In een recente presentatie bracht
dr. Ian Lipkin,
bekend geworden van dé studie naar XMRV/MLV,
tussentijds verslag uit van zijn onderzoeksresultaten in het kader van
het Chronic Fatigue Initiative.
Zijn bevindingen,
gebaseerd op een groot aantal monsters, zijn opmerkelijk te noemen:
- Lipkin en collega's vonden geen virussen/bacteriën in het bloed én
in het ruggenmergvloeistof.
- Wel vonden zij in 85% van de monsters tekenen van een retrovirus (!)
Echter, hij schat in dat dat retrovirus waarschijnlijk van geen betekenis is.
- In ontlasting-monsters vond hij en zijn collega's het
anellovirus,
een virus dat oorspronkelijk
geassocieerd werd met bloedtransfusies en hepatitis:
Torque Teno Virus (TTV), Torque Teno Midi Virus (TTMDV) en Torque Teno Mini Virus (TTMV),
maar de rol van dit virus en het belang voor ME/CVS is nog onduidelijk en lijkt gering.
- Het bloed van patiënten vertoont tekenen van immuunactivatie:
TNFa,
IL-8,
IL-2 en
IL-17.
- ME/CVS-patiënten die minder dan 3 jaar ziek zijn en patiënten die langer dan 3 jaar ziek zijn,
kunnen op basis van subtiele verschillen in cytokine-profielen van elkaar onderscheiden worden.
Allergieën lijken vooral in het begin een rol te spelen
(eosinofielen-respons, IL-17-concentraties).
Het immuunsysteem lijkt een (centrale) rol te spelen in de progressieve karakters van de ziekte.
- Het onderzoek van het ruggenmergloeistof liet zeer opmerkelijke resultaten zien.
- verhoogde hoeveelheden
IL-10,
IL-5,
IL-13,
kenmerkend door Th2-immuunactivatie,
verhoogde concentraties IL-1b, illustratief voor inflammatie, en
een toename van IL-17, een cytokine die een centrale rol speelt in Th17-immuunactivatie.
Als dit juist is, is de naam (Myalgisch) Encephalomyelitis gerechtvaardigd
(zie ook hier).
- Ondanks het feit dat Lipkin geen virussen en bacterieen in bloed en ruggenmerg vond,
lijkt hij ervan overtuigd dat een
"infectieuze agent" de inflammatie/immuunactivatie veroorzaakt.
- Volgens Lipkin speelt het microbioom
(de micro-organismen) in de darmen een centrale rol.
Voor een ander (ongeverifiëerd) verslag van de presentatie, klik op onderstaande afbeelding:
Kanttekening:
Volgens een toelichting van dr. Chia opgetekend door Patrick Calvin
onderzocht Lipkin het bloedplasma op de aanwezigheid van virussen, en
werden de witte bloed-cellen, een aantrekkelijke "schuilplaats" voor virussen, niet onderzocht.
Foremost Virus Hunter Finds Biomarkers,
Few Viruses in Big Chronic Fatigue Syndrome Study
Cort Johnson
September 11, 2013
A Surprise Presentation
We will publish data very soon on biomarkers of cytokines.
Our evidence now suggests
there is ongoing stimulus to the immune system.
Dr. Ian Lipkin
...
Virus Study Results Revealed
...
A special feature of the study involved Simmaron Research's spinal fluid samples.
Called a 'unique resource' earlier by Dr. Mady Hornig,
these samples allowed the researchers to get as close to the brain –
long thought to be a key area in chronic fatigue syndrome –
as they could. And the spinal fluid results were spectacular.
The Studies
...
Pathogens
First Phase -
Screens for 18 specific pathogens already implicated in ME/CFS
(herpesviruses, HTLV, enteroviruses, West Nile Virus, etc.)
were done on blood from Montoya's patients and
the CFI's group (Dr's Peterson, Klimas, Bateman, Levine, etc.).
Dr. Lipkin was looking for the virus,
not an indication it was present, but the virus itself.
...
Immune Response
A 'multiplexed immunoassay' looked at
50 proteins associated with immune activation/inflammation and oxidative stress.
Active Viruses Strike Out
Four of the 285 ME/CFS blood samples tested positive for HHV-6B.
