Preprint Initial findings from the DecodeME genome-wide association study of myalgic encephalomyelitis/chronic fatigue syndrome, 2025, DecodeMe Collaboration

Issues with mitochondrial biogenesis, quality control, dynamics and whatever else can very easily elicit stress signalling responses that could plausibly drive many of the issues we have been recently suspecting here on s4me.
Can mildly excessive mitophagy promote metabolic inflexibility by removing mitochondria that might perform a little worse under optimal conditions but better in certain specific situations?
 
So is an infection triggered neuro-immune condition a broadly correct characterisation of ME/CFS, based on these findings?


Maybe it is identifying currently healthy people who have an increased genetic risk of getting ME/CFS.

Would be interesting to follow that group for a few decades and see if they do get it at a higher rate than those without that risk.

I think we are on fairly safe ground there - with caveats. At least one gene is pretty specific for a subgroup of T cells - not even any old T cells. T cells will be upstream in this because T cells don't feel ill, brains do. So it looks like it is going to have something to do with immune cells making brains feel ill. That could still be via screwing up metabolism in other places.

There doesn't need to be an infection but the clinical evidence is already there for that.
 
Another thing on the potential mislabeling of pwME/healthy in the analysis is that we don’t know how common it is to have (very?) mild ME/CFS that’s not diagnosed.

Maybe some people just take longer to recover? Maybe they have sleep issues after having overdone it. Maybe this is temporary for them following an infection so it is never diagnosed as anything. But it could still be the same process as in us and require a similar genetic makeup.
Following up on this: in Norway there has been a huge increase in consultations for «fatigue» and various diagnostic codes that have traditionally been used for ME here following the start of the covid pandemic. So many seem to be susceptible of «something» following infection, although it might not be full blown ME/CFS.
 
Just had a look at the SMC post about this and it was a well yes but from
Your work and findings plot and map the many problems that those with ME have been explaining and living through so a huge thank you.

I know you are busy but I need to ask

Where do we go with the unknowns because they look like keys to me.

In 2004 White with others carried out a study, their findings found the delay between start of activity and then 4 -5 days after TNF-a and TGF beta. They looked at this as deconditioning but with your findings of TRIM38 and known link to TGF beta would all these be elevated when in a PEM state and is that something we could ask researchers to do?
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Not a scientist just a mother asking
 
I have mixed feelings about the results. I'm happy that a big step forward has occurred, but the results are merely a hint where to look more in detail. We're still far away from a diagnostic test, understanding the disease and treatment. At least we can call it disease now, and the results seem to confirm that it's most likely an immune-mediated neurological disease.

There's a lot more to discover about the genetics of ME/CFS. DecodeME was just a successful attempt to find signals of the disease and some leads.

The lack of strong or even any association between the SNPs and depression also tells us that it's the people who made these claims of association that were biased. I think they're stuck in a certain way of thinking and interpreting information. I've also seen this in my contact with psychiatry/psychology, problems are tendentially seen through a lense of depression, character flaws and flawed thinking, which on reflection doesn't fit reality. The field has issues and needs to overcome its own biases and mindless labeling of everything as depression.

Also, I think we need better PEM questionnaires. I'm sorry to say but I'm not a fan of Jason's work on PEM questionnaires. PEM should be strictly defined as atypical and delayed aggravation of symptoms after relatively mild exertion, and not in ways that allow confusion of PEM with more ordinary responses to exercise which can include fatigue, muscle pain, or vague concepts like feeling dead or heavy after exercise. The aggravation has to be atypical (not expected even in people unaccustomed to exertion), like increased nerve sensitivity, inability to relax, difficulty thinking or organizing daily activities, disturbed sleep, feeling awful but ONLY beginning at least several hours AFTER exertion.
 
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Tagging @DMissa to make sure I am not propagating falsehoods.
Not on my best form today but seems fine to me!
Can mildly excessive mitophagy promote metabolic inflexibility by removing mitochondria that might perform a little worse under optimal conditions but better in certain specific situations
This is a very ambitious question that I’m not sure we have the answers to, but I am not a mitophagy expert. Starting points might be 1) Can heteroplasmy and mitochondrial contiguity interact to produce localised “mitochondria” of different functional profiles? 2) If this is possible can they be differentially turned over versus the rest of the mitochondrial pool? 3) Proportionate to whole-cell metabolism are such variations in function sufficient to elicit feedback?

This is very abstract from my POV but I may be lacking knowledge.
 
