Erythrocyte Deformability As a Potential Biomarker for Chronic Fatigue Syndrome, Davis et al (2018)

[Marco]

@Marco, @chrisb
It seems Livedo is not a widespread issue for pwME though, would we expect that if this paper was on the track of a biomarker?

You would think so.

 

[Binkie4]

Can I add another blood condition which creates more likelihood of clots?
https://en.m.wikipedia.org/wiki/Factor_V_Leiden

I have it but I don’t know if there is any link with ME. There are no noticeable daily symptoms, but it is genetic and can throw severe clots.
I have seen a couple of haematologists because of this but neither knew anything about Les Simpson’s work on red blood cell lack of deformability and ME from the 80/90s. I hope they connect to this article, and (eta) it gets us closer to a biomarker.

 

[Sunshine3]

Is 9 patients and 9 controls an unusually small study or are studies often this small? Sorry if this is a beyond basic question..

 

[Jim001]

Is 9 patients and 9 controls an unusually small study or are studies often this small? Sorry if this is a beyond basic question..

It seems to be typical for this sort of study. Usually they will include the minimum number of subjects required to still produce a statistically significant result if the hypothesis being tested is indeed true. And if it checks out, then they will follow it up with higher powered, more expensive studies.

 

[BurnA]

Is 9 patients and 9 controls an unusually small study or are studies often this small? Sorry if this is a beyond basic question..

I know nothing about this but I would speculate they did some tests and found some unusual results. So then they decided to formalise their testing by doing this small but official study.

So I would say for what it is, it is not unusually small. You have to start somewhere and this seems to be their starting point.

 

[obeat]

It helps to generate interest getting it published.

 

[leokitten]

I agree ESR isnt a good biomarker for ME

Like others here while I had very low ESR early in the disease like 0-2 (and it was measure multiple different times a months or so apart), later tests showed normal ESR even as the disease worsened.

 

[leokitten]

A few errors and oddities (at least to me).


Well, I'll just wait it out then...





Not that they impact on what they seem to have found but it doesn't look great.

I wouldn’t worry. There isn’t a paper yet, this is just an oral or poster abstract that they’d submitted for the annual ASH conference happening now in San Diego. Blood journal always publishes ASH abstracts as part of a volume supplemental each year.

 

[Andy]

“These are clearly interesting preliminary findings from America that could also link in with the research on red blood cell shape that was published by Dr Les Simpson in New Zealand many years ago.”

“The number of recruits is clearly very small. So, we will need to have results from much larger numbers of people with ME/CFS (in various stages of illness and of differing illness severities) and confirmatory results from other independent research groups.”

“Also, I think we would need to see comparisons made with other groups of individuals (e.g. people with multiple sclerosis, rheumatoid arthritis, depression and sedentary populations) before coming to any firm conclusions about the validity of this finding and its possible use as a diagnostic biomarker for ME/CFS.”

Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

https://www.meassociation.org.uk/20...ced-ability-to-change-shape-04-december-2018/

 

[Sunshine3]

https://www.meassociation.org.uk/20...ced-ability-to-change-shape-04-december-2018/

How many years will that take....

 

[ME/CFS Skeptic]

Les Simpson’s work on red blood cell lack of deformability and ME from the 80/90s.

Leslie O Simpson is the pioneer of this theory. He wrote a book on red blood cell deformability and capillary restriction in ME together with Nancy Blake. It’s called Ramsay’s Disease. Myalgic Encephalomyelitis (Me) and the Unfortunate Creation of 'Cfs'(2013).

His studies go back as early as 1986, when he wrote that ME is “associated with changes in blood rheology which could impair microcirculatory blood flow.” Simpson speculated “that ME is a hemorrheological disorder in which symptoms are manifestations of the consequences of impaired capillary blood flow.” How fascinating that more than 30 years later, scientists are looking at the same issue in patients with ME/CFS (It’s also a sad reflection of the lack of research into this disease).

Simpson saw blood cell deformability to be a key element of the pathophysiology of ME, but he didn’t think it was unique to this disease. “The changes in red cell shape populations which occur in ME also occur in other chronic disorders”, he wrote, “so red cell shape analysis alone is not diagnostic for ME. The observed changes are probably of importance in the pathogenesis of tiredness.”

