Cytokine profile - can anyone explain this result?

[Georgelis]

I have suffered from me/cfs for about twenty years. Having read quite a few papers that mention elevated inflammatory cytokines, I decided to do a cytokine profile to see if that would give me any clues, and got a very low result for interferon gamma. Everything else was fairly normal:


Interferon (IFN) gamma: 366.0 (pg/ml) (2046.6 - 4738.0 normal range pg/ml)

TNF alpha: 1898.0 (1208.3 - 4156.1)

Interleukin 10: 753.0 (695.6 – 3048.4)

Interleukin 4: 23.0 (20.0 – 80.6)

Interleukin 5: 19.0 (20.0 – 59.8)

Interleukin 2: 69.0 (20.0 – 62.5)

I take high dose Morepa (high EPA/ low DHA), which might possibly explain/partially explain it (?) https://www.ncbi.nlm.nih.gov/pubmed/10944484 Or perhaps I’ve got a virus and can’t deal with it (?) and perhaps should try something like oxymatrine to raise interferon? I have done tests for CMV, EBV, various coxsackies, hepatitis A, B, C, and they’ve all come back negative. Any advice or thoughts much appreciated!

 

[vaer]

where did you get this done? i don't understand cytokines enough to comment (yet) sorry

 

[used_to_race]

That's interesting. Is this Mayo or ARUP (or some other lab)? Cytokines are difficult to interpret even for most immunologists. Who is running this test for you, a rheumatologist or something? Low IFN gamma doesn't seem like it has to be clinically significant to me.

 

[Georgelis]

Hi, thanks for replying. I got it done in Poland via a laboratory called Synevo. No-one ordered the test for me - I just did it on my own - in Poland you don't need a referral from a doctor to do tests.

 

[used_to_race]

Unfortunately it isn't easy to interpret this result - maybe you've had low IFN gamma your whole life. Everyone's cytokine milieu is a bit different. The paper you linked is interesting. There isn't much of clinical significance to be done here either way. It's definitely not clear that more IFN gamma would help you, given that we know nothing of the underlying pathology you're dealing with. I wouldn't try taking oxymatrine, it is contraindicated in autoimmune diseases (and it is probably more likely you have that than some underlying infection).

It is worth noting that if you examine the literature on more established inflammatory diseases such as IBD and RA, it is not always the case that someone has elevated serum TNF-alpha, even though they may have a great response to a drug such as Humira. Have you ever had general inflammatory markers tested, like ANA, CRP, ESR, and complements?

 

[Georgelis]

Used_to_race, in answer to your question – I have done C reactive protein and erythrocyte sedimentation rate in the last couple of years, and they both came back normal. I’m not sure if I’ve done Antinuclear Antibody at some stage in the past two decades – I will try to check. Anyway, the normal CRP and ESR, together with the fact that none of my cytokines are particularly elevated (only interleukin2 mildly elevated) – in fact, the cytokines are mostly on the low side – make me think that autoimmunity is currently unlikely in my case. However, I do have the HLAB27 gene, and lots of food etc sensitivities, and, furthermore, both my siblings have autoimmune conditions (sister: ulcerative colitis; brother: ankylosing spondylitis, ulcerative colitis) – so these might point to some sort of autoimmunity in me.

(I don’t know whether the cytokine profile I did reflects values in the gut area – perhaps local concentrations of cytokines could differ there (?)).

Something else worth mentioning is that when I get a cold/flu, it really knocks me out, but I don’t get other classic symptoms strongly, such as sneezing, runny nose, coughing. Could this mean that my organism is unable to mount a good immune defence? That would seem to tie in with the very low interferon result.

Another point worth bringing up is that, from what I’ve read, me/cfs tends to be TH2 dominant (e.g. https://www.researchgate.net/public...lating_the_ThlTh2_Cytokine_Expression_Balance ) Interferon gamma is part of the TH1 immune response. In my understanding, if you boost TH1, thenTH2 automatically tends to decrease, so taking oxymatrine/equilibrant might help me/cfs patients with TH2 dominant autoimmunity (as well as me/cfs patients with some sort of viral problem as the dominant pathology).

Anyway, that’s my thinking at the moment on this extremely complex condition – I’m hoping that taking oxymatrine or equilibrant will help me whether my main pathology is some sort of viral infection or TH2 dominant autoimmunity or innate interferon gamma deficiency. But I may well be missing something, and perhaps a visit to an immunologist would be in order.

 

[Lucky luke]

My cytoxines from redlabs/meirleir were all high out of range.
I was having the flu or a coldvirus at that moment.
Doesn’t look like you’re body is fighting lyme or a virus.
Think there would me more things out of range.
Don’t worry about it is my opinion. I know nothing about this stuff by the way.
But i do nothing about my results.

 

[used_to_race]

Used_to_race, in answer to your question – I have done C reactive protein and erythrocyte sedimentation rate in the last couple of years, and they both came back normal. I’m not sure if I’ve done Antinuclear Antibody at some stage in the past two decades – I will try to check. Anyway, the normal CRP and ESR, together with the fact that none of my cytokines are particularly elevated (only interleukin2 mildly elevated) – in fact, the cytokines are mostly on the low side – make me think that autoimmunity is currently unlikely in my case. However, I do have the HLAB27 gene, and lots of food etc sensitivities, and, furthermore, both my siblings have autoimmune conditions (sister: ulcerative colitis; brother: ankylosing spondylitis, ulcerative colitis) – so these might point to some sort of autoimmunity in me.

