3 Dec 2017 | Interview with Nancy Klimas on 'Unrest'

Sasha

Sasha

Senior Member (Voting Rights)
It's only short but I like this bit:

Interview said:
You know, in this documentary there’s a scene where I’m talking - and I’m talking about my first patient. And that really is what hooked me up. This patient came in, she had all the symptoms, she’s totally miserable. She had been to a lot of different doctors, and every doctor had said there was nothing wrong with her.

And we have a research laboratory, so we can look in a much deeper way. We did the whole nine yards. We looked at every immune function we knew, and I came back to this patient and I said, ‘You know, I’m sorry, I found an awful lot wrong with your immune system. This is like, a serious problem.’ And she burst into tears. And I was shattered, I thought, ‘Oh my God, I really handled that badly. I should have done something better.’

But they were tears of joy. She was so happy that someone had actually found something, that this was real.
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Whole thing here (please give them the traffic!): http://wlrn.org/post/beyond-tired-n...al&utm_source=twitter.com&utm_campaign=buffer
 
I give Dr Klimas all credit for taking this seriously. What worries me is that this was ten or maybe twenty years ago and since then nothing has been confirmed that could be called 'an awful lot wrong with the immune system'. I worry that people seeing the film will take it that these findings are established and that treatments have been developed. That is rather reinforced by Jen saying she is lucky to have access to treatments. I think there is a serious risk that people are going to feel let down when they realise this is not the reality.
 
Jonathan Edwards said:
I give Dr Klimas all credit for taking this seriously. What worries me is that this was ten or maybe twenty years ago and since then nothing has been confirmed that could be called 'an awful lot wrong with the immune system'. I worry that people seeing the film will take it that these findings are established and that treatments have been developed. That is rather reinforced by Jen saying she is lucky to have access to treatments. I think there is a serious risk that people are going to feel let down when they realise this is not the reality.
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Yes, I share that concern. It did feel like a film made by someone who had not been ill that long, so was lacking some justified cynicism. I suspect that's part of the reason why the film was able to make some sort of emotional connection with a wider audience though?

I worry that this element of the film could lead to more people feeling pressured to try speculative treatments that are unlikely to help, when we'd be much better off using that money to conduct rigorous research. Also, if people are embracing one set of unfounded theories/treatments, that makes advocacy efforts around PACE and other forms of quackery more difficult.
 
ahimsa said:
Hi @Jonathan Edwards -

Does any of the more recent research by Dr. Klimas look useful?

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I can't say that I really recognise any of those as being established findings. I worry when lists like this are put up as if they were agreed findings. For cytokines the findings have been all over the place. I do not really believe in the Th1/Th2 business and TNF is put in the Th1 group so I am not sure what to make of the list as it stands.
 
Jonathan Edwards said:
I can't say that I really recognise any of those as being established findings.
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Thanks. I'm certainly not planning on getting any of these tests!

I thought they were meant as markers still being researched, not yet established clinical tests a patient should do, but perhaps I've misunderstood.

Have you watched the video? I may have taken that chart out of context.
 
Jonathan Edwards said:
What worries me is that this was ten or maybe twenty years ago and since then nothing has been confirmed that could be called 'an awful lot wrong with the immune system'. I worry that people seeing the film will take it that these findings are established and that treatments have been developed
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To clarify, this immune findings are not bizarre or unique to CFS (except for the low NK activity which is in research) for example: In my case I have low NK cells, this is accepted internationally as NK cell dysfunction (please google), I do not remember the ICD code. And her treatment was standard for that (in my case antivirals to lower the herpes infection). I know another patient who had low IGG subclass. Also a known immune deficiency and treated accordingly. Some have low cd4s......

We are all a bit different, and need to be treated depending on what is going on (this is unfortunately symptom treatment) she is not saying the immune system is the cause per say (it could be a consequence)

Also anybody with CFS has to look at sleep study, hormones, OI, .... For now all we have is to relieve symptoms until we know the cause.
But I am testimony if you get the systems under control, it is not cure, but you will feel SOOOOO much less miserable: When I was checked first time I felt HORRRIBLE and I had: a hh6v, coazaxie b2, Parvo virus b19 and EBV infection!!!!!! After those went away (all by standard recognized Test) and my CBC got better, I feel much more decent (still my cytokine profile and lymphocyte subset)is a mess. I also still struggle with low NK number. But have gone up and down in the years.
 
ahimsa said:
Thanks. I'm certainly not planning on getting any of these tests!

I thought they were meant as markers still being researched, not yet established clinical tests a patient should do, but perhaps I've misunderstood.

