Open GEM study - Prevalence of genetic diseases in ME/CFS patients, 2022, Esther Crawley, Bristol University

I've seen on Twitter that apparently the ME Association have highlighted this study in their weekly email newsletter.

This is the listing on the Be Part of Research website, https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=11083&location=&distance=, where the contact is Georgia Treneman-Evans.

In the study documents that I have looked at, the research lead is given as Katy Pike.

The listing on the ISRTCN Registry,https://www.isrctn.com/ISRCTN12242529, has been updated in the last month or so.

Interestingly, Esther Crawley is not listed as a staff member of the unit conducting this study, the Centre for Academic Child Health, https://www.bristol.ac.uk/academic-child-health/staff-directory/, or in a wider search of staff at the Uni of Bristol. It may be that I have missed something, or perhaps she has moved elsewhere.
 
"Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.
The recruitment start and end dates are as follows:
01 Sep 202230 Sep 2024

Participants are asked to complete one questionnaire and provide a saliva sample via an Oragene kit
Patients aged 8 - 70 years with ME/CFS who live in the UK."

I am interested to know what will be done with the genetic information.
If I agree to take part, can I change my mind?
Yes. You can leave the study at any point and, if you would like us to, we will take out some of the information we collected about you at any point before we carry out data analysis.

If you would like to hear more about the study, a member of the research team will arrange a time to talk to you over the telephone. They will explain the study to you and answer any questions you may have. They might ask you about how you are feeling in relation to the study to ensure you are happy to participate.

Once you have agreed to take part and you have completed the online forms, you will be asked to complete some online questions about you and how you’re feeling. These questions won’t take long to complete.

Your saliva sample will be used to obtain DNA at a laboratory within the University of Bristol. Some of your DNA sample will then be sent to Newcastle University for genetic analysis. The laboratory in Newcastle will be looking at the spelling of the genes that are linked to Pompe disease and LGMD2A.

If you’re happy to, any DNA remaining after analysis will be stored at the University of Bristol for future genetics research. Your sample may be made available to researchers working in universities, hospitals or other organisations in the UK or abroad. We may ask for a fee from researchers to help cover the costs associated with sending them to other places. We will not sell or make any profit from the samples you donate, and they will only be used in ethically approved research. Others will not be able to identify you from the sample.

I'm feeling pretty concerned about this. Participants may be talked into giving their DNA sample to Bristol University, to do whatever they want with. It also sounds as though there will be online forms about "you and how you are feeling". It sounds as though there is phone screening of participants.

With Bristol's history, and Crawley's (previous?) involvement in this study, I can't help but be suspicious. Is this a sleight of hand to get the DNA of 1000 children and 1000 adults with ME/CFS, along with information about "you and how you are feeling"?

At the very least, promoters like the MEA need to be making it abundantly clear that part of Bristol's plan is essentially to make a genetic databank.

I will be interested to hear about the experiences of people who start the process of participating.
 
Last edited:
If you take part, you will have to spend some time completing the online questionnaires and providing the saliva sample. The questionnaires will take you about 20 minutes to complete and the saliva sample will only take minutes to do.

We may need to use information from your medical records for this research project. This information will include your NHS number, name, date of birth, gender, ethnicity, and routine clinical data. People will use this information to do the research or to check your records to make sure that the research is being done properly. People who do not need to know who you are will not be able to see your name or contact details. Your data will have a code number instead. We will keep all information about you safe and secure. Once we have finished the study, we will keep some of the data so we can check the results. We will write our reports in a way that no-one can work out that you took part in the study.
Looks as if they get your medical records as well as genetic data and the 20 minutes of questionnaires.

You can stop being part of the study at any time, without giving a reason, but we will keep information about you that we already have. We need to manage your records in specific ways for the research to be reliable. This means that we won’t be able to let you see or change the data we hold about you.

It might all be legitimate, but it's just that Crawley was such a key part of MEGA.

I wonder if all the medical records and questionnaire data goes along with the DNA into the Bristol data bank, for later use by whoever.
 
Last edited:
Interestingly, Esther Crawley is not listed as a staff member of the unit conducting this study, the Centre for Academic Child Health, https://www.bristol.ac.uk/academic-child-health/staff-directory/, or in a wider search of staff at the Uni of Bristol. It may be that I have missed something, or perhaps she has moved elsewhere.

