Welcome to the 81st 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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Cortical autonomic network connectivity predicts symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Authors: Zinn MA and Jason LA (DePaul University)
Publication: International Journal of Psychophysiology
Link: https://www.sciencedirect.com/science/article/abs/pii/S0167876021009004#!

Previous research suggests many features of ME/CFS may be the result of autonomic nervous system (ANS) dysfunction. The ANS is distributed throughout the body and controlled by interrelated neuronal cell groups, with a primary function of maximising brain efficiency for optimal task performance, and increasing blood supply to groups involved in particular tasks. This study aimed to investigate the involvement of the cortical autonomic network (CAN) in the higher-order control of ANS functioning.
Participants were recruited from the DePaul Brain Imagery Study database and included 34 participants with ME/CFS (Fukuda criteria) and 34 healthy controls. All participants completed resting-state quantitative electroencephalographic scalp recordings (closed eye conditions), and data was analysed to estimate intrinsic functional connectivity. Symptoms were also measured via questionnaire.
Analysis of the measurements were completed across seven frequency bands. Results showed cognitive, affective, and somatomotor symptom cluster ratings were associated with alteration to CAN topology in ME/CFS participants, depending on the frequency band. The authors propose that this is suggestive of problems with homeostatic regulation (maintaining stability in different conditions) in ME/CFS patients.
The authors conclude that these results suggest reduced higher-order homeostatic regulation and adaptability is present in ME/CFS. The authors propose that further investigation into this topic is required to confirm these results. The authors suggest that the CAN may provide a potential therapeutic target for symptom management for ME/CFS patients.

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Complement Component C1q as a Potential Diagnostic Tool for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Subtyping

Authors: Castro-Marrero J, Zacares M, Almenar-Pérez E, Alegre-Martín J, and Oltra E. (Universidad Católica de Valencia San Vicente Mártir, Spain)
Publication: Journal of Clinical Medicine
Link:https://www.mdpi.com/2077-0383/10/18/4171
 
While the identification of altered blood factors in ME/CFS patients would be clinically useful, to date few significant results have been found in studies examining routine clinical parameters. This study aimed to identify clinical parameters which will differentiate ME/CFS subgroups.
Two hundred and fifty adult females with ME/CFS (Fukuda and Canadian Consensus Criteria) participated in the study. The cohort was divided into three clusters: mild (n = 49), moderate (n = 107) or severe (n = 94). Participants provided a fasting blood sample, completed validated standardised questionnaires to assess disease and symptom severity, and provided demographic and clinical data. The levels of 69 blood factors were measured in each blood sample.  
Blood analysis identified five blood parameters which, while within the normal reference ranges, were significantly different across the three clusters. However none of these five factors could differentiate all three individual clusters.
Analysis further identified several factors which were outside the normal reference range in the cohort, including vitamin D (60.4%), in which many patients were deficient, and increased levels of complement factor C1q (42.8%). The authors noted that several patients (8.8%) also had decreased levels of C1 inhibitor, and that elevated C1q coupled with C1q deficiency is associated with several autoimmune diseases. Further analysis did not show significant differences between C1q levels and symptom severity scores, however there was a non-significant trend towards an association between higher C1q levels and increased bodily pain. In addition, several blood factors (including higher red blood cell count and lower IgG3 and IgG4 concentrations) were associated with elevated C1q levels.
This study is the first to identify that the C1q may be involved in ME/CFS pathology and creates a pathway for further research in this area.

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Orthostatic Symptoms and Reductions in Cerebral Blood Flow in Long-Haul COVID-19 Patients: Similarities with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Authors: van Campen CMC, Rowe PC and Visser FC (Stichting CardioZorg, The Netherlands)
Publication: Medicina   
Link: https://www.mdpi.com/1648-9144/58/1/28
 
There is significant overlap in symptoms between Long COVID and ME/CFS. As patients with both conditions commonly experience orthostatic intolerance, these authors compared haemodynamic and cerebral blood flow response to an orthostatic test in Long COVID and ME/CFS patients.
Ten Long COVID patients with postural orthostatic tachycardia syndrome (POTS) were compared to three groups of 20 people each that were all age- and gender-matched: ME/CFS patients with POTS, ME/CFS patients with normal heart rate and blood pressure responses, and healthy controls. ME/CFS patients were diagnosed according to the International Consensus Criteria (ICC). In order to compare symptoms between Long COVID and ME/CFS, the three patient groups were also compared with the Fukuda criteria, the ICC and the Institute of Medicine (IOM) criteria. All participants underwent the tilt test while heart rate, systolic blood pressure, and diastolic blood pressure were continuously recorded. Additionally, extracranial cerebral blood flow, cardiac output and orthostatic symptoms were assessed.
All Long COVID patients fulfilled the Fukuda and IOM criteria and 9 fulfilled the ICC criteria. There were no significant differences in symptom clusters between Long COVID and ME/CFS patients. In response to the tilt test, all three patient groups had significantly reduced cerebral blood flow and cardiac output compared with healthy controls. The reduction in cerebral blood flow in Long COVID patients was similar to that of ME/CFS patients with POTS, and significantly higher than in ME/CFS patients with normal heart rate and blood pressure responses. There were no significant differences in cardiac output between the three patient groups. The number of orthostatic symptoms did not differ between Long COVID patients, ME/CFS patients with POTS and ME/CFS patients with normal heart rate and blood pressure responses.

This study highlights the similarities between Long COVID patients and ME/CFS patients on aspects like symptom prevalence and response to the tilt test, supporting the notion that SARS-CoV-2 infection can act as a trigger for the development of ME/CFS in Long COVID patients.

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Authors: Chris Smith
Publication: The Chris Smith Show, 2GB
Link: https://www.2gb.com/podcast/the-chris-smith-full-show-podcast-6-2-22/
 
Emerge Australia CEO, Anne Wilson, was interviewed about ME/CFS by 2GB presenter Chris Smith on Sunday February 6. Anne talked about getting a diagnosis of ME/CFS in the absence of a diagnostic test, the stigma facing patients, and the critical need for more GP education and new Australian clinical guidelines, better access to supports like NDIS, and more research funding. 
 
“It needs to be understood that people with ME/CFS often have this total change to their life. They were previously happy, healthy, working or studying … and their life goes from being this fully functioning person to often being housebound or bedridden. … Their lives have changed and for many of them they have been suffering for ten or twenty years.”
“Our 250,000 people [with ME/CFS] have been forgotten and overlooked by our healthcare system. People are often not believed. They are told that it’s in their mind, or they’re told by well-meaning people or by GPs to go and exercise, which only makes them far worse and makes people crash.”
The interview starts at 2 hrs 41 mins 05 secs and runs for about 17 minutes. Note: there is a loud song playing just before the interview starts, so we recommend setting the sound low at the beginning if you are sensitive to sound.