• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

MEA RRF to fund study into tests for mitochondrial dysfunction

charles shepherd

Senior Member
Messages
2,239
So is the idea to see which discriminates better between patients and controls? Is this study aiming to identify an ME/CFS biomarker?

No

We are simply wanting to compare the results of the commercial test for mitochondrial function and the Newcastle 'Gold Standard' test for mitochondrial function in a group of people with ME and CFS and 20 healthy controls
 

charles shepherd

Senior Member
Messages
2,239
Just thinking aloud. Perhaps to expose any deficiencies in the current 'Gold Standard' tests? AFAIK, we've always been told that there are no functional mitochondrial abnormalities in ME. Is that because the Gold Standard isn't comprehensive enough?

Not correct.

We do now have a number of published studies (including some that I have personally been involved in through a donation of a muscle biopsy sample or through MEA RRF funding) which have demonstrated structural abnormalities in mitochondria (i.e. the electron microscopy work that I did with Professor Mina Behan in Glasgow) or biochemical abnormalities using MRS (e.g. the study I did with Professor Goerge Radda at Oxford - published in The Lancet, or the MEA funded research that Prof Julia Newton et al have been doing in Newcastle) that is consistent with a significant abnormality in skeletal muscle mitochondrial function.
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
No

We are simply wanting to compare the results of the commercial test for mitochondrial function and the Newcastle 'Gold Standard' test for mitochondrial function in a group of people with ME and CFS and 20 healthy controls

Thanks for persisting in trying to explain this to me!

I still don't understand quite what this is getting at (and if anyone else can help Charles get through to me, please jump in!).

Compare them with what hypothesis in mind?
 

lansbergen

Senior Member
Messages
2,512
Why do you think there must be more to it than just comparing two products?


Thanks for persisting in trying to explain this to me!

I still don't understand quite what this is getting at (and if anyone else can help Charles get through to me, please jump in!).

Compare them with what hypothesis in mind?
 

charles shepherd

Senior Member
Messages
2,239
Thanks for persisting in trying to explain this to me!

I still don't understand quite what this is getting at (and if anyone else can help Charles get through to me, please jump in!).

Compare them with what hypothesis in mind?

OK - let me try again with a different sort of explanation as to why we are funding this item of relatively rapid and low budget research into a commercial blood test

A considerable number of people with ME/CFS are spending quite a lot of money on a commercial test for mitochondrial function whose accuracy has not been demonstrated in any form of independent study

Consequently, it is not used by doctors who specialise in mitochondrial disease and is regarded with considerable scepticism (even hostility) by many of my medical colleagues

There are various ways in which you can investigate the structure and function of skeletal muscle mitochondria

One of the leading centres in the UK for muscle and mitochondrial research is situated at the University of Newcastle, where the unit also investigates muscle abnormalities in ME/CFS

The muscle research team there have developed what is regarded as a Gold Standard test for looking at a key part of the biochemistry that results in energy production in mitochondria

We are therefore going to see what happens to blood samples from people with ME and CFS and healthy controls that are tested using the both the commercial test and the 'Gold Standard' test to see if there are any similarities and differences

The results will then be analysed - which should give us some indication as to the value of the commercial test

Depending on the results, there are a number of directions that could then be taken to pursue this research
 

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
@charles shepherd Hope you don't mind me copying and pasting the full article from MEA - there are days when my brain just won't tolerate the site design.

New award from the MEA Ramsay Research Fund for further mitochondrial research | 21 July 2015

ME ASSOCIATION RAMSAY RESEARCH FUND:RESEARCH FUNDING ANNOUNCEMENT

Comparison of results from a commercial and a clinical diagnostic-based blood test to assess mitochondrial function in ME/CFS

The MEA Ramsay Research Fund is pleased to announce an award of £21,305 to Dr Sarah Jayne Boulton and colleagues at Newcastle University.
The award will be funding a new research study that will be comparing the results of a commercial blood test for mitochondrial function that has been developed by Dr Sarah Myhill and colleagues with the results from an international and widely accepted test of mitochondrial function which has a long and successful track record in clinical diagnosis and research of muscle disease, particularly in the UK.

BACKGROUND
Mitochondria play a vital role in energy production at a cellular level, especially in skeletal muscle, and a number of research studies – including some carried out at Newcastle University – have demonstrated abnormalities in muscle in people with ME/CFS that are linked to mitochondrial function.
The ME Association therefore believes that research into mitochondrial dysfunction in ME/CFS should be a high priority research item – as does the Medical Research Council.

