![Glowing star :star2: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f31f.png)
๐๐๐ฐ ๐๐ซ๐ญ๐ข๐๐ฅ๐: ๐ญ๐ก๐ ๐๐จ๐ง๐ง๐๐๐ญ๐ข๐จ๐ง ๐๐๐ญ๐ฐ๐๐๐ง ๐๐จ๐ง๐ ๐๐๐๐๐, ๐๐ฒ๐๐ฅ๐ ๐ข๐ ๐๐ง๐๐๐ฉ๐ก๐๐ฅ๐จ๐ฆ๐ฒ๐๐ฅ๐ข๐ญ๐ข๐ฌ ๐๐ง๐ ๐ฉ๐จ๐ฌ๐ญ-๐ฏ๐๐๐๐ข๐ง๐๐ฅ ๐ฌ๐ฒ๐ง๐๐ซ๐จ๐ฆ๐๐ฌ ๐ฅ๐ข๐๐ฌ ๐ข๐ง ๐ญ๐ก๐ ๐๐๐ฏ๐๐ฅ๐จ๐ฉ๐ฆ๐๐ง๐ญ ๐จ๐ ๐๐ง ๐๐ฎ๐ญ๐จ๐ข๐ฆ๐ฆ๐ฎ๐ง๐ ๐๐ฒ๐ฉ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ฅ๐๐ฆ๐ข๐ ๐๐ฒ๐ง๐๐ซ๐จ๐ฆ๐
![Globe with meridians :globe_with_meridians: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f310.png)
I am excited to share with you our latest paper entitled "๐๐ฒ๐ฉ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ฅ๐๐ฆ๐ข๐ ๐๐๐๐: ๐ ๐ฏ๐๐๐๐ข๐ง๐- ๐๐ง๐ ๐๐ก๐ซ๐จ๐ง๐ข๐ ๐ข๐ง๐๐๐๐ญ๐ข๐จ๐ง-๐ข๐ง๐๐ฎ๐๐๐ ๐ฌ๐ฒ๐ง๐๐ซ๐จ๐ฆ๐ ๐๐๐ก๐ข๐ง๐ ๐ญ๐ก๐ ๐จ๐ซ๐ข๐ ๐ข๐ง ๐จ๐ ๐ฅ๐จ๐ง๐ ๐๐๐๐๐ ๐๐ง๐ ๐ฆ๐ฒ๐๐ฅ๐ ๐ข๐ ๐๐ง๐๐๐ฉ๐ก๐๐ฅ๐จ๐ฆ๐ฒ๐๐ฅ๐ข๐ญ๐ข๐ฌ". In this paper, we explain the links between Long COVID, Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (ME/CFS) and COVID-19 post-vaccine syndromes.
![Thinking face :thinking: ๐ค](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f914.png)
Stay reading to the end and you will also find our treatment proposal that could improve symptoms.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ข๐ง๐ค ๐ญ๐จ ๐๐ฐ๐ข๐ญ๐ญ๐๐ซ/๐ ๐ญ๐ก๐ซ๐๐๐ ๐๐ฑ๐ฉ๐ฅ๐๐ข๐ง๐ข๐ง๐ ๐ข๐ญ:
https://x.com/manruipa/status/1810664159354192253
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ข๐ง๐ค ๐จ๐ ๐จ๐ฎ๐ซ ๐ซ๐๐ฏ๐ข๐๐ฐ ๐๐ซ๐ญ๐ข๐๐ฅ๐:
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1422940/full
![Magnifying glass tilted left :mag: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f50d.png)
๐๐๐ฌ๐ญ๐ซ๐๐๐ญ: We present a model for the development of these diseases that involves a complex interplay between immune hyperactivation, autoimmune hypophysitis or pituitary hypofunction, and immune exhaustion. We believe that the starting point is a deficient CD4 T-cell response to viral infections in genetically predisposed individuals (HLA-DRB1). This would follow from an uncontrolled immune response with hyperactivation of CD8 T cells and elevated antibody production, some of which could be directed against self-antigens, triggering autoimmune hypophysitis or direct damage to the pituitary, resulting in decreased production of pituitary hormones, such as ACTH.
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
๐๐ก๐๐ญ'๐ฌ ๐ญ๐ก๐ ๐๐ข๐ ๐๐๐๐ฅ?
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐๐ฅ๐๐ญ๐ข๐จ๐ง๐ฌ๐ก๐ข๐ฉ ๐ญ๐จ ๐๐๐๐ ๐๐ฒ๐ง๐๐ซ๐จ๐ฆ๐: We propose that Long COVID, ME/CFS and post-vaccine COVID-19 syndrome could be included in adjuvant-induced autoimmune/inflammatory syndrome (ASIA) due to their similar clinical manifestations and possible relationship to genetic factors, such as polymorphisms in the HLA-DRB1 gene.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐๐ฏ๐๐ฅ๐จ๐ฉ๐ฆ๐๐ง๐ญ๐๐ฅ ๐๐จ๐๐๐ฅ: We suggest that these diseases begin with a deficient immune response and progress to uncontrolled immune hyperactivation, followed by immune exhaustion, exacerbating symptoms and pathology.
![Keycap: 3 :three: 3๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0033-20e3.png)
๐๐ฒ๐ฉ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ฅ๐๐ฆ๐ข๐: We highlight the decrease in ACTH production and its impact on immune function and clinical symptoms, establishing a direct link with pituitary dysfunction.
![Keycap: 4 :four: 4๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0034-20e3.png)
๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐๐ซ๐จ๐ฉ๐จ๐ฌ๐๐ฅ: We propose a treatment approach including antivirals, corticosteroids/ginseng, antioxidants and metabolic precursors to improve symptoms by modulating immune response, pituitary function, inflammation and oxidative stress.
