TGI Friday! Our weekly round-up of recently published research abstracts | 26 June 2015

June 26, 2015

From the World Journal of Gastroenterology, 7 January 2015 (full text available).

Fecal microbiota transplantation broadening its application beyond intestinal disorders

Meng-Que Xu (1), Hai-Long Cao(1), Wei-Qiang Wang(1), Shan Wang, Xiao-Cang Cao(1), Fang Yan(1,2), and Bang-Mao Wang(1)
1) Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin 300052, China
2) Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232-0696, United States.
Correspondence to: Hai-Long Cao, MD, Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, 154 Anshan Rd, Heping District, Tianjin 300052, China.


Intestinal dysbiosis is now known to be a complication in a myriad of diseases.

Fecal microbiota transplantation (FMT), as a microbiota-target therapy, is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases.

New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota.

This review shows that it is an exciting time in the burgeoning science of FMT application in previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.

A randomized controlled trial was conducted on FMT in metabolic syndrome by infusing microbiota from lean donors or from self-collected feces, with the resultant findings showing that the lean donor feces group displayed increased insulin sensitivity, along with increased levels of butyrate-producing intestinal microbiota.

Case reports of FMT have also shown favorable outcomes in Parkinson’s disease, multiple sclerosis, myoclonus dystonia, chronic fatigue syndrome, and idiopathic thrombocytopenic purpura. FMT is a promising approach in the manipulation of the intestinal microbiota and has potential applications in a variety of extra-intestinal conditions associated with intestinal dysbiosis.

From Arthritis Care and Research (Hoboken), 19 June 2015 [Epub ahead of print]

Gene expression factor analysis to differentiate pathways linked to fibromyalgia, chronic fatigue syndrome, and depression in a diverse patient sample.

Iacob E (1) , Light AR(2), Donaldson GW(1) , Okifuji A(1), Hughen RW(2) White AT(3), Light KC(2).
1) Department of Anesthesiology Pain Research Center, University of Utah, Salt Lake City, UT.
2) Department of Anesthesiology, University of Utah, Salt Lake City, UT.
3) Department of Exercise and Sport Science, University of Utah, USA, Salt Lake City, UT.



To determine if independent candidate genes can be grouped into meaningful biological factors and if these factors are associated with the diagnosis of chronic fatigue syndrome (CFS) and fibromyalgia
(FMS) while controlling for co-morbid depression, sex, and age.


We included leukocyte mRNA gene expression from a total of 261 individuals including healthy controls (n=61), patients with FMS only (n=15), CFS only (n=33), co-morbid CFS and FMS (n=79), and medication-resistant (n=42) or medication-responsive (n=31) depression. We used Exploratory Factor Analysis (EFA) on 34 candidate genes to determine factor scores and regression analysis to examine if these factors were associated with specific diagnoses.


EFA resulted in four independent factors with minimal overlap of genes between factors explaining 51% of the variance. We labeled these factors by function as: 1) Purinergic and cellular modulators; 2) Neuronal growth and immune function; 3) Nociception and stress mediators; 4) Energy and mitochondrial function.

Regression analysis predicting these biological factors using FMS, CFS, depression severity, age, and sex revealed that greater expression in Factors 1 and 3 was positively associated with CFS and negatively associated with depression severity (QIDS score), but not associated with FMS.


Expression of candidate genes can be grouped into meaningful clusters, and CFS and depression are associated with the same 2 clusters but in opposite directions when controlling for co-morbid FMS. Given high co-morbid disease and interrelationships between biomarkers, EFA may help determine patient subgroups in this population based on gene expression.

From Diagnostics, 23 June 2015

Unintended Consequences of not Specifying Exclusionary Illnesses for Systemic Exertion Intolerance Disease

Leonard A. Jason *, Madison Sunnquist, Bobby Kot and Abigail Brown
Center for Community Research, DePaul University, Chicago, IL 60614, USA


The Institute of Medicine recently proposed a new case definition for chronic fatigue syndrome (CFS), as well as a new name, Systemic Exertion Intolerance Disease (SEID).

Contrary to the Fukuda et al.’s CFS case definition, there are few exclusionary illnesses specified for this new SEID case definition.

The current study explored this decision regarding exclusionary illnesses using the SEID criteria with four distinct data sets involving patients who had been identified as having CFS, as well as healthy controls, community controls, and other illness groups.

The findings indicate that many individuals from major depressive disorder illness groups as well as other medical illnesses were categorized as having SEID. The past CFS Fukuda et al. prevalence rate in a community based sample of 0.42 increased by 2.8 times with the new SEID criteria.

The consequences for this broadening of the case definition are discussed.

From Clinical Infectious Diseases, 16 June 2015 (e-published before print).

Lyme Disease Diagnosed by Alternative Methods: A Common Phenotype with Chronic Fatigue Syndrome

David M. Patrick(1,2), Ruth R. Miller(1), Jennifer L. Gardy(1,2), Shoshana M. Parker(3), Muhammad G. Morshed(4,5), Theodore S. Steiner(6), Joel Singer(1,3), Kam Shojania(6), and Patrick Tang(4,5) For the Complex Chronic Disease Study Group
1) School of Population and Public Health, University of British Columbia, Vancouver, Canada
2) British Columbia Centre for Disease Control, Vancouver, Canada
3) UBC Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
4) Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
5) British Columbia Public Health Microbiology and Reference Laboratory, Vancouver, Canada
6) 6Department of Medicine, University of British Columbia, Vancouver, Canada
Correspondence to: Dr. David Patrick, UBC School of Population and Public Health, 2206 East Mall, Vancouver BC V6T 1Z3 Canada, Tel: 604-822-3910 Fax: 604-822-4994 email:
Alternate Corresponding Author: Dr. Patrick Tang, British Columbia Public Health Microbiology and Reference Laboratory, 655 West 12 Ave, Vancouver BC V5Z 4R4 Canada, Tel: 604-707-2616, Fax: 604-707-2675, email:



A subset of patients reporting a diagnosis of Lyme disease can be described as having alternatively diagnosed chronic Lyme syndrome (ADCLS), in which diagnosis is on the basis of laboratory results from a non-reference Lyme specialty laboratory using in-house criteria. ADCLS patients report similar symptoms to patients with chronic fatigue syndrome (CFS).


We performed a case-control study comparing patients with ADCLS and CFS to each other and to both healthy controls and controls with the chronic disease systemic lupus erythematosus (SLE). Subjects completed a history, physical exam, screening laboratory tests, seven functional scales, reference serology for Lyme disease using CDC criteria, reference serology for other tick-associated pathogens, and cytokine expression studies.


The study enrolled 13 cases with ADCLS, 12 of whom were diagnosed by one alternative US laboratory, 25 CFS cases, 25 matched healthy controls, and 11 SLE controls. Baseline clinical data and functional scales indicate significant disability among ADCLS and CFS cases and many important differences between these groups and controls, but no significant differences between each other. No ADCLS patient was confirmed as having positive Lyme serology by reference laboratory testing and there was no difference in distribution of positive serology for other tick-transmitted pathogens or cytokine expression across the groups.


In British Columbia, a setting with low Lyme disease incidence, ADCLS patients have a similar phenotype to CFS patients. Disagreement between alternative and reference laboratory Lyme testing results in this setting is most likely explained by false positive results from the alternative laboratory.

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