Longitudinal cytokine and multi-modal health data of an extremely severe ME/CFS patient with HSD reveals insights into immunopathology, and disease severity

Introduction

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) presents substantial challenges in patient care due to its intricate multisystem nature, comorbidities, and global prevalence. The heterogeneity among patient populations, coupled with the absence of FDA-approved diagnostics and therapeutics, further complicates research into disease etiology and patient managment. Integrating longitudinal multi-omics data with clinical, health,textual, pharmaceutical, and nutraceutical data offers a promising avenue to address these complexities, aiding in the identification of underlying causes and providing insights into effective therapeutics and diagnostic strategies.

Methods

This study focused on an exceptionally severe ME/CFS patient with hypermobility spectrum disorder (HSD) during a period of marginal symptom improvements. Longitudinal cytokine profiling was conducted alongside the collection of extensive multi-modal health data to explore the dynamic nature of symptoms, severity, triggers, and modifying factors. Additionally, an updated severity assessment platform and two applications, ME-CFSTrackerApp and LexiTime, were introduced to facilitate real-time symptom tracking and enhance patient-physician/researcher communication, and evaluate response to medical intervention.

Results

Longitudinal cytokine profiling revealed the significance of Th2-type cytokines and highlighted synergistic activities between mast cells and eosinophils, skewing Th1 toward Th2 immune responses in ME/CFS pathogenesis, particularly in cognitive impairment and sensorial intolerance. This suggests a potentially shared underlying mechanism with major ME/CFS comorbidities such as HSD, Mast cell activation syndrome, postural orthostatic tachycardia syndrome (POTS), and small fiber neuropathy. Additionally, the data identified potential roles of BCL6 and TP53 pathways in ME/CFS etiology and emphasized the importance of investigating adverse reactions to medication and supplements and drug interactions in ME/CFS severity and progression.

Discussion

Our study advocates for the integration of longitudinal multi-omics with multi-modal health data and artificial intelligence (AI) techniques to better understand ME/CFS and its major comorbidities. These findings highlight the significance of dysregulated Th2-type cytokines in patient stratification and precision medicine strategies. Additionally, our results suggest exploring the use of low-dose drugs with partial agonist activity as a potential avenue for ME/CFS treatment. This comprehensive approach emphasizes the importance of adopting a patient-centered care approach to improve ME/CFS healthcare management, disease severity assessment, and personalized medicine. Overall, these findings contribute to our understanding of ME/CFS and offer avenues for future research and clinical practice.

A DUAL MTOR/NAD+ ACTING GEROTHERAPY

The geroscience hypothesis states that a therapy that prevents the underlying aging process should prevent multiple aging related diseases. The mTOR (mechanistic target of rapamycin)/insulin and NAD+ (nicotinamide adenine dinucleotide) pathways are two of the most validated aging pathways. Yet, it's largely unclear how they might talk to each other in aging. In genome-wide CRISPRa screening with a novel class of N-O-Methyl-propanamide-containing compounds we named BIOIO-1001, we identified lipid metabolism centering on SIRT3 as a point of intersection of the mTOR/insulin and NAD+ pathways. In vivo testing indicated that BIOIO-1001 reduced high fat, high sugar diet-induced metabolic derangements, inflammation, and fibrosis, each being characteristic of non-alcoholic steatohepatitis (NASH). An unbiased screen of patient datasets suggested a potential link between the anti-inflammatory and anti-fibrotic effects of BIOIO-1001 in NASH models to those in amyotrophic lateral sclerosis (ALS). Directed experiments subsequently determined that BIOIO-1001 was protective in both sporadic and familial ALS models. Both NASH and ALS have no treatments and suffer from a lack of convenient biomarkers to monitor therapeutic efficacy. A potential strength in considering BIOIO-1001 as a therapy is that the blood biomarker that it modulates, namely plasma triglycerides, can be conveniently used to screen patients for responders. More conceptually, to our knowledge BIOIO-1001 is a first therapy that fits the geroscience hypothesis by acting on multiple core aging pathways and that can alleviate multiple conditions after they have set in.

Exotic weeds and fluctuating microclimate can constrain native plant regeneration in urban forest restoration

Restoring forest structure and composition is an important component of urban land management, but we lack clear understanding of the mechanisms driving restoration success. Here we studied two indicators of restoration success in temperate rainforests: native tree regeneration and epiphyte colonization. We hypothesized that ecosystem properties such as forest canopy openness, abundance of exotic herbaceous weeds, and the microclimate directly affect the density and diversity of native tree seedlings and epiphytes. Relationships between environmental conditions and the plant community were investigated in 27 restored urban forests spanning 3-70 years in age and in unrestored and remnant urban forests. We used structural equation modelling to determine the direct and indirect drivers of native tree regeneration and epiphyte colonization in the restored forests. Compared to remnant forest, unrestored forest had fewer native canopy tree species, significantly more light reaching the forest floor annually, and higher exotic weed cover. Additionally, epiphyte density was lower and native tree regeneration density was marginally lower in the unrestored forests. In restored forests, light availability was reduced to levels found in remnant forests within 20 years of restoration planting, followed shortly thereafter by declines in herbaceous exotic weeds and reduced fluctuation of relative humidity and soil temperatures. Contrary to expectations, canopy openness was only an indirect driver of tree regeneration and epiphyte colonization, but it directly regulated weed cover and microclimatic fluctuations, both of which directly drove the density and richness of regeneration and epiphyte colonization. Epiphyte density and diversity were also positively related to forest basal area, as large trees provide physical habitat for colonization. These results imply that ecosystem properties change predictably after initial restoration plantings, and that reaching critical thresholds in some ecosystem properties makes conditions suitable for the regeneration of late successional species, which is vital for restoration success and long-term ecosystem sustainability. Abiotic and biotic conditions that promote tree regeneration and epiphyte colonization will likely be present in forests with a basal area ≥27 m² /ha. We recommend that urban forest restoration plantings be designed to promote rapid canopy closure to reduce light availability, suppress herbaceous weeds, and stabilize the microclimate.