![Light bulb :bulb: ๐ก](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4a1.png)
๐๐ฆ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง๐ฌ ๐๐ง๐ ๐๐จ๐ง๐๐ฅ๐ฎ๐ฌ๐ข๐จ๐ง๐ฌ:
![Small blue diamond :small_blue_diamond: ๐น](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f539.png)
These disorders could have an autoimmune origin against the adenohypophysis.
![Small blue diamond :small_blue_diamond: ๐น](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f539.png)
Treatment with antivirals and corticosteroid replacement therapy in patients with permanent pituitary damage could improve symptoms by addressing immune and hormonal dysfunction.
![Brain :brain: ๐ง](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9e0.png)
๐๐ก๐ ๐ค๐๐ฒ ๐ข๐ฌ ๐ฉ๐ข๐ญ๐ฎ๐ข๐ญ๐๐ซ๐ฒ ๐๐๐ฆ๐๐ ๐: ๐ก๐จ๐ฐ ๐๐จ๐๐ฌ ๐ญ๐ก๐ข๐ฌ ๐ซ๐๐ฅ๐๐ญ๐ ๐ญ๐จ ๐ญ๐ก๐ ๐๐๐ฏ๐๐ฅ๐จ๐ฉ๐ฆ๐๐ง๐ญ ๐จ๐ ๐๐/๐๐
๐, ๐๐จ๐ง๐ ๐๐๐๐๐ ๐๐ง๐ ๐จ๐ญ๐ก๐๐ซ ๐ฉ๐จ๐ฌ๐ญ-๐ฏ๐ข๐ซ๐๐ฅ ๐๐ง๐ ๐ฉ๐จ๐ฌ๐ญ-๐ฏ๐๐๐๐ข๐ง๐ ๐ฌ๐ฒ๐ง๐๐ซ๐จ๐ฆ๐๐ฌ?
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
Certain viruses (and other pathogens) and vaccines can affect the pituitary gland, interfering with cortisol production and triggering a cascade of complex symptoms. In patients with weak HLA-DRB1 alleles, such as DR15, immune hyperactivation can trigger an autoimmune response against ACTH, crucial for cortisol production. This is exactly analogous to how other autoimmune diseases such as multiple sclerosis or lupus develop, where the immune system attacks other antigens in the body, but in the syndromes we are discussing, the autoimmunity is specifically directed against pituitary ACTH.
![Microbe :microbe: ๐ฆ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9a0.png)
This link explains why patients with chronic infections often experience persistent hypocortisolemia, as the pathogen continues to produce ACTH-mimicking antigens, maintaining the active autoimmune response or generates direct pituitary damage. In contrast, patients without chronic infections and with the same weak alleles treated with immune checkpoint inhibitors (ICIs) may develop temporary hypophysitis and similar cortisol deficits, but discontinuation of treatment usually allows recovery.
This also explains why patients experience chronic fatigue, dysautonomia, orthostatic intolerance, exercise intolerance, intolerance to stressful events and mild hypoglycemia due to low cortisol. Cortisol is crucial in providing the body with needed energy and regulating the stress response. When cortisol levels are low, as they are in these syndromes, the body cannot respond effectively to physical and emotional demands.
![Drop of blood :drop_of_blood: ๐ฉธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1fa78.png)
Cortisol plays a crucial role in maintaining stable blood sugar levels by promoting gluconeogenesis (glucose production) and stimulating the release of stored glucose in the form of glycogen in the liver. When there is insufficient cortisol, the body faces difficulties in increasing glucose levels in demand situations, such as during physical exercise or in response to stress, which can lead to episodes of mild hypoglycemia. In times of fright or anger, adrenaline release may temporarily improve symptoms by temporarily increasing glucose availability, briefly compensating for cortisol deficiency. However, this response does not adequately replace the long-term regulatory functions of cortisol, so symptoms may return once adrenaline subsides.
![Man lifting weights :man_lifting_weights: ๐๏ธโโ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f3cb-2642.png)
In the case of physical exercise, which naturally increases cortisol levels to mobilize energy and respond to physical exertion, the lack of this hormone limits the body's ability to maintain sustained physical activity. Patients may experience rapid muscle fatigue, feelings of weakness and slower recovery after exercise.
![Anxious face with sweat :cold_sweat: ๐ฐ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f630.png)
As for stressful events (exams, travel, surgical operations, etc) , cortisol also plays a crucial role in the body's response to emotional or physical stress. When cortisol levels are insufficient, the body has difficulty handling stressful situations effectively. This can manifest itself in an exacerbation of existing symptoms, such as intense fatigue, dizziness, difficulty concentrating and a generalized feeling of malaise.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
For years, many of these patients have been misunderstood and mislabeled as having psychosomatic illness. This is because their symptoms tend to worsen during periods of stress, which has led to the suggestion that the origin of their problems lies in psychological factors. However, the reality is that these patients are not experiencing symptoms due to an underlying psychological disorder, but as a direct result of insufficient cortisol. The lack of this vital hormone prevents the body from adapting and responding appropriately to stress, which perpetuates and aggravates their physical symptoms.