Have you watched the video? I may have taken that chart out of context.
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It was not that they were not established as clinical tests but that they were not established as reproducible research findings that we can take as established fact. I have not sen the video and will try to do that now.
 
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Jonathan Edwards said:
It was not that they were not established as clinical tests but that they were not established as reproducible research findings that we can take assailed fact. I have not sen the video and will try to do that now.
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The problem is the immune issues you see are different per person, that does not mean as an individual you do not care, I know a few people and they all had different issues: One had sojern, another some IGG subclass deficiency.... That we are not the same does not mean the standard finds do not apply, the only bizarre one I heard of was IGM or IGG subclass I think it was (so not standard treatment because was a not so common one) The point being, the findings are mostly standard known issues, they are not reproducible because the spectrum is wide.
I have also known another patient where all was ok on the immune system and nothing was given (still has CFS) so we are all different. We have to address our individual issues (until we can find the initial issue / CFS cause).\
Edit: Sorry forgot to add I also have colitis and POTs both tested and treated at standard treatment.
 
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ahimsa said:
There's another thread on this 12-minute long video ( see https://www.s4me.info/threads/solve...7-highlights-me-cfs-and-gulf-war-illness.956/) in case that is a better spot for this discussion.
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This is a fascinating video. If I understand it correctly, they have tried to simulate the complex interactions of the immune system using a large computer system specifically built for that purpose. They believe that, in both ME/CFS and Gulf War Syndrome, the immune system has been perturbed out of its normal stable state and has landed in another abnormal but also stable state. The immune system is stuck in this alternate mode not because of a continuing infection or other outside pressure, but because the alternate mode is self-reinforcing and thus stable. In Gulf War Syndrome, they've run thousands of "in silico [silicon]" simulations to test various ways of "knocking" the immune system back into its normal state. The most promising method seems to be a non-intuitive two-step process. They will soon be running trials of this in GWS patients.

[ I'm just guessing here, but it could be that, superficially, the values of the various immune signaling components are within normal limits in the abnormal mode, but it might be that it's the combined interactions of multiple shifts within the normal range that add up to an abnormal state. ]
 
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Forbin said:
This is a fascinating video. If I understand it correctly, they have tried to simulate the complex interactions of the immune system using a large computer system specifically built for that purpose. They believe that, in both ME/CFS and Gulf War Syndrome, the immune system has been perturbed out of its normal stable state and has landed in another abnormal but also stable state. The immune system is stuck in this alternate mode not because of a continuing infection or other outside pressure, but because the alternate mode is self-reinforcing and thus stable. In Gulf War Syndrome, they've run thousands of "in silico [silicon]" simulations to test various ways of "knocking" the immune system back into its normal state. The most promising method seems to be a non-intuitive two-step process. They will soon be running trials of this in GWS patients.

[ I'm just guessing here, but it could be that, superficially, the values of the various immune signaling components are within normal limits in the abnormal mode, but it might be that it's the combined interactions of multiple shifts within the normal range that add up to an abnormal state. ]
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I think the systems dynamics analysis set up by Broderick in this group is important. There is a very bright young scientist called Travis Craddock working on this who I know well from another branch of science in fact. What they are proposing is very similar to what we proposed for rheumatoid arthritis in 1998 - that the disease is a stable 'dip' in a dynamic landscape that once you get into you do not roll out of. Whether you need a computer to model this or not I am not very sure. We did it all without computers. But if you are constructing abstract general models without much data to start with it makes sense.

The problem is, though, that you have to have some sort of data to test the model. In RA we had data dripping from the walls. We had ESRs of 100, autoantibodies sky high, tissue pathology slides dating back to 1890, immunohistology findings, known genetic predispositions and evidence from cytokine blockade. In ME/CFS there is pretty much nothing to test the model on. I am afraid that combined interactions within the normal range is not going to work. If they are within the normal range you have no reason to think they are doing anything abnormal. You have the Bonferoni problem that you can create thousands and thousands of models and one or other is bound to seem to fit the results by chance.

I think this modelling effort is really strong, but I do worry that people are trying to run before they can walk when it comes to actual data.
 
In the video, Dr. Klimas mentions this:

"In Gulf War Illness we have an animal model that's darn good. We took our dynamic modeling model and we looked at all the animal models that are out there for Gulf War Illness, and we actually had people do exercise challenges on the animals and do the dynamic modeling in the animals, and found the best fit.

"And we picked that model as our testing model and then we aged that animal out (after we induced the illness) the equivalent of 10 years of illness, and then we did this [ran numerous computer simulations of various ways to shift the system back to normal].

