Immunological Patient Stratification in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 2023 Rohrhofer et al

Published - see here

Preprint
https://www.preprints.org/manuscript/202311.2007/v1

Immunological Patient Stratification in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Johanna Rohrhofer
,
Lisa Hauser
,
Lisa Lettenmaier
,
Lena Lutz
,
Larissa Koidl
,
Salvatore Alessio Gentile
,
Davide Ret
,
Michael Stingl
,
Eva Untersmayr
*

Version 1 : Received: 30 November 2023 / Approved: 30 November 2023 / Online: 30 November 2023 (16:56:26 CET)

How to cite: Rohrhofer, J.; Hauser, L.; Lettenmaier, L.; Lutz, L.; Koidl, L.; Gentile, S.A.; Ret, D.; Stingl, M.; Untersmayr, E. Immunological Patient Stratification in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Preprints 2023, 2023112007. https://doi.org/10.20944/preprints202311.2007.v1

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease characterized by profound fatigue, post-exertional malaise (PEM), and neurocognitive dysfunction.

Immune dysregulation and gastrointestinal symptoms are commonly observed in ME/CFS patients.

Despite affecting approximately 0.89% of the general population, the underlying pathophysiological mechanisms remain poorly understood.

This study aimed to elucidate the relationship between immunological characteristics and intestinal barrier function in ME/CFS patients.

ME/CFS patients were stratified into two groups based on their immune competence.

After documentation of detailed medical records, serum and plasma samples were collected for assessment of inflammatory immune mediators and biomarkers for intestinal barrier integrity by ELISA.

We found reduced complement protein C4a levels in immunodeficient ME/CFS patients suggesting a sub-group specific innate immune dysregulation.

ME/CFS patients without immunodeficiencies exhibit a mucosal barrier leakage, as indicated by elevated levels of Lipopolysaccharide-binding protein (LBP).

Stratifying ME/CFS patients based on immune competence enabled the distinction of two subgroups with different pathophysiological patterns.

The study highlights the importance of emphasizing precise patient stratification in ME/CFS, particularly in the context of defining suitable treatment strategies.

Given the substantial health and socioeconomic burden associated with ME/CFS, urgent attention and research efforts are needed to define causative treatment approaches.

 

Not really clear how they are separating patients who they say do or don't have immunodeficiency:

But even with this somewhat mysterious stratification, the differences they are showing do not look very significant:


Claiming there is a difference between groups here seems like a stretch:


Looks like there is something going on for some patients for (LBP) Lipopolysaccharide‐binding protein here, but definitely not all patients or all the ones they are calling non-immunodeficient:

 

Maybe it would be interesting to look at gut microbiota or gut symptoms and LBP in those with high levels.

 

"ME/CFS was diagnosed based on the Institute of Medicine (IOM) criteria [32] which define that following three symptoms and at least one of two additional manifestations are required for diagnosis. The three required symptoms are: (1) a substantial reduction/impairment in the ability to engage in pre‐illness levels of activity, (2) PEM and (3) unrefreshing sleep."

 

Interesting clustering there indeed! Makes me think about altered metabolism, as in a shift in equilibrium at some level. Looks like two different states, with the eternal caveat of ‘needs to be reproduced in a larger dataset’.

 

It was pointed out to me that the answer to this is in the figures:

 

Is MBL mucosal barrier leakage?

 

I think it would be mannan-binding lectin deficiency (which is very common).

 

Now published

https://www.mdpi.com/2077-0383/13/1.../CFS) is,PEM), and neurocognitive dysfunction.

 

MedUni Vienna scientists identify possible biomarkers for chronic fatigue syndrome (msn.com)

 

New press release from Austria:
"Chronic fatigue syndrome: number of patients is expected to double due to long-term effects of the COVID-19 pandemic"
https://www.eurekalert.org/news-releases/1034516

 

ScienceAlert The Number of People With Persistent Fatigue Could Soon Double. Here's Why.

quote:

We're still a long way from properly understanding how ME/CFS starts or how to cure it, but it's progress. As long COVID continues to have a debilitating impacton tens of millions of people across the globe, sicknesses like ME/CFS that seem to be triggered by viruses may get worse before they get better.

 

If so many people get sick that societies can’t function things will get worse and worse and never get better for us. It seems that’s where we’re headed.