Couldn't resist to try google and found this note on a study that seems unrelated to ME/CFS:

Acknowledgments

"The GenROC study was originally conceptualised with significant mentorship and guidance from Professor Esther Crawley who has now retired. We thank her for her significant contribution to the concept of the GenROC study. [...]"

Low KJ, Watford A, Blair P, et al
Improving the care of children with GENetic Rare disease: Observational Cohort study (GenROC)—a study protocol
BMJ Open 2024;14:e085237. doi: 10.1136/bmjopen-2024-085237

https://bmjopen.bmj.com/content/14/5/e085237
 
Last edited:
Is this a sleight of hand to get the DNA of 1000 children and 1000 adults with ME/CFS, along with information about "you and how you are feeling"?

I'd be surprised, specially as it's such a small cohort and there's going to be data from a much bigger one (albeit only adults) available to researchers soon.

There's a more obvious motive: a drug company has an expensive product for which they need to recover their investment, but only a small patient pool. It's in their interests to try and make that pool a bit wider by looking for people who could have been misdiagnosed, especially in countries with socialised healthcare. To them, the costs of a small genetic study like this will be nothing more than petty cash, specially as any participant who has relevant genetic markers will be referred to the NHS for a more in-depth (i.e. expensive) screening.

Looks as if they get your medical records as well as genetic data and the 20 minutes of questionnaires.

I think some access to summary medical data is standard in some trials, e.g. to make sure all participants have actually been given a clinical diagnosis. I'm more dubious about the fact that participants who withdraw from the trial cannot withdraw their data, although it's possible there are respectable reasons for it.
 
The analysis sounds like a specific panel:

What will happen to my saliva sample?

Your saliva sample will be used to obtain DNA at a laboratory within the University of Bristol. Some of your DNA sample will then be sent to Newcastle University for genetic analysis. The laboratory in Newcastle will be looking at the spelling of the genes that are linked to Pompe disease and LGMD2A.


People can opt out of the remaining genetic material being stored for future research, but I suspect they'd need to read the consent form very carefully to make sure they do:

What will happen to my DNA sample?

If you’re happy to, any DNA remaining after analysis will be stored at the University of Bristol for future genetics research.


This is unclear, and I'd probably ask more about it if I were taking part. If the analysis hasn't already been done, why can't they take out all of it?:

If I agree to take part, can I change my mind?

Yes. You can leave the study at any point and, if you would like us to, we will take out some of the information we collected about you at any point before we carry out data analysis.
 
Last edited:
Yes, if Crawley is not involved, that makes me feel better about this.

But, prospective participants need to be aware that, if they agree, their DNA/DNA information, medical records and answers to the questionnaires are being stored, and they have no control over who has access to that information. They might want to ask some questions about who is making decisions about how the data is used. Is there patient involvement?

I wouldn't discount the utility of a 2000 person genetic data sample, linked to questionnaire data and medical records, in the hands of researchers with a BPS outlook, looking to put a psychosomatic overlay on a suggestion of a biological cause of ME/CFS from the DecodeME results. E.g. "70% of people in the Bristol sample with a relevant variant identified in DecodeME met the criteria for at least mild depression..."ME/CFS and Depression may share the same genetic basis"

Finding out the content of the questionnaires would be useful.
 
Information from the Trial registry

Study type: screening

Current interventions
All data will be collected via REDCap, which is an online secure and safe platform. Participants will complete online forms to provide the following:
1. Consent to the study
2. Personal details such as gender and ethnicity
3. Symptom data, including fatigue severity
4. Quality of life data
5. Pain data
6. Well-being data

Previous interventions:

Data collection:
Data collection using REDCap: The Paediatric service uses online systems to collect assessment and outcome data online in CYP. The research team at the service have developed, tested and use online consent to enable participants to take part in trials. Therefore, all participants will use REDCap to record their answers. Only members of the research team will have access to the participant’s data recorded in REDCap.

Demographic Data: we will collect the following demographic data: date of birth, gender, ethnicity, NHS number.

Symptom data: We will collect the following data at assessment (yes=frequently present): cognitive problems, headaches, muscle aches, joint aches, sore throats, tender lymph nodes, nausea, dizziness, palpitations, respiratory problems.

Patient Reported Outcome Measures (PROMs): We will collect the following Patient Reported Outcomes Measures which are routinely collected at assessment in the ME/CFS clinics: Fatigue (Chalder fatigue scale, 11 items; Physical Function (SF-36 physical function subscale); pain (visual analogue scale); Anxiety and Depression (Adults: Hospital Anxiety and Depression Scale, Children and young people: Revised Childrens Anxiety and Depression Scale).