![Police car light :rotating_light: ๐จ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f6a8.png)
๐๐ก๐ ๐๐๐ฏ๐๐ฅ๐จ๐ฉ๐ฆ๐๐ง๐ญ ๐จ๐ ๐๐ฎ๐ญ๐จ๐ข๐ฆ๐ฆ๐ฎ๐ง๐ข๐ญ๐ฒ ๐ญ๐จ ๐๐๐๐: ๐ ๐๐ซ๐จ๐๐๐ฌ๐ฌ ๐๐ข๐ฆ๐ข๐ฅ๐๐ซ ๐ญ๐จ ๐๐ญ๐ก๐๐ซ ๐๐ฎ๐ญ๐จ๐ข๐ฆ๐ฆ๐ฎ๐ง๐ ๐๐ข๐ฌ๐๐๐ฌ๐๐ฌ ๐ฌ๐ฎ๐๐ก ๐๐ฌ ๐๐ฎ๐ฅ๐ญ๐ข๐ฉ๐ฅ๐ ๐๐๐ฅ๐๐ซ๐จ๐ฌ๐ข๐ฌ
This same mechanism occurs in other autoimmune diseases. Some HLA-II alleles, such as the DR15 variant, are associated with an impaired ability to recognize cells infected with certain pathogens, such as Epstein-Barr virus (EBV). In multiple sclerosis this poor recognition ability specifically affects CD4 T cells, which are crucial for coordinating the immune response. When CD4 T cells cannot correctly recognize infected cells, this leads to hyperactivation of CD8 T cells and an increase in antibodies against the pathogen to compensate for the deficient CD4 T cell response. Without the coordinated help of CD4 T cells, CD8 T cells cannot eliminate all EBV-infected cells, thus never effectively eliminating or controlling the infection and resulting in chronic infection. This results in an increase of infected cells, an exhaustion of CD8 T cells and an increased risk of developing autoimmune diseases, since CD4 T cells, by misrecognizing these viral antigens presented on the HLA-II antigen-presenting cells, can confuse them with the body's own proteins, generating an autoimmune disease. In multiple sclerosis, autoimmunity develops when the EBNA-1 antigen of the Epstein-Barr virus is mistaken for myelin, due to a similar amino acid sequence and molecular mimicry in patients with DR15 alleles. The same could occur in patients with Long COVID, myalgic encephalomyelitis and post-vaccinal syndromes, where autoimmunity against ACTH develops.
![Loudspeaker :loudspeaker: ๐ข](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4e2.png)
๐๐ก๐ฒ ๐๐๐๐๐ข๐ง๐๐ฌ ๐๐๐ง ๐๐๐ฏ๐๐ฅ๐จ๐ฉ ๐๐๐ญ๐ก๐จ๐ฅ๐จ๐ ๐ข๐๐ฌ ๐๐ข๐ฆ๐ข๐ฅ๐๐ซ ๐ญ๐จ ๐๐๐ซ๐ฌ๐ข๐ฌ๐ญ๐๐ง๐ญ ๐๐๐๐๐ ๐๐ง๐ ๐๐จ๐ฌ๐ญ-๐๐ง๐๐๐๐ญ๐ข๐จ๐ฎ๐ฌ ๐๐/๐๐
๐?
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
๐๐จ๐ฆ๐ฆ๐จ๐ง ๐๐๐๐ก๐๐ง๐ข๐ฌ๐ฆ: ๐๐ง๐๐จ๐ง๐ญ๐ซ๐จ๐ฅ๐ฅ๐๐ ๐๐ฆ๐ฆ๐ฎ๐ง๐ ๐๐๐ญ๐ข๐ฏ๐๐ญ๐ข๐จ๐ง.
Both persistent COVID and post-infectious ME/CFS and post-vaccine syndrome share a common basis: an overactive immune response. In our study, we propose the presence of:
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐๐ซ๐ฌ๐ข๐ฌ๐ญ๐๐ง๐๐ ๐จ๐ ๐๐ข๐ซ๐๐ฅ ๐๐ง๐ญ๐ข๐ ๐๐ง๐ฌ ๐จ๐ซ ๐๐๐ฃ๐ฎ๐ฏ๐๐ง๐ญ๐ฌ:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐ก๐ซ๐จ๐ง๐ข๐ ๐ฏ๐ข๐ซ๐๐ฅ ๐ข๐ง๐๐๐๐ญ๐ข๐จ๐ง: after a viral infection, such as SARS-CoV-2 or Epstein-Barr virus (EBV), viral antigens may remain in the body, triggering a continuous immune response.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐๐๐๐ข๐ง๐๐ญ๐ข๐จ๐ง: Vaccines contain adjuvants designed to stimulate the immune system. In genetically predisposed individuals (HLA-DRB1), this stimulation may be excessive, leading to uncontrolled immune activation similar to a viral infection. In addition, the introduced viral antigens could have molecular mimicry with ACTH, exacerbating the immune response and potentially contributing to the development of autoimmunity against ACTH.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐ฎ๐ญ๐จ๐ข๐ฆ๐ฆ๐ฎ๐ง๐ข๐ญ๐ฒ ๐๐ ๐๐ข๐ง๐ฌ๐ญ ๐ญ๐ก๐ ๐๐๐๐ง๐จ๐ก๐ฒ๐ฉ๐จ๐ฉ๐ก๐ฒ๐ฌ๐ข๐ฌ:
* Both conditions can lead to autoimmune inflammation of the adenohypophysis (autoimmune hypophysitis), resulting in hormonal dysfunction, especially ACTH production.
![Keycap: 3 :three: 3๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0033-20e3.png)
๐๐ฒ๐ฉ๐๐ซ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ฅ๐๐ฆ๐ข๐ ๐๐ง๐ ๐๐๐ ๐๐ฑ๐ข๐ฌ ๐๐ฒ๐ฉ๐จ๐๐ฎ๐ง๐๐ญ๐ข๐จ๐ง:
* Chronic inflammation and proinflammatory cytokine production can alter the hypothalamic-pituitary-adrenal (HPA) axis, leading to low cortisol levels, which exacerbate fatigue and other symptoms.