Here are some relevant papers/abstracts (most of his studies lacked a control group though...)

https://www.ncbi.nlm.nih.gov/pubmed/3093959

https://www.ncbi.nlm.nih.gov/pubmed/2886780

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(89)90399-1/fulltext?code=lancet-site

https://www.ncbi.nlm.nih.gov/pubmed/2927808

http://orthomolecular.org/library/jom/1997/pdf/1997-v12n04-p221.pdf

http://orthomolecular.org/library/jom/1997/pdf/1997-v12n02-p069.pdf

https://pdfs.semanticscholar.org/fb5a/d891d78ee0e74849fe348503263230770fef.pdf

https://www.ncbi.nlm.nih.gov/pubmed/3588027

 

[Jonathan Edwards]

I must say i am missing @Jonathan Edwards' input on these things. (assuming i understand why he's not around but i still miss his input )

Sorry to have been in Madagascar for three weeks.

The meeting abstract looks bit jumbled tome. I am not sure what oxidative stress has to do with anything here and nor do I see why a low ESR corroborates decreased deformability. I suspect that the authors may not have much insight into the serious risk of confounding factors like taking analgesics or shifts in red cell turnover related to altered levels of activity. The thing that seems most odd is the bit saying they measured red cells moving at 4000fps, which is nearly four times the speed of sound in my book!

 

[Andy]

The thing that seems most odd is the bit saying they measured red cells moving at 4000fps, which is nearly four times the speed of sound in my book!

It will be Frames Per Second (is my assumption anyway), although admittedly it's not terribly clear

We recorded the movement of the cells at high speed (4000 fps)

 

[Barry]

It will be Frames Per Second (is my assumption anyway), although admittedly it's not terribly clear

Yes I agree it likely refers to recording speed. So 4000 fps will be very fast, presumably so they can look at what is happening greatly slowed down.

 

[Forbin]

Interesting computer simulation of RBCs moving through a retina capillary. Gives a sense of the deformation that goes on. I suspect that this is slowed down compared to real time. You can set it to go 1.5x faster by clicking on the gearwheel next to "YouTube."

 

[Barry]

Interesting computer simulation of RBCs moving through a retina capillary. Gives a sense of the deformation that goes on.

So being the non-scientist non-medic that I am, is this deformation an important part of how red blood cells do what they need to do? Or is it an unavoidable side effect which the body has to cope with?

 

[JemPD]

Sorry to have been in Madagascar for three weeks.

How exciting Jonathan, it's somewhere i have always wanted to go, those boabab trees look amazing.

LOL i had thought it was likely absence due to expert witnessing to a certain committee you're going to be doing , thought perhaps you'd been staying away for some wise-but-unknown-to-me reason connected to that - seems a bit of a silly idea now but it seemed plausible to me at the time

Thanks for your input on it, i am always reluctant to get at all excited about these studies until someone who understands what on earth they are on about.

I suspect that the authors may not have much insight into the serious risk of confounding factors like taking analgesics or shifts in red cell turnover related to altered levels of activity.

I hope someone appropriate will point these things out to them before they commence a larger study.

 

[Hutan]

is this deformation an important part of how red blood cells do what they need to do?

There was a comment upthread I think, about how the deformation of the blood cells dramatically increases the contact area between the red blood cells and the capillary walls, and therefore the opportunity for molecule exchange, compared to what would happen if the red blood cells were rigid little concave things.

 

[obeat]

There was a comment upthread I think, about how the deformation of the blood cells dramatically increases the contact area between the red blood cells and the capillary walls, and therefore the opportunity for molecule exchange, compared to what would happen if the red blood cells were rigid little concave things.

So could this reduced contact with the capillary wall partially contribute to the reduction in oxygen extraction in skeletal muscle that Systrom has observed?

 

[Jonathan Edwards]

I don't think contact actually matters for oxygen exchange. Molecules the size of oxygen zip through tissue as if there was nothing in the way. And contact does not make anything any thinner. The capillary still has the same diameter and the cell is in the middle of it.