Welcome to the 44th Emerge Australia Research Digest, where you will find summaries of some of the latest research and information about ME/CFS, with links to the complete articles.

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Biomedical Insights That Inform the Diagnosis of ME/CFS

Authors: Lidbury, B.A., Fisher, P.R.
Link: https://www.mdpi.com/2075-4418/10/2/92/htm

This book is a collection of articles published in the ME/CFS special issue of the journal Diagnostics, which had Australian ME/CFS researchers Ass Prof Brett Lidbury and Prof Paul Fisher as guest editors. ME/CFS “is a disease with a physiological basis, rooted in biochemical and molecular dysfunction in the cells of sick individuals, and not attitudes that can be alleviated by psychological therapies. This book is intended as a landmark volume to mark this shift in thinking and to consolidate recent fundamental discoveries and biomedical insights as pathways towards tangible diagnostics, and eventual ME/CFS treatments”. 

This special issue was sponsored by Emerge Australia, as part of our 2019 ME/CFS International Research Symposium.

The book is divided into two sections. Part One presents commentaries and reviews of the broader ME/CFS literature and Part Two presents the latest biomedical research. 

Notable research insights include:
•    A survey by Holtzman et al which collected valuable information on post-exertional malaise (PEM) including data on PEM triggers, timing and duration. 
•    A pathology test, identified by Nacul et al, which links low serum concentration levels of creatine kinase to severe ME/CFS cases. 
•    Additional research which identified several biomarkers which indicate metabolomic biochemistry anomalies for ME/CFS patients as well as a new hypothesis on the pathology of ME/CFS. 

Overall, the book highlights the value of biomedical research in ME/CFS and provides a stepping stone to further research into the field.

A print edition of this book is available for purchase from the journal’s website.


Interventions to treat pain in paediatric CFS/ME: a systematic review

Author: Ascough, C., King, H,. Serafimova, T., Beasant, L., Jackson, S., Baldock, L., Pickering, A.E., Brooks, J., Crawley, E.
Link: https://bmjpaedsopen.bmj.com/content/bmjpo/4/1/e000617.full.pdf

ME/CFS is prevalent in 1-2% of adolescents and of those, nearly two-thirds report moderate or severe pain. Pain is associated with increased fatigue and decreased physical function in adolescents with ME/CFS.

This paper attempts to identify whether specialist treatment of paediatric ME/CFS improved pain scores. A detailed literature search was conducted. Twenty six studies were identified which measured treatment of paediatric ME/CFS. Of these, just five measured pain, though none of the interventions were specifically targeted at pain. The treatments in four of the five trials were behavioural, with one study examining a pharmaceutical treatment.  

The systematic review of these five trials found that there is low evidence that treatments targeted at ME/CFS improved pain levels. Unsurprisingly, those who recovered from ME/CFS (according to study definitions) reported less pain. Given the low number of trials and low evidence quality, the authors concluded that more robust studies were required in this area.


Cytomegalovirus, Epstein‐Barr virus, and human herpesvirus‐6 infections in patients with myalgic encephalomyelitis/chronic fatigue syndrome

Author: Shikova, E., Reshkova, V., Kumanova, A., Raleva, S., Alexandrova, D., Capo, N., Murovska, M.
Link: https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.25744

Human herpes viruses have long been associated with ME/CFS, with some considered to be possible triggering events for the development of ME/CFS. This study examines the prevalence and type (active or latent) of three human herpesviruses: cytomegalovirus (CMV), Epstein‐Barr virus (EBV), and human herpes virus‐6 (HHV-6) among ME/CFS patients compared with healthy controls. The study involved 58 ME/CFS patients (Fukuda criteria) and 50 healthy controls in Bulgaria. 

There was no significant difference in latent virus infection rates (CMV, EBV and HHV-6), nor in active CMV or HHV-6 infection rates between ME/CFS patients and healthy controls. However, ME/CFS patients had significantly higher rates of active EBV infection as compared to healthy controls.

These results may indicate that, at least for a subset of patients, EBV represents an important factor for the development of ME/CFS.


Peripheral endothelial dysfunction in myalgic encephalomyelitis / chronic fatigue syndrome

Authors: Scherbakov, N., Szklarski, M., Hartwig, J., Sotzny, F., Lorenz, S., Meyer, A., Grabowski, P., Doehner, W., Scheibenbogen, C.
Link: https://doi.org/10.1002/ehf2.12633
 
Symptoms of orthostatic intolerance and cerebral hypoperfusion are common in ME/CFS patients, and are suggestive of dysfunctional vascular regulation. The aim of this study was to examine peripheral endothelial dysfunction (PED) in ME/CFS.

This study used peripheral arterial tonometry to assess PED in 35 ME/CFS patients (Canadian Consensus Criteria) and 20 healthy controls. PED was found in 51% of ME/CFS patients and 20% of healthy controls, and this difference was significant. ME/CFS patients with PED reported more severe fatigue-related symptoms such as increased demand for breaks, sore throat, painful lymph nodes, and more severe disease. 

The authors note that PED is a risk factor for cardiovascular disease, and conclude that further research is warranted to determine if PED may be a prognostic marker to assess risk of cardiovascular morbidity and mortality in ME/CFS.

The authors acknowledged the limitation of the relatively small sample sizes used and recommended further research using more participants.