![Counterclockwise arrows button :arrows_counterclockwise: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f504.png)
๐๐ฒ๐๐ฅ๐ ๐จ๐ ๐๐ฒ๐ฉ๐๐ซ๐๐๐ญ๐ข๐ฏ๐๐ญ๐ข๐จ๐ง ๐๐ง๐ ๐๐ฆ๐ฆ๐ฎ๐ง๐ ๐๐๐ฉ๐ฅ๐๐ญ๐ข๐จ๐ง:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐ง๐ข๐ญ๐ข๐๐ฅ ๐๐ฒ๐ฉ๐๐ซ๐๐๐ญ๐ข๐ฏ๐๐ญ๐ข๐จ๐ง: Initial immune response is excessive, with high cytokine production and CD8 T-cell activation.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐ฆ๐ฆ๐ฎ๐ง๐ ๐๐ฑ๐ก๐๐ฎ๐ฌ๐ญ๐ข๐จ๐ง: Over time, this hyperactivation leads to T-cell exhaustion, decreasing the body's ability to control infection and exacerbating the pathology.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐ฒ๐ฉ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ฅ๐ข๐ฌ๐ฆ: Insufficient cortisol maintains the state of immune hyperactivation, perpetuating inflammation and hindering resolution of the immune cycle.
![Bar chart :bar_chart: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4ca.png)
๐๐ฏ๐ข๐๐๐ง๐๐ ๐๐ง๐ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐ข๐ฆ๐ข๐ฅ๐๐ซ๐ข๐ญ๐ข๐๐ฌ:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐ก๐๐ซ๐๐ ๐๐ฒ๐ฆ๐ฉ๐ญ๐จ๐ฆ๐ฌ: chronic fatigue, muscle and joint pain, sleep disturbances, cognitive problems, and post-exertional malaise.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
๐๐จ๐ฆ๐ฆ๐จ๐ง ๐๐๐ง๐๐ญ๐ข๐: Polymorphisms in the HLA-DRB1 gene predispose to an exaggerated immune response to both viral infections and vaccine components.
![Magnifying glass tilted left :mag: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f50d.png)
๐๐จ๐ง๐๐ฅ๐ฎ๐ฌ๐ข๐จ๐ง: Our review suggests that both Long COVID and post-infectious ME/CFS and post-vaccination syndromes could be considered as part of the autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA). These findings underline the need for a personalized therapeutic approach that takes into account the genetic predisposition and immune status of the patient.
![Globe showing Europe-Africa :earth_africa: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f30d.png)
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
๐๐จ๐ฐ ๐๐๐ง ๐๐จ๐ฆ๐ ๐๐๐๐๐ข๐ง๐๐ฌ ๐๐ซ๐ข๐ ๐ ๐๐ซ ๐๐๐ซ๐ฌ๐ข๐ฌ๐ญ๐๐ง๐ญ ๐๐๐๐ฅ๐ญ๐ก ๐๐ซ๐จ๐๐ฅ๐๐ฆ๐ฌ?
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐๐๐ก๐๐ง๐ข๐ฌ๐ฆ ๐จ๐ ๐๐๐ญ๐ข๐จ๐ง:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Vaccines contain adjuvants and antigens designed to stimulate robust immune responses.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
In some cases, this stimulation can lead to a dysregulated autoimmune response, similar to that seen in diseases such as systemic lupus erythematosus.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐๐๐๐ข๐ง๐๐ฌ ๐๐ง๐ฏ๐จ๐ฅ๐ฏ๐๐:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
COVID-19: Cases of prolonged symptoms after infection or vaccination, known as Long COVID or post-COVID syndrome, have been reported.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Hepatitis B and C, HPV: Some individuals develop ME/CFS after vaccination, related to autoimmunity and immune alterations.
![Keycap: 3 :three: 3๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0033-20e3.png)
๐๐ข๐ฌ๐ค ๐
๐๐๐ญ๐จ๐ซ๐ฌ:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Genetic predisposition such as polymorphisms in the HLA-DRB1 gene may increase susceptibility to abnormal immune responses.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Viral persistence or chronic antigen exposure may trigger a continuous and pathologic immune response.
![Globe showing Europe-Africa :earth_africa: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f30d.png)
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
๐๐ข๐ ๐ฒ๐จ๐ฎ ๐ค๐ง๐จ๐ฐ ๐ญ๐ก๐๐ญ ๐ฏ๐๐๐๐ข๐ง๐๐ฌ ๐๐๐ฌ๐ข๐ ๐ง๐๐ ๐ฐ๐ข๐ญ๐ก ๐๐๐๐ง๐จ๐ฏ๐ข๐ซ๐ฎ๐ฌ๐๐ฌ ๐ฆ๐๐ฒ ๐ก๐๐ฏ๐ ๐ ๐ฌ๐ฅ๐ข๐ ๐ก๐ญ๐ฅ๐ฒ ๐ข๐ง๐๐ซ๐๐๐ฌ๐๐ ๐ซ๐ข๐ฌ๐ค ๐จ๐ ๐ญ๐ซ๐ข๐ ๐ ๐๐ซ๐ข๐ง๐ ๐ฉ๐ซ๐จ๐ฅ๐จ๐ง๐ ๐๐ ๐ข๐ฆ๐ฆ๐ฎ๐ง๐ ๐ซ๐๐ฌ๐ฉ๐จ๐ง๐ฌ๐๐ฌ ๐๐จ๐ฆ๐ฉ๐๐ซ๐๐ ๐ญ๐จ ๐ฆ๐๐ฌ๐ฌ๐๐ง๐ ๐๐ซ ๐๐๐ ๐ฏ๐๐๐๐ข๐ง๐๐ฌ?
