes).

The metabolic products from several pathways are gender and control distinct.

Sphingolipids stood out as most significant. (Biochemistry is beyond her comfort zone) but these are important part of cell membranes and particularly associated with nerve and brain cells.

* 33:27 People at Swedish [?] conference:

Jonas Blomberg (virologist) and Anders Rosén (B-Cell specialist), in Sweden (both very distinguished). Reviewed the [Naviaux?] metabolomics paper.

Jo Cambridge (B-Cell specialist in London) - part of lab that first showed Rituximab would work for auto-immune disease too.

Øystein Fluge (also at IACFS/ME) - oncologist from Norway who's studied Rituximab in CFS.

Dr Per Julin - Swedish neurologist has rehab clinic for other diseases, now including CFS patients, taking high tech imaging.

(35:25) Blomberg - gave preview of paper. Gut microbes help train immune system, learning what's self and foreign. If gut permeability changes, then new pathogens my trigger immune system response.

Certain B-Cells are involved in auto-immunity. In primary biliary cirrhosis there are anti-mitochondrial anti-bodies and patients have PEM.

(37:30) Rosén - on metabolomics paper and sphingolipids: viruses exploit and manipulate membranes, e.g. HIV, rhinovirus, measles, ebola, hepatitis C, influenza. Also Epstein Barr viruses modify lipid raft micro-domains.

(38:50) Japanese group showed TCA cycle is abnormal [picture]. Fluge and Mella also think there's disruption of ATP in cells. Don't know which cells in body. [Artificially] disrupting this at various points and then comparing the metabolites seen could help pin this down.

(40:58) [Enlargement of Mitochondrial membrane - proteins, etc]

(41:42) Why does B-Cell depletion help? Auto-immunity has not been so much part of the thinking in the US, more so in Europe. But B-Cells are what make anti-bodies.

Rosén's hypothesis [like Naviaux's] that mitochondria are a regulating hub signalling the cell nucleus and circulation. Inflammatory signalling, etc. bacterial trigger activates B-Cells, then they get confused and attack some kind of normal tissue.

(42:55) Some studies presented showed certain allergies more common (in ME/CFS).

Mast Cell Dysregulation [MCAD] - they release histamine. Some may be overactive, could also be a membrane issue. Cause POTS, chemical/drug sensitivities.

* 44: 14 - What's next? Exponential growth. The end.

Bateman Horne web centre links:
https://batemanhornecenter.org/
https://batemanhornecenter.org/blog/
https://batemanhornecenter.org/donate/


Questions:

+ 44:52 - The auto-immune angle.

Many different viruses can result in post viral syndrome. Lots of studies now, micro-biome, metabolomics, starting to change the perspective now, but need to remember everything from before.

Things are really changing and you should have hope.

Biggest problem is we don't have clinicians who can look after patients. Needs to trickle down into medical schools. Training clinicians is something the Bateman Horne centre is trying to do.


+ 47:45 - Did Montoya's exercise study look at same chemicals as Dr Light's?

Alan Light only looked at a few cytokines and there have been a lot more looked at in many more studies since.

Cytokines vary all the time, depending on context, so hard to make sense. So exercise response test was interesting.

(48:47) Dane Cook (exercise physiologist and PhD) - looked at gene expression in exercise, as with Alan Light, but results varied, due to different types of exercise. Hypothesised that we might tolerate intense exercise better than prolonged, based on this.

Dane's unpublished study (with SolveCFS and biobank) - showed clear changes in cognition after exercise provocation.


+ 50:37 - Rituximab - are they looking at the difference between (non)responders?

They've devised a 3 year study of repeat dosing, so during this time they've been reassessing their data.

Enbrel (another immune modulating drug) they tried but had to stop because patients immediate got significantly worst.

Cyclophosphamide - used as chemotheraputic, seems to work, but has much worst side effects.

They're collected a huge amount of very valuable data.


+ 53:10 - ME/CFS has to compete with all those blockbuster diseases for funding, are we getting somewhere now?

Yes, well we've had an invisible fraction of the total funding. We need to study the underlying processes and it will aid other diseases and funding will grow when there's this overlap.

Once we've had a couple of good papers there will be a lot more people taking interest. The metabolomics paper jump started a bunch more. The samples are already available, so they can be just run through like a lab test.


+ 55:25 - Money for NIH centres might include Bateman Horne?

Possibly. They collaborate with the CDC site[?], who could apply for money. Also Ian Lipkin, because they don't have a clinic so have agreement with a number of clinics. Would love to see money come in.


+ 56:35 - LDN (low does naltrexone) verses Opioids?

LDN is the opposite, it blocks opioid receptor. It calms glial cells in CNS immune system (as per Dr Younger). When the release cytokines sometimes surrounding neurons are harmed. It's as effective for FM pain as approved drugs. But there are all kinds of pain from other sources. And you can't take LDN with opioids as their effects cancel out.