I have come across rabgap genes in this glaucoma paper

Some of the transcription factors are interesting in decode ME genes
Eg foxo3 pax2/3 sox5
Interesting, since the GPCR autoimmunity theory with BC 007 originally came from glaucoma people. So these auto antibodies are related to glaucoma.
 
I could be wrong, but I understood it to mean that whatever process causes CFS after an infection involves the same genes as CFS without an infection.
Did they test the remaining 10, 000 (known) virally-triggered ME/CFS samples and still find the association in these samples without the other 5,000? I think you would have to know that?
 
I have mixed feelings about the results. I'm happy that a big step forward has occurred, but the results are merely a hint where to look more in detail. We're still far away from a diagnostic test, understanding the disease and treatment. At least we can call it disease now, and the results seem to confirm that it's most likely an immune-mediated neurological disease.

There's a lot more to discover about the genetics of ME/CFS. DecodeME was just a successful attempt to find signals of the disease and some leads.

The lack of strong or even any association between the SNPs and depression also tells us that it's the people who made these claims of association that were biased. I think they're stuck in a certain way of thinking and interpreting information. I've also seen this in my contact with psychiatry/psychology, problems are tendentially seen through a lense of depression, character flaws and flawed thinking, which on reflection doesn't fit reality. The field has issues and needs to overcome its own biases and mindless labeling of everything as depression.

Also, I think we need better PEM questionnaires. I'm sorry to say but I'm not a fan of Jason's work on PEM questionnaires. PEM should be strictly defined as atypical and delayed aggravation of symptoms after relatively mild exertion, and not in ways that allow confusion of PEM with more ordinary responses to exercise which can include fatigue, muscle pain, or vague concepts like feeling dead or heavy after exercise. The aggravation has to be atypical (not expected even in people unaccustomed to exertion), like increased nerve sensitivity, inability to relax, difficulty thinking or organizing daily activities, disturbed sleep, feeling awful but ONLY beginning at least several hours AFTER exertion.
That would significantly modify CCC though.

I get that this is what a subgroup feels, but from my impression there's also a significant other portion where there is already worse symptoms quite immediately after some exertion.
In your proposed case with many hours between worsening and exertion I would not make it anymore with the definition I think.

But this represents what I have been observing, maybe this is especially applicable for people who have a low number or even no symptoms doing absolutely nothing and then getting worse when doing anything. I have read from severe people who have zero symptoms at rest, but very bad symptoms when they do anything in the delayed way.

This is absolutely not how I feel, relatively spoken I'm always at a 7 out of 10 so the difference to 8.5 after too much exertion is not as large and not as significant.
 
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Re: diagnostic criteria and the different cohorts they generate in studies: I am too unwell to look at the preprint in detail at the moment but was hoping someone would know.

I remember the samples were taken in two phases with separate ones taken at a later stage possibly on slightly different inclusion criteria as they did not know how many participants initially would be asked to give a sample and they perhaps wanted more people in the end. Some people were not invited to give a sample in the first round, and then were invited to give a sample later.

Do they mention the extra samples they took from people in their second round of collection and any differences in signal generated? Do they mention any difference or information from these separate groups?
 
I wondered if there was a way to use the UK Bio bank to see if common genetic variants being talked about had predictive power. I assume the Biobank data was recorded sometime ago and prior to the pandemic. So could people with these variants be contacted to see their current health and whether they have a higher than normal chance of developing ME (or LC meeting ME criteria)?
 
The failed replications are disappointing but I suspect that next too broad case definitions for ME/CFS in the other databases, the sample size might also have been too small.

In the supplementary material it says that the Lifelines cohort only had 3,440 cases and 17,080 controls (compared to 15.000 case and 250.000 controls for DecodeME).

I don't know more about this sample but there have been problems with the selection criteria of the Lifelines cohort in previous studies. Some Dutch patient organisations objected against this study getting ME/CFS funding because of this reason. And in a previous paper on heritability of ME/CFS, a lifelines paper used a prevalence of more than 4.7% for ME/CFS which is 10x larger than expected.
 
I noticed that the HLA-region also got a significant finding (HLA-DQA1*05:01 at p = 1.4 x 10-10 but that it somehow reported separately form the other 8 hits. It seems to be a different SNP than what the Norwegians found but perhaps this is due to HLA being difficult to sequence?
 
DecodeME found evidence for DQA1 0501 being protective rather than high risk. DQ has come up repeatedly and I would like to see if these findings are actually complementary and consistent. The DQ link is nothing like that seen for MS or celiac. There is also an anomaly in the linkage. It will need its own thread.
 
One think that struck me on a quick read of the decode paper is how little I feel I understand about the methods and genetics in general. Are there good resources to understand more about the details?
 
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