Adenoviruses used as vectors may persist longer in the body, exposing the immune system to viral components for extended periods.
![Microbe :microbe: ๐ฆ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9a0.png)
Adenoviruses are linear double-stranded DNA viruses and remain in an episomal condition in the nucleus. The mechanism of adenovirus vector persistence has not yet been elucidated. But they can persist for a long time in the organism. It is thought that it could be by their integration into the genome or by episomal gene duplication facilitated by the transcription machinery of the host cells. That is, it could happen that it transmits episomes to its cells as occurs in Epstein-Barr virus without lytic phase. During mitosis, EBV episomes are bound to chromosomes in metaphase through EBNA-1, allowing efficient segregation of episomes into daughter cells.
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
This theoretical phenomenon could predispose certain genetically susceptible individuals to develop chronic autoimmune or inflammatory disorders, as discussed in the context of ASIA syndrome. In contrast, messenger RNA vaccines, by rapidly degrading after inducing the desired immune response, limit this prolonged exposure.
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
![Warning :warning: โ ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/26a0.png)
Regardless of the type of vaccine against COVID-19 or other pathologies, whether messenger RNA or adenoviral vector, there is a theoretical possible risk of developing autoimmune disease only in individuals with certain genetic alleles, such as HLA-DRB1. The key lies in prolonged exposure to viral antigens, which could trigger persistent autoimmune responses.
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
mRNA vaccines are characterized by rapidly degrading after inducing the desired immune response, thus limiting prolonged exposure to viral components. In contrast, adenoviral vector-based vaccines can persist in the body longer, potentially increasing the risk of a longer-lasting autoimmune reaction in susceptible individuals.
![Light bulb :bulb: ๐ก](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4a1.png)
It is crucial to remember that these risks are rare when compared to the total number of vaccinated individuals and that all vaccines, including adenovirus and messenger RNA vaccines, are critical to combat pandemic diseases such as COVID-19 at the species level. However, understanding these differences may help improve future vaccine design and surveillance for potential adverse effects in these susceptible individuals.
![Glowing star :star2: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f31f.png)
Recall that vaccines save millions of lives and prevent serious consequences of infections in the majority of the population. However, it is crucial to recognize that they may also present risks in some susceptible individuals.
![Dna :dna: ๐งฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9ec.png)
![Syringe :syringe: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f489.png)
HLA-DRB1 genetic alleles play a crucial role in predisposition to diseases such as Long COVID, myalgic encephalomyelitis (ME/CFS) and ASIA syndrome, as well as in post-vaccine syndromes.
![Magnifying glass tilted left :mag: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f50d.png)
These HLA-DRB1 alleles are part of the HLA (human leukocyte antigen) system, which regulates how the immune system recognizes and responds to foreign antigens, such as viruses and vaccine components. In individuals with certain HLA-DRB1 alleles, the immune system may trigger excessive or inappropriate responses to these antigens, leading to autoimmune conditions and inflammatory syndromes.
![Microbe :microbe: ๐ฆ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9a0.png)
This explains why some patients, after significant viral infection or vaccination, may develop persistent autoimmune reactions. In the case of Long COVID and ME/CFS, persistence of viral antigens could trigger an autoimmune response against self tissues, including the pituitary gland.
![Magnifying glass tilted left :mag: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f50d.png)
![Sparkles :sparkles: โจ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/2728.png)
In a ๐ค๐๐ฒ ๐ฌ๐ญ๐ฎ๐๐ฒ, patients who developed hypophysitis after infection with the first SARS-CoV recovered their health months after treatment with replacement corticosteroids. This finding underscores the importance of detecting hypophysitis early to prevent permanent damage.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188349/
![Brain :brain: ๐ง](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9e0.png)
Hypophysitis can cause a decrease in ACTH production, crucial for adrenal function and immune response. Controlling ACTH levels is critical if symptoms such as chronic fatigue, orthostatic hypotension and sleep disturbances are present after a viral infection.
![Pill :pill: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f48a.png)
Early administration of replacement corticosteroids can stop ACTH secretion and prevent autoimmunity against this hormone, thus protecting the pituitary from further damage. Over time, as hypophysitis and viral infection subside, the dose of replacement corticosteroids can be gradually reduced until normal pituitary function is restored.
![Magnifying glass tilted left :mag: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f50d.png)
Challenges in HPA Axis Evaluation in Patients with Long COVID, ME/CFS and Post-Vaccine Syndromes.
Studies are often limited to single morning cortisol measurements, ignoring diurnal variability and cortisol response to physical/mental stress, which may underestimate problems in the HPA axis. In addition, CRH or ACTH stimulation tests, crucial for assessing pituitary and adrenal function, are not frequently performed.
It is crucial to detect HPA axis dysfunctions as early as possible to prevent adrenal atrophy due to low ACTH levels. Newly diagnosed patients may recover HPA axis function if autoimmune or direct damage by infection to the pituitary is detected early. Conversely, as time passes, the risk of pituitary damage from autoimmunity against ACTH increases, leading to further adrenal atrophy and the need for hydrocortisone replacement therapy. Early detection and treatment of these dysfunctions is crucial to improve the clinical management and quality of life of these patients.
