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Boruch AE, Barhorst EE, Rayne TJ, Roberge GA, Brukardt SM, Leitel ZT, Coe CL, Fleshner M, Falvo MJ, Cook DB, Lindheimer JB. Exercise does not cause post-exertional malaise in Veterans with Gulf War Illness: A randomized, controlled, dose-response, crossover study. Brain Behav Immun 2024; 120:221-230. [PMID: 38777281 PMCID: PMC11269017 DOI: 10.1016/j.bbi.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic multisymptom illnesses (CMI) such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Long-COVID, and Gulf War Illness (GWI) are associated with an elevated risk of post-exertional malaise (PEM), an acute exacerbation of symptoms and other related outcomes following exercise. These individuals may benefit from personalized exercise prescriptions which prioritize risk minimization, necessitating a better understanding of dose-response effects of exercise intensity on PEM. METHODS Veterans with GWI (n = 40) completed a randomized controlled crossover experiment comparing 20 min of seated rest to light-, moderate-, and vigorous-intensity cycling conditions over four separate study visits. Symptoms, pain sensitivity, cognitive performance, inflammatory markers (C-reactive protein and plasma cytokines) were measured before and within 1 h after exercise and seated rest. Physical activity behavior was measured ≥ 7 days following each study visit via actigraphy. Linear mixed effects regression models tested the central hypothesis that higher intensity exercise would elicit greater exacerbation of negative outcomes, as indicated by a significant condition-by-time interaction for symptom, pain sensitivity, cognitive performance, and inflammatory marker models and a significant main effect of condition for physical activity models. RESULTS Significant condition-by-time interactions were not observed for primary or secondary measures of symptoms, pain sensitivity, cognitive performance, and a majority of inflammatory markers. Similarly, a significant effect of condition was not observed for primary or secondary measures of physical activity. CONCLUSIONS Undesirable effects such as symptom exacerbation were observed for some participants, but the group-level risk of PEM following light-, moderate-, or vigorous-intensity exercise was no greater than seated rest. These findings challenge several prior views about PEM and lend support to a broader body of literature showing that the benefits of exercise outweigh the risks.
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Affiliation(s)
- Alexander E Boruch
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Gunnar A Roberge
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin-Madison, Madison, WI, USA
| | | | - Zoie T Leitel
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Michael J Falvo
- VA Airborne Hazards and Burn Pits Center of Excellence, East Orange, NJ, USA
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin-Madison, Madison, WI, USA
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin-Madison, Madison, WI, USA; James A. Haley Veterans' Hospital, Tampa, FL, USA.
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2
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Bernhoff G, Rasmussen-Barr E, Bunketorp Käll L. A comparison of health-related factors between patients diagnosed with ME/CFS and patients with a related symptom picture but no ME/CFS diagnosis: a cross-sectional exploratory study. J Transl Med 2022; 20:577. [PMID: 36494693 PMCID: PMC9733040 DOI: 10.1186/s12967-022-03769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), the capacity for activity and participation is strongly limited. The disease definition is very broad, and considering the lack of evidence for best treatment, it is important to understand what is ME/CFS-specific in the biopsychosocial perspective in comparison with similar syndromes. The objective was to study the difference between those diagnosed with ME/CFS and those with similar symptoms but no ME/CFS diagnosis for self-perceived level of physical activity, work ability, anxiety/depression, and health-related quality of life. METHODS This was a clinical cross-sectional study with data collected from mailed questionnaires. The following variables were compared between patients diagnosed with ME/CFS (n = 205) and those with similar symptoms but no diagnosis (n = 57); level of physical activity, Work ability index (WAI), Hospital anxiety and depression scale (HAD-A/HAD-D), and RAND-36 Physical functioning, Role limitations due to physical health problems, Role limitations due to personal or emotional problems, Social functioning, Energy/fatigue, Bodily pain, Emotional well-being, and General health perceptions. The Chi-squared test (nominal data), the Mann-Whitney U test, the Student's t test and regression analysis were used to analyze the data. RESULTS The group diagnosed with ME/CFS had a more impaired physical and mental exertion ability as compared to the group that had similar symptoms but was not diagnosed with ME/CFS, shown by a RAND-36 lower index of physical role functioning, social functioning, energy, worse pain and poorer overall health (p ≤ 0.05). In contrast, no significant group differences emerged for weekly level of physical activity, work ability, anxiety/depression, and RAND-36 Emotional role limitation and well-being. CONCLUSION Our results indicate that those with a diagnosis of ME/CFS are characterized by an impaired ability for physical or mental exertion, worse pain, and poorer overall health as compared to individuals with similar symptoms but for whom ME/CFS-diagnosis was not established. The results may be cautiously interpreted as support when focusing on patients' self-care in terms of management of energy levels. The results must however be verified in future studies.
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Affiliation(s)
- Gabriella Bernhoff
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobels allé 23 D2, Huddinge, 141 83, Stockholm, Sweden ,ME Centre, Bragée Clinics, Stockholm, Sweden
| | - Eva Rasmussen-Barr
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Lina Bunketorp Käll
- grid.8761.80000 0000 9919 9582Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden ,grid.1649.a000000009445082XCentre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
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3
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James LM, Georgopoulos AP. At the Root of 3 “Long” Diseases: Persistent Antigens Inflicting Chronic Damage on the Brain and Other Organs in Gulf War Illness, Long-COVID-19, and Chronic Fatigue Syndrome. Neurosci Insights 2022; 17:26331055221114817. [PMID: 35910083 PMCID: PMC9335483 DOI: 10.1177/26331055221114817] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/28/2022] [Indexed: 12/16/2022] Open
Abstract
Several foreign antigens such as those derived from viruses and bacteria have been linked to long-term deleterious effects on the brain and other organs; yet, health outcomes subsequent to foreign antigen exposure vary depending in large part on the host’s immune system, in general, and on human leukocyte antigen (HLA) composition, in particular. Here we first provide a brief description of 3 conditions characterized by persistent long-term symptoms, namely long-COVID-19, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and Gulf War Illness (GWI), followed by a brief overview of the role of HLA in the immune response to foreign antigens. We then discuss our Persistent Antigen (PA) hypothesis and highlight associations between antigen persistence due to HLA-antigen incongruence and chronic health conditions in general and the 3 “long” diseases above in particular. This review is not intended to cover the breadth and depth of symptomatology of those diseases but is specifically focused on the hypothesis that the presence of persistent antigens underlies their pathogenesis.
