New test uses a single drop of blood to reveal entire history of viral infections

[Kati]

I think it would be very interesting for patients to be forward thinking and build their own studies. Wouldn't that be something?

Here is how I would go about.

1) Patients go on a site, fill out a questionnaires (as usual) to ensure they have ME and meet Canadian criteria. Doctor diagnosed would be optimal. Decide what the entry criteria would be-can patients be on anti-virals, does it matter?
2) Patients pay their own way for the test, a 25$ expense. Patients receive their own results.
3) Results are tallied and shared with interested physicians and those willing to co-author.
4) Publish somewhere.
5) Present results in conferences, and to CFSAC.

Has this been done before? This is very basic, but could it be done? This would be closest to patient-oriented research.

 

[Never Give Up]

Susanne Vernon just posted this on Facebook:




Suzanne Vernon
2 hrs · The New York Times · Edited ·
It was so fun to work with this remarkable team on this really cool approach to test for more than 200 viruses (and more than 1,000 virus strains!) in a drop of blood. Blood from ME/CFS patients was included along with blood samples from around the world. George Xu, Steve Elledge and I will continue to dive into the data to see if there are virus patterns unique to ME/CFS.


Single Test for All Virus Exposure Opens Doors for Researchers
It’s like one-stop shopping for scientists: a blood test can now show every virus that has a crossed a person’s path, lending insight into disease.
NYTIMES.COM|BY DENISE GRADY
Like · Comment · Share

 

[Snow Leopard]

When we lose seroconversion, and this happens a lot in ME and CFS patients, then we lose the antibodies. Many of us test positive at one point then negative after that. We do not know why this happens, except that its probably a B cell issue. In this case the test in this thread will give a false negative. There is also the issue of low affinity antibodies, I am not sure how this test will go with those.

If there are patients that are seronegative to most viruses, then this too should stick out in a decent study.

 

[Bob]

@Jonathan Edwards if u have access to the full paper, do u think that the tests shown in figure 3 might have any value in investigating autoimmune diseases? I think the idea of such tests might go against your teachings re autoimmunity, but I thought I'd ask for your thoughts anyway.

 

[Bob]

This blood test can tell you every virus you’ve ever had
The Washington post
4th June 2015
http://www.washingtonpost.com/news/...test-can-tell-you-every-virus-youve-ever-had/

"The approach is clever and a technological tour de force," said Ian Lipkin, a professor of epidemiology and director of the Center for Infection and Immunity at Columbia University, who was not involved in the creation of VirScan. "It has the potential to reveal viruses people have encountered recently or many years earlier ... Thus, this is a powerful new research tool."

"There are a lot of chronic diseases where we think a virus might be involved, but we can't quite pinpoint it ... Right now we can't quite make the connection," said Vincent Racaniello, a professor of microbiology and immunology at Columbia, who was not involved in developing VirScan. "I think this is really going to be helpful. It's very cool."

Racaniello said he envisions a day when patients will get the VirScan test as part of a regular checkup.

 

[Marco]

"There are a lot of chronic diseases where we think a virus might be involved, but we can't quite pinpoint it ... Right now we can't quite make the connection," said Vincent Racaniello, a professor of microbiology and immunology at Columbia, who was not involved in developing VirScan. "I think this is really going to be helpful. It's very cool."

Racaniello said he envisions a day when patients will get the VirScan test as part of a regular checkup.

Maybe Vincent will do a TWIV netcast on this?

 

[Bob]

Just quoting some interesting extracts from each article...

Cheap blood test reveals every virus you've ever been exposed to
New Scientist
4th June 2015
http://www.newscientist.com/article...-youve-ever-been-exposed-to.html#.VXGKAuBwYv4

As well as playing an investigative role in outbreaks, VirScan could also offer a way to investigate whether viruses are involved in disorders that aren't well understood. For example, Elledge's team will be collaborating with another group to test people with chronic fatigue syndrome, to see if they might have been infected with any of the same viruses.

 

[adreno]

Now, if only we had the same test for bacteria...

 

[Bob]

Maybe Vincent will do a TWIV netcast on this?

Yes, I guess they'll probably discuss it on TWIV... Vincent has already blogged about it:
http://www.virology.ws/2015/06/04/your-viral-past/

 

[Bob]

Now, if only we had the same test for bacteria...

They say the technology is adaptable to other pathogens. Perhaps they started with human viruses because they are limited in number.

