Mood Symptoms and CFS due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron 2023,Almulla

Mood Symptoms and Chronic Fatigue Syndrome due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron

Abstract:
Background: Multiple sclerosis (MS) is a chronic autoimmune and neuroinflammatory disease of the central nervous system characterized by peripheral activation of immune-inflammatory pathways which culminate in neurotoxicity causing demyelination of central neurons. Nonetheless, the pathophysiology of relapsing-remitting MS (RRMS)-related chronic fatigue, depression, anxiety, cognitive impairments, and autonomic disturbances is not well understood.

Objectives: The current study aims to delineate whether the remitted phase of RRMS is accompanied by activated immune-inflammatory pathways and if the latter, coupled with erythron variables, explain the chronic fatigue and mood symptoms due to RRMS.

Material and Methods: We recruited 63 MS patients, 55 in the remitted phase of RRMS and 8 with secondary progressive MS, and 30 healthy controls and assessed erythron variables, and used a bio-plex assay to measure 27 serum cytokines.

Results: A significant proportion of the MS patients (46%) displayed activation of the immune-inflammatory response (IRS) and compensatory immune response (CIRS) systems, and T helper (Th)1 and Th17 cytokine profiles. Remitted RRMS patients showed increased chronic fatigue, depression, anxiety, physiosomatic, autonomic, and insomnia scores, which could partly be explained by M1 macrophage, Th1, Th-17, growth factor, and CIRS activation, as well as aberrations in the erythron including lowered hematocrit and hemoglobin levels.

Conclusions: Around 50% of remitted RRMS patients show activation of immune-inflammatory pathways in association with mood and chronic-fatigue-like symptoms. IRS and CIRS activation as well as the aberrations in the erythron are new drug targets to treat chronic fatigue and affective symptoms due to MS.

https://www.mdpi.com/2076-3425/13/7/1073

 

"All the individuals were free of (lifetime and current) axis-1 neuropsychiatric disorders including a major depressive episode, schizophrenia, bipolar disorder, psycho-organic disorders, substance-use disorders (except nicotine dependence), medical disorders including chronic fatigue syndrome, diabetes mellitus, cardiovascular, thyroid, renal, liver, gastrointestinal, oncologic disorders, and (auto)immune, other neuroinflammatory, and neurodegenerative diseases, including psoriasis, chronic obstructive pulmonary disease, inflammatory bowel disease, Parkinson’s disease, and Alzheimer’s disease."

"Clinical Assessment
A senior psychiatrist evaluated sociodemographic, neuropsychiatric, and clinical data through a semi-structured interview. The EDSS [8] was used for the clinical evaluation of disabilities, while the MSSS [9] was used to evaluate the progression of disability over time reflecting the severity of MS. Activities of daily living (ADL) were determined using the Arabic-translated index of ADL [40]. In addition, the Hamilton Depression Rating Scale (HAMD) [41], Hamilton Anxiety Rating Scale (HAMA) [42], the Beck Depression Inventory, and the Fibro-Fatigue Scale (FF) [43] were used to determine the severity of depressive, anxiety and fibromyalgia-fatigue symptoms, respectively."

The Fibro-Fatigue Scale is what they used to 'determine' if someone had CFS, see A rating scale for fibromyalgia and chronic fatigue syndrome (the FibroFatigue scale), 2002, Zachrisson et al for discussion of the scale. They didn't use any modern ME/CFS criteria.