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Affiliation(s)
- Lisa M James
- Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
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4
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Papaioannou F, Karatzanos E, Chatziandreou I, Philippou A, Nanas S, Dimopoulos S. Epigenetic effects following acute and chronic exercise in cardiovascular disease: A systematic review. Int J Cardiol 2021; 341:88-95. [PMID: 34339767 DOI: 10.1016/j.ijcard.2021.07.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Acute exercise and exercise training may confer epigenetic modifications in healthy subjects. Epigenetic effects after exercise have been showed in patients with cardiovascular disease. The aim of this systematic review was to summarize the evidence from available clinical trials that study epigenetic adaptations after exercise in patients with cardiovascular disease. METHODS The search strategy was performed in PubMed and CENTRAL databases on articles published until September 2020. Studies with titles and abstracts relevant to exercise epigenetic modification applied to cardiovascular patients were fully examined. Inclusion and exclusion criteria were utilized for studies screening. Quality assessment with PEDro scale and evaluation by two independent reviewers was performed. RESULTS Of the 1714 articles retrieved, 88 articles were assessed for eligibility criteria and 8 articles matched our search criteria and finally included in the systematic analysis. The acute exercise epigenetic (miRNAs) effects were assessed in three studies and the chronic exercise training effects (miRNAs and DNA methylation) in six studies. The results have shown that there is possibly an acute significant exercise effect on epigenetic targets which is more evident after chronic exercise training. CONCLUSIONS By the present systematic review, we provide preliminary evidence of beneficial epigenetic adaptations following acute and chronic exercise in patients with cardiovascular disease. More controlled studies are needed to confirm such evidence.
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Affiliation(s)
- Foivos Papaioannou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilenia Chatziandreou
- 1(st) Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastassios Philippou
- Department of Physiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens, Greece; Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens, Greece.
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5
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Mackay A. A Paradigm for Post-Covid-19 Fatigue Syndrome Analogous to ME/CFS. Front Neurol 2021; 12:701419. [PMID: 34408721 PMCID: PMC8365156 DOI: 10.3389/fneur.2021.701419] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of COVID-19 patients are suffering from prolonged Post-COVID-19 Fatigue Syndrome, with characteristics typically found in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, no clear pathophysiological explanation, as yet, has been provided. A novel paradigm for a Post-COVID-19 Fatigue Syndrome is developed here from a recent unifying model for ME/CFS. Central to its rationale, SARS-CoV-2, in common with the triggers (viral and non-viral) of ME/CFS, is proposed to be a physiologically severe stressor, which could be targeting a stress-integrator, within the brain: the hypothalamic paraventricular nucleus (PVN). It is proposed that inflammatory mediators, released at the site of COVID-19 infection, would be transmitted as stress-signals, via humoral and neural pathways, which overwhelm this stress-center. In genetically susceptible people, an intrinsic stress-threshold is suggested to be exceeded causing ongoing dysfunction to the hypothalamic PVN's complex neurological circuitry. In this compromised state, the hypothalamic PVN might then be hyper-sensitive to a wide range of life's ongoing physiological stressors. This could result in the reported post-exertional malaise episodes and more severe relapses, in common with ME/CFS, that perpetuate an ongoing disease state. When a certain stress-tolerance-level is exceeded, the hypothalamic PVN can become an epicenter for microglia-induced activation and neuroinflammation, affecting the hypothalamus and its proximal limbic system, which would account for the range of reported ME/CFS-like symptoms. A model for Post-COVID-19 Fatigue Syndrome is provided to stimulate discussion and critical evaluation. Brain-scanning studies, incorporating increasingly sophisticated imaging technology should enable chronic neuroinflammation to be detected, even at a low level, in the finite detail required, thus helping to test this model, while advancing our understanding of Post-COVID-19 Fatigue Syndrome pathophysiology.
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Affiliation(s)
- Angus Mackay
- The Brain Health Research Centre, University of Otago, Dunedin, New Zealand
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6
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Yoon KJ, Park S, Kwak SH, Moon HY. Effects of Voluntary Running Wheel Exercise-Induced Extracellular Vesicles on Anxiety. Front Mol Neurosci 2021; 14:665800. [PMID: 34276303 PMCID: PMC8280765 DOI: 10.3389/fnmol.2021.665800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Anxiety disorders are the most frequently diagnosed psychological condition, associated with serious comorbidities including excessive fear and interference with daily life. Drugs for anxiety disorders are typically prescribed but the side effects include weight gain, nausea, and sleepiness. Exercise is an effective treatment for anxiety. Exercise induces the release of extracellular vesicles (EVs) into the circulation, which transmit signals between organs. However, the effects of exercise-induced EVs on anxiety remain poorly understood. Here, we isolated EVs from the sera of mice that were sedentary or that voluntarily exercised. We characterized the changes in the miRNA profile of serum EVs after 4 weeks of voluntary exercise. miRNA sequencing showed that 82 miRNAs (46 of which were positive and 36 negative regulators) changed after exercise. We selected genes affected by at least two miRNAs. Of these, 27.27% were associated with neurotrophin signaling (9.09% with each of central nervous system neuronal development, cerebral cortical cell migration, and peripheral neuronal development). We also analyzed behavioral changes in mice with 3 weeks of restraint stress-induced anxiety after injection of 20 μg amounts of EVs from exercised or sedentary mice into the left cerebral ventricle. We found that exercise-derived EVs reduced anxiety (compared to a control group) in a nest-building test but found no between-group differences in the rotarod or open field tests. Exercise-derived EVs enhanced the expression of neuroactive ligand-receptor interaction genes. Thus, exercise-derived EVs may exhibit anti-anxiety effects and may be of therapeutic utility.
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Affiliation(s)
- Kyeong Jin Yoon
- Department of Physical Education, Seoul National University, Seoul, South Korea
| | - Suhong Park
- Department of Physical Education, Seoul National University, Seoul, South Korea
| | - Seung Hee Kwak
- Department of Physical Education, Seoul National University, Seoul, South Korea
| | - Hyo Youl Moon
- Department of Physical Education, Seoul National University, Seoul, South Korea.,Institute of Sport Science, Seoul National University, Seoul, South Korea.,Institute on Aging, Seoul National University, Seoul, South Korea
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7
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O'Neal AJ, Hanson MR. The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review. Front Med (Lausanne) 2021; 8:688486. [PMID: 34222292 PMCID: PMC8253308 DOI: 10.3389/fmed.2021.688486] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, multi-system disease whose etiological basis has not been established. Enteroviruses (EVs) as a cause of ME/CFS have sometimes been proposed, as they are known agents of acute respiratory and gastrointestinal infections that may persist in secondary infection sites, including the central nervous system, muscle, and heart. To date, the body of research that has investigated enterovirus infections in relation to ME/CFS supports an increased prevalence of chronic or persistent enteroviral infections in ME/CFS patient cohorts than in healthy individuals. Nevertheless, inconsistent results have fueled a decline in related studies over the past two decades. This review covers the aspects of ME/CFS pathophysiology that are consistent with a chronic enterovirus infection and critically reviews methodologies and approaches used in past EV-related ME/CFS studies. We describe the prior sample types that were interrogated, the methods used and the limitations to the approaches that were chosen. We conclude that there is considerable evidence that prior outbreaks of ME/CFS were caused by one or more enterovirus groups. Furthermore, we find that the methods used in prior studies were inadequate to rule out the presence of chronic enteroviral infections in individuals with ME/CFS. Given the possibility that such infections could be contributing to morbidity and preventing recovery, further studies of appropriate biological samples with the latest molecular methods are urgently needed.
