ME/CFS Science Profile picture
In-depth analysis of research on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Jun 4 8 tweets 3 min read
1) Some thoughts on this new paper and what it means for 2-day cardiopulmonary exercise testing (CPET) protocol in ME/CFS.

For a long time, this was one of the most valuable and replicated findings in ME/CFS research, with patients failing to replicate objective exercise values. 2) This new paper by Natelson’s team doesn’t fully reverse that. It’s not the biggest study on this topic and most previous studies did find an effect.

See reviews here and here:
pmc.ncbi.nlm.nih.gov/articles/PMC77…

tandfonline.com/doi/full/10.10…
May 30 18 tweets 5 min read
1) Impressive paper from Iwasaki’s lab pointing at autoimmunity in a subgroup of Long Covid patients. They replicated previous experiments of human antibody transfer causing symptoms in mice.

A couple of findings that stand out… Image 2) They extracted antibodies from blood and found that those from LC patients more often reacted to brain tissue such as the thalamus or locus coeruleus. However, after accounting for sex and age, only the results for mouse meninges were significant. Image
May 28 10 tweets 3 min read
1) An NIH study found that ME/CFS and Long Covid patients have reduced levels of norepinephrine and its metabolites in the cerebrospinal fluid.

The norepinephrine reduction correlated with clinical measures such as fatigue, handgrip strength, and general health. Self-made plot of the main results showing reduced cerebrospinal fluid concentration levels of norepinephrine + DHPG + MHPG in patients with ME/CFS and Long Covid. 2) This was first reported in the famous intramural NIH study on ME/CFS. Unfortunately, the sample size of that study was tiny (n = 16), so they also tested it in Long Covid patients from the Neuro-PASC study.

Patients with Parkinson's were included as disease controls.
May 26 28 tweets 6 min read
1) There's an interesting lead in the ME/CFS genetic data: the eccentric medium spiny neuron (eMSN), a cell type in the brain discovered only a couple of years ago.

All based on preliminary findings, but the data looks rather interesting. Image 2) We have previously discussed how genetic data strongly points towards the brain in ME/CFS to synapses, neuronal communication, and even glutamatergic signals

But this is still quite vague and nonspecific.
May 19 10 tweets 2 min read
1) Researchers from the Department of Psychiatry and Psychotherapy in Leipzig highlight that evidence for psychological factors in ME/CFS and Long Covid remains limited and speculative.

They warn that psychologising these conditions carries significant risks. Image 2) The first risk caused by activation, such as graded activity. Psychological models often assume a vicious cycle of deconditioning. So treatment consists of pushing patients to extend their perceived limits.

In ME/CFS and Long Covid, however, this may cause deterioriation.
May 18 17 tweets 3 min read
1) Independent researcher Paolo Maccalini published an impressive paper implicating synaptic function in various brain regions in the pathology of ME/CFS. It’s based on three major genetic studies, including DecodeME.

The most replicated signal was for glutamatergic synapses. Image 2) He used the DNA results of more than 15.000 ME/CFS patients from DecodeME, but managed to add genetic data on 3891 ME/CFS cases from the Million Veteran Program (MVP) using a meta-analysis.
May 16 10 tweets 4 min read
1) With genetic evidence pointing to the brain, there is renewed interest on the S4ME forum for the buspirone tests done in the 1990s.

A couple of small studies found an increased prolactin response in ME/CFS patients but these findings were never studied further. Graph showing prolactin responses for evening, morning and one hour after buspirone are shown for ME/CFS patients and controls. Bars indicate standard error. 2) Buspirone activates serotonin receptors in the hypothalamus and hippocampus. At the time, ME/CFS was often (but incorrectly) viewed as an atypical form of depression where the serotonin pathway was already implicated.

Suspect that was one reason for doing this test.
May 7 4 tweets 2 min read
Michelle James from Harvard says the TPSO whole body imaging results were very striking and blew her away. Says there's undeniably something significant going on.

Most signal is found in the shoulders, postural muscles, the neck, glutes but also in the bone marrow. Image
Image
Surprisingly: she found a decreased TPSO signal in the brain in ME/CFS, while they expected an increased signal due to microglia activation Image
May 5 6 tweets 2 min read
1) The Selin lab has received Solve ME/CFS grant to continue its work on T-cell receptors in ME/CFS. They have formed a collaboration with Harvard immunologist Ayano Kohigruber to study what the T-cells are responding to. Image 2) Dr. Lisa Selin has been studying T-cells in ME/CFS for a long time, finding subtle clues that point to T-cell exhaustion and Increased ratio of CD4+CD8+ T cells. She suspects this reflects problems keeping persistent pathogens such as Epstein-Barr virus under control.
May 2 11 tweets 3 min read
1) There's a new review on Long Covid by Mark Faghy and (many familiar) co-authors.

I wanted to zoom in on their section on post-exertional malaise (PEM). I'm a bit skeptical, for example, about their statement that 50-80% of Long Covid patients experience PEM. Image 2) The review makes clear that most guidelines from the WHO, CDC, NICE and World Physiotherapy do not recommend graded exercise therapy (GE) for Long Covid patients with PEM.
Apr 1 10 tweets 3 min read
1) 🇧🇷 A big trial from Brazil reports that the antidepressant fluvoxamine improved fatigue in Long Covid patients while the diabetes drug Metformin had no effect.

