Research on ME/CFS

Research update on ME/CFS

What is ME/CFS?

Myalgic encephalomyelitis/encephalopathy (ME) is characterised by a range of neurological symptoms and signs, muscle pain with intense physical and mental exhaustion, relapses and specific cognitive disabilities.

During the 1990s the term chronic fatigue syndrome (CFS) came into vogue. Since there was no specific diagnostic test for ME, and since post exercise 'fatigue' was one of it's prominent symptoms, people with ME began to be diagnosed with 'CFS'. At present, efforts are being made to elucidate the diagnostic confusion, and meanwhile the term ME/CFS is used.

ME/CFS affects 120,000 to 240,000 people in the UK and is classified by the world health organisation as a neurological illness (ICD 10:G93.3). Most people with ME/CFS are unable to work to full capacity, some house or bed bound. Little support is available to their families and carers. The cause of the illness is unknown, and no cure or universally effective treatment has yet been found.

A report to the chief medical officer of England in 2002 states..."ME/CFS is a genuine illness and imposes a substantial burden on the health of the UK population, Improvement of health and social care for people affected by the condition is AN URGENT CHALLENGE!

PATIENTS WITH CFS HAVE ALTERATIONS IN GENE EXPRESSION


Dr Johnathan Kerr and others have analysed gene expression in blood cells using microarray. Genes showing differential expression were further analysed using Tagman real-time polymerase chain reaction (PCR).

15 Genes were upregulated in patients with CFS compared to normal blood donors and 1 was downregulated. The genes affected suggest T cell activation and peturbation of neuronal and mitochondrial function. Some of the genes affected suggest links to organophosphate exposure and viral infection.

-- Journal of Clinical Pathology, 2005.
according to Dr Shepherd of the MEA, "This is an important new UK study. It drives another nail into the flawed theory that graded exercise works for everybody with ME because their muscle weakness is solely due to inactivity".

BLOOD CIRCULATION IS ABNORMAL IN PEOPLE WITH ME

Dr Vance Spence and colleagues at Dundee University have been carrying out a series of experiments on blood vessels.They have been measuring skin blood flow in the forearm through laser Doppler imaging and have now published four papers with their results. The first paper showed that the blood flow in people with CFS is sensitive to a chemical transmitter called acetylcholine (Ach)which makes blood vessels dilate. This is unusual because all other diseases studied so far show a blunted response to ACh. The second study showed people with primary fibromyalgia didn't show this sensitivity. The third study looked at why the blood vessels in people with CFS were sensitive to ACh. It found that when ACh was applied it took longer for the blood flow to return to normal in people with CFS. This suggests that there may be a problem with the mechanisms in the body that break down ACh. The fourth study showed that peole with Gulf War syndrome and agricultural workers exposed to pesticides did not have this sensitivity. This shows that although there are many clinical similarities between these illnesses, they are different.

If there are problems with blood circulation as Dr Spence suggests this could account for the symptoms of faintness and low blood pressure many people with ME experience.
This research has been funded by MERGE, a very worthwhile national charity that funds ME research. See our links for more information or to give donations.

EXERCISE LOWERS PAIN THRESHOLD IN ME

Research by Dr Chaudhuri and neurological and physics colleagues at the University of Glasgow has shown that patients with ME are more sensitive to pain after exercise. This contrasted with healthy people in the study who were less sensitive to pain following exercise. Their pain threshold had become higher but the pain threshold of people with ME had become lower. Pain was measured in the skin web between thumb and index finger.

INCREASED CELL DEATH IN M.E.

Dr Gwen Kennedy and colleagues at Ninewells Medical School, Dundee, have shown evidence of increased programmed cell death in ME/CFS patients. Neutrophils are 50-60% of the circulating white blood cells. Damaged neutrophils are removed by a process called apoptosis. Dr Kennedy showed increased neutrophil apoptosis in patients with ME. This suggests a persisting or reactivating viral infection or toxic state. In its August 2004 edition, the British Medical Journal referred to this research and concluded, "Evidence is emerging that people with CFS have a detectable immunological abnormality." ME expert, Ellen Goudsmit says, "This is such an important paper. Show this report to any disbelieving doctor and watch their face!" Dr Kennedy is a MERGE research fellow. See our link for more information on MERGE.

BREAKTHROUGH IN GENE RESEARCH

The CFS Foundation has carried out a very important study on gene expresiion in the blood of patients with ME. Gene expression describes the behaviour of genes when attacked by infection or other disturbance. Some genes become very active while others shut down. The overactive genes produce chemicals which cause the symptoms of the illness.

The study analysed 9,522 genes. The genes of patients with ME showed problems in the immune system, in neurological function and in mitochondrial metabolism. Mitochondria are like batteries in cells.

The team will go on to examine all the genes in the human genome and to compare the genes of people with ME to people with other diseases in order to identify changes that are found only in ME. They will then aim to develop diagnostic tests and drug therapies. The blood of some patients will be sampled at monthly intervals over nine months to see the possible relationship between gene activity and the coming and going of symptoms.





New hope for chronic fatigue syndrome patients

9 May 2008

This research gives people hope that they have not had before

Sue Waddle, ME Research UK
Key facts

* Chronic fatigue syndrome (CFS) is also known as myalgic encephalomyelitis (ME).
* Seven subtypes of CFS were identified in the study. Type three (the mildest of all the types), type five (linked to stomach complaints and the most severe muscle weakness) and seven (the type with the most severe symptoms including pain, swollen glands, sore throat and headaches) were found only in women and subtype two - characterised by extreme tiredness after exercise as well as joint and muscle pains - was found predominantly in men.

* The 'New Horizons 2008: International Conference on ME/CFS Biomedical Research' has been organised by ME Research UK (www.meresearch.org.uk) and the Irish ME Trust (www.imet.ie) to highlight the latest advances in identifying the biological origins of the disease.


Chronic fatigue syndrome (CFS) might be split into a number of distinct genetic types in the future, according to new research presented at a conference in Cambridge. It's hoped the research will eventually pave the way for new diagnostic tests and treatments for the illness, which affects about one in 200 people in the UK.

The new research involved a genetic analysis of 55 patients with CFS and 75 healthy blood donors. There were 88 genetic differences in CFS patients - and this enabled the condition to be divided into seven subtypes (each separated by a specific genetic pattern). Each subtype has a different severity and combination of symptoms.

Lead researcher, Dr Jonathan Kerr of St George's University of London believes viruses can trigger chronic fatigue syndrome. He told the health information team: "Our research holds the potential to allow us to narrow down the subtype of CFS - and the type of infection that has caused it - so you can then treat it with the appropriate medicine."

He said a blood test to distinguish between the subtypes is "in the pipeline". Dr Kerr also stressed that further research is needed to develop these findings.

Sue Waddle, representative of ME Research UK, told the health information team that CFS has traditionally been viewed as a psychological illness in the medical profession, which has led to frustration in patients.

"Doctors get quite frightened by illnesses that they don't understand," said Sue Waddle. "If this research increases understanding of the condition then doctors will be more confident in dealing with patients, so hopefully we can move away from the psychological aspects and concentrate on the biological."

Sue Waddle explained that to date there hasn't been a proper diagnosis and therefore no treatments for the condition. "There is now real hope for treatments in the not too distant future - this research gives people hope that they have not had before."

Funding is urgently needed for this important research. Please send donations to the CFS Foundation, 2 The Briiars, Sarratt, Rickmansworth, Herts WD3 6AU.