Lyrica, Cymbalta, Savella are the FDA approved drugs for FM. Naltrexone is used in recovering drug addicts to prevent them getting a high from relapse, but dose is far about 1/10th, so needs a compounding pharmacy. But makes it very cheap ~$30 per month.

+ 1:00:00 - Side effects from LDN?

No big studies yet. Can be a bit activating, nightmares, (extra) sleep problems. But generally well tolerated in FM, less so in ME/CFS. Need to do trials across different conditions to find out fully.


+ 1:01:22 - 'Ōura' ring study (Via Dr Suzanne D Vernon.)

The study was a pilot with 20 rings [shown]. Has been picking up the different physiology in ME/CFS people (body temperature, etc), so may not give out the same interpreted information as with healthy people, hence why it was developed.

With traditional polysomnography - terrible as only studies one night of likely bad sleep, all wired up in lab, cost ~$2000. Ring can be worn for months of continuous data, $300-$400. Not sure where we're going to go next. Could buy one online, made in Finland. Uploads data to smartphone, etc. https://ouraring.com/

End. (Everybody's ATP has run out, heh.)

There's going to be this huge progress in research and such, but there we will still have this huge problem in lack of programs and care. Need to make demands of our politicians and help to make progress fast.
 
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Neunistiva

Senior Member
Messages
442
Here are my short notes for Wednesday, November 2 | Lucinda Bateman, MD | Global Report of Progress.
Clicking on the time marker will take you to that portion of the video:

· [1:48] CDC Multisite Chronical Assessment (MCAM)

· [4:02] The Chronic Fatigue Syndrome Advisory Committee (CFSAC)

· [7:17] IOM Report

· [8:38] P2P (Pathways to Prevention) Report

· [9:00] 2015 Director of the NIH statement

· [10:20] Trans-NIH ME/CFS Working Group (Walter Koroshetz, M.D., and Vicky Whittemore, Ph.D.)

· [12:30] NIH intramural clinical study on ME/CFS

· [13:42] NIH notice of intent to publish a funding opportunity for extramural studies (ME/CFS collaborative research centers and ME/CFS data management coordinating centers)

· [15:05] What do we already know about ME/CFS?

· [18:10] “Scientific research definitely and clearly supports that ME/CFS is a biological disease. We are never going back. Everything has changed. Research advances will become exponential, I believe that, and clinical medicine is totally unprepared for what’s going to happen.”


Sweden and 2016 IACFS/ME summary:

· [19:00] Romberg’s test and lean test show abnormalities. (CDC and Japan)

· [20:03] Cognitive testing suited for ME/CFS coming soon

· [21:12] Dr. Jarred Younger - low dose naltrexone for fibromyalgia, Dr. Peter Rowe – treatments orthostatic intolerance, Dr. Jon D. Kaiser - combination of methylphenidate and micronutrient supplement for approval by FDA

· [22:33] Rituximab monoclonal antibody

· [23:47] Dr. Shungu proton magnetic resonance spectroscopy - way of imaging chemicals in brain (lactate was higher, glutathione lower, suggests problem with energy metabolism in brain; tried N-Acetylcysteiene)


Potential objective biomarkers:

· [25:22] Dr. Montoya’s group: cytokines after exercise challenge and genomics showing pattern consistent with systemic inflammatory response

· [26:29] Less diversity in microbiome in gut and colon, [28:00] Mitochondria, [28:07] Two day cardio-pulmonary test



General themes emerging:

· [28:35] Metabolomics, hypometabolism, Dr. Naviaux, Dr. Hanson, etc.

· [33:23] Prof. Jonas Blomberg and Prof. Anders Rosén reviewed the metabolomics paper and talked about it at Swedish conference (more about microbiome and gut, and autoimmune attacks on mitochondria at [35:13])

· [34:10] Dr Geraldine (Jo) Cambridge and her lab showed Rituximab works for auto-immune diseases

· [34:45] Dr. Per Julin opened neuro-rehab clinic and doing neuroimaging on ME/CFS patients

· [38:55] Japanese group showed that TCA and urea cycle are abnormal in ME/CFS patients. Dr. Fluge and Dr. Mella think there is a disruption in production of ATP in cells.

· [41:38] Why does depletion of B-cells improve ME/CFS? It might not be auto-immune. Prof. Rosén: Mitochondria regulate inflammatory signaling, might confuse B-cells.

· [42:52] Immune: allergies, mast cell dysregulation


Please donate to Bateman Horne Center!


