Welcome to the 82nd 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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Limbic perfusion is reduced in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Authors: Li X, Julin P and Li TQ (Karolinska Institutet, Stockholm)
Publication: Tomography
Link: https://www.mdpi.com/2379-139X/7/4/56/htm

 
Previous studies have consistently identified neurological and cognitive abnormalities in ME/CFS patients. In contrast, little is known about the regional cerebral blood flow (rCBF) in ME/CFS. rCBF can be quantitively measured by the pseudo-continuous arterial spin labelling (PCASL) technique, and can show neural activity changes and can act as a biomarker for brain function. This study aimed to compare rCBF between ME/CFS patients and healthy controls to identify variations.
31 ME/CFS patients were recruited from the patient registry at the Neurological Rehabilitation Clinic-Stora Sköndal. All patients met the Canadian Consensus Criteria, International Consensus Criteria and Institute of Medicine (National Academy of Medicine) criteria. Other medical and psychiatric illnesses were excluded and participants self-reported symptom severity. 48 healthy controls were also recruited. Participants provided self-rated general physical function and fatigue measurements weekly over 8 weeks. All participants completed one MRI session to obtain PCASL measurements.
The authors found that the patient group showed statistically significant hypoperfusion (about 34% reduction) in several brain regions of the limbic system compared with healthy controls. These included the anterior cingulate cortex, putamen, pallidum, and anterior ventral insular area. The authors also found that for the patient group, overall symptom severity score at rest was associated with reduced rCBF in the anterior cingulate cortex.
The authors conclude that the results of this study show that brain blood flow abnormalities found in the limbic system may contribute to ME/CFS pathogenesis. This may provide avenues for further research and targets for treatment in the future.

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Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Authors: Stanculescu D, Sepúlveda N, Lim CL, and Bergquist J (Uppsala University, Sweden).
Publication: Frontiers in Neurology
Link: https://www.frontiersin.org/articles/10.3389/fneur.2021.789784/full

Heat stroke is caused by the body’s inability to maintain a normal core temperature when exposed to high temperature environments or strenuous exercise. It a serious condition that can lead to central nervous system disturbances, multi-organ dysfunction and potentially death. Despite the differences in onset and outcome of the condition, there are several similarities with ME/CFS. These authors assume that different stressors and disease symptoms may have a common physiological pathway. The paper describes the similarities between heat stroke and ME/CFS and highlights how heat stroke research can contribute to understanding ME/CFS.
Heat stroke research has identified the pathophysiological role of endotoxemia of intestinal origin. The dual pathway model of heat stroke proposes that two sequential but independent pathways can be involved in triggering heat stroke: heat toxicity pathway (toxicity derived directly from hyperthermia) and endotoxemia (or heat sepsis) pathway. The endotoxemia pathway results in systemic inflammation, and is increasingly recognised as the leading cause of severe organ damage and death from heat stroke.
Several similarities have been observed between the endotoxemia pathway in heat stroke and ME/CFS, including vasoconstriction and hypoxia, gastrointestinal hyper-permeability and endotoxemia, oxidative and nitrosative stress and cytokine-associated inflammation, central nervous system dysfunction, coagulopathy dysfunction and endothelial cell injury, mitochondrial dysfunction, and altered gene expressions. Similarities in pre-disposing factors for both conditions were also discussed.

While a review of the relevance of heat stroke therapies for ME/CFS was beyond the scope of this paper, the authors highlighted that further research into the role of supplements and pharmacological therapies to repair gastrointestinal immune and barrier functions, modulate inflammatory responses, and reduce endotoxemia may be warranted in ME/CFS.



Figure: Pathophysiological mechanisms during heat stroke, and similarities in ME/CFS

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Analysis of post COVID-19 condition and its overlap with myalgic encephalomyelitis/chronic fatigue syndrome

Authors: Sukocheva OA, Maksoud R, Beeraka NM, Madhunapantula SV, Sinelnikov M, Nikolenko VN, …. and Marshall-Gradisnik S (Griffith University, Australia)
Publication: Journal of Advanced Research
Link: https://www.sciencedirect.com/science/article/pii/S2090123221002320

The World Health Organisation has defined post COVID-19 condition as one which occurs three months following infection with the SARS-CoV-2 virus. This condition may be representative of, or related to, other post-infective conditions, including ME/CFS. This study reviews key aspects of post-COVID-19, commonalities with ME/CFS, and potential interventions for COVID-19 survivors.
 
There is considerable overlap in symptomatology between ME/CFS and post-COVID-19. Post-COVID-19 features persistent fatigue and post-exertional malaise, as well as many symptoms commonly described by people with ME/CFS. Both conditions are multi-systemic, with changes observed in cardiovascular, metabolic, immune, gastrointestinal, and autonomic and central nervous systems. One study found that 45% of those who had had COVID-19 met ME/CFS diagnostic criteria six months after infection.
 
The authors highlighted several areas where future research is warranted to better understand post-COVID-19 condition and ME/CFS. These include the roles of angiotensin converting enzyme 2 (ACE2) polymorphism, interleukin-6 (IL-6), natural killer (NK) cells, calcium signalling, nervous system pathophysiology, and mitochondrial changes. While there is evidence of ongoing physiological dysfunction post-COVID-19 infection, the authors conclude that suitable treatment options are unlikely to be identified until the cause of the condition has been confirmed.
 
Given the wide overlap between ME/CFS and post-COVID-19 found in this review, the authors conclude that many patients presenting that chronic symptoms following COVID-19 infection could eventually meet the criteria for a diagnosis of ME/CFS, and should be monitored and assessed accordingly.


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How long COVID is putting the spotlight on chronic fatigue syndrome

Authors: Harper H, Mackenzie M
Publication: ABC Life Matters
Link: https://www.abc.net.au/radionational/programs/lifematters/how-long-covid-is-putting-the-spotlight-on-chronic-fatigue/13797106

On a recent episode of ABC Life Matters, Emerge Australia CEO, Anne Wilson, ME/CFS patient, Sara Gingold, and Associate Professor of Rehabilitation and Human Performance, Mount Sinai Health System, Dr David Putrino, were interviewed about ME/CFS and Long COVID.
Anne spoke about the injustice and neglect that people with ME/CFS have long experienced.
“Right now we’ve got stories of patients that have had to wait ten years to be diagnosed. We’ve also got stories of people who’ve been in bed, at home, not out of the house for ten years.
I say, quite passionately, in what universe is it okay for us to keep people at home, in bed, with a condition and not provide any funds… not do anything to see how we can help those people.”

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