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My Hypothesis on Th2 to Th1 Immunomodulators in CFS

Hip

Senior Member
Messages
17,870
Didn't know LDN promotes Th2, curious why Dr. C would prescribe that.

I've not seen any studies showing low-dose naltrexone promotes Th2, but I know LDN does a number of other things that may be helpful:

Effects of LDN:
blocks TLR-4 on microglia (anti-inflammatory)
antagonizes TLR-9, as well as TLR-7 and TLR-8
increases levels of met-enkephalin (opioid growth factor) and its receptor
• blocks the mu-opioid, delta-opioid and kappa-opioid receptors for a short while (thought to up-regulate endorphins)
• has an effect the nociceptin system
• may reduce peroxynitrite and may thereby increase astrocyte glutamate transport
 
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shannah

Senior Member
Messages
1,429
I've not seen any studies showing low-dose naltrexone promotes Th2, but I know LDN does a number of other things that may be helpful:

Effects of LDN:
blocks TLR-4 on microglia (anti-inflammatory)
antagonizes TLR-9, as well as TLR-7 and TLR-8
increases levels of met-enkephalin (opioid growth factor) and its receptor
• blocks the mu-opioid, delta-opioid and kappa-opioid receptors for a short while (thought to up-regulate endorphins)
• has an effect the nociceptin system
• may reduce peroxynitrite and may thereby increase astrocyte glutamate transport


Any speculation @Hip on why it backfires in some people and seems to make them worse?
 

shannah

Senior Member
Messages
1,429
Do you mean worse initially, in the first months of starting LDN, such that some patients have to very slowly titrate up from very tiny doses?

I'm referring to the ones who can't tolerate it all, no matter the dose — who actually go downhill from it.
Years ago, the theory was that this applied to people who had yeast issues, that the LDN would kick it up further, but I don't think that was ever confirmed.
 

Hip

Senior Member
Messages
17,870
I'm referring to the ones who can't tolerate it all, no matter the dose — who actually go downhill from it.

I was not actually aware of such a group. But how do you distinguish that group from those who feel worse on LDN for 6 months or so, before they start to feel better?

Generally LDN helps only around 10 to 20% of ME/CFS patients, according to Dr Chia.
 

godlovesatrier

Senior Member
Messages
2,554
Location
United Kingdom
Hi all,

Interesting point someone made here about the bodys response to normal colds and viruses. Lyme disease patients report that they never get sick and they often say that when they go into remission they suddenly start to get sick, with colds and the flu etc. I always believed this could be a co-incidence because many people are housebound and never come into contact with a air bourne or surface contaminated virus, so they never get sick. When they feel better they go out and hence they get sick as they come into contact with other people. What are peoples thoughts on this?

I also ask because like someone else on this thread I feel better when I intially get a cold or virus and then after that I feel worse, which makes sense, but is interesting from the TH1 hypothesis side of things. The only things that mimic this effect of feeling almost symptom free prior to a cold/viral infection is taking herbs like cordyceps, astrgalus, reishi etc. I only learnt the other day that these are actually recommended to create a TH1 shift from TH2?

Also as I have always got sick with bacterial infections, viral infections and colds since day dot of being sick with ME, I wonder if this points towards a probable auto immune condition or broken immune state(switched on after viral infection), instead of a viral or bacterial pathogen such as an enterovirus or lyme bacteria?

Dr Byron Hyde also talks about clinical history and says that patients who are suffering from enterovirus ME would have got sick between May and Sept - the warm months of the year when these viruses are active. I guess we can't disprove or prove that, but I got sick in March and 2 weeks later I could barely move. I managed to regain a lot of strength using anti bacterial and viral herbs, but I realise now these are just helping and I would have to take them for life.
 

Art Vandelay

Senior Member
Messages
470
Location
Australia
A lot of the drugs/supplements prescribed and used by people with CFS do shift from Th2 to Th1. These Th2 to Th1 immunomodulator drugs/supplements include:

Imunovir (isoprinosine), inosine, azithromycin, oxymatrine, naltrexone, Epicor (Saccharomyces cerevisiae), astragalus, colostrum, transfer factor, beta sitosterol.

As far as I know, Th2 to Th1 shifting is still a reasonably popular approach.

After seeing a new doctor who has recommended this, I was interested to come across this old thread. I wonder how many CFS docs still use the Th2 to Th1 shifting approach.

Amongst other things, this doctor recommended ranitidine (zantac) as a H2 blocker (which can also be used in combination with Telfast as a H1 blocker) to shift the immune system away from Th2. Also suggested was the Marshall Protocol.

I've had a reactivation of EBV and he mentioned that EBV can trick/force(?) the immune system into a Th2 response in order to survive. I've found that ranitidine seems to work as advertised and prompt an immune shift so that there is a Th1 immune response to the EBV. I was on the MP but had to stop because the immunopathy it was provoking with this EBV reactivation was way too intolerable.
 