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Affiliation(s)
- Adam J O'Neal
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, United States
| | - Maureen R Hanson
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, United States
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8
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Boruch AE, Lindheimer JB, Klein-Adams JC, Stegner AJ, Wylie GR, Ninneman JV, Alexander T, Gretzon NP, Samy B, Van Riper SM, Falvo MJ, Cook DB. Predicting post-exertional malaise in Gulf War Illness based on acute exercise responses. Life Sci 2021; 280:119701. [PMID: 34119538 DOI: 10.1016/j.lfs.2021.119701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/22/2021] [Accepted: 05/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS Post-exertional malaise (PEM) is poorly understood in Gulf War Illness (GWI). Exercise challenges have emerged as stimuli to study PEM; however, little attention has been paid to unique cardiorespiratory and perceptual responses during exercise. This study tested whether select exercise parameters explained variability in PEM responses. MAIN METHODS Visual analog scale (0-100) versions of the Kansas questionnaire were used for daily symptom measurements one week before and one week after 30-min of cycling at 70% heart rate reserve in 43 Veterans with GWI and 31 Veteran controls (CON). Cardiopulmonary exercise testing (CPET) methods were used to measure oxygen (VO2), carbon dioxide (VCO2), ventilation (VE), heart rate, work rate, and leg muscle pain. Symptom changes and CPET parameters were compared between groups with independent samples t-tests. Linear regression (GLM) with VE/VCO2, cumulative work, leg muscle pain, and self-reported physical function treated as independent variables and peak symptom response as the dependent variable tested whether exercise responses predicted PEM. KEY FINDINGS Compared to CON, Veterans with GWI had greater ventilatory equivalent for oxygen (VE/VO2), peak leg muscle pain, fatigue, and lower VCO2, VO2, power, and cumulative work during exercise (p < 0.05), and greater peak symptom responses (GWI = 38.90 ± 29.06, CON = 17.84 ± 28.26, g = 0.70, p < 0.01). The final GLM did not explain significant variance in PEM (Pooled R2 = 0.15, Adjusted R2 = 0.03, p = 0.34). SIGNIFICANCE The PEM response was not related to the selected combination of cardiorespiratory and perceptual responses to exercise.
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Affiliation(s)
- Alexander E Boruch
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America; Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Jacquelyn C Klein-Adams
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Glenn R Wylie
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America; Kessler Foundation, The Rocco Ortenzio Neuroimaging Center, West Orange, NJ, United States of America; Department of Pharmacology, Physiology, and Neuroscience, Rutgers, New Jersey Medical School, Newark, New Jersey, United States of America; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, United States of America
| | - Jacob V Ninneman
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Thomas Alexander
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Nicholas P Gretzon
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Bishoy Samy
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Stephanie M Van Riper
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Michael J Falvo
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America; Department of Pharmacology, Physiology, and Neuroscience, Rutgers, New Jersey Medical School, Newark, New Jersey, United States of America; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, United States of America
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America.
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The Effect of Eight Weeks of Endurance Training with Saffron on miR133bFC, miR29aFC in the Hippocampus Tissue and Depression in Rats with Alzheimer’s Disease. Jundishapur J Nat Pharm Prod 2021. [DOI: 10.5812/jjnpp.103333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recent studies indicate that deregulation of microRNAs (miRNAs) expression is associated with neurological and cognitive disorders, but physical activity and medicinal plants have favorable effects on physiological and psychological factors in these patients. Objectives: Therefore, we aimed to investigate the effect of endurance training (ET) with saffron (S) on miR133bFC, miR29aFC in the hippocampus tissue and depression of rats with Alzheimer’s disease (AD). Methods: Forty AD rats with the mean age of eight weeks and mean weight of 250 ± 30.65 g were randomly divided into five groups of eight rats including: (1) control (C), (2) ET, (3) ET + S, (4) S, and (5) sham (normal saline) (Sh). During eight weeks, groups 2 and 3 ran on a treadmill for three sessions per week, each session lasting for 15 - 30 minutes, at a speed of 20 - 15 m/min, and groups 3 and 4 received 25 mg/kg daily aqueous extract of S peritoneally. Depression was evaluated by the forced swim test. Results: The levels of miR29aFC were higher in the ET + S group than in the C (P = 0.002), Sh (P = 0.003), ET (P = 0.003), and S (P = 0.001) groups. The levels of miR133bFC in the S (P = 0.02) and ET (P = 0.005) groups were lower than the C group. The mobility time in the ET (P = 0.001), S (P = 0.001), and ET + S (P = 0.001) groups was higher than the C group; in the ET + S group, the mobility time was higher than in the ET (P = 0.001) and S (P = 0.001) groups, and in the S group the mobility time was higher than in the ET group (P = 0.001). Conclusions: It seems that ET and S administration alone do not have favorable effects on miR29aFC and miR133bFC expression levels, but both can decrease depression; however, the simultaneous administration S and ET has interactive effects on improving miR29aFC expression and reducing depression.