One of the sixty spinal fluid samples tested positive for a virus (HHV-6B).
None of the other viruses commonly associated with ME/CFS
(Epstein Barr-Virus, enteroviruses, the cytomegalovirus, etc.)
showed up in the first pathogen screen.
The high throughput screening designed to look for any viruses
including novel viruses drew a blank as well.
...
With two large sample sets turning up negative
in the lab of one of most acclaimed virus hunters on the planet,
it's probably safe to say that
the hunt for an active infectious agent
in the blood of people with ME/CFS is over.
(Lipkin did report 85% of pooled samples
possibly showed evidence of a retrovirus
but believes they will not be related to CFS.
He also dismissed earlier rumors
that a novel infectious agent had been found.)
Infectious Agent Still Proposed
That doesn't mean an infectious agent is not involved.
In fact, Dr. Lipkin stated he didn't doubt that an infectious agent was involved.
He didn't say where and he didn't say it was still present.
...
Dr. Lipkin specifically alluded to an 'agent'
driving the immune activation he found
in both the blood and spinal fluid of ME/CFS patients
(but not the healthy controls).
Localized Infections Still Appear to Be a Possibility
...
The blood is the most convenient place to search for an virus and
active viruses usually do travel through the blood
but central nervous system or localized infections
may not show up in the blood or the spinal fluid.
...
The Three Year Breakpoint
Data suggests there may be
substantial differences in biomarkers
in people with less than 3 years of disease
and those with more than 3 years of disease.
Dr. Lipkin
Two research groups suggest the immune systems of
people with recent onset and longer duration ME/CFS are significantly different.
...
Dr. Lipkin's ability to independently
differentiate 'newer' from 'older' patients using cytokine results is pivotal, and
points to the central and progressive role the immune system
may play in this disorder.
With Broderick suggesting that two distinct illnesses emerge over time,
and Lipkin proposing treatment options should reflect illness duration,
it was clear these changes were significant indeed.
...
An Early Allergic Response
Allergy is not usually mentioned in association with ME/CFS
but eosinophils and other markers suggested to Dr. Lipkin that
the allergic response was enhanced in ME/CFS early on.
The cast of immune characters Lipkin's biomarker search fleshed out
was refreshingly familiar with IL-17, IL-2, IL-8 and TNF-a leading the list.
Levels of Il-17 were raised in recent onset ME/CFS patients.
Lipkin suggested immunomoculators able to bring IL-17 levels down
might be treatment option at some point.
...
The spinal fluid, interestingly enough, showed a very different pattern.
It showed a consistent profile of
immunological dysregulation in CFS,
regardless of duration of illness.
Dr. Lipkin identified
increased IL-10 and IL-13 levels
suggesting enhanced Th2 activation and
increased IL-1B, IL-5 and IL-17
suggesting Th1 (proinflammatory) activation.
Dr. Lipkin was obviously intrigued by the differences in
cytokine findings between spinal fluid and blood.
A Focus on the Gut
I think the gut microbiome is going to be
where the action is (in chronic fatigue syndrome).
Dr. Ian Lipkin
Lipkin's prime focus at this point is the gut and fecal matter.
...
Unfortunately, the fecal samples originally collected
didn't provide enough material for analysis
so they're restarting that part of the study.
Even more unfortunately,
characterizing the bacteria in fecal matter is extremely expensive.
...
Conclusion
The Chronic Fatigue Initiative's pathogen study set a benchmark
for rigor and size in the ME/CFS research field,
not the least because of Dr. Lipkin's leadership.
Surprisingly few viruses were found in the blood of ME/CFS patients,
yet Lipkin asserted that
an infectious agent was likely driving the immune activation
he found in the blood and spinal samples.
Cytokine analyses of the blood suggested
a different pattern of immune dysregulation
was present in newer onset patients (<3 years) and
patients with a longer duration of illness.
Dr. Lipkin believes
the "primary cause is likely to be an infectious agent" and
the gut microbiome is where 'the action' will be in ME/CFS.
http://simmaronresearch.com/2013/09/
foremost-virus-hunter-finds-biomarkers-few-viruses-chronic-fatigue-syndrome
Met dank aan Manja, die mij attendeerde op het aanvullende verslag op Wiki ME/CVS forums
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