The effect of fluvoxamine unfortunately looks quite small and it's unclear if it is clinically significant. 2) This was a big trial with 150 participants getting fluvoxamine (100 mg twice daily), 111 metformin (750 mg twice daily), and 138 a matched placebo pill.

The trial used Bayesian analysis with early stopping; they collected data until interim analyses showed a clear result.
Mar 23 10 tweets 3 min read
1) Two age peaks: a fascinating paper confirmed two peaks for when people get ME/CFS: around 16 years old and in the mid thirties.

The early onset in adolescence was associated with severe ME/CFS, an infectious onset, and having relatives with the disease.

A brief summary... Image 2) Healthcare data from Norway had previously suggests that Incidence age is bimodal for ME/CFS. This study checked this pattern using two big sources: the DecodeME study and a large European survey with more than 8000 respondents.
Mar 21 18 tweets 3 min read
1) 🔬🦠New article: we've made a comprehensive overview of the immune system in ME/CFS, analyzing major studies of the past 40 years.

A longread with separate chapters on:

- viral persistence
- cytokines
- neuroinflammation
- antibodies
- immune cells such as NK, B, and T cells Image 2) One of the major findings is that current evidence in blood does not point to (low-grade) inflammation as driving ME/CFS symptoms.

This probably means that it’s either hidden (in tissue) or involves an entirely different immune pathway.
Mar 8 10 tweets 2 min read
1) 🇩🇪 This German study will test the feasibility of home-based diagnostics in patients with severe and very severe ME/CFS (Bell score < 30).

They plan to take blood and saliva samples, questionnaires and measurements such as ECG, ultrasound, pupillary responses, HRV, etc. Image 2) The authors argue that this is urgently needed because these patients are often excluded from research:
"A central limitation of the current body of research is the insufficient inclusion of patients with severe and very severe ME/CFS into clinical studies."
Feb 21 9 tweets 3 min read
1) The ME Association collaborated with the research team of Prof. Sarah Tyson to develop a new questionnaire for assessing ME/CFS symptoms: The Index of ME Symptoms (TIMES).

It assesses 58 symptoms grouped into 9 domains. Image 2) The TIMES questionnaires is based on the DePaul Symptom Questionnaire (DSQ) but the authors adapted it to make it more suitable for clinical assessment (rather than diagnosis).

The goal is to make this part of a suitable ME/CFS toolkit for healthcare professionals.
Feb 18 7 tweets 2 min read
1) The ME Association is funding a new study on neuroimmune biomarkers for ME/CFS and Long Covid.

It will use the new NULISA technology to measure hundreds of proteins linked to the immune system and brain, including many that are too few to detect with standard tests. Image 2) The project will be based at the UK Dementia Research Institute’s Fluid Biomarker Laboratory.

It's led by Sophie Hicks, Research Assistant at UCL Institute of Neurology, who has family members with ME/CFS and Long Covid.
Feb 9 7 tweets 2 min read
1) In this old study from 2005, researchers induced catastrophic thinking in their participants and then recorded their pain intensity after immersing their hand in ice water.

Catastrophizing didn't have any influence on pain. Image 2) The researchers split the participants into two groups and told one of them (the catastrophizing group) that a few people who did the experiment fainted during the ice-water immersion. And the people who fainted had similar responses to the questionnaire as you.
Feb 7 20 tweets 4 min read
1) Dr. Felipe Correa da Silva shared more info about the first 10 brain autopsies from the Netherlands.

In this new thread, we made a brief summary of his presentation. Image 2) The Netherlands Brain Bank has 40 years of experience.

Their ME/CFS program started in April 2024. They currently have 61 registrations and the aim is to have 200 by the end of their 5-year project.
Feb 6 8 tweets 2 min read
1) 🏴󠁧󠁢󠁷󠁬󠁳󠁿 Researchers from Cardiff University followed-up on their findings on complement activation in Long Covid. In this new study, they found differences in the lectin pathway and suggest it might explain endothelial damage and persistent coagulopathy in LC. Image 2) The complement system consists of tiny proteins all over your body that can be activated to initiate an immune response and tagg pathogens so that you immune cells can more easily catch and destroy them.
Feb 2 10 tweets 3 min read
1) Reading this old hypothesis by Michael VanElzakker on how infection of the vagus nerve might cause symptoms similar to ME/CFS.

This nerve passes on info about what's happening internally in the body. So an infection there might cause constant and severe sickness symptoms. Image 2) The vagus nerve is like a highway from your brainstem all the way down to your abdomen, wandering (vagus means wandering in Latin) through major organs along the way.

It picks up pro-inflammatory cytokines and passes on the danger response to the brain.
Jan 28 10 tweets 3 min read
1) Todd Davenport and his colleagues from the Workwell foundation published new data on 2-day exercise testing in patients with Long Covid.

These showed reductions in workload and VO2 max on the second test, similar to ME/CFS patients. Image 2) These cardiopulmonary exercise tests (CPET) involve riding a bike for about 10 minutes. The resistance is increased until you reach your maximum effort.

ME/CFS and Long Covid show lower values on these tests but this doesn't' fully reflect their disease or disability.