Immunologist dismisses TH1/TH2 test

[Uno]

Hi all

I don't know where to put this so I have posted under 'doctors'. I am in the United Kingdom and have been to Southampton Hospital (the UK's largest immunology unit outside of London) Immunology department with a whole battery of abnormal tests, one of them was the TH1/TH2 shift where I was found to be TH2 dominant. The doctor said these tests were a load of rubbish and meant nothing in the scientific community. All the top ME docs use this test, why did he say it was invalidated and "quackery" as it were. I am so annoyed!

 

[Esther12]

I have no knowledge about TH1/TH2 testing, or anything similar but...

All the top ME docs use this test, why did he say it was invalidated and "quackery" as it were. I am so annoyed!

I wouldn't give too much weight to the fact that ME docs use the test. There is a lot of quackery in this area, and it could well be that lots of 'specialists' are using a quack test. Personally, I would trust an immunologist over an ME specialist on this sort of thing, but it could be that the immunologist is just wrong.

Have you tried looking for any published data on the specific testing you had?

Sorry for not being more help, I know that it can be difficult and confusing.

 

[Firestormm]

I have had some past experience with 'experts' offering me tests and proffering 'treatments' that when I related them to consultants in practice were deemed similarly worthless or unrecognised. It's a tough thing to hear and whilst I haven't heard of or had the test you mention I am aware that others do talk about TH levels.

I've never really looked into them to be honest, but would only echo what Esther has said, that this consultant could be wrong, but I would put more faith and trust in him than anyone operating off the books. There is simply not enough know about our condition to suggest any test is significant.

Unless of course your expert is a duly recognised individual? Someone employed similarly within the NHS for example? You weren't specific (not saying name names but was said person qualified for example?).

I'm sure others will be way more familiar with this specific test. I'm sure it's cropped up in research. But as to whether or not it is well regarded, well it would appear not at least by this particular expert.

Edit:

http://www.bmj.com/content/321/7258/424.1.full I'm guessing then it was the test or the test results that were deemed untrustworthy/unspecific or not recognised as being relevant/significant enough.

Been reading/skimming this: http://www.prohealth.com/library/showarticle.cfm?libid=9040 and I noticed at least one commercial test available though not in the UK but in the US for autoimmune diseases.

 

[maryb]

Off the top of my head I know I've read many US ME top notch docs (not quacks) consider the Th1/Th2 shift to be important in ME patients - as for NHS consultants as soon as you mention ME I wouldn't bother giving them my urine to test for ermm well... urine.

 

[richvank]

Hi, all.

I think that the shift to the Th2 immune response is one of the best documented immune abnormalities in ME/CFS, right up there with the low natural killer cell function. There is actually quite a lot known about lab test abnormalities in ME/CFS that has not gotten out to the conventional practitioners and incorporated into their thinking, specialists or otherwise. The new primer that the IACFS/ME has put out may help with this.

For those interested in hypotheses about the origin of the Th2 shift in ME/CFS, I would like to note that in the GD-MCB hypothesis, glutathione depletion in the antigen-presenting cells is suggested as the cause. This is based on a paper by Peterson et al., some years ago.

Best regards,

Rich

 

[Seven7]

I got some immune abnormalities also, by CFS specialist. All Drs (GP, neuro..) agree that there is something wrong with my immune system, NK cell, T cell are very accepted test, even though they do not accept the CFS diagnosis they are still looking for something wrong (MS now). The CFS Dr gave me an immune modulator (imunovir) to increase T cells and NK cells. I got Equillibrant for Viral reactivation.

Note: I have abnormalities in both Th1 and Th2 so you can have the cytokines Off from each arm. That explains why I felt so miserable then trying th1 shifters (like echinacea tea).

 

[Firestormm]

Difficult to know what the original issue was with the Immunologist - was it that the results were not significant or that the test was not recognised? I don't think we were suggesting that cytokine profiles and/or TH levels were not indicators of immune dysfunction per se.

 

[Gamboa]

Hi all

The doctor said these tests were a load of rubbish and meant nothing in the scientific community. All the top ME docs use this test, why did he say it was invalidated and "quackery" as it were. I am so annoyed!