This is why we have already funded a study that was carried out by Professor Julia Newton and colleagues at Newcastle University and we are currently funding, along with the Medical Research Council, further research into mitochondrial dysfunction. This is being carried out by Professor Anne McArdle and colleagues at the University of Liverpool.

We have also made a contribution to research that is being carried out by Dr Joanna Elson at Newcastle University, which is looking at mitochondrial DNA.

DIAGNOSIS OF MITOCHONDRIAL DYSFUNCTION
Interest in the role of mitochondrial dysfunction in ME/CFS has also led to the development of a commercial blood test – often referred to as the ATP profiling test – by Dr Sarah Myhill and colleagues (references 1 and 2).

In very simple terms, the test measures a number of components that determine a person’s ability to generate a substance called ATP, which is the cell’s unit of energy currency at a molecular level.

However, this test has not been validated by independent assessments. It is not therefore used to diagnose mitochondrial disease in the NHS.

The comparison study involves using a series of spectroscopic assays which are based upon published assays both for research and diagnosing mitochondrial disease, and the functionality of individual mitochondrial respiratory complexes are determined. These assays have been validated by other independent groups and laboratories.

These respiratory chain complexes, like links in a chain, must all be fully functional and tightly cooperative to allow the necessary ATP-producing oxidative phosphorylation reactions to occur. Any ‘weak link’ in the respiratory chain will result in sub-optimal respiratory function, poor ATP production and metabolic dysfunction, of which fatigue is a major symptom.

An array of spectroscopic mitochondrial diagnostic techniques to measure the respiratory chain complexes were first reported by Newcastle University in 1994 (reference 3) and were the foundation for current clinical diagnostic assays in the UK.

And in October 2014, Dr Boulton began a six month project funded by the MRC Confidence in Concept call that investigates the usefulness of the spectroscopic methods in stratifying ME/CFS patients based on their mitochondrial respiratory complex function.

Pilot data that supported the hypothesis of mitochondrial respiratory Complex II involvement in fatigue was generated from cultured muscle.

HOW WILL THIS COMPARISON OF TESTS WILL BE CARRIED OUT?
The research will involve a comparison between the data generated using the ATP profiling tests and the established mitochondrial complex assays using spectrophotometric techniques.

The aim is to determine the efficacy of each set of tests in relation to ME/CFS. In the exciting case that a synergy between the two diagnostic approaches exists, it is hoped that this preliminary study will promote an investigation into a more inclusive and highly resolved analytical technique for metabolic testing of people with ME/CFS.

REFERENCES
1. Myhill, S., Booth, N. E., and McLaren-Howard, J. (2009) Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med 2, 1-16
2. Booth, N. E., Myhill, S., and McLaren-Howard, J. (2012) Mitochondrial dysfunction and the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Int J Clin Exp Med 5, 208-220
3. Birch-Machin, M. A., Briggs, H. L., Saborido, A. A., Bindoff, L. A., and Turnbull, D. M. (1994) An evaluation of the measurement of the activities of complexes I-IV in the respiratory chain of human skeletal muscle mitochondria.
Biochem Med Metab Biol 51, 35-42
 
Last edited:

bertiedog

Senior Member
Messages
1,740
Location
South East England, UK
I also look forward to the results because I have had test done too but it was around 2007 I believe so maybe a bit out of date. I think it is a good idea that this study is being done because I have also experienced a disinterest in the results from various GPs.

Pam
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
Why do you think there must be more to it than just comparing two products?

When you compare two things, it's always with a hypothesis (and some assumptions) in mind. Otherwise, there's no point. I wanted to understand the reason for the comparison.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
The Newcastle team obviously have their reasons to carry out this study but I think it's a missed opportunity if they don't use the opportunity to compare the two tests to see how each performs at diagnosing ME/CFS patients, or to see if either test is able to select patients with certain specific symptoms, or if either test is able to give an indication of severity of symptoms. Or if they already have any info in relation to the test that they usually use, then it would be interesting to see it. But, in any case, the Newcastle team are a great team to support and invest in, to further their research interests. It's nice for the patient community, via the ME Association, to demonstrate our support for them.
 

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
This study found no difference in oxidative phosphorylation in peripheral blood mononuclear cells between Fukuda patients and controls. This group of cells include lymphocytes - but not neutrophils, on which the ATP profile test is based.

In their discussion, they comment on oxidative phosphorylation in neutrophils.

