IIMEC 2023: Maureen Hanson

Hutan

Hutan

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IIMEC15 08 Professor Maureen Hanson 15th Invest in ME Research International ME Conference 2023


29 minutes

Terrific presentation from Professor Maureen Hanson including some unpublished work

I think we are getting close to some real answers - exhausted t-cells, abnormal classical monocytes. The technology is there now for looking at each type of cell, identifying the surface markers and the RNA inside them.

Things seem to be pointing to latent infections.
 
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Not sure if you've had a chance to watch the video yet, @Midnattsol, but Maureen sets up her talk very nicely around your point about asymptomatic infections. She cites some research on people who were tested for Covid-19 very regularly. The majority of people actually had an asymptomatic infection! And there were some people who were pre-symptomatic at the time of their positive test and only developed symptoms later.

But if the problem in fact is a virus that has become latent, EBV or something like that, perhaps it just takes some sort of stressor to activate it.

Maureen isn't claiming to know, it's just that there is accumulating evidence to support the idea of the immune system dealing with a chronic viral infection.
 
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Hutan said:
Not sure if you've had a chance to watch the video yet, @Midnattsol, but Maureen sets up her talk very nicely around your point about asymptomatic infections. She cites some research on people who were tested for Covid-19 very regularly. The majority of people actually had an asymptomatic infection! And there were some people who were pre-symptomatic at the time of their positive test and only developed symptoms later.
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I will watch it later :) An example of commenting without having looked at the content :angelic:

I look forward to having the asymptomatic infection can cause long term consequences as a recognized fact, at least in the media over here the "experts" cited often only focus on those hospitalised.

Hutan said:
But if the problem in fact is a virus that has become latent, EBV or something like that, perhaps it just takes some sort of stressor to activate it.

Maureen isn't claiming to know, it's just that there is accumulating evidence to support the idea of the immune system dealing with a chronic viral infection.
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I remember when I started to get sick and I was told it was "just mono" and it was typical to not get right back up again. Then I was actually tested and I didn't have antibodies to EBV. I then had a remission, where I would have to do A LOT to get PEM (I averaged 17-20k steps daily, was hiking in mountains more or less daily, biked everywhere), and when I crashed later I was tested again and this time I did have antibodies against EBV. I have wondered if that two-week-in-bed PEM crash I experienced was actually an infection. Since that crash I haven't had a period where I have been able to average 17k steps/day for a prolonged time.

Edit: I've seen cytomegalovirus being another potential source of a latent infection, and when I tested negative for EBV I did test positive for CMV. I could possibly have had an asymptomatic CMV infection as a newborn as there was an outbreak at the newborn ward when I was born. I say asymptomatic because my mother was very surprised when the test results came back positive for CMV.
 
Midnattsol said:
I remember when I started to get sick and I was told it was "just mono" and it was typical to not get right back up again. Then I was actually tested and I didn't have antibodies to EBV.
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oh, that's interesting. I was so ill I got hospitalised, had had 40 degrees in fever for a week with antibiotics and not feeling better. Throat so painful I couldn't drink so was dehydrated and liver and spleen enlarged. Suspected mono, but negative test at hospital. Later had antibodies. Hmm....
 
Hutan said:
I think we are getting close to some real answers - exhausted t-cells, abnormal classical monocytes.
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We've seen a number of recent papers in LC discussing macrophage infiltration.

Morphological Changes in the Myocardium of Patients with Post-Acute Coronavirus Syndrome: A Study of Endomyocardial Biopsies (2023, Diagnostics)
Immune mechanisms underlying COVID-19 pathology and post-acute sequelae of SARS-CoV-2 infection PASC (2023, eLife)
GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19 (2023, Nature)
Post-COVID syndrome is associated with capillary alterations, macrophage infiltration and distinct transcriptomic signatures in skeletal muscles (2023, Preprint: MedRxiv)

ETA: not to forget Monocyte migration profiles define disease severity in acute COVID-19 and unique features of long COVID (2023, European Respiratory Journal)
 
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Kalliope said:
oh, that's interesting. I was so ill I got hospitalised, had had 40 degrees in fever for a week with antibiotics and not feeling better. Throat so painful I couldn't drink so was dehydrated and liver and spleen enlarged. Suspected mono, but negative test at hospital. Later had antibodies. Hmm....
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I did not have fever or anything like that that I can remember, so it was either asymptomatic or that the infection was long before I started to notice I would feel terrible when doing stuff. It was just assumed I, especially as a teen, likely had had a recent EBV infection.
 
If pathogens are involved, certainly if they persist and are causal, then that becomes the playing field, and identifying them is essential.

Hubris said:
How do we plan on identifying the pathogen if all previous methods have failed?
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Diagnostics need to re-invent their industry, or at least recalibrate it. Like most of medicine, diagnostics need an overhaul. And researchers cannot limit themselves to serology. Think tissue. But in general, the whole testing-for-pathogens is an epic failure once you toe the waters of chronic infections - and likely, frequently, even acute ones.