"And we re-booted. We brought neuro-inflammation down about 50%, which was enough, and then we threw the mifepristone dose in there - in a single does of mifepristone - and we rebooted those animals back to normal.

"The autonomic function normalized. Their immune function normalized. Their neuroendocrine balance all normalized... and we can challenge the animals and get normal dynamic models out of them."

https://www.s4me.info/threads/solve...7-highlights-me-cfs-and-gulf-war-illness.956/
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[I believe the animal model was a mouse. Just to emphasize, this was a Gulf War Illness model, not ME/CFS.]
 
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Forbin said:
In the video, Dr. Klimas mentions this:

[I believe the animal model was a mouse. Just to emphasize, this was a Gulf War Illness model, not ME/CFS.]
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the problem with animal models is that they work the way you have engineered them to work. That does not tell you anything about whether they work like the human illness you are 'modelling'. Animal models in rheumatoid arthritis have been almost completely useless and misleading.
 
From looking at the video, I think that Dr. Klimas is talking about the post-exercise network analysis being very different in CFS, GWI and normal controls. I think this change in network activity after exercise is why she refers to looking at the system "dynamically."

In GWI the network is distinctly overactive compared to normal controls after exercise.

In ME/CFS the network is distinctly underactive compared to normal controls after exercise.

Klimas 2 small.jpg

I would assume that getting the post-exercise network analysis in ME/CFS and GWI to look like that of normal controls would be an objective marker of the effectiveness of the treatment. Other indicators she mentioned in the animals were normalization of autonomic and immune function, and normalization of neuroendocrine balance. If the patients also report subjective improvements in symptoms, that would no doubt justify further trials.

The fact that they were able to do this in a GWI animal model does not mean that they can do it in a human, but we may know more about that relatively soon. In the video, Dr. Klimas says she anticipates that "we will be running this trial [in humans] before Christmas [presumably of 2017]."
 
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Forbin said:
They believe that, in both ME/CFS and Gulf War Syndrome, the immune system has been perturbed out of its normal stable state and has landed in another abnormal but also stable state. The immune system is stuck in this alternate mode not because of a continuing infection or other outside pressure, but because the alternate mode is self-reinforcing and thus stable.
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Jonathan Edwards said:
What they are proposing is very similar to what we proposed for rheumatoid arthritis in 1998 - that the disease is a stable 'dip' in a dynamic landscape that once you get into you do not roll out of.
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I think there many parallels for this. Self tuning algorithms for process controllers can get into this pickle, dropping into a bad state of tuning but unable to find a way out, sometimes adopting a completely stable but bad state, or sometimes hunting around close to such a state, unable to escape; no doubt many other kinds of self tuning algorithms also.

If they are right (that 'if' word again) it would be fascinating to know what the biological mechanism were. (The BSP brigade have been convinced all this time the stable state is one of being deconditioned, and the way out of it is mental and physical effort; we know this is not true of course).
 
In physics, the concept of the there being alternate, but not indefinitely stable states is referred to as metastability. It's metaphorically similar to the graphic that Dr. Klimas showed in the video.


Klimas 3 Smaller.jpg



250px-Meta-stability.svg.png


https://en.wikipedia.org/wiki/Metastability
 
Jonathan Edwards said:
I give Dr Klimas all credit for taking this seriously. What worries me is that this was ten or maybe twenty years ago and since then nothing has been confirmed that could be called 'an awful lot wrong with the immune system'. I worry that people seeing the film will take it that these findings are established and that treatments have been developed. That is rather reinforced by Jen saying she is lucky to have access to treatments. I think there is a serious risk that people are going to feel let down when they realise this is not the reality.
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One of the issues I think we face is that while many things are wrong they are not sufficiently reliable and present in the patient pool to qualify as diagnostic. On an individual basis things are wrong, on a group basis its not consistent enough, or hasn't been given the technology of the time and the tests run. Things are wrong, but they do not add up to a provable discrete disease entity. Yet for that individual patient there might be an advantage to knowing what is wrong. Its just not generalisable.
 
Forbin said:
In physics, the concept of the there being alternate, but not indefinitely stable states is referred to as metastability. It's metaphorically similar to the graphic that Dr. Klimas showed in the video.


View attachment 1351



250px-Meta-stability.svg.png


https://en.wikipedia.org/wiki/Metastability
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In chaos theory such states are due to a strange attractor, the balance of forces that keep things moving around that projected attractor. There are maybe a few threads on this on PR, probably old threads.
 
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