N.B Remember that Newcastle are looking at muscle cells.

http://www.translational-medicine.com/content/8/1/93
Patients with chronic fatigue syndrome performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity
Ruud CW Vermeulen1*, Ruud M Kurk1, Frans C Visser1, Wim Sluiter2 and Hans R Scholte3

Abstract


Background

The aim of this study was to investigate the possibility that a decreased mitochondrial ATP synthesis causes muscular and mental fatigue and plays a role in the pathophysiology of the chronic fatigue syndrome (CFS/ME).

Methods

Female patients (n = 15) and controls (n = 15) performed a cardiopulmonary exercise test (CPET) by cycling at a continuously increased work rate till maximal exertion. The CPET was repeated 24 h later. Before the tests, blood was taken for the isolation of peripheral blood mononuclear cells (PBMC), which were processed in a special way to preserve their oxidative phosphorylation, which was tested later in the presence of ADP and phosphate in permeabilized cells with glutamate, malate and malonate plus or minus the complex I inhibitor rotenone, and succinate with rotenone plus or minus the complex II inhibitor malonate in order to measure the ATP production via Complex I and II, respectively. Plasma CK was determined as a surrogate measure of a decreased oxidative phosphorylation in muscle, since the previous finding that in a group of patients with external ophthalmoplegia the oxygen consumption by isolated muscle mitochondria correlated negatively with plasma creatine kinase, 24 h after exercise.

Results

At both exercise tests the patients reached the anaerobic threshold and the maximal exercise at a much lower oxygen consumption than the controls and this worsened in the second test. This implies an increase of lactate, the product of anaerobic glycolysis, and a decrease of the mitochondrial ATP production in the patients. In the past this was also found in patients with defects in the mitochondrial oxidative phosphorylation. However the oxidative phosphorylation in PBMC was similar in CFS/ME patients and controls. The plasma creatine kinase levels before and 24 h after exercise were low in patients and controls, suggesting normality of the muscular mitochondrial oxidative phosphorylation.

Conclusion

The decrease in mitochondrial ATP synthesis in the CFS/ME patients is not caused by a defect in the enzyme complexes catalyzing oxidative phosphorylation, but in another factor.

ATP synthesis in PBMC
The results are summarized in table 4. The cells were isolated before the exercise tests. The amount of the mitochondria of PBMC was estimated by the assay of citrate synthase, and the activity was not different between the four groups (patients and controls at CEPT1 and 2).
Table 4. Citrate synthase activity, and complex I- and II-dependent oxidative phosphorylation in PBMC and CK in plasma of CFS patients and controls before CPET1 and CPET2&
The ATP synthesis assayed via the reduction of complex I, expressed on basis of protein were similar in the groups, and also when the ATP synthesis rate was expressed on basis of citrate synthase. The same was found for ATP synthesis via complex II.
In the present study, plasma CK was low and not increased before and 24 h after exercise in the patient group, and not different from the control group, suggesting no muscle damage and no major intrinsic abnormalities of muscular oxidative phosphorylation in CFS/ME patients.

Discussion
-
-
A recent publication 6] claimed to have found a defective oxidative phosphorylation in neutrophils of CFS/ME patients, but the flux through this process had not been measured. These investigators performed a so called "ATP profile" test, and determined ATP under five different conditions, and the sum of these was found to be abnormal in 70 of 71 patients. One of us (WS) was involved in an investigation that clearly showed that neutrophils do not catalyze oxidative phosphorylation and the remaining complexes of the respiratory chain maintain the mitochondrial membrane potential 35]. Their mitochondria are only active in apoptosis 36].
-
-
Conclusions
The decrease in mitochondrial ATP production at increasing work rate, detected by the CPET tests in the present well-characterized though small group of CFS/ME patients, is a secondary phenomenon. This was shown by the normality of the oxidative phosphorylation in peripheral blood mononuclear cells. The chain of mechanisms that couple (external) pulmonary to (internal) cellular respiration showed no abnormal differences in this study between CFS patients and healthy controls at the pulmonary, cardiac and circulatory level. Two possible explanations for the insufficient energy production in CFS remained: a lower transport capacity of oxygen as in anemia or a mitochondrial insufficiency. We showed that the mitochondrial ATP production shows no defect. Then the conclusion must be that the transport capacity of oxygen is limited in CFS patients.
 