![Glowing star :star2: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f31f.png)
๐๐ซ๐จ๐ฉ๐จ๐ฌ๐๐ ๐๐๐ญ๐ข๐จ๐ง ๐๐ซ๐จ๐ญ๐จ๐๐จ๐ฅ ๐๐จ๐ซ ๐๐ก๐ซ๐จ๐ง๐ข๐ ๐๐๐ฌ๐๐ฌ ๐จ๐ซ ๐จ๐ฏ๐๐ซ ๐ ๐ฆ๐จ๐ง๐ญ๐ก๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐จ๐ง๐ ๐๐๐๐๐, ๐๐/๐๐
๐ ๐จ๐ซ ๐๐จ๐ฌ๐ญ-๐๐๐๐๐ข๐ง๐ ๐๐ฒ๐ง๐๐ซ๐จ๐ฆ๐๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐ข๐ญ๐ฎ๐ข๐ญ๐๐ซ๐ฒ ๐๐๐ฆ๐๐ ๐:
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ง๐ข๐ญ๐ข๐๐ฅ ๐๐ฏ๐๐ฅ๐ฎ๐๐ญ๐ข๐จ๐ง:
![Test tube :test_tube: ๐งช](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9ea.png)
Laboratory and Imaging Tests: Pituitary MRI, Serum cortisol, saliva cortisol, 24h urine cortisol, plasma ACTH, DHEA-S and stimulation tests such as Synacthen test (synthetic ACTH stimulation test) to assess the status of the cortisol-producing adrenal glands. The diagnostic value of Synacthen lies in the assumption that chronic ACTH deficiency leads to adrenal atrophy and a consequent diminished response to stimulation with synthetic ACTH. A diagnosis of secondary adrenal insufficiency can also be confirmed with CRH stimulation testing.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ง๐ข๐ญ๐ข๐๐ฅ ๐ญ๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ:
![Pill :pill: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f48a.png)
If presenting pituitary with decreased ACTH, initiate treatment with oral hydrocortisone to decrease the damage caused by autoimmunity to pituitary ACTH.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐
๐จ๐ฅ๐ฅ๐จ๐ฐ-๐ฎ๐ฉ:
-Perform cortisol and ACTH tests every 3 months during the first year
![Bar chart :bar_chart: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4ca.png)
.
-Repeat Synacthen stimulation tests to assess HPA axis recovery.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ฏ๐๐ฅ๐ฎ๐๐ญ๐ข๐จ๐ง ๐จ๐ ๐๐๐ ๐๐ฑ๐ข๐ฌ ๐๐๐๐จ๐ฏ๐๐ซ๐ฒ:
![A button (blood type) :a: ๐
ฐ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f170.png)
If post-stimulation cortisol is greater than 550 nmol/l:
-Consider gradually reducing the dose of hydrocortisone under medical supervision.
-Periodic post-suspension assessments to ensure that the HPA axis remains functional and that ACTH and cortisol levels remain at normal levels.
![B button (blood type) :b: ๐
ฑ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f171.png)
If post-stimulation cortisol is less than 550 nmol/l or there are symptoms when reducing hydrocortisone:
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐ฒ๐๐ซ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ง๐ ๐๐๐ข๐ง๐ญ๐๐ง๐๐ง๐๐:
Maintain hydrocortisone therapy at appropriate doses to control symptoms and avoid adrenal insufficiency.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐๐ ๐ฎ๐ฅ๐๐ซ ๐๐จ๐ง๐ข๐ญ๐จ๐ซ๐ข๐ง๐ :
-Periodic cortisol and ACTH assessments.
-Adjust hydrocortisone dose based on test results and clinical presentation.
-Consider other hormonal treatments if deficiencies in other pituitary hormones are identified (e.g. thyroid consequences, DHEA).
![Glowing star :star2: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f31f.png)
๐๐ซ๐จ๐ฉ๐จ๐ฌ๐๐ ๐๐๐ญ๐ข๐จ๐ง ๐๐ซ๐จ๐ญ๐จ๐๐จ๐ฅ ๐๐จ๐ซ ๐๐๐ฐ ๐๐๐ฌ๐๐ฌ ๐จ๐ซ ๐ฅ๐๐ฌ๐ฌ ๐ญ๐ก๐๐ง ๐ ๐ฆ๐จ๐ง๐ญ๐ก๐ฌ ๐จ๐ฅ๐ ๐ฐ๐ข๐ญ๐ก ๐๐จ๐ง๐ ๐๐๐๐๐, ๐๐/๐๐
๐ ๐จ๐ซ ๐๐จ๐ฌ๐ญ-๐๐๐๐๐ข๐ง๐ ๐๐ฒ๐ง๐๐ซ๐จ๐ฆ๐๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐ข๐ญ๐ฎ๐ข๐ญ๐๐ซ๐ฒ ๐๐๐ฆ๐๐ ๐:
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ง๐ข๐ญ๐ข๐๐ฅ ๐๐ฏ๐๐ฅ๐ฎ๐๐ญ๐ข๐จ๐ง:
![Test tube :test_tube: ๐งช](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f9ea.png)
Laboratory and Imaging Tests: Pituitary MRI, Serum cortisol, saliva cortisol, 24h urine cortisol, plasma ACTH, DHEA-S and stimulation tests such as Synacthen test. ACTH testing may not be accurate in these patients when they present with secondary adrenal insufficiency for a shorter period because their adrenal glands have not yet shrunk and may still respond to ACTH. In such situations, CRH stimulation tests may be more appropriate, as they assess the ability of the pituitary to secrete ACTH. A low or absent ACTH response on CRH testing would indicate a problem at the pituitary level.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ง๐ข๐ญ๐ข๐๐ฅ ๐ญ๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ:
![Pill :pill: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f48a.png)
If presenting pituitary with decreased ACTH, initiate treatment with oral hydrocortisone to decrease the damage caused by autoimmunity to pituitary ACTH.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐
๐จ๐ฅ๐ฅ๐จ๐ฐ-๐ฎ๐ฉ:
-Perform cortisol and ACTH tests every 3 months during the first year
![Bar chart :bar_chart: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4ca.png)
.
