Research Digest 26/07/19

Welcome to the 28th 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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Post-exertional malaise is associated with hypermetabolism, hypoacetylation and purine metabolism deregulation in ME/CFS cases

Authors: McGregor N, Armstrong C, Lewis D, Gooley P.


Post-exertional malaise (PEM) is the primary symptom of ME/CFS. In this study, Australian researchers examined biomarkers of ME/CFS patients after a PEM episode for a period of seven days, and compared these to those of healthy controls. This is a complex paper, analysing changes in biochemistry.

Results showed a fall in hypoxanthine, a purine metabolite that was associated with PEM severity. ‘This decrease correlated with alterations in the glucose:lactate ratio, highly suggestive of a glycolytic anomaly.’ Glycolysis is the energy production pathway in the body that converts glucose into usable energy.

Increased levels of urine metabolites were also found, which suggests there is hypermetabolism occurring during PEM. ‘Increases in urine excretion of methylhistidine (muscle protein degradation), mannitol (intestinal barrier deregulation) and acetate were noted with the hypermetabolic event.’ These findings suggest the primary events associated with PEM were due to hypoacetylation and metabolite loss during the acute PEM response.

The authors also indicated that their results suggest that graded exercise therapy (GET) is more likely to be harmful than beneficial for people with ME/CFS.

‘The findings that PEM is associated with a loss of metabolites, reduction in acetylation, deregulation of purine metabolism, increased contractile protein breakdown and bacteremia associated with exercise, suggest that treatments such as graded exercise may be more detrimental than beneficial, as claimed in some studies. Until such time as these biological changes can be further investigated, the use of graded exercise as a therapy for those with severe forms of ME/CFS should be considered potentially harmful. In support of this, the use of graded exercise therapy has caused significant protest by ME/CFS sufferers as they see it as harmful.’

This paper is from the Emerge Australia sponsored issue of Diagnostics.

Advances in understanding the pathophysiology of chronic fatigue syndrome

Author: Komaroff AL.


Over the past 35 years, significant progress has been made in ME/CFS research. In this paper, Dr Komaroff, who has been studying ME/CFS since the 1980s, provides a brief summary of the main research findings. The paper was published in the Journal of American Medical Association (JAMA) Network, one of the most popular journals among doctors globally.

The author explored areas of research in the central and autonomic nervous system, metabolic changes, and immunologic changes. The paper summarises this research, as well as provocation studies, (studies which provoke post-exertional malaise using exercise, in order to study its effects), and provides an overview of potential unifying models, which integrate several ideas into a single explanation of the illness. The paper concludes that biological measurements clearly distinguish patients with ME/CFS from healthy control individuals, while acknowledging the ongoing challenges facing ME/CFS research.

Current research provides insight into the biological basis and diagnostic potential for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Authors: Sweetman E, Noble A, Edgar C, Mackay A, Helliwell A, Vallings R, Ryan M, Tate W.


Researchers in New Zealand suggest that the biological basis of ME/CFS lies in an elevation of inflammatory and immune processes, ongoing neuroinflammation, and decreases in general metabolism and mitochondrial function for energy production.

They propose that the Canadian Consensus Criteria (CCC) is the best available definition for clinical diagnosis of ME/CFS. They also propose that nanoneedle bioassay technology is another promising mode of diagnosis, which works by testing for the presence of unique ‘impedance signatures’ that exist only in ME/CFS patients. These signatures are specific patterns in the way that patients reduce the interfering electrical signals that prevent optimal muscle performance.

Finally, Ritalin, a central nervous system stimulant used in conjunction with mitochondrial support nutrients, has suggested a trend in improvement in fatigue.

This paper is from the Emerge Australia sponsored issue of Diagnostics.
International ME/CFS conference videos

In the last three weeks, two separate international ME/CFS conferences have released videos from their events. The inaugural Harvard ME/CFS Collaboration Symposium was held in the US on 8 June. The symposium was sponsored by the Open Medicine Foundation and focused on finding clarity in the complexities of ME/CFS. You can find all their videos from the event on their Youtube channel here:

In the UK, Invest in ME held their 14th International Conference on 31 May. Running since 2006, Invest in ME’s annual conference is one of the longest-running ME/CFS conferences dedicated to biomedical research. You can find all their videos from the event on their Youtube channel here:

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