· [44:53] Q&A
 
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ZeroGravitas

Senior Member
Messages
141
Location
UK
Great job @ZeroGravitas. I am also making some note and will publish it here when I'm done watching. I haven't checked everything, but I think it's Dr. Younger not Dr. Unger using low dose naltrexone for fibromyalgia.
Oops, hope I didn't tread on your toes too much. And well caught; spot the 'deliberate' mistakes. o_O

Here is something interesting, at about 36:50, primary biliary cirrhosis patients, who also have anti-mitochondrial antibodies, also demonstrate what appears to be PEM.
I thought this had come up around here a bit recently... I thought in relation to @Hip's thread on Dr Myhill et al's Mitochondrial and Energy Metabolism Dysfunction... But I don't actually see anything in there now, just a brief mention in the "ME is in the blood" thread (from @skipskip30).
 

A.B.

Senior Member
Messages
3,780
Here is something interesting, at about 36:50, primary biliary cirrhosis patients, who also have anti-mitochondrial antibodies, also demonstrate what appears to be PEM.

Pyruvate dehydrogenase antibodies to be specific.

Wikipedia said:
Pyruvate dehydrogenase is an autoantigen recognized in primary biliary cirrhosis. These antibodies appear to recognize oxidized protein that has resulted from inflammatory immune responses. Some of these inflammatory responses could be related to gluten sensitivity as over 50% of the acute liver failure patients in one study exhibited a nonmitochondrial autoantibody against tissue transglutaminase.[5] Other mitochondrial autoantigens include oxoglutarate dehydrogenase and branched-chain alpha-keto acid dehydrogenase complex, which are antigens recognized by anti-mitochondrial antibodies.

Pyruvate dehydrogenase is involved in glycolysis.
 
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trails

Senior Member
Messages
114
Location
New Hampshire
Julia Newton's muscle culture work indicated the problem was with pyruvate dehydrogenase ie in the cytoplasm so glycolysis seems to be normal, but not neough pyruvate is produced, needed to fuel the mitochondira

The problem is in the pyruvate dehydrogenase complex. Cort's other tweets from Fluge's talk expand on this.

Pyruvate dehydrogenase antibodies to be specific.

Pyruvate dehydrogenase is involved in glycolysis.

@A.B., @Simon, @Sidereal, @alex3619 Are these references to pyruvate dehydrogenase starting to come together in a meaningfully significant way? See especially, A.B.'s Wikipedia excerpt above this.
 
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A.B.

Senior Member
Messages
3,780
@A.B., @Simon, @Sidereal, @alex3619 Are these references to pyruvate dehydrogenase starting to come together in a meaningfully significant way? See especially, A.B.'s comment above this.

I don't know. I'm not a scientist. In fact I have made an error referring to pyruvate dehydrogenase (PDH) as being involved in glycolysis.

According to this medical biochemistry site PDH actually connects glycolysis, gluconeogenesis and fatty acid oxidation to the TCA cycle.

PDH is inside mitochondria, while glycolysis takes place in the cytosol (the fluid inside cells).

Glycolysis takes glucose and produces pyruvate:

When transported into the inner mitochondrial matrix, pyruvate encounters two principal metabolizing enzymes: pyruvate carboxylase, PC (a gluconeogenic enzyme) and pyruvate dehydrogenase (PDH), the first enzyme of the PDHc. With a high cell-energy charge, co-enzyme A (CoA) is highly acylated, principally as acetyl-CoA, and able to obligately activate pyruvate carboxylase, directing pyruvate toward gluconeogenesis. When the energy charge is low, CoA is not acylated, therefore, pyruvate carboxylase is inactive, and pyruvate is preferentially metabolized via the PDHc and the TCA cycle to CO2 and H2O. The acetyl-CoA produced by the PDHc enters the TCA cycle and the reduced electron carriers (NADH and FADH2) that are generated during the oxidative reactions can then be used to drive ATP synthesis via oxidative phosphorylation.

Which I find interesting and makes me wonder if poor fasting tollerance could be a sign of poorly functioning PDH. Or if a drop in cell energy charge (e.g. increased physical activity) could result in the cells trying to shift more towards a PDH dependent pathway, which doesn't work well.

Anyway, I can't answer your question, but I suspect we will soon get answers from the researchers working in this area.

Edit: maybe @ChrisArmstrong has something to say about this?
 
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alex3619

Senior Member
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13,810
Location
Logan, Queensland, Australia
We might find the target in ME is not pyruvate dehydrogenase. It would make just as much sense for it to be something else. The bridge between glycolysis and the TCA cycle is just one spot. Early research suggested there might be elevated citric acid, and this is not currently a favoured view, but this is why some of my earlier work focused on the enzyme aconitase, which ties into nitric oxide, peroxynitrate and glutathione models. On the other hand I think lipoic acid is important in PDH, and I have not currently investigated this in detail.

Researchers have been looking for an obvious block in the citric acid cycle since the 90s, and have failed to prove one. However back then they measured metabolites etc. in resting patients, not exercised patients.