 

[Marco]

Yes, I guess they'll probably discuss it on TWIV... Vincent has already blogged about it:
http://www.virology.ws/2015/06/04/your-viral-past/

Thanks Bob - so he has and interesting too.

 

[alex3619]

If there are patients that are seronegative to most viruses, then this too should stick out in a decent study.

I think this is only really documented for EBV, so it might be just this one virus. Maybe others can comment. If so then it might indeed show up.

 

[alex3619]

Now, if only we had the same test for bacteria...

And fungal, ricketsia etc. Only prions do not make sense with this technology.

 

[Simon]

Yes, I guess they'll probably discuss it on TWIV... Vincent has already blogged about it:
http://www.virology.ws/2015/06/04/your-viral-past/

These results are not unexpected: all of us are infected with at least a dozen viruses at any time, and the viruses identified in this study known to infect much of the human population. What was surprising is the absence of some common viruses, such as rotaviruses, and the ubiquitous polyomaviruses. According to serological surveys, the most common human viruses are the small, single-stranded DNA containing anelloviruses. Yet the related torque teno virus was only found in 1.7% of samples. These differences are likely due to a combination of technical and biological issues (e.g., failure of antibodies to certain viruses to persist in serum).

Thats the one thing that looks odd: an average of only ten viruses - which includes past infections, seems like an important undercount if we have an average of a dozen current ones. Still, if Vincent Racaniello and Ian Lipkin are so impressed I guess we should continue to be so too.

 

[Bob]

Thats the one thing that looks odd: an average of only ten viruses - which includes past infections, seems like an important undercount if we have an average of a dozen current ones. Still, if Vincent Racaniello and Ian Lipkin are so impressed I guess we should continue to be so too.

They do acknowledge that the sensitivity of the test isn't yet perfected, esp in relation to (but not limited to) small viruses. They give various reasons why they think they may not be detecting all antibodies. They have some further refining to do, and they say it's not ready for commercialisation yet.

 

[anciendaze]

When we lose seroconversion, and this happens a lot in ME and CFS patients, then we lose the antibodies. Many of us test positive at one point then negative after that. We do not know why this happens, except that its probably a B cell issue. In this case the test in this thread will give a false negative. There is also the issue of low affinity antibodies, I am not sure how this test will go with those.

There is an inherent contradiction in attempting to diagnose problems in immune response by measuring immune response. Unfortunately, we do not have good tests which tell us if a person's immune system is healthy, only -- in some cases -- if it is seriously defective.

There may still be patterns in this data which give clues, either in the form of viruses which show up more often in patients, or gaps in the list of viruses found which do not correspond well with patient histories. If the problem was simply one of all patients having been infected with virus X, Y or Z I suspect the problem would have been solved some time ago.

It is still worthwhile to try looking, so long as you don't go directly to psychological handwaving as soon as you reject a simple first hypothesis, and stop further research. We have now found enough physiological abnormalities, outside the short period of acute infection at the beginning, to know that something physical is going on.

 

[Gemini]

Now, if only we had the same test for bacteria...

The Science article, 5 June 2015:

"VirScan...could easily be expanded to include new viruses as they are discovered, as well as other human pathogens, such as bacteria, fungi, and protozoa."

 

[Jonathan Edwards]

I think it would be very interesting for patients to be forward thinking and build their own studies. Wouldn't that be something?

Here is how I would go about.

1) Patients go on a site, fill out a questionnaires (as usual) to ensure they have ME and meet Canadian criteria. Doctor diagnosed would be optimal. Decide what the entry criteria would be-can patients be on anti-virals, does it matter?
2) Patients pay their own way for the test, a 25$ expense. Patients receive their own results.
3) Results are tallied and shared with interested physicians and those willing to co-author.
4) Publish somewhere.
5) Present results in conferences, and to CFSAC.

Has this been done before? This is very basic, but could it be done? This would be closest to patient-oriented research.

My own feeling is that a large study using this screen would only really be useful as a way of trying to show some systematic difference between PWME and normal controls on a statistical basis (as anciendaze mentions). Results for individuals may be hard to know what to make of. And a comparison with controls has to very carefully avoid bias from recruitment. People who enter studies on the internet may be systematically different in their viral experiences for all sorts of reasons - including that they participate because of some viral history. So I think gathering patients through the net is not going to yield a solid result. It needs to be done on patients trawled from primary care systems with the absolute minimum of referral bias allowed to creep in. That may be disappointing for patients willing to participate but I think it is important. I worry a bit that a number of studies in the US are based on cohorts from referral to specialists services or through the net. This could introduce a really big bias on results - with either a false positive or false negative outcome.

