Here are some of my notes on Dr. Selin's talk, my notes don't capture all of the minutia, so worth watching if you are interested.
ME/CFS involves a dysregulated immune response to viral infection
Long-COVID-19 creates a similar dysregulated immune response
CD8 T-cell exhaustion is a feature of post-viral syndromes like ME/CFS
In order to get CD8 T-cell exhaustion, you have to have a viral antigen that doesn’t clear
Some people become ill after the flu, this may be because their latent viruses reactivate
The most common latent viruses include the herpes viruses, HHV-6, CMV, and Zoster (for you enterovirus fans, Dr. Poal brought them into the mix too). One of the challenges is that it is hard to measure viral activity/load, but so much research is pointing to it.
Features of CD8 T-cell exhaustion
- Inhibitory receptor expression on CD8 cells, leading to further CD8 T-cell exhaustion
- The innate immune system continues to be activated and present viral antigen to get an adaptive (T-cell) response leading to increased INF-1
- The body tries to shut down the over-activation of the innate immune system, leading to elevated inhibitory cytokines IL-10 and TGF-b1
- The resulting cytokine soup dysregulates our metabolism and increases oxidative stress, leading to symptoms
- The brain is full of cytokine receptors and neurological symptoms are often present
- CD8 and NK cells are low in number in ME/CFS
- Most T-Cells express either CD4 or CD8, but not both (once they have left the thymus). In ME/CFS there is increased CD4/CD8 + cells in peripheral blood compared to healthy controls. This is also seen following some viral infections and in MS (there is a link between MS and EBV).
- T-cell exhaustion leads to vulnerability to new infections and responses to infections that deviate from normal
- CD8-T cell exhaustion may be preceded by a heterologous immune response that has gone awry.
Some people who get long-COVID had asymptomatic COVID, this points to the possibility that some people who get ME/CFS may not have been aware of the triggering infection.
Dr. Selin reported benefit in herself with use of Inspiritol
, which is a new investigational drug that combines 5 antioxidants in a nebulized formula, particularly to alleviate her severe reaction to the COVID vaccine. Working with Nancy Klimas to start a study. She says she has seen reversal of T-cell exhaustion in the data they have so far.