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10
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Baraniuk JN, Kern G, Narayan V, Cheema A. Exercise modifies glutamate and other metabolic biomarkers in cerebrospinal fluid from Gulf War Illness and Myalgic encephalomyelitis / Chronic Fatigue Syndrome. PLoS One 2021; 16:e0244116. [PMID: 33440400 PMCID: PMC7806361 DOI: 10.1371/journal.pone.0244116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
Myalgic encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) and Gulf War Illness (GWI) share many symptoms of fatigue, pain, and cognitive dysfunction that are not relieved by rest. Patterns of serum metabolites in ME/CFS and GWI are different from control groups and suggest potential dysfunction of energy and lipid metabolism. The metabolomics of cerebrospinal fluid was contrasted between ME/CFS, GWI and sedentary controls in 2 sets of subjects who had lumbar punctures after either (a) rest or (b) submaximal exercise stress tests. Postexercise GWI and control subjects were subdivided according to acquired transient postexertional postural tachycardia. Banked cerebrospinal fluid specimens were assayed using Biocrates AbsoluteIDQ® p180 kits for quantitative targeted metabolomics studies of amino acids, amines, acylcarnitines, sphingolipids, lysophospholipids, alkyl and ether phosphocholines. Glutamate was significantly higher in the subgroup of postexercise GWI subjects who did not develop postural tachycardia after exercise compared to nonexercise and other postexercise groups. The only difference between nonexercise groups was higher lysoPC a C28:0 in GWI than ME/CFS suggesting this biochemical or phospholipase activities may have potential as a biomarker to distinguish between the 2 diseases. Exercise effects were suggested by elevation of short chain acylcarnitine C5-OH (C3-DC-M) in postexercise controls compared to nonexercise ME/CFS. Limitations include small subgroup sample sizes and absence of postexercise ME/CFS specimens. Mechanisms of glutamate neuroexcitotoxicity may contribute to neuropathology and “neuroinflammation” in the GWI subset who did not develop postural tachycardia after exercise. Dysfunctional lipid metabolism may distinguish the predominantly female ME/CFS group from predominantly male GWI subjects.
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Affiliation(s)
- James N Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Grant Kern
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Vaishnavi Narayan
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Amrita Cheema
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Centre, Georgetown University, Washington, DC, United States of America
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11
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Narayan V, Shivapurkar N, Baraniuk JN. Informatics Inference of Exercise-Induced Modulation of Brain Pathways Based on Cerebrospinal Fluid Micro-RNAs in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. NETWORK AND SYSTEMS MEDICINE 2020; 3:142-158. [PMID: 33274349 PMCID: PMC7703497 DOI: 10.1089/nsm.2019.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: The post-exertional malaise of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) was modeled by comparing micro-RNA (miRNA) in cerebrospinal fluid from subjects who had no exercise versus submaximal exercise. Materials and Methods: Differentially expressed miRNAs were examined by informatics methods to predict potential targets and regulatory pathways affected by exercise. Results: miR-608, miR-328, miR-200a-5p, miR-93-3p, and miR-92a-3p had higher levels in subjects who rested overnight (nonexercise n=45) compared to subjects who had exercised before their lumbar punctures (n=15). The combination was examined in DIANA MiRpath v3.0, TarBase, Cytoscape, and Ingenuity software® to select the intersection of target mRNAs. DIANA found 33 targets that may be elevated after exercise, including TGFBR1, IGFR1, and CDC42. Adhesion and adherens junctions were the most frequent pathways. Ingenuity selected seven targets that had complementary mechanistic pathways involving GNAQ, ADCY3, RAP1B, and PIK3R3. Potential target cells expressing high levels of these genes included choroid plexus, neurons, and microglia. Conclusion: The reduction of this combination of miRNAs in cerebrospinal fluid after exercise suggested upregulation of phosphoinositol signaling pathways and altered adhesion during the post-exertional malaise of ME/CFS. Clinical Trial Registration Nos.: NCT01291758 and NCT00810225.
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Affiliation(s)
- Vaishnavi Narayan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Narayan Shivapurkar
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - James N. Baraniuk
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
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Profile of circulating microRNAs in myalgic encephalomyelitis and their relation to symptom severity, and disease pathophysiology. Sci Rep 2020; 10:19620. [PMID: 33184353 PMCID: PMC7665057 DOI: 10.1038/s41598-020-76438-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex chronic disease, rooted in multi-system dysfunctions characterized by unexplained debilitating fatigue. Post-exertional malaise (PEM), defined as the exacerbation of the patient's symptoms following minimal physical or mental stress, is a hallmark of ME/CFS. While multiple case definitions exist, there is currently no well-established biomarkers or laboratory tests to diagnose ME/CFS. Our study aimed to investigate circulating microRNA expression in severely ill ME/CFS patients before and after an innovative stress challenge that stimulates PEM. Our findings highlight the differential expression of eleven microRNAs associated with a physiological response to PEM. The present study uncovers specific microRNA expression signatures associated with ME/CFS in response to PEM induction and reports microRNA expression patterns associated to specific symptom severities. The identification of distinctive microRNA expression signatures for ME/CFS through a provocation challenge is essential for the elucidation of the ME/CFS pathophysiology, and lead to accurate diagnoses, prevention measures, and effective treatment options.
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Dickey B, Madhu LN, Shetty AK. Gulf War Illness: Mechanisms Underlying Brain Dysfunction and Promising Therapeutic Strategies. Pharmacol Ther 2020; 220:107716. [PMID: 33164782 DOI: 10.1016/j.pharmthera.2020.107716] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
Gulf War Illness (GWI), a chronic multisymptom health problem, afflicts ~30% of veterans served in the first GW. Impaired brain function is among the most significant symptoms of GWI, which is typified by persistent cognitive and mood impairments, concentration problems, headaches, chronic fatigue, and musculoskeletal pain. This review aims to discuss findings from animal prototypes and veterans with GWI on mechanisms underlying its pathophysiology and emerging therapeutic strategies for alleviating brain dysfunction in GWI. Animal model studies have linked brain impairments to incessantly elevated oxidative stress, chronic inflammation, inhibitory interneuron loss, altered lipid metabolism and peroxisomes, mitochondrial dysfunction, modified expression of genes relevant to cognitive function, and waned hippocampal neurogenesis. Furthermore, the involvement of systemic alterations such as the increased intensity of reactive oxygen species and proinflammatory cytokines in the blood, transformed gut microbiome, and activation of the adaptive immune response have received consideration. Investigations in veterans have suggested that brain dysfunction in GWI is linked to chronic activation of the executive control network, impaired functional connectivity, altered blood flow, persistent inflammation, and changes in miRNA levels. Lack of protective alleles from Class II HLA genes, the altered concentration of phospholipid species and proinflammatory factors in the circulating blood have also been suggested as other aiding factors. While some drugs or combination therapies have shown promise for alleviating symptoms in clinical trials, larger double-blind, placebo-controlled trials are needed to validate such findings. Based on improvements seen in animal models of GWI, several antioxidants and anti-inflammatory compounds are currently being tested in clinical trials. However, reliable blood biomarkers that facilitate an appropriate screening of veterans for brain pathology need to be discovered. A liquid biopsy approach involving analysis of brain-derived extracellular vesicles in the blood appears efficient for discerning the extent of neuropathology both before and during clinical trials.
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Affiliation(s)
- Brandon Dickey
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA; Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Leelavathi N Madhu
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, TX, USA.
