Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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Theorell et al: Unperturbed cytotoxic lymphocyte phenotype and function in ME/CFS

Discussion in 'Latest ME/CFS Research' started by mango, Jun 25, 2017.

  1. mango

    mango Senior Member

    Unperturbed cytotoxic lymphocyte phenotype and function in myalgic encephalomyelitis/chronic fatigue syndrome patients

    Jakob Theorell1*, Indre Bileviciute Ljungar2, 3, Bianca Tesi4, 5, Heinrich Schlums1, Mette S. Johnsgaard6, Babak Asadi Azarbaijani7, 8, Elin Bolle Strand7, 9 and Yenan T. Bryceson1, 10*
    1. Department of Medicine, Huddinge, Karolinska Institutet, Sweden
    2. Department of Rehabilitation Medicine, Karolinska Institutet, Sweden
    3. Department of Clinical Sciences, Danderyd, Karolinska Institutet, Sweden
    4. Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
    5. Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden
    6. Klinikk for Alle, Storo, Norway
    7. Department of Geriatric Medicine, Oslo University, Norway
    8. VID Specialized University, Norway
    9. Department of Geriatric Medicine, Oslo University, Norway
    10. Department of Clinical Science, University of Bergen, Norway
    Front. Immunol. | doi: 10.3389/fimmu.2017.00723
    Received: 15 Dec 2016; Accepted: 08 Jun 2017.

    Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) is a debilitating disorder linked to diverse intracellular infections as well as physiological stress.

    Cytotoxic lymphocytes combat intracellular infections. Their function is attenuated by stress.

    Despite numerous studies, the role of cytotoxic lymphocytes in ME/CFS remains unclear.

    Prompted by advances in the understanding of defects in lymphocyte cytotoxicity, the discovery of adaptive NK cell subsets associated with certain viral infections, and compelling links between stress, adrenaline and cytotoxic lymphocyte function, we re-assessed the role of cytotoxic lymphocytes in ME/CFS.

    Forty-eight patients from two independent cohorts fulfilling the Canada 2003 criteria for ME/CFS were evaluated with respect to cytotoxic lymphocyte phenotype and function. Results were compared to values from matched healthy controls.

    Reproducible differences between patients and controls were not found in cytotoxic lymphocyte numbers, cytotoxic granule content, activation status, exocytotic capacity, target cell killing or cytokine production.

    One patient expressed low levels of perforin, explained by homozygosity for the PRF1 p.A91V variant. However, overall, this variant was present in a heterozygous state at the expected population frequency among ME/CFS patients.

    No single patient displayed any pathological patterns of cellular responses. Increased expansions of adaptive NK cells or deviant cytotoxic lymphocyte adrenaline-mediated inhibition were not observed.

    In addition, supervised dimensionality reduction analyses of the full, multidimensional datasets did not reveal any reproducible patient/control discriminators.

    In summary, employing sensitive assays and analyses for quantification of cytotoxic lymphocyte differentiation and function, cytotoxicity lymphocyte aberrances were not found among ME/CFS patients. These assessments of cytotoxic lymphocytes therefore do not provide useful biomarkers for the diagnosis of ME/CFS.
  2. mango

    mango Senior Member

    Please note that isolated NK cells were used in this study, unlike in many other previous studies. Which means that if it's true that there's something in the blood of pwme that negatively affects the cells (as suggested by for example Drs Ron Davis and Fluge & Mella), the method the researchers chose for this particular study might have affected the result.

    I believe this issue was discussed during the Invest in ME conference in London recently? Please correct me if I'm wrong, or add more info if you can, please :)
  3. Kalliope

    Kalliope Senior Member

    Nice to see cooperation between Swedish and Norwegian researchers!
    GreyOwl, Snow Leopard, MEMum and 4 others like this.
  4. mango

    mango Senior Member

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  5. msf

    msf Senior Member

    Would the lack of difference with controls suggest that these patients did not have intracellular infections? I can´t seem to access the full article to see the authors´ conclusions.
  6. Helen

    Helen Senior Member

    I think you should get an answer if you´d ask him. . Swedish researchers usually respond to e-mails according to my experience.
    MEMum, msf and Manganus like this.
  7. Manganus

    Manganus Senior Member

    Canary islands
    Kudos, @mango !

    Often, we focus too much on positive findings and forget articles that don't show a result.
    That's understandable, psychologically, but nevertheless unfortunate.