I hate to say this but many doctors think that ME doctors are quacks. I live in Canada and it seems that the few doctors that specialize in ME/CFS are not respected by their fellow physicians. I was, in fact, just talking to three neurologists recently about this exact thing and they agreed that this is the case. They also admitted still not knowing much about ME/CFS and didn't know about the Canadian Criteria let alone the newer international one. They only believe and know about things that appear in their journals and at meetings with fellow neurologists. The ME/CFS research and all the things now known about CFS are still "unknown" by most doctors.

I am just guessing but I would think that if I asked an immunologist here in Canada about your test results I would get the same response as you.

We'll just have to wait for more research to be done and for it to get published in prominent medical journals. Unfortunately even that might not convince people since even a good journal can publish a peer reviewed study that , when under scrutiny, falls apart, as we saw with XMRV. Also, one study isn't even. Results need to be replicated and validated by well known and respected researchers. It's sad to say, but even some really good research that is done by a researcher who is considered by colleagues to be a quack, might be dismissed.

Okay...that's enough doom and gloom for now. I do really believe that one day we will triumph and ME/CFS will be considered a real illness ( or illnesses) and treatment will be available.

 

[merylg]

I was fed that I "know that little is known about CFS"...now is this double-speak or triple-speak or a conspiracy on behalf of Neurologists???
(by the way it is NOT what I know at all...are they playing with my mind?)

 

[WillowJ]

here is a non-ME/CFS doctor who uses a Th1/Th2 assay (it is a reproductive specialist):
https://www.repro-med.net/repro-med...d=8:th1th2-assay-&catid=2:pages-ett&Itemid=25
there is a pretty nice, basic, discussion of what Th1 and Th2 cells are

They also test NK cell function:
https://www.repro-med.net/repro-med...le&id=7:nk-assay-&catid=2:pages-ett&Itemid=70

Also see Cincinnati Children's; on a page describing tests for cancer patients, check out the assay descriptions under Cytokines (both assays)
http://www.cincinnatichildrens.org/service/c/cancer-blood/hcp/diagnostic-lab/assay/

Cytokines, Intracellular

Various diseases show disturbances in the proportion of circulating Th1 and Th2 CD4 cells, and in overall cytokine production by T-cells. By observing intracellular IFN-g, the Th1 CD4 cells can be enumerated and by looking at IL-4, the Th2 CD4 cells can be quantitated.

If overproduction of cytokines is suspected, IFN-g, IL4 and TNF-a can be analyzed in CD4, CD8, NKT and NK cells.

Cytokine production is stimulated by incubating whole blood or mononuclear cells with Phorbol 12-Myristate 13 Acetate and Ionomycin. Activation is carried out in the presence of Brefeldin A, which inhibits intracellular transport, causing all cytokines produced during the activation to be retained inside the cell.

The activated cells are stained with surface monoclonal antibodies for phenotyping, then fixed, permeabilized and stained with antibodies to the cytokines IFN-g, TNF-a and IL4. The cells are then analyzed by flow cytometry.

(bolding and breaks added)

Cytokines, Plasma

Cytokines are small secreted proteins that mediate and regulate immunity, inflammation and hematopoiesis. Cytokines are produced de novo in response to an immune stimulus. They generally (although not always) act over short distances and short time spans and at very low concentrations.

They act by binding to specific membrane receptors, which then signal the cell via second messengers, often tyrosine kinases, to alter its behavior. Responses to cytokines include increasing or decreasing expression of membrane proteins (including cytokine receptors), proliferation and secretion of effector molecules.

It is common for different cell types to secrete the same cytokine or for a single cytokine to act on several different cell types (pleiotropy). Cytokines are redundant in their activity, meaning similar functions can be stimulated by different cytokines.

Cytokines are often produced in a cascade, as one cytokine stimulates its target cells to make additional cytokines. Cytokines can also act synergistically (two or more cytokines acting together) or antagonistically (cytokines causing opposing activities). Cytokine short half life, low plasma concentrations, pleiotropy, and redundancy all complicate their isolation and characterization.

Cytokine levels in plasma and other biological fluids are now recognized as potential and useful markers of ongoing clinical disorders. The measurement of the levels of cytokines and / or soluble markers of immune activation can provide reliable information regarding the disease diagnosis, disease stage, prognosis, and the evaluation of therapy.

This assay uses spectrally encoded antibody-conjugated beads to measure the following cytokines: IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IFN-g, TNF-a, and GM-CSF.

(bolding and breaks added)

NK Cell Function and Perforin/Granzyme is also listed, which are things used for ME/CFS patients

Natural Killer (NK) cells are a subset of cytotoxic lymphocytes that have the ability to induce cell death in tumor cells or in virally infected cells.

