Altered Fatty Acid Oxidation in Lymphocyte Populations of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, 2023, Maya et al

https://www.mdpi.com/1422-0067/24/3/2010


Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disabling multisystem illness in which individuals are plagued with fatigue, inflammatory symptoms, cognitive dysfunction, and the hallmark symptom, post-exertional malaise. While the cause of this disease remains unknown, there is evidence of a potential infectious component that, along with patient symptoms and common onsets of the disease, implicates immune system dysfunction.

To further our understanding of the state of ME/CFS lymphocytes, we characterized the role of fatty acids in isolated Natural Killer cells, CD4+ T cells, and CD8+ T cells in circulation and after overnight stimulation, through implicit perturbations to fatty acid oxidation. We examined samples obtained from at least 8 and as many as 20 subjects for immune cell fatty acid characterization in a variety of experiments and found that all three isolated cell types increased their utilization of lipids and levels of pertinent proteins involved in this metabolic pathway in ME/CFS samples, particularly during higher energy demands and activation.

In T cells, we characterized the cell populations contributing to these metabolic shifts, which included CD4+ memory cells, CD4+ effector cells, CD8+ naïve cells, and CD8+ memory cells. We also discovered that patients with ME/CFS and healthy control samples had significant correlations between measurements of CD4+ T cell fatty acid metabolism and demographic data. These findings provide support for metabolic dysfunction in ME/CFS immune cells. We further hypothesize about the consequences that these altered fuel dependencies may have on T and NK cell effector function, which may shed light on the illness’s mechanism of action.

 

5. Conclusions
Our findings support the theory of a consistently altered bioenergetic state in ME/CFS immune cells, specific to certain immune cell types that rely on fatty acids more heavily than healthy control subjects. This study detected increases in fatty acid oxidation in CD4+ T cells, CD8+ T cells, and NK cells at varying degrees, with CD4+ T cell fatty acid utilization correlating with ME/CFS illness duration. This data indicates that ME/CFS NK cell dysfunction could be in part due to greater levels of lipid accumulation and subsequent fatty acid oxidation. We also propose that the combined metabolic profile of ME/CFS T cells suggests an exhausted T cell state, resulting in reduced effector functions that may contribute to ME/CFS symptom presentation.

 

I found this YouTube video about the study, just posted today.

https://www.youtube.com/watch?v=dYZE_fRKhbs

 

I've read it through once and will watch the video later. Seems pretty informative on first-pass: esp given the evaluation of cell sub-populations.

I also noted the metformin comment with interest, given this thread.

Also wonder what this unstated therapy was...

Spoiler: Obligatory

A little more T cells and a little less psychology would be welcome.

 

PD-1 alters T-cell metabolic reprogramming by inhibiting glycolysis and promoting lipolysis and fatty acid oxidation (2015)

ETA: Thread here

 

Thanks for the analysis @SNT Gatchaman (and Hutan)

The metformin use is very interesting and in line with emerging long covid research, ME clinicians used this for a while but proof wasn’t determined.

Yes I wonder what it is, maybe new therapeutic medication in its infancy….we live in hope……

I think they are talking about physical stress from multiple dysregulated systems via metabolic processes, rather than psychology, unless I misread your quote.

 

Sorry, perhaps I should have put it in quotes. I was inverting Wessely's famous line. I.e. if T cell dysfunction were ultimately shown to be fundamental to the pathology then it could be regarded as ironic that his 1989 exhortation was perfectly wrong.

 

This is cool, in line with what prior work has been suggesting and from a new angle (new cell types, more direct measures of function). I love this lab's work. Immune cells from pwme, in vitro, are definitely seeming to want more fats based on what we can see in the current literature.

I really want to know how and why this is persisting outside of the body.

In any case, really good that this area is receiving attention with more direct measurements of substrate utilisation. We can only draw so many functional inferences from gene expression data (As I have in my past, preliminary work). A few things are on the boil in this space, so it's really exciting.

 

It's definitely labor intensive work. I believe this work was presented at IACFSME last summer, but I may be wrong. The main author presented something, I remember that.

 

Thought occurs that sometimes these are artifacts --- not suggesting that in this case.

I'm hoping that GWAS may help to direct research e.g. this looks like it may be a downstream consequence of disease --- I think one suggestion, re cause, was increased bacterial translocation (from the gut) --- MAIT cells --- GWAS may help to identify cause/source.

 

Unless there is a specific reason for this concern, it could be applied to any scientific observation. Of course, as a reader this is always borne in mind with individual or not yet validated studies, but when you see the same trend across multiple sample types, investigative techniques, research groups and geographical populations it suggests something is actually there imo. Of course, key word in this case being "suggests" not proves! Just my musings!