Is a lymph node biopsy study in ME/CFS feasible?

[V.R.T.]

Polybio recently announced a cervical lymph node tissue biopsy study in Long Covid, and @ME/CFS Science Blog said on BlueSky that they're not aware of anything similar happening in ME/CFS research.

Info about the polybio study:

Decoding lymphoid tissue adaptive immune responses connected with Long COVID - PolyBio Research Foundation

Project Summary:This study will determine if Long COVID is connected to altered immune responses in lymphoid tissue. The project team is...

polybio.org

Apparantly done by fine needle aspirate.

@Jonathan Edwards has hypothesised that the abberant signalling in ME/CFS may take place in hard to reach tissues, including lymph nodes.

I am wondering why a lymph tissue study has not been done in ME/CFS, and whether it would be sensible for researchers to attempt to get one going now in order to look for abberant immune signalling.

It seems to me it might be a possible shortcut to an answer if it is feasible.

 

[forestglip]

Couple things previously said:

Sampling lymph nodes is a very unrewarding exercise. We did needle aspirations in the 1990s and learnt nothing much. They can diagnose cancer, that's about all. Biopsy removes the functioning node and is not justified unless you are looking for a clear diagnosis like lymphoma or TB. Cell populations vary enormously otherwise.

Is there no good way to test with fine needle aspiration for what antigen made its way to the lymph node to initiate the swelling? Like with transcriptomics or proteomics to compare to before it was swollen maybe.

And isn't there a good chance there are new B cells and antibodies being produced if a lymph node is swollen? So would it make sense to see how the B cell/antibody repertoire changes in people whose lymph nodes swell after exertion?

We tried this sort of thing in the 1990s and it was clear that sampling problems made findings uninterpretable. That is not going to change with new omics techniques. It wasn't that you could not find things, just that because the tissue architecture is so variable and complicated you could never expect to get a representative answer.

 

[Dolphin]

Of interest?
Comparative Analysis of Lymphocytes in Lymph Nodes and Peripheral Blood of Patients with Chronic Fatigue Syndrome

https://www.tandfonline.com/doi/abs/10.1300/J092v07n03_06

 

[Dolphin]

Of interest?
Clinical and Immunologic Effects of Autologous Lymph Node Cell Transplant in Chronic Fatigue Syndrome

https://www.tandfonline.com/doi/abs/10.1300/J092v08n01_03

 

[Hutan]

Another problem I guess is that the lymph node extracted from the living donor may not actually be one where something problematic is going on.

If researchers had access to donated bodies from people with ME/CFS who have died, what would be the things worth looking for in the lymph nodes?

 

[Jonathan Edwards]

I am not aware of any chronic immunological disease where lymph node needle aspiration studies have told as anything useful. The study I referred to previously was in lupus. It was the PhD project for an extremely bright, conscientious medical trainee, with excellent manual skills. She was so demoralised by the impossibility of getting any useful results she decided to go off and become a professor of rehabilitation!!

Cervical lymph nodes tend to be quite small and difficult to get samples from. They are close to a lot of very important structures like arteries to the brain so you. have to be careful. The cells you get out will be dependent on exactly where the needle goes. To be representative even of cervical node cells you would probably need at least five samples from different nodes. In most people I doubt you can find five nodes big enough to sample.

 

[Utsikt]

The study I referred to previously was in lupus. It was the PhD project for an extremely bright, conscientious medical trainee, with excellent manual skills. She was so demoralised by the impossibility of getting any useful results she decided to go off and become a professor of rehabilitation!!

What a shame - unless she’s using her abilities to debunk the entire field?

 

[Jonathan Edwards]

What a shame - unless she’s using her abilities to debunk the entire field?

Sadly not. She was at the NICE Round Table meeting extolling the virtues of exercise for ME/CFS and the value of 'clinical experience'.

 

[V.R.T.]

Sadly not. She was at the NICE Round Table meeting extolling the virtues of exercise for ME/CFS and the value of 'clinical experience'.

Those pesky lymph nodes have a lot to answer for!

 

[DMissa]

I attended days and days' worth of talks about B cells the week before last. Phenotypes change so much with the most subtle of context changes, even within different regions of the same GC. I can't imagine how one would combat spatial sampling artefacts if aspirating by fine needle from lymph node. As JE says you'd need many samples? Seems tricky and even then there would be some assumptions at play.

I would love for this to be an easy and useful thing to do, though.