At Royal United Hospital Bath, demographic data and the PROMs are collected using REDCap and we will therefore obtain consent to use this data, rather than ask the CYP to complete these questionnaires again. We will therefore only collect symptom data on REDCap for CYP. At North Bristol Trust, participants will be asked to provide all the data using REDCap.

Sample collection: Saliva samples will be collected from all consenting participants. They will be labelled with barcode ID numbers and personal information will not be passed to researchers/technicians processing or analysing the samples. Participants can choose to collect saliva at home or in clinic. If participants chose to collect saliva at home, we would send them an Oragene Saliva collection kits with a returned address envelope, sample pot and instructions.

The instructions include a link to a video describing how to collect the saliva. Previous feasibility work has demonstrated that adults with ME/CFS have found these easy to use at home and have produced saliva from which good quality DNA can be extracted. If participants prefer, samples can be collected in the specialist ME/CFS service with help from the research nurse (or the recruiting clinician). All samples will be posted to the Bristol Bioresource Laboratories (BBL), Oakfield House, University of Bristol. If there is indication of Pompe disease and/or LGMD2A, these participants will undergo further testing to confirm the diagnosis of Pompe disease/LGMD2A. This is likely to include providing a second saliva sample for testing or a blood sample for DBS testing in a certified NHS clinical setting.

Intervention type
Other

Primary outcome measure
1. Symptoms are measured via a 4-point Likert scale from 1 (all of the time) to 4 (none of the time) at baseline.
2. Fatigue is measured by the Chalder Fatigue Questionnaire which is 11 items. Participants answer these items on a 4-point Likert scale from 1 (less than usual) to 4 (much more than usual) at baseline.
3. Pain is measured using a visual analogue scale (VAS) at baseline.
4. Anxiety and depression for adults is measured by the Hospital Anxiety and Depression Scale which is 14 items. Participants answer these items on a 4-point Likert scale at baseline.
5. Anxiety and depression for children and young people is measured by the Revised Children’s Anxiety and Depression Scale which is 47 items. Participants answer these items on a 4-point Likert scale from 1 (never) to 4 (always) at baseline.
 
crossposted with Yann

The PROMs don't look too bad. But I question why it is necessary to collect anxiety and depression data with specific tools (47 items for children) for a study attempting to find a disease with a genetic biomarker. Why not just include anxiety and depression as line items in the symptom survey? e.g. Anxiety 1 (none of the time) to 4 (all of the time). (by the way, the directions on their likert scales are muddled up)

I think you could make a stronger case for having a detailed PEM survey than a detailed anxiety and depression survey, if you are trying to differentiate any people found to have the rare diseases from people with ME/CFS.
 
Last edited:
Information from the Trial registry

If there is indication of Pompe disease and/or LGMD2A, these participants will undergo further testing to confirm the diagnosis of Pompe disease/LGMD2A. This is likely to include providing a second saliva sample for testing or a blood sample for DBS testing in a certified NHS clinical setting.

It looks like participants could receive a diagnosis through the study. Are there ethical considerations about that?

I'd thought about taking part, because I can't be useful in other ways. So thanks all for unpicking this. It doesn't look like it'll provide any useful information and I certainly don't want to hand over my DNA, medical records, and answers to dodgy questionnaires to this lot.
 
But I question why it is necessary to collect anxiety and depression data with specific tools (47 items for children) for a study attempting to find a disease with a genetic biomarker.

My ten bob's on "because we always do".

I went through my working life wondering why people did what they did, the way that they did. It took me 20 years to learn not say "it would be quicker/easier/make more sense to...", because they wouldn't want to know that.

I never did quite master "but it's pointless and unnecessary", because my face had a habit of saying it before I'd opened my mouth.
 
Are there ethical considerations about that?

There are, but it's not an unusual situation. A patient or participant can be taken through a lengthy diagnostic process, an answer can be found, and they can then be asked if they want to know what it is. Obviously I don't know how this study will handle it, but I've been in that situation (autism diagnosis), as have close relatives (two different things).

If someone had markers suggestive of a genetic disorder—which I think is all this study could tell them, even if they chose to know the outcome—they'd be referred to the NHS genetic service to have the panel repeated. If they took it up the usual NHS procedures would be followed, probably after a long wait for an appointment.
 
Back
Top Bottom