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Odegaard KE, Chand S, Wheeler S, Tiwari S, Flores A, Hernandez J, Savine M, Gowen A, Pendyala G, Yelamanchili SV. Role of Extracellular Vesicles in Substance Abuse and HIV-Related Neurological Pathologies. Int J Mol Sci 2020; 21:E6765. [PMID: 32942668 PMCID: PMC7554956 DOI: 10.3390/ijms21186765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Extracellular vesicles (EVs) are a broad, heterogeneous class of membranous lipid-bilayer vesicles that facilitate intercellular communication throughout the body. As important carriers of various types of cargo, including proteins, lipids, DNA fragments, and a variety of small noncoding RNAs, including miRNAs, mRNAs, and siRNAs, EVs may play an important role in the development of addiction and other neurological pathologies, particularly those related to HIV. In this review, we summarize the findings of EV studies in the context of methamphetamine (METH), cocaine, nicotine, opioid, and alcohol use disorders, highlighting important EV cargoes that may contribute to addiction. Additionally, as HIV and substance abuse are often comorbid, we discuss the potential role of EVs in the intersection of substance abuse and HIV. Taken together, the studies presented in this comprehensive review shed light on the potential role of EVs in the exacerbation of substance use and HIV. As a subject of growing interest, EVs may continue to provide information about mechanisms and pathogenesis in substance use disorders and CNS pathologies, perhaps allowing for exploration into potential therapeutic options.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sowmya V. Yelamanchili
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA; (K.E.O.); (S.C.); (S.W.); (S.T.); (A.F.); (J.H.); (M.S.); (A.G.); (G.P.)
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15
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Washington SD, Rayhan RU, Garner R, Provenzano D, Zajur K, Addiego FM, VanMeter JW, Baraniuk JN. Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Brain Commun 2020; 2:fcaa070. [PMID: 32954325 PMCID: PMC7425336 DOI: 10.1093/braincomms/fcaa070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022] Open
Abstract
Gulf War Illness affects 25-30% of American veterans deployed to the 1990-91 Persian Gulf War and is characterized by cognitive post-exertional malaise following physical effort. Gulf War Illness remains controversial since cognitive post-exertional malaise is also present in the more common Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An objective dissociation between neural substrates for cognitive post-exertional malaise in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome would represent a biological basis for diagnostically distinguishing these two illnesses. Here, we used functional magnetic resonance imaging to measure neural activity in healthy controls and patients with Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome during an N-back working memory task both before and after exercise. Whole brain activation during working memory (2-Back > 0-Back) was equal between groups prior to exercise. Exercise had no effect on neural activity in healthy controls yet caused deactivation within dorsal midbrain and cerebellar vermis in Gulf War Illness relative to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients. Further, exercise caused increased activation among Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients within the dorsal midbrain, left operculo-insular cortex (Rolandic operculum) and right middle insula. These regions-of-interest underlie threat assessment, pain, interoception, negative emotion and vigilant attention. As they only emerge post-exercise, these regional differences likely represent neural substrates of cognitive post-exertional malaise useful for developing distinct diagnostic criteria for Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
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Affiliation(s)
- Stuart D Washington
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Rakib U Rayhan
- Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC 20059, USA
| | - Richard Garner
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Destie Provenzano
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Kristina Zajur
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Florencia Martinez Addiego
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - John W VanMeter
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA.,Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC 20059, USA.,Center for Functional and Molecular Imaging, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - James N Baraniuk
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
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Does Motor Cortex Engagement During Movement Preparation Differentially Inhibit Nociceptive Processing in Patients with Chronic Whiplash Associated Disorders, Chronic Fatigue Syndrome and Healthy Controls? An Experimental Study. J Clin Med 2020; 9:jcm9051520. [PMID: 32443565 PMCID: PMC7290436 DOI: 10.3390/jcm9051520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). METHODS The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. RESULTS No differences in N1, N2, N2P2, and P2 LEP amplitudes were found between the HC, CFS, and cWAD groups. After nociceptive stimulation, N1, N2 (only at hand location), N2P2, and P2 LEP amplitudes significantly decreased during movement preparation compared to no task (within group differences). CONCLUSION Movement preparation induces a similar attenuation of LEPs in patients with CFS, patients with cWAD and HC. These findings do not support reduced motor-induced nociceptive inhibition in these patients.
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Cheema AK, Sarria L, Bekheit M, Collado F, Almenar‐Pérez E, Martín‐Martínez E, Alegre J, Castro‐Marrero J, Fletcher MA, Klimas NG, Oltra E, Nathanson L. Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS. J Cell Mol Med 2020; 24:5865-5877. [PMID: 32291908 PMCID: PMC7214164 DOI: 10.1111/jcmm.15260] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multisystem illness characterized by medically unexplained debilitating fatigue with suggested altered immunological state. Our study aimed to explore peripheral blood mononuclear cells (PBMCs) for microRNAs (miRNAs) expression in ME/CFS subjects under an exercise challenge. The findings highlight the immune response and inflammation links to differential miRNA expression in ME/CFS. The present study is particularly important in being the first to uncover the differences that exist in miRNA expression patterns in males and females with ME/CFS in response to exercise. This provides new evidence for the understanding of differential miRNA expression patterns and post-exertional malaise in ME/CFS. We also report miRNA expression pattern differences associating with the nutritional status in individuals with ME/CFS, highlighting the effect of subjects' metabolic state on molecular changes to be considered in clinical research within the NINDS/CDC ME/CFS Common Data Elements. The identification of gender-based miRNAs importantly provides new insights into gender-specific ME/CFS susceptibility and demands exploration of sex-suited ME/CFS therapeutics.
