Welcome to the 37th 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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Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Author: Polo O, Pesonen P, Tuominen E.
Link: https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20

This study retrospectively examined the effectiveness of using low-dose naltrexone (LDN) from the health records of 218 patients. Results showed that 73.9% of patients reported positive responses to the treatment.

Patients reported improved vigilance/alertness and physical and cognitive performance. Some experienced less pain and fever while around 18% reported no treatment response. Initial adverse side effects include mild insomnia and nausea and no severe or long-term adverse effects were reported.

The high positive response rate in this retrospective study should prompt further research to confirm the feasibility of using LDN as a possible treatment for ME/CFS.


$1.2m NHMRC grant for ME/CFS neuroimaging project

Link: https://www.usc.edu.au/explore/usc-news-exchange/news-archive/2019/december/usc-research-to-diagnose-invisible-illness-faster

The National Health & Medical Research Council (NHMRC) recently announced the results of its annual funding round. For the first time since 2003, a biomedical ME/CFS research project has been successful in this highly competitive process. Of the 2651 applications for Ideas Grants, just 294 were funded, meaning that this application was in the top 11% of all applications.

About the project

Investigator: Dr Zack Shan (University of Sunshine Coast) 
Title: Multimodal MRI of myalgic encephalomyelitis/chronic fatigue syndrome: Understanding its neuropathophysiology and developing an objective neuromarker

This is a five-year grant that will allow Dr Shan to explore his hypothesis that abnormal neurovascular coupling may be the cause of ME/CFS. 'Neurovascular coupling – known as NVC –  refers to the regulation of cerebral blood flow to match brain activity, which is critically important for normal brain function,' Dr Shan said.

This grant is in addition to funding that the Department of Health has already pledged for ME/CFS:

  • Health economics study (Emerge Australia is proud to be a partner on this project)
  • $3m targeted call for research (applications are currently open and will close on Jan 29, 2020).

Identification of actin network proteins, talin-1 and filamin-A, in circulating extracellular vesicles as blood biomarkers for human myalgic encephalomyelitis/chronic fatigue syndrome

Author: Eguchi A, Fukuda S, Kuratsune 3, Nojima J, Nakatomi Y, Watanabe Y, Feldstein AE.
Link: https://www.ncbi.nlm.nih.gov/pubmed/31759091

Researchers in Japan and the US have identified a group of proteins which may be used as non-invasive diagnostic biomarkers. The study compared the circulating extracellular vesicles (EVs) among patients with those of patients diagnosed with depression or idiopathic chronic fatigue (ICF), and healthy controls. EVs are substances released from damaged or stressed cells with cellular content, such as proteins, which are used for cell-to-cell communication.

Results showed that circulating EV levels were significantly increased in ME/CFS patients. The study also found that these EVs contained specific proteins (namely talin-1, filamin-A, and 14-3-3 family proteins) which could be used as biomarkers for ME/CFS. In addition, these proteins could differentiate between ME/CFS and patients with depression or ICF.

The next step would be to expand the study cohort and to have the findings replicated by other researchers. 


Understanding neuromuscular disorders in chronic fatigue syndrome

Authors: Yves Jammes, Frédérique Retornaz
Link: https://f1000research.com/articles/8-2020

This paper explains the abnormalities that exist at an electrophysiological level in the muscles of people with ME/CFS.

Some studies have found evidence of central fatigue, an altered central nervous system command to muscles in people with ME/CFS, compared with healthy controls. In particular, there is evidence of a reduced capacity to voluntarily contract muscles during maximal effort tests, reduced amplitude of myopotentials with stimulation of the motor cortex, and slower reaction times. 


Studies have also found evidence of peripheral fatigue, or muscle failure, including alterations of M-waves (muscle response to stimulation), suggesting impaired muscle membrane excitability, which may contribute to the delayed recovery from exercise in people with ME/CFS. 

The authors also note that ME/CFS patients exhibit reduced ion fluxes through muscle membranes, increased production of reactive oxygen species (ROS), and reduced heat shock protein (HSP) production and expression following exercise. As HSPs help protect the cells against the damaging effects of ROS, the authors conclude that the reduced HSPs may explain both the elevated oxidative stress and altered myopotentials, and could represent a potential treatment opportunity.