  8. Anne

    Anne Senior Member

    The full article is here:

    Can be downloaded as a pdf file using the "Download article" in the upper right corner.
  9. Anne

    Anne Senior Member

    From the article:

    "Our negative results contrast a number of previously published studies indicating diminished NK cell function in ME/CFS (for a comprehensive list of relevant publications overall content and outcome, see Table S4 in Supplementary Material). A few studies have shown that K562 cell killing was diminished in whole-blood assays (13, 37). Other studies found similarly diminished NK cell cytotoxic activity using PBMC immediately after isolation (15, 46), whereas other investigators have not found any impairments of NK cell cytotoxic activity using isolated PBMC (16, 62). Timing of functional assays vis-à-vis PBMC isolation may explain differences, with an effect of soluble factors, such as cytokines, catecholamines, and hormones, waning with time from cell isolation from whole blood. Such a discrepancy would therefore suggest that NK cells from ME/CFS patients in general are intrinsically normal but might be responding to an abnormal external milieu, rendering them hypofunctional in whole blood or immediately after isolation. Congruently, the addition of adrenaline, as shown above, did not attenuate NK cell functionality more in the patients than in the controls. If anything, the opposite was observed, which could hypothetically be explained by the presence of β2-adrenergic receptor autoantibodies (63), or downregulations of β2-adrenergic receptors due to an increased tonic adrenergic signaling in the ME/CFS patients. Regardless, our results indicate that cell intrinsic differences in cytotoxic lymphocyte differentiation or function do not clearly distinguish ME/CFS patients from controls."

    So they are concluding that when isolated NK cells are studied their function is no different in ME patients, but as overthehill said in his/her blog post: "Perhaps some serum factor makes the NK cells functionally incompetent in patients, but not when cells have been separated out."

    I am disappointed that they didn't extend the study to do a whole blood analysis in parallel with analysis of isolated NK cells. As I understand it, they would have made a breakthrough in the ME field if they had been able to prove that NK cell function is lowered in ME in whole blood or serum, but not in isolated NK cells. I am very much hoping now that someone else will do that experiment. Ron Davis' team? @Janet Dafoe (Rose49) @Ben Howell One of the teams cooperating with Invest in ME Research in the UK? The CDC, who will be studying NK cells as a part of their multisite study?

    @Janet Dafoe (Rose49) @Jonathan Edwards , I would love to hear your comments!

    @alex3619 @alicec @mango FYI
    Last edited: Jul 8, 2017
  10. Snow Leopard

    Snow Leopard Hibernating

    South Australia
    I don't believe the low NK Cell activity found in other studies is a causative factor in ME or CFS, it is just a secondary consequence.
    The explanation provided in Anne's post above seems plausible, though I hypothesise it is dysfunction of other GPCR, rather than β2-adrenergic receptors specifically.
    Sidereal, Manganus and Anne like this.
  11. Anne

    Anne Senior Member

    To take this issue forward I have emailed Elizabeth Unger at the CDC (no reply yet) and Avindra Nath at the NIH. For Dr Nath's response, see below.

    I would also love to hear if a comparison of NK cell function in blood vs in isolated cells is something the Stanford/OMF team could include in the Severely Ill Study? @Ben Howell @Janet Dafoe (Rose49)

    Från: Nath, Avindra (NIH/NINDS)
    Skickat: den 27 juli 2017 21:47
    Till: Anne Örtegren
    Ämne: Re: Question regarding the NIH Intramural ME/CFS study

    Dear Anne,
    Thank you for bringing this to my attention. We will be glad to look into this further.
    All the best.

    From: Anne Örtegren
    Date: Wednesday, July 26, 2017 at 11:44 AM
    To: "Nath, Avindra (NIH/NINDS) [E]"

    Dear Dr Nath,

    Firstly, let me thank you for your work with the ME/CFS intramural study! It brings hope.

    I’m sure you have seen the following paper on NK cell function in ME/CFS from Karolinska in Stockholm, which was also discussed at the Invest in ME Research conference in London:

    They conclude that when isolated NK cells are studied their function is no different in ME patients, but they note that other studies using whole blood have shown lower NK cell function. This led them to discuss in London the possibility that there might be some serum factor making the NK cells functionally incompetent in patients, while isolated cells which have been separated out function normally. This seems to chime in with findings from the Fluge and Mella group and the Ron Davis group indicating that some serum factor is inhibiting cell function in ME.

    As I understand it, a study would now need to be done which uses blood from a group of well-defined ME patients and performs parallel analyses: NK cell function in whole blood or serum and NK cell function in isolated NK cells.

    If it could thus be shown that NK cell function is normal in isolated cells but abnormal in whole blood or serum, we would have taken a large step towards the understanding of the disease mechanisms in ME, wouldn’t we? It would tell us that a serum factor is in fact at play, and that NK cell function is indeed low in ME patients’ blood.

    It seems to me extremely important that this is followed up. Unfortunately as I understand it the Stockholm group aren’t planning any further studies, so it is up to other research groups to pursue this important lead.

    Would you include this seemingly potentially ground-breaking comparison between whole blood analysis of NK cell function and analysis of function of isolated NK cells as a part of your intramural study at the NIH?

    Thank you in advance.

    Best wishes,
    Anne Ortegren

    I would also love to hear if @Jonathan Edwards or @charles shepherd have any comments.
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  12. Ben H

    Ben H OMF Correspondent

    Hi @Anne

    Will try to find out for you. It may well have already been done.

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