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Affiliation(s)
- Amanpreet K. Cheema
- Institute for Neuro Immune MedicineDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
- Department of NutritionDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
| | - Leonor Sarria
- Institute for Neuro Immune MedicineDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
| | - Mina Bekheit
- Halmos College of Natural Sciences and OceanographyNova Southeastern UniversityFort LauderdaleFLUSA
| | - Fanny Collado
- Department of Veterans AffairsMiami VA Healthcare System, Research ServiceMiamiFLUSA
- South Florida Veterans Affairs Foundation for Research and Education IncFort LauderdaleFLUSA
| | - Eloy Almenar‐Pérez
- Escuela de DoctoradoUniversidad Católica de Valencia San Vicente MártirValenciaSpain
| | | | - Jose Alegre
- Vall d'Hebron University HospitalVall d'Hebron Research InstituteUniversitat Autónoma de BarcelonaBarcelonaSpain
| | - Jesus Castro‐Marrero
- Vall d'Hebron University HospitalVall d'Hebron Research InstituteUniversitat Autónoma de BarcelonaBarcelonaSpain
| | - Mary A. Fletcher
- Institute for Neuro Immune MedicineDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
- Department of Veterans AffairsMiami VA Healthcare System, Research ServiceMiamiFLUSA
- South Florida Veterans Affairs Foundation for Research and Education IncFort LauderdaleFLUSA
| | - Nancy G. Klimas
- Institute for Neuro Immune MedicineDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
- Department of Veterans AffairsMiami VA Healthcare System, Research ServiceMiamiFLUSA
- South Florida Veterans Affairs Foundation for Research and Education IncFort LauderdaleFLUSA
| | - Elisa Oltra
- School of MedicineUniversidad Católica de Valencia San Vicente MártirValenciaSpain
| | - Lubov Nathanson
- Institute for Neuro Immune MedicineDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
- Department of NutritionDr. Kiran C. Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleFLUSA
- Halmos College of Natural Sciences and OceanographyNova Southeastern UniversityFort LauderdaleFLUSA
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18
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Lindheimer JB, Stegner AJ, Wylie GR, Klein-Adams JC, Almassi NE, Ninneman JV, Van Riper SM, Dougherty RJ, Falvo MJ, Cook DB. Post-exertional malaise in veterans with gulf war illness. Int J Psychophysiol 2020; 147:202-212. [PMID: 31786249 PMCID: PMC6957714 DOI: 10.1016/j.ijpsycho.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/07/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
Abstract
Post-exertional malaise (PEM) is a potentially debilitating aspect of Gulf War Illness (GWI) that has received limited research attention. The purpose of the present investigation was to determine symptom severity changes following exercise in Veterans with GWI compared to control Veterans without GWI (CO). Sixty-seven Veterans (n = 39 GWI; n = 28 CO) underwent a 30-minute submaximal exercise challenge at 70% of heart rate reserve. Symptom measurements (e.g. fatigue, pain) occurred pre-, immediately post-, and 24-hour post-exercise. Self-reported physical and mental health, and physiological and perceptual responses to exercise were compared between groups using descriptive statistics, independent samples t-tests and repeated measures Analysis of Variance (RM-ANOVA). Post-exertional malaise was modeled using Group by Time (2 × 3) doubly-multivariate, RM-MANOVAs for (1) mood, (2) pain and (3) GWI-related symptoms, respectively (α = 0.05). Data were analyzed for the full sample of Veterans with GWI (n = 39) compared to CO (n = 28) and a subsample of Veterans (n = 18) who endorsed "feeling unwell after physical exercise or exertion" ("PEM endorsers") during screening. Veterans with GWI reported significantly lower physical and mental health. Groups exercised at similar relative exercise intensities, but GWI perceived exercise as more painful and fatiguing. Group-by-Time interactions were not significant for the entire sample for the three PEM models, however limiting the GWI sample to "PEM endorsers" resulted in significant interactions for Pain- and GWI-related PEM models. These results indicate that not all GVs with GWI experience PEM 24 h after exercise, and that more research is needed to determine the extent that exercise worsens symptoms in GWI.
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Affiliation(s)
- Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Glenn R Wylie
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America; Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States of America; New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Jacquelyn C Klein-Adams
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America
| | - Neda E Almassi
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Jacob V Ninneman
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Stephanie M Van Riper
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Ryan J Dougherty
- Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Michael J Falvo
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America; New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America.
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20
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Garner R, Baraniuk JN. Orthostatic intolerance in chronic fatigue syndrome. J Transl Med 2019; 17:185. [PMID: 31159884 PMCID: PMC6547462 DOI: 10.1186/s12967-019-1935-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/23/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Orthostatic intolerance (OI) is a significant problem for those with chronic fatigue syndrome (CFS). We aimed to characterize orthostatic intolerance in CFS and to study the effects of exercise on OI. METHODS CFS (n = 39) and control (n = 25) subjects had recumbent and standing symptoms assessed using the 20-point, anchored, ordinal Gracely Box Scale before and after submaximal exercise. The change in heart rate (ΔHR ≥ 30 bpm) identified Postural Orthostatic Tachycardia Syndrome (POTS) before and after exercise, and the transient, exercise-induced postural tachycardia Stress Test Activated Reversible Tachycardia (START) phenotype only after exercise. RESULTS Dizziness and lightheadedness were found in 41% of recumbent CFS subjects and in 72% of standing CFS subjects. Orthostatic tachycardia did not account for OI symptoms in CFS. ROC analysis with a threshold ≥ 2/20 on the Gracely Box Scale stratified CFS subjects into three groups: No OI (symptoms < 2), Postural OI (only standing symptoms ≥ 2), and Persistent OI (recumbent and standing symptoms ≥ 2). CONCLUSIONS Dizziness and Lightheadedness symptoms while recumbent are an underreported finding in CFS and should be measured when doing a clinical evaluation to diagnose orthostatic intolerance. POTS was found in 6 and START was found in 10 CFS subjects. Persistent OI had symptoms while recumbent and standing, highest symptom severity, and lability in symptoms after exercise. Trial registration The trial was registered at the following: https://clinicaltrials.gov/ct2/show/NCT03567811.
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Affiliation(s)
- Richard Garner
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd NW Preclinical Science LD03, Washington, DC 20007 USA
| | - James N. Baraniuk
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd NW Preclinical Science LD03, Washington, DC 20007 USA
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Epigenetic Components of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Uncover Potential Transposable Element Activation. Clin Ther 2019; 41:675-698. [PMID: 30910331 DOI: 10.1016/j.clinthera.2019.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/02/2019] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Studies to determine epigenetic changes associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) remain scarce; however, current evidence clearly shows that methylation patterns of genomic DNA and noncoding RNA profiles of immune cells differ between patients and healthy subjects, suggesting an active role of these epigenetic mechanisms in the disease. The present study compares and contrasts the available ME/CFS epigenetic data in an effort to evidence overlapping pathways capable of explaining at least some of the dysfunctional immune parameters linked to this disease. METHODS A systematic search of the literature evaluating the ME/CFS epigenome landscape was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Differential DNA methylation and noncoding RNA differential expression patterns associated with ME/CFS were used to screen for the presence of transposable elements using the Dfam browser, a search program nurtured with the Repbase repetitive sequence database and the RepeatMasker annotation tool. FINDINGS Unexpectedly, particular associations of transposable elements and ME/CFS epigenetic hallmarks were uncovered. A model for the disease emerged involving transcriptional induction of endogenous dormant transposons and structured cellular RNA interactions, triggering the activation of the innate immune system without a concomitant active infection. IMPLICATIONS Repetitive sequence filters (ie, RepeatMasker) should be avoided when analyzing transcriptomic data to assess the potential participation of repetitive sequences ("junk repetitive DNA"), representing >45% of the human genome, in the onset and evolution of ME/CFS. In addition, transposable element screenings aimed at designing cost-effective, focused empirical assays that can confirm or disprove the suspected involvement of transposon transcriptional activation in this disease, following the pilot strategy presented here, will require databases gathering large ME/CFS epigenetic datasets.