I think, too, it will matter, this identification of the pathogens, on several different levels, not the least of which more leverage potentially in finding therapies.
 
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Well, not to get ahead of ourselves, it's just that those charts in Maureen's presentation looked compelling compared to the usual equivocal charts we see, and I trust her team's work more than many others.

We may need to find the pathogens, or at least know what is triggering immunological abnormalities, in order to know if an immune response needs to be ramped up to eliminate real pathogens, or whether, conversely, we need to dampen down an immune response to things that the body has confused with a problematic pathogen. I suppose the alternative approach is that we start clinical trials of things that might address one of those two options and see what happens. It's just possibly a bit risky.

For identifying pathogens, looking at post mortem tissue would probably be useful, as it would provide access to more than the usual blood and CSF e.g. brain, bone marrow, vagal nerve and other neurons, spleen, muscles, eyes. I think we need to get more organised about that. What else? Biopsies?
 
Midnattsol said:
I will watch it later :) An example of commenting without having looked at the content :angelic:

I look forward to having the asymptomatic infection can cause long term consequences as a recognized fact, at least in the media over here the "experts" cited often only focus on those hospitalised.


I remember when I started to get sick and I was told it was "just mono" and it was typical to not get right back up again. Then I was actually tested and I didn't have antibodies to EBV. I then had a remission, where I would have to do A LOT to get PEM (I averaged 17-20k steps daily, was hiking in mountains more or less daily, biked everywhere), and when I crashed later I was tested again and this time I did have antibodies against EBV. I have wondered if that two-week-in-bed PEM crash I experienced was actually an infection. Since that crash I haven't had a period where I have been able to average 17k steps/day for a prolonged time.

Edit: I've seen cytomegalovirus being another potential source of a latent infection, and when I tested negative for EBV I did test positive for CMV. I could possibly have had an asymptomatic CMV infection as a newborn as there was an outbreak at the newborn ward when I was born. I say asymptomatic because my mother was very surprised when the test results came back positive for CMV.
Click to expand...

You're right, Cytomegalovirus is seem as a potential cause of ME.

The ME expert I saw tested me for EBV, and Cytomegalovirus.
 
Hutan said:
Well, not to get ahead of ourselves, it's just that those charts in Maureen's presentation looked compelling compared to the usual equivocal charts we see, and I trust her team's work more than many others.

We may need to find the pathogens, or at least know what is triggering immunological abnormalities, in order to know if an immune response needs to be ramped up to eliminate real pathogens, or whether, conversely, we need to dampen down an immune response to things that the body has confused with a problematic pathogen. I suppose the alternative approach is that we start clinical trials of things that might address one of those two options and see what happens. It's just possibly a bit risky.

For identifying pathogens, looking at post mortem tissue would probably be useful, as it would provide access to more than the usual blood and CSF e.g. brain, bone marrow, vagal nerve and other neurons, spleen, muscles, eyes. I think we need to get more organised about that. What else? Biopsies?
Click to expand...

I've listened to a number of these talks now and they all seem to be converging somewhat. Reactivated viruses, possible pathogen, immune response that doesn't die down etc. I don't understand half the stuff they say in those talks but they do seem to overlap more and more. Delph a bit deeper every time they do. I've seen Hanson, Moreau and Phair talking about possible treatment targets. Phair was talking about the JAK-stat pathway among others, I know filgotinib is already being tested for that. Hanson was saying we should be testing a plethora of drugs but I don't quite remember what for. Alain Moreau's talk was the hardest to follow for me, but he also talked about a couple of drugable targets.

I'm hoping we're getting to the stage where researchers can try out different treatment pathways, even if we don't have full understanding of what ME/CFS is yet.
 
Hutan said:
IIMEC15 08 Professor Maureen Hanson 15th Invest in ME Research International ME Conference 2023


29 minutes

Terrific presentation from Professor Maureen Hanson including some unpublished work

I think we are getting close to some real answers - exhausted t-cells, abnormal classical monocytes. The technology is there now for looking at each type of cell, identifying the surface markers and the RNA inside them.

Things seem to be pointing to latent infections.
Click to expand...


Prof. Hanson is fantastic! Re latent infection, I think that is a bit premature, you would expect the same "pattern" of findings in tissue damage not related to latent infection.
 
Midnattsol said:
So those of us without a clear infectious onset may have had an asymptomatic infection, or have seemingly recovered from an infection but accumulated damage over time causing us to gradually decline in health over months/years..?
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I've known a few gradual onset pwM.E that took many antibiotics during their young life, they didn't have a known infectious onset but suffer with allergies, MCS and mold for decades. Their immune profile and phenotyping lymphocyte counts were worse than mine.
 
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