It's hard to say - some people would argue that CRP and ESR aren't particularly good measures of inflammation. It's better to do a short trial of prednisone and see how that affects you. If prednisone makes you feel better then you have inflammation, whereas if it doesn't then you are unlikely to have inflammation. You may also have an autoimmune process that's not inflammatory, which is what POTS is believed to be. Like I said before, cytokines are basically impossible to interpret, and you didn't have IL6 measured which is a major therapeutic target.

Another point worth bringing up is that, from what I’ve read, me/cfs tends to be TH2 dominant (e.g. https://www.researchgate.net/public...lating_the_ThlTh2_Cytokine_Expression_Balance ) Interferon gamma is part of the TH1 immune response. In my understanding, if you boost TH1, thenTH2 automatically tends to decrease, so taking oxymatrine/equilibrant might help me/cfs patients with TH2 dominant autoimmunity (as well as me/cfs patients with some sort of viral problem as the dominant pathology).

The Th1/Th2 idea is outdated and overly simplistic from what I understand. There is some overlap in their roles, and there are other Th cells that do different things in addition. I'm not sure you'll find a citation for the idea that boosting Th1 will do anything to Th2, or that oxymatrine even does anything to T helper cells at all. I don't believe that Dr. Chia's reported success rate with oxymatrine is anywhere close to legitimate, and even if it were, it's basically an unblinded trial with subjective endpoints involving one doctor. When I took oxymatrine under his care, my liver enzymes went up above normal and I began feeling worse. It's not a good idea in my opinion for anyone but the sickest patients to try it.

I would again recommend the short prednisone trial as a first step - a week of 20mg prednisone won't suppress your immune system appreciably so there's little risk of any kind of infection proliferating. It will give you a lot more info than taking some random chinese herb.

 

[Georgelis]

It's hard to say - some people would argue that CRP and ESR aren't particularly good measures of inflammation. It's better to do a short trial of prednisone and see how that affects you. If prednisone makes you feel better then you have inflammation, whereas if it doesn't then you are unlikely to have inflammation. You may also have an autoimmune process that's not inflammatory, which is what POTS is believed to be. Like I said before, cytokines are basically impossible to interpret, and you didn't have IL6 measured which is a major therapeutic target.



The Th1/Th2 idea is outdated and overly simplistic from what I understand. There is some overlap in their roles, and there are other Th cells that do different things in addition. I'm not sure you'll find a citation for the idea that boosting Th1 will do anything to Th2, or that oxymatrine even does anything to T helper cells at all. I don't believe that Dr. Chia's reported success rate with oxymatrine is anywhere close to legitimate, and even if it were, it's basically an unblinded trial with subjective endpoints involving one doctor. When I took oxymatrine under his care, my liver enzymes went up above normal and I began feeling worse. It's not a good idea in my opinion for anyone but the sickest patients to try it.

I would again recommend the short prednisone trial as a first step - a week of 20mg prednisone won't suppress your immune system appreciably so there's little risk of any kind of infection proliferating. It will give you a lot more info than taking some random chinese herb.

Many thanks for your input - a lot to digest - let me think about this!

 

[Markus83]

I have done tests for CMV, EBV, various coxsackies, hepatitis A, B, C, and they’ve all come back negative.

What exactly did they measure? IgG and IgM antibodies for every germ? It's really unlikely that you are IgG negative for all these viruses. Besides, EBV requires further testing adding EA-IgG and EBNA IgG to the normal VCA IgM and IgG. I'm not sure if this has been done in your case.

The cytokines, where they measured natively or after stimulation/incubation? This makes a huge difference in interpretation the results. How long did your blood sample take until it arrived at the lab? It should be no older than 24 hours for these kind of testings.

A question that is interesting for myself: Do you know if I can send blood from Germany to Poland in your lab? How much did you have to pay for these blood values? I'm asking because lab testing is quite expensive here in Germany.

We have a very good immunological lab in Berlin, called IMD. It should also be possible to send blood from Poland. Maybe this would be useful for you if you can take the prices (look them up on their internet site).

 

[Georgelis]

Hi Markus, many thanks for your feedback. I’m a bit tired at the moment (exhausted ), so I’ll just address your question about labs in Poland and then look at the other issues in the coming days.

I did my cytokine test at a clinic called Medichouse, which sent the blood to a lab called Synevo https://www.synevo.pl/badania/cba/ it was a CBA (Cytometric Bead Array) test – I’m not sure what that means. It usually costs 450 zl, but I think I paid 415 zl, which is just under 100 Euro.

I’ve checked on the synevo webpage and on the webpages of a couple of other big labs: www.diag.pl and https://www.alablaboratoria.pl/ and none of them seem to have an English language page nor take international orders, as far as I can see. ( www.diag.pl will soon have an English language webpage (and therefore take international orders?) – I know this because I am a translator and they recently approached me about translating their webpage.).

Lab test prices in Poland are generally much lower than in England (my other home).