Last edited:

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
https://www.facebook.com/pages/ME-CFS-Research-Newcastle/526359017390431
ME / CFS Research Newcastle
3 February 2014 ·
-
-
A few months ago one of the team working on the muscle studies came to see me because after completing their PhD they moved to a lab working on skin cells. SJ thought that the novel studies of mitochondrial she was doing in skin could easily be done in muscle cells too. She knew that we had muscle cells in the lab from CFS patients and wanted to see whether I thought it would be a good idea to look at them too. I found a small amount of funding for her to perform these pilot studies and she emailed last week to say that she was very excited about the results. We are meeting up to look at the results on Thurs ... So more of that soon...
http://www.meassociation.org.uk/2015/07/new-award-from-the-mea-ramsay-research-fund-for-further-mitochondrial-research-20-july-2015/
Pilot data that supported the hypothesis of mitochondrial respiratory Complex II involvement in fatigue was generated from cultured muscle.
 

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
Does anyone have a plausible explanation why mitochondria in muscle cells should behave differently from mitochondria in PBMCs?
 

charles shepherd

Senior Member
Messages
2,239
The Newcastle team obviously have their reasons to carry out this study but I think it's a missed opportunity if they don't use the opportunity to compare the two tests to see how each performs at diagnosing ME/CFS patients, or to see if either test is able to select patients with certain specific symptoms, or if either test is able to give an indication of severity of symptoms. Or if they already have any info in relation to the test that they usually use, then it would be interesting to see it. But, in any case, the Newcastle team are a great team to support and invest in, to further their research interests. It's nice for the patient community, via the ME Association, to demonstrate our support for them.

Thanks

I should explain that this research was basically commissioned by the MEA after extensive discussion over a longish period of time with the researchers in Newcastle who have great expertise in muscle and mitochondrial research

We are very open minded about the various directions in which this study might take us and I hope that the results will help to add to our understanding of mitochondrial dysfunction in ME/CFS - as well as the main aim of comparing the two tests and providing an initial assessment of the possible value of the commercial test
 

charles shepherd

Senior Member
Messages
2,239
This study found no difference in oxidative phosphorylation in peripheral blood mononuclear cells between Fukuda patients and controls. This group of cells include lymphocytes - but not neutrophils, on which the ATP profile test is based.

In their discussion, they comment on oxidative phosphorylation in neutrophils.

N.B Remember that Newcastle are looking at muscle cells.

http://www.translational-medicine.com/content/8/1/93

Worth having a look at this paper from the Newcastle group if you haven't already seen it:

http://www.ncbi.nlm.nih.gov/pubmed/21749371
 

ahmo

Senior Member
Messages
4,805
Location
Northcoast NSW, Australia
This may be a totally inappropriate question for this thread, but...What will either or these tests lead to? Is it for the purpose of diagnosis? As far as I understand it, we have some ways of supporting mitochondria, eg. threads on Mitochondria 101, but what else can we do when we come up with results verifying mitochondrial dysfunction?
 

charles shepherd

Senior Member
Messages
2,239
This may be a totally inappropriate question for this thread, but...What will either or these tests lead to? Is it for the purpose of diagnosis? As far as I understand it, we have some ways of supporting mitochondria, eg. threads on Mitochondria 101, but what else can we do when we come up with results verifying mitochondrial dysfunction?

The main reason we are funding this comparison study is because a significant number of people with ME/CFS here in the UK are paying for a fairly expensive commercial test of mitochondrial function that has not been properly validated and which is regarded with some scepticism (to put it mildly) by many clinicians and researchers who are involved in ME/CFS

So we felt it was time to take some steps to assess the value of this test

The muscle research team in Newcastle is already involved in looking at ways in which the function of skeletal muscle mitochondria can be assessed and agreed that this would be a useful thing to do

We may not be able to provide a simple yes/no answer on completion of this fairly small piece of research

But it should help to clarify if the commercial test is doing what it is claimed to do

If we get a positive result then this could obviously lead to further research in this area and would help to get the commercial test regarded as a useful part of the clinical assessment of people with ME/CFS

We may even be a step nearer to finding a a test that would help to make a firm diagnosis

Most research into ME/CFS involves trying to find small pieces of a jigsaw that can be fitted into a bigger picture

Hopefully, we can find another small piece of the ME/CFS research jigsaw!
 

charles shepherd

Senior Member
Messages
2,239
I suspect that most people are not aware of this very interesting research that was carried out by Professor Mina Behan in Glasgow many years ago which demonstrated structural abnormalities in skeletal muscle mitochondria

Part of my thigh muscle was used in this research and I still have a large scar to prove it!

Paper: http://link.springer.com/article/10.1007/BF00294431#page-1