Enhanced insulin secretion and cholesterol metabolism in congenic strains of the spontaneously diabetic (Type 2) Goto Kakizaki rat are controlled by independent genetic loci in rat chromosome 8

AIMS/HYPOTHESIS

Genetic investigations in the spontaneously diabetic (Type 2) Goto Kakizaki (GK) rat have identified quantitative trait loci (QTL) for diabetes-related phenotypes. The aims of this study were to refine the chromosomal mapping of a QTL ( Nidd/gk5) identified in chromosome 8 of the GK rat and to define a pathophysiological profile of GK gene variants underlying the QTL effects in congenics.

METHODS

Genetic linkage analysis was carried out with chromosome 8 markers genotyped in a GKxBN F2 intercross previously used to map diabetes QTL. Two congenic strains were designed to contain GK haplotypes in the region of Nidd/gk5 transferred onto a Brown Norway (BN) genetic background, and a broad spectrum of diabetes phenotypes were characterised in the animals.

RESULTS

Results from QTL mapping suggest that variations in glucose-stimulated insulin secretion in vivo, and in body weight are controlled by different chromosome 8 loci (LOD3.53; p=0.0004 and LOD4.19; p=0.00007, respectively). Extensive physiological screening in male and female congenics at 12 and 24 weeks revealed the existence of GK variants at the locus Nidd/gk5, independently responsible for significantly enhanced insulin secretion and increased levels of plasma triglycerides, phospholipids and HDL, LDL and total cholesterol. Sequence polymorphisms detected between the BN and GK strains in genes encoding ApoAI, AIV, CIII and Lipc do not account for these effects.

CONCLUSIONS/INTERPRETATION

We refined the localisation of the QTL Nidd/gk5 and its pathophysiological characteristics in congenic strains derived for the locus. These congenic strains provide novel models for testing the contribution of a subset of GK alleles on diabetes phenotypes and for identifying diabetes susceptibility genes.

Predator odor as an unconditioned fear stimulus in rats: elicitation of freezing by trimethylthiazoline, a component of fox feces

Four experiments tested whether an odor from a rat predator can unconditionally elicit a fear response in rats. In a large chamber, rats displayed fear-related behaviors to trimethylthiazoline (TMT, a volatile compound isolated from fox feces), including avoidance and immobility, while showing less exploratory behavior. In a smaller chamber, TMT induced a species-typical fear response, freezing, whereas other odors did not. In addition, TMT systematically elicited more freezing as the amount of TMT increased. Moreover, there was no within-sessions or between-sessions habituation of freezing to TMT, nor did TMT promote contextual conditioning. The results indicate that the predator odor, TMT, can induce a fear-related behavioral response in rats that is controllable and quantifiable, suggesting that TMT-induced freezing may be a useful paradigm for a neurobehavioral system analysis of ecologically relevant, unconditioned fear.

Neurotoxic lesions of the lateral nucleus of the amygdala decrease conditioned fear but not unconditioned fear of a predator odor: comparison with electrolytic lesions

Considerable evidence suggests that the lateral (LA) and basal (BA) nuclei of the amygdala are sites of plasticity and storage of emotional memory. Recent arguments, however, have seriously challenged this view, suggesting that the effects of amygdala lesions are attributable to interference with performance of fear behavior and not learning and memory. One way to address this controversy is to measure the same behavioral response during both conditioned and unconditioned fear. This is done in the present study by measuring fear-related freezing behavior after electrolytic and neurotoxic lesions of the LA or LA/BA nuclei in rats in a contextual fear conditioning paradigm and unconditioned fear to a predator odor. Electrolytic LA lesions attenuated post-shock freezing, retention test freezing, and freezing to the predator odor trimethylthiazoline (TMT). In contrast, excitotoxic NMDA lesions of the LA had no effect on post-shock freezing but significantly attenuated retention test freezing. Furthermore, excitotoxic LA lesions did not diminish freezing to TMT. Larger excitotoxic lesions that included the BA significantly reduced freezing in both the post-shock and retention tests but did not appreciably decrease freezing to TMT. The results suggest that the LA is important for memory of learned fear but not for generation of freezing behavior. In addition, the BA plays a role in freezing in conditioned fear situations but not in unconditioned fear. The studies suggest that the LA and BA play different roles in fear conditioning, but neither of them has a significant role in unconditioned freezing to a predator odor.

Predator odor as an unconditioned fear stimulus in rats: elicitation of freezing by trimethylthiazoline, a component of fox feces

Four experiments tested whether an odor from a rat predator can unconditionally elicit a fear response in rats. In a large chamber, rats displayed fear-related behaviors to trimethylthiazoline (TMT, a volatile compound isolated from fox feces), including avoidance and immobility, while showing less exploratory behavior. In a smaller chamber, TMT induced a species-typical fear response, freezing, whereas other odors did not. In addition, TMT systematically elicited more freezing as the amount of TMT increased. Moreover, there was no within-sessions or between-sessions habituation of freezing to TMT, nor did TMT promote contextual conditioning. The results indicate that the predator odor, TMT, can induce a fear-related behavioral response in rats that is controllable and quantifiable, suggesting that TMT-induced freezing may be a useful paradigm for a neurobehavioral system analysis of ecologically relevant, unconditioned fear.