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Almenar-Pérez E, Sánchez-Fito T, Ovejero T, Nathanson L, Oltra E. Impact of Polypharmacy on Candidate Biomarker miRNomes for the Diagnosis of Fibromyalgia and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Striking Back on Treatments. Pharmaceutics 2019; 11:pharmaceutics11030126. [PMID: 30889846 PMCID: PMC6471415 DOI: 10.3390/pharmaceutics11030126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 12/14/2022] Open
Abstract
Fibromyalgia (FM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are diseases of unknown etiology presenting complex and often overlapping symptomatology. Despite promising advances on the study of miRNomes of these diseases, no validated molecular diagnostic biomarker yet exists. Since FM and ME/CFS patient treatments commonly include polypharmacy, it is of concern that biomarker miRNAs are masked by drug interactions. Aiming at discriminating between drug-effects and true disease-associated differential miRNA expression, we evaluated the potential impact of commonly prescribed drugs on disease miRNomes, as reported by the literature. By using the web search tools SM2miR, Pharmaco-miR, and repoDB, we found a list of commonly prescribed drugs that impact FM and ME/CFS miRNomes and therefore could be interfering in the process of biomarker discovery. On another end, disease-associated miRNomes may incline a patient’s response to treatment and toxicity. Here, we explored treatments for diseases in general that could be affected by FM and ME/CFS miRNomes, finding a long list of them, including treatments for lymphoma, a type of cancer affecting ME/CFS patients at a higher rate than healthy population. We conclude that FM and ME/CFS miRNomes could help refine pharmacogenomic/pharmacoepigenomic analysis to elevate future personalized medicine and precision medicine programs in the clinic.
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Affiliation(s)
- Eloy Almenar-Pérez
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain.
| | - Teresa Sánchez-Fito
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain.
| | - Tamara Ovejero
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain.
| | - Lubov Nathanson
- Kiran C Patel College of Osteopathic Medicine, Nova Southeastern University, Ft Lauderdale, FL 33314, USA.
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft Lauderdale, FL 33314, USA.
| | - Elisa Oltra
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain.
- Unidad Mixta CIPF-UCV, Centro de Investigación Príncipe Felipe, 46012 Valencia, Spain.
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23
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Rayhan RU, Washington SD, Garner R, Zajur K, Martinez Addiego F, VanMeter JW, Baraniuk JN. Exercise challenge alters Default Mode Network dynamics in Gulf War Illness. BMC Neurosci 2019; 20:7. [PMID: 30791869 PMCID: PMC6385399 DOI: 10.1186/s12868-019-0488-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Gulf War Illness (GWI) affects 30% of veterans from the 1991 Gulf War and has no known cause. Everyday symptoms include pain, fatigue, migraines, and dyscognition. A striking syndromic feature is post-exertional malaise (PEM). This is recognized as an exacerbation of everyday symptoms following a physically stressful or cognitively demanding activity. The underlying mechanism of PEM is unknown. We previously reported a novel paradigm that possibly captured evidence of PEM by utilizing fMRI scans taken before and after sub-maximal exercises. We hypothesized that A) exercise would be a sufficient physically stressful activity to induce PEM and B) Comparison of brain activity before and after exercise would provide evidence of PEM's effect on cognition. We reported two-exercise induced GWI phenotypes with distinct changes in brain activation patterns during the completion of a 2-back working memory task (also known as two-back > zero-back). RESULTS Here we report unanticipated findings from the reverse contrast (zero-back > two-back), which allowed for the identification of task-related deactivation patterns. Following exercise, patients developed a significant increase in deactivation patterns within the Default Mode Network (DMN) that was not seen in controls. The DMN is comprised of regions that are consistently down regulated during external goal-directed activities and is often altered within many neurological disease states. CONCLUSIONS Exercise-induced alterations within the DMN provides novel evidence of GWI pathophysiology. More broadly, results suggest that task-related deactivation patterns may have biomarker potential in Gulf War Illness.
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Affiliation(s)
- Rakib U Rayhan
- Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC, 20059, USA. .,Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
| | - Stuart D Washington
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Richard Garner
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Kristina Zajur
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Florencia Martinez Addiego
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - John W VanMeter
- Center for Functional and Molecular Imaging, Georgetown University Medical Center, 3900 Reservoir Road Suite LM14, Washington, DC, 20007, USA
| | - James N Baraniuk
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
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24
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Mackay A. A neuro-inflammatory model can explain the onset, symptoms and flare-ups of myalgic encephalomyelitis/chronic fatigue syndrome. J Prim Health Care 2019. [DOI: 10.1071/hc19041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
A neuro-inflammatory model is proposed to explain the onset, symptoms and perpetuation of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) via characteristic flare-ups (relapses). In this article, I explore the proposition that a range of triggers (intense physiological stressors such as severe viral infections, chemical toxin exposure or emotional trauma) in ME/CFS-predisposed people causes disruption in the neural circuitry of the hypothalamus (paraventricular nucleus), which induces a neuro-inflammatory reaction in the brain and central nervous system of ME/CFS patients, via over-active innate immune (glial) cells. Resulting dysfunction of the limbic system, the hypothalamus and consequently of the autonomic nervous system can then account for the diverse range of ME/CFS symptoms. Ongoing stressors feed into a compromised (inflamed) hypothalamus and if a certain (but variable) threshold is exceeded, a flare-up will ensue, inducing further ongoing neuro-inflammation in the central nervous system, thus perpetuating the disease indefinitely.
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25
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Mackay A, Tate WP. A compromised paraventricular nucleus within a dysfunctional hypothalamus: A novel neuroinflammatory paradigm for ME/CFS. Int J Immunopathol Pharmacol 2018. [PMCID: PMC6291860 DOI: 10.1177/2058738418812342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A neuroinflammatory paradigm is presented to help explain the pathophysiology of
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The hypothalamic
paraventricular nucleus (PVN) is responsible for absorbing and processing
multiple, incoming and convergent ‘stress’ signals, and if this cluster of
neurons were affected (by neuroinflammation), the ongoing hypersensitivity of
ME/CFS patients to a wide range of ‘stressors’ could be explained.
