Hypothesis Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (Me/Cfs): The Biology of a Neglected Disease, 2023/4, Pretorius et al

Edit The article is now published, see post #11

Preprint

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https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4622074

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (Me/Cfs): The Biology of a Neglected Disease
Heliyon
60 Pages Posted: 8 Nov 2023 Publication Status: Under Review

Hayley Arron
Stellenbosch University

Benamin Marsh
Royal College of Paediatrics and Child Health

M. Asad Khan
The University of Manchester - Manchester University NHS Foundation Trust

Beate Jaeger
Saint Georg Hospital

Douglas Kell
Stellenbosch University - Department of Physiological Sciences

Etheresia Pretorius
Stellenbosch University - Cardio-Metabolic Research Group (CMRG)

Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic disease with debilitating symptoms that impact all aspects of life. The diverse symptom presentation indicates that ME/CFS is likely to have a multifactorial origin. However, it is an extremely understudied disease with no standardised diagnostic criteria or proven treatment avenues. It is hypothesised that environmental insults (such as acute infection, mainly viral) or stress in genetically susceptible individuals may trigger the development of ME/CFS. These insults result in acute inflammatory responses, along with aberrant immune activation. A spiralling disruption of homeostasis promotes subsequent patho-mechanisms including gut dysbiosis and systemic inflammation, and eventually a pathological clotting system, chronic endothelialitis, vasoconstriction, and hypoxia. Additionally, dysfunctional energy metabolism including oxidative stressis also present in the development of ME/CFS. Since the exact pathophysiology of ME/CFS remains unclear, additional research is required to reveal further insight into this “neglected” disease.



Note:

Funding Information: H.E.A. thanks the Harry Crossley Foundation for research funding. D.B.K. thanks the Novo Balvi Research Foundation and Nordisk Foundation for funding (grant NNF20CC0035580). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. E.P. thanks Balvi Research Foundation, the NRF of South Africa (grant number 142142) and SA MRC (self-initiated research (SIR) grant).

Conflict of Interests: We have no Conflict of Interest.

Keywords: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Pathology, treatment

 

"ME causes some symptoms. Additional research is required." So, are they offering a new plan for how to accomplish this, or are they just asking for funding for professionally restating the obvious?

 

These are the same authors that are continuing to spread disinformation re ME/CFS micro clots and hypercoagulation immune activation theories that have been proven not to be in the case over 20 years ago.

 

I doubt think they care about justification. "Will someone cite our paper?" might be more important. I can easily imagine another paper with the title "Meta-study reveals that ME has a multifactorial origin!", based on a bunch of poorly-done studies.

 

https://undark.org/2024/05/20/bad-blood-microclots-long-covid/

Bad Blood? The Uncertainty Around Microclots and Long Covid

Scientists are debating whether microscopic blood clots are responsible for the wide range of symptoms in long Covid.

 

A fairly sobering analysis.

 

"But the nature of the biological evidence remains contentious. Jeffrey Winters, a pathologist and chair of the division of transfusion medicine at the Mayo Clinic, said the way Pretorius and Kell describe amyloid clots is confusing to scientists who view amyloids in a different context. “I don’t understand how they are using this term,” he said. “I assume that what they are referring to is not what I refer to as amyloids,” which he describes as various proteins that deposit into organs and don’t ordinarily float around in the blood. “I don’t understand what they are testing, and I don’t understand what they are seeing.” The dye used in the test, thioflavin T, can and does stain other things that are not amyloids, Winters said in an email"

 

Only read some of it - my reaction was to think --- why don't they [Long COVID] run a large GWAS [DecodeME size]? I think Jonathan posted (previously) that there was some evidence of abnormalities in clotting proteins - sort of theory GWAS would test.

 

It's only an N=1, but I've been on rivaroxaban for 8 years and warfarin for 10 years previous to that and my ME/CFS has actually gotten worse while I've been on anti-coagulants. The one I'm more agnostic about is enoxaprin (Lovenox) as I did experience a significant improvement during the 10 days I was on it. However, there were several other chemical confounders during my use of that to be able to know if it was indeed the enoxaprin that caused the improvement.

 

Merged thread

Now published:

Abstract:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic, debilitating disease characterised by a wide range of symptoms that severely impact all aspects of life.

Despite its significant prevalence, ME/CFS remains one of the most understudied and misunderstood conditions in modern medicine.

ME/CFS lacks standardised diagnostic criteria owing to variations in both inclusion and exclusion criteria across different diagnostic guidelines, and furthermore, there are currently no effective treatments available.

Moving beyond the traditional fragmented perspectives that have limited our understanding and management of the disease, our analysis of current information on ME/CFS represents a significant paradigm shift by synthesising the disease’s multifactorial origins into a cohesive model.

We discuss how ME/CFS emerges from an intricate web of genetic vulnerabilities and environmental triggers, notably viral infections, leading to a complex series of pathological responses including immune dysregulation, chronic inflammation, gut dysbiosis, and metabolic disturbances.

This comprehensive model not only advances our understanding of ME/CFS’s pathophysiology but also opens new avenues for research and potential therapeutic strategies.

By integrating these disparate elements, our work emphasises the necessity of a holistic approach to diagnosing, researching, and treating ME/CFS, urging the scientific community to reconsider the disease’s complexity and the multifaceted approach required for its study and management.

https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1386607/full