-Repeat stimulation tests to assess HPA axis recovery.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
๐๐ฏ๐๐ฅ๐ฎ๐๐ญ๐ข๐จ๐ง ๐จ๐ ๐๐๐ ๐๐ฑ๐ข๐ฌ ๐๐๐๐จ๐ฏ๐๐ซ๐ฒ:
![A button (blood type) :a: ๐
ฐ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f170.png)
If post-stimulation ACTH is in normal ranges:
-Consider gradually reducing the dose of hydrocortisone under medical supervision.
-Periodic post-suspension assessments to ensure that the HPA axis remains functional and that ACTH and cortisol levels remain at normal levels.
![B button (blood type) :b: ๐
ฑ๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f171.png)
If post-stimulation cortisol is below normal levels or there are symptoms when reducing hydrocortisone:
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐ฒ๐๐ซ๐จ๐๐จ๐ซ๐ญ๐ข๐ฌ๐จ๐ง๐ ๐๐๐ข๐ง๐ญ๐๐ง๐๐ง๐๐:
Maintain hydrocortisone therapy at appropriate doses to control symptoms and avoid adrenal insufficiency.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐๐ ๐ฎ๐ฅ๐๐ซ ๐๐จ๐ง๐ข๐ญ๐จ๐ซ๐ข๐ง๐ :
-Periodic cortisol and ACTH assessments.
-Adjust hydrocortisone dose based on test results and clinical presentation.
-Consider other hormonal treatments if deficiencies in other pituitary hormones are identified (e.g. thyroid consequences, DHEA
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐๐ซ๐จ๐ฉ๐จ๐ฌ๐๐ฅ๐ฌ ๐๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐๐ซ๐ฌ๐ข๐ฌ๐ญ๐๐ง๐ญ ๐๐๐๐๐, ๐๐จ๐ง๐ -๐๐ฏ๐จ๐ฅ๐ฎ๐ญ๐ข๐จ๐ง ๐๐/๐๐
๐ ๐๐ง๐ ๐๐จ๐ฌ๐ญ-๐๐๐๐๐ข๐ง๐ ๐๐ฒ๐ง๐๐ซ๐จ๐ฆ๐๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐ข๐ญ๐ฎ๐ข๐ญ๐๐ซ๐ฒ ๐๐๐ฆ๐๐ ๐:
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐๐จ๐ซ๐ญ๐ข๐๐จ๐ฌ๐ญ๐๐ซ๐จ๐ข๐๐ฌ/๐๐จ๐ซ๐๐๐ง ๐ซ๐๐ ๐ ๐ข๐ง๐ฌ๐๐ง๐ :
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
How Do They Help? May reduce inflammation and regulate immune response. Reduces NF-kB pathway by decreasing oxidative stress and antioxidant intake. Corticosteroids in replacement doses are useful in cases of permanent pituitary damage, while ginseng may be beneficial in the long term by decreasing the production of proinflammatory cytokines and improving immune and adrenal function in cases with HPA axis disruption.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Important: In cases where mildly low cortisol levels are present, ginseng treatment alone could be started to assess whether cortisol levels increase naturally. If no improvement is observed, consider starting replacement doses with hydrocortisone, always under medical supervision.
![Keycap: 2 :two: 2๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0032-20e3.png)
๐๐ง๐ญ๐ข๐ฏ๐ข๐ซ๐๐ฅ๐ฌ: How Do They Help? Crucial in suppressing persistent viral replication, thus mitigating immune hyperactivity. Valtrex for herpesviruses such as EBV and Paxlovid for SARS-CoV-2.
![Keycap: 3 :three: 3๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0033-20e3.png)
๐๐๐๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐ฅ๐๐ฆ๐๐ง๐ญ๐๐ญ๐ข๐จ๐ง ๐ข๐ ๐๐๐๐ข๐๐ข๐๐ง๐๐ฒ ๐๐ฑ๐ข๐ฌ๐ญ๐ฌ:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
How Does It Help? DHEA is important for hormonal balance, especially when corticosteroid use inhibits ACTH production. It helps maintain energy and decrease the autoreactive T-cell response.
![Keycap: 4 :four: 4๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0034-20e3.png)
๐๐ง๐ญ๐ข๐จ๐ฑ๐ข๐๐๐ง๐ญ๐ฌ ๐๐ง๐ ๐๐๐ญ๐๐๐จ๐ฅ๐ข๐ ๐๐ซ๐๐๐ฎ๐ซ๐ฌ๐จ๐ซ๐ฌ:
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
Vitamins (C, B-complex), NAC, ALA, SAM-e, Selenium:
* How do they help? Reduce oxidative stress, improve mitochondrial function and restore glutathione levels, thus supporting cellular recovery and immune function.
![Black small square :black_small_square: โช๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/25aa.png)
NMN (Nicotinamide Mononucleotide):
* How does it help? Restores NAD+ levels, crucial for antiviral activities and cellular health.
![Keycap: 5 :five: 5๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0035-20e3.png)
๐๐ฅ๐ฎ๐ญ๐๐ฆ๐ข๐ง๐:
* How Does It Help. Supports energy metabolism and immune function, especially during states of high immune demand.
![Keycap: 6 :six: 6๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0036-20e3.png)
๐๐ฌ๐ญ๐ซ๐๐ ๐๐ฅ๐ฎ๐ฌ:
* How Does It Help? Reduces oxidative stress and has immunomodulatory properties that may enhance CD4 T-cell deficient immune response and prevent viral reactivation, especially of EBV. Astragalus has shown indications of reducing clotting, which could have potential benefits in conditions associated with microclot formation.