Hip

Senior Member
Messages
17,870
I was on the MP but had to stop because the immunopathy it was provoking with this EBV reactivation was way too intolerable.

Was the MP still causing you immunopathology even after being on it for many years? I don't know that much about the MP, but thought the immunopathology would disappear after a year or two, as patients improved and the intracellular infections were destroyed.
 

Art Vandelay

Senior Member
Messages
470
Location
Australia
Was the MP still causing you immunopathology even after being on it for many years? I don't know that much about the MP, but thought the immunopathology would disappear after a year or two, as patients improved and the intracellular infections were destroyed.

It all seems to depend on the individual and the infections. I've found over the years that the immunopathy (IP) would wax and wane a lot. For example, some years ago, I felt amazing for 3-4 months after increasing my dose of olmesartan to 40mg x 4/day but the IP then sparked up again with renewed vengeance after that period of relief.

Over the last 6-7 months, I've experienced a sharp increase in IP. Initially it was 2-3 days a week but it really took off over the New Year. Thinking back on it (and comparing it to my symptoms from the first time I got EBV 20 years ago), it almost feels as though this was a stuttering response to EBV this whole time (which has now become a full-blown response).
 

uglevod

Senior Member
Messages
220
@Art Vandelay, that's really sucks that you are still highly symptomatic, after so many years on MP. :(

My 2.5 year Olm experience that apart from immune stimulation effect(IP, herx) Olm suppresses inflammation by a lot in fact ton of inflammation just like steroids do(and a total of 160mg sometimes suppresses much more than 80mg), also low levels of D25 seems to blunt inflammation too, so unless some additional immune provocative therapy is used, in conjunction with basic, Olm-only MP like:

- specific diet: low carb, strictly avoiding common palliative measures like tea, coffee, refined sugars, veg oils
- abx, especially microdoses: good enough to have their effects but not high to suppress receptors(like TLR4?)
- sun light once in a while (?)
- anti emf measures (big player, IMO)

... hanging around in sort of limbo state with very little progress or even regressing is highly possible.

P.S. Personally, I still do not see any alternatives to MP, not even close, so I am continuing to be locked into protocol.
 
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uglevod

Senior Member
Messages
220
Effects of LDN:
blocks TLR-4 on microglia (anti-inflammatory)

That's not 100% positive effect because of:

Inhibition of Toll-Like Receptor Signaling as a Promising Therapy for Inflammatory Diseases: A Journey from Molecular to Nano Therapeutics
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516312/
Although, significant efforts have been made in developing different kinds of new TLR inhibitors/antagonists, only limited numbers of them have undergone clinical trials, and none have been approved for clinical uses to date. Nevertheless, these findings and continuous studies of TLR inhibition highlight the pharmacological regulation of TLR signaling, especially on multiple TLR pathways, as future promising therapeutic strategy for various inflammatory and autoimmune diseases.
...
Due to their capability of recognizing a variety of PAMPs, TLRs play a critical role in fighting against pathogen infection (Mogensen, 2009). The first identified TLR4 can detect a wide range of Gram-negative bacteria by recognizing and responding to the coating molecules on the bacteria cell wall—lipopolysaccharide (LPS). TLR2 (in conjunction with either TLR1 or TLR6) primarily recognizes lipoproteins/lipopeptides and glycolipids from various pathogens including microbes and fungi. TLR5 is the only TLR that identifies a protein ligand—flagellin from nearly all flagellated bacteria. On the other hand, the endosomal TLRs (TLR3, and TLR7-TLR9) are mainly responsible for the recognition of nucleic acid ligands, including dsRNA, ssRNA, and CpG-DNA, from viral and intracellular bacterial infection. Therefore, activation of TLRs by engaging with these PAMPs allows the host to combat invading pathogens. In fact, TLR agonists have long been considered as vaccine adjuvants to boost the immune system to eliminate viral infections and most recently fight cancer (O'Neill et al., 2009; Hedayat et al., 2011).
...
The expression of TLRs can be found in a variety of immune cells (e.g., dendritic cells, monocytes, macrophages, and B lymphocytes) and non-immune cells (e.g., epithelial cells, endothelial cells, and fibroblasts; Takeda et al., 2003).

The development status of TLR antagonists/inhibitors: class of SMIs:

Valsartan ARB, TLR4
Animal study Novartis Pharma Yang et al., 2009

Usefulness of oral administration of lipopolysaccharide for disease prevention through the induction of priming in macrophages
http://ar.iiarjournals.org/content/34/8/4497.long
Coley's toxin has been used as an immunotherapy in patients with cancer since 1891, and this practice is continued even today because of positive experience gained from more than 120 yearsn of use. Coley's toxin contains a mixture of dead Serratia marcescens and Streptococcus pyogenes bacteria and is known as a LPS-containing therapeutic agent (17).
...
Considering the purposiveness of the LPS, we believe that LPS may be regarded as a micronutrient with some medicinal properties for the human body rather than as an endotoxin. For example, epidemiological studies show that LPS is inversely correlated with risk of allergic disease (hygiene hypothesis) (23). The knockout of the gene of the LPS receptor in mice results in low resistance to infection (24). Moreover, the amount of LPS in various foods indicates that some herbal Chinese medicines contain a few tens of micrograms of LPS per gram of dry weight (8), whereas health foods contain several micrograms. These data suggest that ingestion of a certain amount of LPS may be important for health maintenance.
...
We have studied the preventative and curative effects on various diseases of oral administration of Pantoea agglomerans LPS, originally isolated from wheat flour. We observed several effects, such as protection from infectious diseases [bacterial and parasitic (toxoplasmosis)], improvement of diabetes and lipid metabolism (14), antiallergic properties in atopic dermatitis (13), an infection prophylaxis effect (25), and beneficial effects in cancer (26). LPS performs an important function in regulation of intestinal bacterial flora through the induction of bactericidal peptides (27). After oral administration, LPS is delivered to Paneth cells in intestinal crypts and induces production of bactericidal peptides defensins, such as regenerating islet-derived protein 3 gamma (28) and cryptdin-4 (29). According to the report of Masuda et al., cryptdin-4 has the ability to control the growth of pathogenic bacteria in the intestine (29).
...
In a model of chronic stress based on daily dexamethasone injection in chicken, antibody production against a Salmonella vaccine was significantly decreased. Oral administration of P. agglomerans LPS improved the antibody titer against Salmonella in this chronic stress model (31). It was also shown that oral administration of LPS protects against steroidal withering of immune system organs: the spleen and bursa. These results indicate that oral administration of LPS saves immune cells from death caused by several types of stress.
Next Section

Conclusion – Macrophages and LPS for Maintaining Health

Macrophages recognize and eliminate oxidized lipids, denatured proteins, advanced glycation end-products, and dead cells. These are the true causative agents of chronic inflammation, which can lead to several diseases such as diabetes, arteriosclerosis, cancer, allergy, and dementia. As mentioned above, the essential role of macrophages in health maintenance is mainly believed to be the removal of waste products from the body. In accordance with this concept, we believe that a new paradigm should be adopted for health maintenance. For example, an outbreak of a disease may be the result of suppression of macrophage function that ensures elimination of waste products.
________________________________________________________________________________
P.S. Lipopolysaccharide(LPS) is a TLR4 agonist: https://www.invivogen.com/review-lps-tlr4
 

Art Vandelay

Senior Member
Messages
470
Location
Australia
@Art Vandelay, that's really sucks that you are still highly symptomatic, after so many years on MP. :(

Thanks @uglevod it has been a very tough year so far. I had to stop the MP because I could no longer cope with extremely bad IP (physical as well as psychological symptoms). Judging from what my doc said and the effect of the H1 and H2 medications, I think the MP was provoking not just a Th1 response but also a very high Th2 response.

I'm hoping that this ranitidine treatment will kill off the EBV (and hopefully the borrelia too) and I may be able to go back on the MP if needed afterwards.
 
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Art Vandelay

Senior Member
Messages
470
Location
Australia
Relevant to @Hip 's hypothesis about shifting to Th1 at the expense of a Th2 response which may cause bacteria and parasites to build up.

As I also have a Dientamoeba fragilis infection, I have been worried that this approach may worsen my gut. Additionally, ranitidine reduces stomach acid which may also make the gut less hostile to pathogens. So I have only been taking 150mg of ranitidine instead of the 2 x 150mg recommended by the doc.

My gut has been getting a bit worse (smelly, watery stools) but it hasn't been really bad. However, I decided to experiment with a Betaine HCL (and pepsin) supplement to raise my acid levels at dinner time to see if it would help (I take the ranitidine with breakfast)

(Note: I haven't found any conclusive safety warnings that ranitidine should not be taken concurrently with betaine so far apart from a statement saying that betaine would reduce the effectiveness of the stomach acid-lowering effects of the ranitidine.)

So far I've noticed that I also get quite strong Herx symptoms that I associate with a Th1 response from taking the betaine. I also feel somewhat better (less fatigue, pain and brain fog) which is a similar experience to taking combined ranitidine and telfast.

I don't really understand why this can be happening? Within this Th1/Th2 theory, could the betaine be killing off some gut bacteria/parasites which have previously been inciting a Th2 response and I am thus able to mount a better Th1 response?

I have had a near remission after taking antibiotics for parasites (although it was only temporary and did not repeat with a second dose) so I wonder if my gut is the prime culprit in keeping my immune system focussed on Th2 responses.

I also note that Cheney says that EBV also tricks the immune system into a Th2 response:

Cheney said this is the point where it gets very interesting. Viruses, especially herpes viruses like EBV, CMV and HHV6, make proteins that mimic IL-10. The virus deceives the immune system into thinking that the threat is coming from the opposite side! So the immune system shifts from the Th1 mode that attacks viruses to the Th2 mode that does not. The virus increases its chances of survival by diverting the immune system. It is now thought that many, if not most, pathogens have this ability.

Any thoughts?
 
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