Insights from myalgic encephalomyelitis/chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID-19 syndrome

nerd

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Komaroff AL, Lipkin WI. Insights from myalgic encephalomyelitis/chronic fatigue syndrome may help unravel the pathogenesis of post-acute COVID-19 syndrome. Trends Mol Med. 2021 Sep;27(9):895-906
doi: 10.1016/j.molmed.2021.06.002
Epub 2021 Jun 7
PMID: 34175230
PMCID: PMC8180841

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause chronic and acute disease. Postacute sequelae of SARS-CoV-2 infection (PASC) include injury to the lungs, heart, kidneys, and brain that may produce a variety of symptoms. PASC also includes a post-coronavirus disease 2019 (COVID-19) syndrome ('long COVID') with features that can follow other acute infectious diseases and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Here we summarize what is known about the pathogenesis of ME/CFS and of 'acute' COVID-19, and we speculate that the pathogenesis of post-COVID-19 syndrome in some people may be similar to that of ME/CFS. We propose molecular mechanisms that might explain the fatigue and related symptoms in both illnesses, and we suggest a research agenda for both ME/CFS and post-COVID-19 syndrome.
 

Pyrrhus

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Thanks for starting a discussion thread on this excellent (Komaroff and Lipkin, 2021) paper!

The article is a great read.
Insights from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome May Help Unravel the Pathogenesis of Post-Acute COVID-19 Syndrome (Komaroff and Lipkin, 2021)
https://www.cell.com/trends/molecular-medicine/fulltext/S1471-4914(21)00134-9

Excerpt:
Komaroff and Lipkin 2021 said:
Highlights

• In some people, the aftermath of acute COVID-19 is a lingering illness with fatigue and cognitive defects, known as post-COVID-19 syndrome or “long COVID”.
• Post-COVID-19 syndrome is similar to post-infectious fatigue syndromes triggered by other infectious agents, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that patients often report is preceded by an infectious-like illness.
• ME/CFS is associated with underlying abnormalities of the central and autonomic nervous system, immune dysregulation, disordered energy metabolism and redox imbalance. It is currently unclear if the same abnormalities will be identified in post-COVID-19 syndrome.
• The US and other developed nations have committed considerable support for research on post-COVID illnesses.
 
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SNT Gatchaman

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Although not the key point of this paper, one of the closing paragraphs caught my attention.

The COVID-19 pandemic is likely to greatly increase the number of people who develop ME/CFS or a similar illness and other post-COVID illnesses (e.g., chronic hypoxia from impaired lung function, congestive heart failure from post-COVID cardiomyopathy. Before the pandemic, ME/CFS was estimated to impact 836 000 to 2.5 million Americans and to cost as much as $24 billion annually. An estimated 10 million people may be affected worldwide [88]. It is too early to know the ultimate health impact of post-COVID chronic illnesses; however, senior economists have estimated that the cumulative future costs in the USA may be as high as $4.2 trillion.
 

Pyrrhus

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Anthony Komaroff talks about this paper in this new blog post:

ME/CFS Research: State of the Art, State of the Science
https://cfsformecfs.org/2021/07/15/me-cfs-research-state-of-the-art-state-of-the-science/

Excerpt:
An illness like ME/CFS has been described in the medical literature for several hundred years. Yet, when interest in the illness resurfaced in the mid-1980s, you could not find any mention of it in the major textbooks of medicine.

There were several reasons for this. First, past medical publications described the symptoms of the illness but did not report underlying biological abnormalities that might be causing those symptoms. Some doctors concluded that if no underlying biological abnormalities had been found, that the illness probably was not “real”.

Furthermore, when doctors seeing patients with the symptoms of ME/CFS ordered the “standard” laboratory tests in the mid-1980s, the “standard” test results typically were normal.

Unfortunately, upon receiving the normal test results some doctors told their patients that “there is nothing wrong with you.” That was one possible conclusion. Another possible conclusion that those doctors might have considered, but did not, was that they were ordering the wrong tests. Indeed, other tests available to them even in the mid-1980s did find abnormalities in many people with ME/CFS1.

Now, in the 21st century, we have state-of-the-art technologies for identifying underlying biological abnormalities that were unavailable (and even unimaginable) in the mid-1980s. Most of the testing being performed by the Columbia Center for Solutions for ME/CFS employs these newer technologies.
 

Pyrrhus

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