![Keycap: 7 :seven: 7๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0037-20e3.png)
๐๐ซ๐จ๐ญ๐๐ข๐ง ๐๐ง๐ ๐๐ซ๐๐๐ญ๐ข๐ง๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐ฅ๐๐ฆ๐๐ง๐ญ๐๐ญ๐ข๐จ๐ง:
* How Do They Help? They maintain protein synthesis and prevent muscle breakdown, thus improving energy and physical recovery. Beware of creatine and protein supplements, as they do not suit everyone equally well, and may generate gastrointestinal problems.
![Keycap: 8 :eight: 8๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0038-20e3.png)
๐๐ข๐ญ๐๐ฆ๐ข๐ง ๐:
* How Does it help? Reduces T-cell hyperactivation and improves insulin sensitivity, which may have additional benefits in inflammatory diseases and insulin resistance.
![Keycap: 9 :nine: 9๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0039-20e3.png)
๐๐๐ฅ๐๐ญ๐จ๐ง๐ข๐ง:
* How Does It Help? Improves sleep, protects the central nervous system and reduces neuroinflammation and oxidative stress. It is essential not to sleep less than 8 hours, as in patients with hypocortisolism, lack of sleep can further destabilize cortisol production, worsen symptoms, destabilize circadian rhythms and reduce cortisol needed for awakening.
![Keycap: 10 :keycap_ten: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f51f.png)
๐๐ง๐ญ๐ข๐ก๐ข๐ฌ๐ญ๐๐ฆ๐ข๐ง๐๐ฌ:
* How Do They Help? They reduce inflammation caused by histamine accumulation due to decreased DAO activity, decreasing Th2 response and improving allergies, food intolerances and fatigue.
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
![Keycap: 1 :one: 1๏ธโฃ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/0031-20e3.png)
๐
๐จ๐จ๐:
* How Do They Help? These patients may tolerate less food and present food intolerances due to inflammation and oxidative stress, as a consequence of immune hyperactivation and low cortisol. The intestine is one of the tissues most affected by oxidative stress, especially during digestion, as this process generates free radicals that can damage intestinal cells. A diet rich in antioxidants is essential to neutralize these free radicals, mitigate tissue damage and improve food tolerance. It is therefore important to take antioxidant supplements during meals and avoid foods that generate more inflammatory load, such as those rich in histamine.
![Right arrow :arrow_right: โก๏ธ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/27a1.png)
More information in our review article:
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1422940/full
๐๐จ๐ฌ๐๐ ๐ ๐๐ง๐ ๐ญ๐ข๐ฆ๐ข๐ง๐ ๐จ๐ ๐ญ๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ๐ฌ
While many of these supplements may be familiar to most patients and some have even been tried before, the real key to this therapeutic approach lies in the precision of dosages and frequency of administration throughout the day to maintain stable blood levels. It is also critical to make these adjustments under proper medical supervision to ensure the long-term safety and efficacy of the treatment.
![Light bulb :bulb: ๐ก](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4a1.png)
๐๐ฑ๐ฉ๐๐๐ญ๐๐ ๐๐๐ง๐๐๐ข๐ญ๐ฌ:
![Small blue diamond :small_blue_diamond: ๐น](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f539.png)
Reduction of Inflammation and Oxidative Stress: Improving quality of life and daily energy.
![Small blue diamond :small_blue_diamond: ๐น](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f539.png)
Immune and Hormonal Regulation: Helping to stabilize immune and hormonal function.
![Small blue diamond :small_blue_diamond: ๐น](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f539.png)
Improving Clinical Symptoms: By addressing the root cause of immune and hormonal dysfunction, symptoms such as fatigue, pain and cognitive issues may decreas
![Microscope :microscope: ๐ฌ](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f52c.png)
To advance the scientific validation of these protocols, we are considering the possibility of conducting a clinical trial. We are currently seeking funding for this project, as we believe it is essential to demonstrate the efficacy of these treatments in a broader context. I also believe that, in order to advance as quickly as possible in the treatment of these pathologies, the collaboration of several centers testing these treatments is necessary. For that reason if any center/institution wants to do a joint study we are open to collaborate and receive funding.
![Loudspeaker :loudspeaker: ๐ข](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4e2.png)
Please, if you are taking these supplements and treatments and you are going to participate in any study of these diseases, I encourage you to communicate it to the responsible of the study. As they could change the results of the study. This is crucial to ensure the validity of the data and to avoid any bias that may mask the reality of these complex medical conditions. In addition, it is critical that these treatments and supplements be supervised by your physician.
![Light bulb :bulb: ๐ก](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f4a1.png)
Let's keep working together to advance the treatment of Long COVID, ME/CFS and post-vaccine syndromes! Thanks for reading this great thread!
![Counterclockwise arrows button :arrows_counterclockwise: ๐](https://cdn.jsdelivr.net/joypixels/assets/7.0/png/unicode/64/1f504.png)
๐๐ก๐๐ซ๐ all this information with other patients and physicians/researchers to improve the quality of life for these patients. Together we can move towards more effective treatments and a better understanding of these medical conditions.
I will be uploading more information related to this article in the coming weeks.
Attached is another thread where we explain the consequences and development of acquired immunodeficiency in these patients:
This article has been possible thanks to the research line funded by @PlzSolveCFS and Helpify, carried out at the @CIMA_unav of the @unav with the team of Dr. Bruno Paiva (@BrunoPaiva_UNAV). we deeply appreciate their support!