NK cells play a crucial role in the homeostasis of the immune system. They are typically characterized by the expression of CD16 and CD56 on their cell surface.

This assay makes use of the fact that NK cells will lyse the human erthroleukemia cell line, K562, in vitro. K562 cells are loaded with radioactive chromium and incubated with various ratios of a mononuclear cell preparation. Lysis of the K562 targets by NK cells contained in the cell preparation is measured by the amount of chromium released into the supernatant.

(bolding and breaks added)



our docs are not crazy. our disease is simply not recognized yet.

 

[August59]

I hate to say this but many doctors think that ME doctors are quacks. I live in Canada and it seems that the few doctors that specialize in ME/CFS are not respected by their fellow physicians. I was, in fact, just talking to three neurologists recently about this exact thing and they agreed that this is the case. They also admitted still not knowing much about ME/CFS and didn't know about the Canadian Criteria let alone the newer international one. They only believe and know about things that appear in their journals and at meetings with fellow neurologists. The ME/CFS research and all the things now known about CFS are still "unknown" by most doctors.

I am just guessing but I would think that if I asked an immunologist here in Canada about your test results I would get the same response as you.

We'll just have to wait for more research to be done and for it to get published in prominent medical journals. Unfortunately even that might not convince people since even a good journal can publish a peer reviewed study that , when under scrutiny, falls apart, as we saw with XMRV. Also, one study isn't even. Results need to be replicated and validated by well known and respected researchers. It's sad to say, but even some really good research that is done by a researcher who is considered by colleagues to be a quack, might be dismissed.

Okay...that's enough doom and gloom for now. I do really believe that one day we will triumph and ME/CFS will be considered a real illness ( or illnesses) and treatment will be available.

It is the same way in the US too! Once a doctor goes into practice the only avenue of increasing their medical knowledge is the journals that they prescribe to and the 1 or 2 conferences a year that they go to that satisfies their "Continuing Education" requirements mandated by the State(s) they are licensed in. A doctor probably gets a list of around 50 conferences every year and they get to pick which ones they want to go to. Doctors that are coming into practice today are still using textbooks that are copyrighted in the "90's".

Until they can come up with clear knowledge of what is happening with our disease, so it can defintely get classifed under a specific discipline, doctors will not get any knowledge of it. I wouldn't be surprised if the different subsets are put into different disciplines once it is all sorted out. There should be certain things that they are mandated to learn about, but not that I have heard of.

 

[SOC]

The doctor said these tests were a load of rubbish and meant nothing in the scientific community. All the top ME docs use this test, why did he say it was invalidated and "quackery" as it were. I am so annoyed!

I've had specialists pull the "baffle 'em with bullshit" ploy when they either didn't know or wanted me to do what they wanted but couldn't justify it logically. It's a ploy designed to intimidate the patient into not questioning the specialist. It's disgusting, but it happens. I'd be inclined not to take the immunologist's dismissal too seriously. You might have to find a new immunologist, though.

 

[Hope123]

I don't know what the exact situation is with your tests and doctors but one of the best ME/CFS docs in the US is in fact a respected immunologist, Nancy Klimas, who has studied both HIV and ME/CFS.

This is a technical paper by her and her colleagues but it documents immune abnormalities:
http://www.translational-medicine.com/content/9/1/81/
for those professionals who might be open-minded.

Some CFS patients do have abnormalities on standardized tests (standardized on other diseases even) but because many docs are uneducated or don't look harder and insurance companies don't cover the tests, patients don't get them.

I do know what other posters mean though by questionable practitioners. There are ME/CFS docs who are ethical and good at what they do , those who are incompetent/ scientifically challenged but mean well, and finally the snake oil sellers. Unfortunately, the latter two groups make it even more difficult for the first group to do their work.

 

[Uno]

Thanks for your help guys. I found some papers on Pub Med which I am printing out and sending off. I was expecting to be dismissed to be honest but I wasn't expecting a diagnosis of a totally seperate disease dismissed as well. Why is it that if we are diagnosed with M.E - doctors think we can't possibly be sick with something else. I have Primary Sclerosing Cholangitis, I've struggled to get a specalist for two years as docs thought my vomiting and pain was all in my head, I have so many complaints lodged against local doctors. Am now finally under a top expert in London and this immunologist tried to undiagnose me and say I didn't have the disease when it's not his place.