Neuroinflammation that was chronic and fluctuating, as ‘inflammatory-marker’
studies support, could reflect a dynamic change in the hypothalamic PVN’s
threshold for managing incoming ‘stress’ signals. This may not only be a
mechanism underpinning the characteristic feature of ME/CFS, post-exertional
malaise, and its associated debilitating relapses, but could also be responsible
for mediating the long-term perpetuation of the disease. Triggers (sustained
physiological ‘stressors’) of ME/CFS, such as a particular viral infection,
toxin exposure, or a traumatic event, could also target the hypothalamic PVN, a
potentially vulnerable site in the brains of ME/CFS susceptible people, and
disruption of its complex neural circuitry could account for the onset of
ME/CFS. In common with the different ‘endogenous factors’ identified in the
early ‘neuroinflammatory’ stages of the ‘neurodegenerative’ diseases, an as yet,
unidentified factor within the brains and central nervous system (CNS) of ME/CFS
patients might induce both an initial and then sustained ‘neuroinflammatory’
response by its ‘innate immune system’. Positron emission tomography/magnetic
resonance imaging has reinforced evidence of glial cell activation centred on
the brain’s limbic system of ME/CFS patients. Neuroinflammation causing
dysfunction of the limbic system and its hypothalamus together with a
consequently disrupted autonomic nervous system could account for the diverse
range of symptoms in ME/CFS relating, in particular to fatigue, mood, cognitive
function, sleep, thermostatic control, gastrointestinal disturbance, and
hypotension.
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Affiliation(s)
- Angus Mackay
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Warren P Tate
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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26
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Hatziagelaki E, Adamaki M, Tsilioni I, Dimitriadis G, Theoharides TC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Metabolic Disease or Disturbed Homeostasis due to Focal Inflammation in the Hypothalamus? J Pharmacol Exp Ther 2018; 367:155-167. [PMID: 30076265 DOI: 10.1124/jpet.118.250845] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease characterized by debilitating fatigue, lasting for at least 6 months, with associated malaise, headaches, sleep disturbance, and cognitive impairment, which severely impacts quality of life. A significant percentage of ME/CFS patients remain undiagnosed, mainly due to the complexity of the disease and the lack of reliable objective biomarkers. ME/CFS patients display decreased metabolism and the severity of symptoms appears to be directly correlated to the degree of metabolic reduction that may be unique to each individual patient. However, the precise pathogenesis is still unknown, preventing the development of effective treatments. The ME/CFS phenotype has been associated with abnormalities in energy metabolism, which are apparently due to mitochondrial dysfunction in the absence of mitochondrial diseases, resulting in reduced oxidative metabolism. Such mitochondria may be further contributing to the ME/CFS symptomatology by extracellular secretion of mitochondrial DNA, which could act as an innate pathogen and create an autoinflammatory state in the hypothalamus. We propose that stimulation of hypothalamic mast cells by environmental, neuroimmune, pathogenic and stress triggers activates microglia, leading to focal inflammation in the brain and disturbed homeostasis. This process could be targeted for the development of novel effective treatments.
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Affiliation(s)
- Erifili Hatziagelaki
- Second Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece (E.H., M.A., G.D.); Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology (I.T., T.C.T.) and Sackler School of Graduate Biomedical Sciences (T.C.T.), Tufts University School of Medicine, Boston, Massachusetts; and Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (T.C.T.)
| | - Maria Adamaki
- Second Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece (E.H., M.A., G.D.); Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology (I.T., T.C.T.) and Sackler School of Graduate Biomedical Sciences (T.C.T.), Tufts University School of Medicine, Boston, Massachusetts; and Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (T.C.T.)
| | - Irene Tsilioni
- Second Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece (E.H., M.A., G.D.); Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology (I.T., T.C.T.) and Sackler School of Graduate Biomedical Sciences (T.C.T.), Tufts University School of Medicine, Boston, Massachusetts; and Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (T.C.T.)
| | - George Dimitriadis
- Second Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece (E.H., M.A., G.D.); Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology (I.T., T.C.T.) and Sackler School of Graduate Biomedical Sciences (T.C.T.), Tufts University School of Medicine, Boston, Massachusetts; and Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (T.C.T.)
| | - Theoharis C Theoharides
- Second Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece (E.H., M.A., G.D.); Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology (I.T., T.C.T.) and Sackler School of Graduate Biomedical Sciences (T.C.T.), Tufts University School of Medicine, Boston, Massachusetts; and Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (T.C.T.)
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27
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Blomberg J, Gottfries CG, Elfaitouri A, Rizwan M, Rosén A. Infection Elicited Autoimmunity and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: An Explanatory Model. Front Immunol 2018; 9:229. [PMID: 29497420 PMCID: PMC5818468 DOI: 10.3389/fimmu.2018.00229] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/26/2018] [Indexed: 12/13/2022] Open
Abstract
Myalgic encephalomyelitis (ME) often also called chronic fatigue syndrome (ME/CFS) is a common, debilitating, disease of unknown origin. Although a subject of controversy and a considerable scientific literature, we think that a solid understanding of ME/CFS pathogenesis is emerging. In this study, we compiled recent findings and placed them in the context of the clinical picture and natural history of the disease. A pattern emerged, giving rise to an explanatory model. ME/CFS often starts after or during an infection. A logical explanation is that the infection initiates an autoreactive process, which affects several functions, including brain and energy metabolism. According to our model for ME/CFS pathogenesis, patients with a genetic predisposition and dysbiosis experience a gradual development of B cell clones prone to autoreactivity. Under normal circumstances these B cell offsprings would have led to tolerance. Subsequent exogenous microbial exposition (triggering) can lead to comorbidities such as fibromyalgia, thyroid disorder, and orthostatic hypotension. A decisive infectious trigger may then lead to immunization against autoantigens involved in aerobic energy production and/or hormone receptors and ion channel proteins, producing postexertional malaise and ME/CFS, affecting both muscle and brain. In principle, cloning and sequencing of immunoglobulin variable domains could reveal the evolution of pathogenic clones. Although evidence consistent with the model accumulated in recent years, there are several missing links in it. Hopefully, the hypothesis generates testable propositions that can augment the understanding of the pathogenesis of ME/CFS.
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Affiliation(s)
- Jonas Blomberg
- Department of Medical Sciences, Uppsala University, Clinical Microbiology, Academic Hospital, Uppsala, Sweden
| | | | - Amal Elfaitouri
- Department of Infectious Disease and Tropical Medicine, Faculty of Public Health, Benghazi University, Benghazi, Libya
| | - Muhammad Rizwan
- Department of Medical Sciences, Uppsala University, Clinical Microbiology, Academic Hospital, Uppsala, Sweden
| | - Anders Rosén
- Department of Clinical and Experimental Medicine, Division of Cell Biology, Linköping University, Linköping, Sweden
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