 

[Kati]

P

My own feeling is that a large study using this screen would only really be useful as a way of trying to show some systematic difference between PWME and normal controls on a statistical basis (as anciendaze mentions). Results for individuals may be hard to know what to make of. And a comparison with controls has to very carefully avoid bias from recruitment. People who enter studies on the internet may be systematically different in their viral experiences for all sorts of reasons - including that they participate because of some viral history. So I think gathering patients through the net is not going to yield a solid result. It needs to be done on patients trawled from primary care systems with the absolute minimum of referral bias allowed to creep in. That may be disappointing for patients willing to participate but I think it is important. I worry a bit that a number of studies in the US are based on cohorts from referral to specialists services or through the net. This could introduce a really big bias on results - with either a false positive or false negative outcome.

Primary care system? You mean GP entering their patients in a study? You'd actually have to assume GPs read their mailers, that GP's know how to differenciate ME from depression and from fatigue at large. You'd have to have GP's who are able to name at least one case definition and its criterias.
We'd have much better 'luck' if a multi-center research took place, from the usual clinics. Incline Village, Miami, Salt Lake city, San Francisco, Griffith U, Norway, and the like, where our own doctors practice. only then we'd know we have a clean cohort.

Edit to add @Jonathan Edwards

Here is my first hand experience with family practice with my disease.
"Get off my exam table. You're not tired, you're depressed. You need anti-depressants"
"You have chest pain? Don't worry. It will go away"
"How come you haven't returned to work yet?"
"Your liver pain, nausea and vomitting, don't worry, it's just the flu" (3 days later I was in emergency receiving morphine for acute gallbladder,and when they discharged me, I was readmitted 22 hours later with more pain and a fever. i stayed int he hospital for 2weeks, gallbladder was necrotic. My doctor never visited.

Do not overestimate the capacity of family practice to recognize this illness. Most physicians have been brainwashed in med school or have never learnt. It will take generations before this changes.

 

[Jonathan Edwards]

P

Primary care system? You mean GP entering their patients in a study? You'd actually have to assume GPs read their mailers, that GP's know how to differenciate ME from depression and from fatigue at large. You'd have to have GP's who are able to name at least one case definition and its criterias.
We'd have much better 'luck' if a multi-center research took place, from the usual clinics. Incline Village, Miami, Salt Lake city, San Francisco, Griffith U, Norway, and the like, where our own doctors practice. only then we'd know we have a clean cohort.

Edit to add @Jonathan Edwards

Here is my first hand experience with family practice with my disease.
"Get off my exam table. You're not tired, you're depressed. You need anti-depressants"
"You have chest pain? Don't worry. It will go away"
"How come you haven't returned to work yet?"
"Your liver pain, nausea and vomitting, don't worry, it's just the flu" (3 days later I was in emergency receiving morphine for acute gallbladder,and when they discharged me, I was readmitted 22 hours later with more pain and a fever. i stayed int he hospital for 2weeks, gallbladder was necrotic. My doctor never visited.

Do not overestimate the capacity of family practice to recognize this illness. Most physicians have been brainwashed in med school or have never learnt. It will take generations before this changes.

I agree that you cannot just expect GPs to find patients and leave it at that. That is not the idea. The idea is that you have a geographic area where all GP practices agree to become involved in a demographic study that involves detailed education of staff and formalised referral protocols. You then have an expert team of validators for every case offered. This sort of thing was used for the big cardiovascular risk studies and has been done for rheumatoid arthritis in Norfolk. You have to remember that secondary and tertiary referral centres are only as good as the primary care referrals in the first place - the more specialist you get the more bias you can get. 'Usual' or well known clinics will have a grossly biased referral pattern based on all sorts of things like whether patients can pay or travel, whether the clinicians are popular with certain types of patient - it is endless. We will never get reliable data from studying populations in tertiary centres. For a start there are no relevant control populations. The people who do epidemiological studies properly just don't touch that sort of cohort with a barge pole. Nobody knows whether samples are from patients or controls right up to the point of publishing and often not even after - everything is analysed in a blind coded form so that you can do more studies without having broken codes. We need to raise the level of research to this sort of quality of methodology.