From Microbiome (open access journal), 23 June 2016.
Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome
Ludovic Giloteaux(1), Julia K. Goodrich(1,2), William A. Walters(1,2), Susan M. Levine(3), Ruth E. Ley(1,20 and Maureen R. Hanson(1)
1) Department of Molecular Biology and Genetics, Cornell University
2) Department of Microbiology, Cornell University
3) Private Practice
Gastrointestinal disturbances are among symptoms commonly reported by individuals diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, whether ME/CFS is associated with an altered microbiome has remained uncertain. Here, we profiled gut microbial diversity by sequencing 16S ribosomal ribonucleic acid (rRNA) genes from stool as well as inflammatory markers from serum for cases (n = 48) and controls (n = 39). We also examined a set of inflammatory markers in blood: C-reactive protein (CRP), intestinal fatty acid-binding protein (I-FABP), lipopolysaccharide (LPS), LPS-binding protein (LBP), and soluble CD14 (sCD14).
We observed elevated levels of some blood markers for microbial translocation in ME/CFS patients; levels of LPS, LBP, and sCD14 were elevated in ME/CFS subjects. Levels of LBP correlated with LPS and sCD14 and LPS levels correlated with sCD14. Through deep sequencing of bacterial rRNA markers, we identified differences between the gut microbiomes of healthy individuals and patients with ME/CFS. We observed that bacterial diversity was decreased in the ME/CFS specimens compared to controls, in particular, a reduction in the relative abundance and diversity of members belonging to the Firmicutes phylum. In the patient cohort, we find less diversity as well as increases in specific species often reported to be pro-inflammatory species and reduction in species frequently described as anti-inflammatory. Using a machine learning approach trained on the data obtained from 16S rRNA and inflammatory markers, individuals were classified correctly as ME/CFS with a cross-validation accuracy of 82.93 %.
Our results indicate dysbiosis of the gut microbiota in this disease and further suggest an increased incidence of microbial translocation, which may play a role in inflammatory symptoms in ME/CFS.
From the Clinical Journal of Pain, 17 June 2016.
Activity Pacing is Associated with Better and Worse Symptoms for Patients with Long-term Conditions.
Antcliff, Deborah PhD, BSc; Campbell, Malcolm PhD; Woby, Steve PhD; Keeley, Philip PhD
Activity pacing has been associated with both improved and worsened symptoms, and its role in reducing disability among patients with long-term conditions has been questioned. However, existing studies have measured pacing according to uni-dimensional subscales, and therefore the empirical evidence for pacing as a multifaceted construct remains unclear. We have developed a 26-item Activity Pacing Questionnaire (APQ-26) for chronic pain/fatigue containing five themes of pacing: activity adjustment, activity consistency, activity progression, activity planning and activity acceptance.
To assess the associations between the five APQ-26 pacing themes and symptoms of pain, physical fatigue, depression, avoidance and physical function.
Cross-sectional questionnaire design study. Data analysed using multiple regression.
257 adult patients with diagnoses of chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.
Hierarchical multiple regression showed that activity adjustment was significantly associated with increased physical fatigue, depression and avoidance, but decreased physical function (all P<=0.030). Activity consistency was associated with decreased pain, physical fatigue, depression and avoidance but increased physical function (all P<=0.003). Activity planning was associated with reduced physical fatigue (P=0.025) and activity acceptance was associated with increased avoidance (P=0.036). CONCLUSION Some APQ-26 pacing themes were associated with worse symptoms and others with symptom improvement. Specifically, pacing themes involving adjusting/reducing activities were associated with worse symptoms, whereas pacing themes involving undertaking consistent activities were associated with improved symptoms. Future study will explore the causality of these associations to add clarification regarding the effects of pacing on patients' symptoms.
From the Scandinavian Journal of Pain, 20 June 2016 (Full text available as a pdf).
Gut gateway to generalized pain
Arnold Berstad, Jørgen Valeur
Unger-Vetlesen's Institute, Lovisenberg Diaconal Hospital, 0440 Oslo, Norway
Corresponding author: Arnold.Berstad@uib.no
In this issue of Scandinavian Journal of Pain, Marum and coworkers  report that a diet low in FODMAPs, “fermentable oligo-, di- and monosaccharides, and polyols”, is effective in treating complaints related to fibromyalgia, a rheumatic disease characterized by widespread myofascial pain of unknown aetiology.
From Open Heart
Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study
Julia L Newton(1,2), Andreas Finkelmeyer(1,3), George Petrides(2), James Frith(1,2), Tim Hodgson(3), Laura Maclachlan(1), Guy MacGowan(1,2) and Andrew M Blamire(1,3)
1) Institute of Cellular Medicine, Newcastle upon Tyne, UK
2) Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
3) Newcastle Magnetic Resonance Centre, Newcastle upon Tyne, UK
Correspondence to Professor Julia L Newton; firstname.lastname@example.org
To explore potential mechanisms that underpin the cardiac abnormalities seen in chronic fatigue syndrome (CFS) using non-invasive cardiac impedance, red cell mass and plasma volume measurements.
Cardiac MR (MR) examinations were performed using 3 T Philips Intera Achieva scanner (Best, NL) in participants with CFS (Fukuda; n=47) and matched case-by-case controls. Total volume (TV), red cell volume (RCV) and plasma volume (PV) measurements were performed (41 CFS and 10 controls) using the indicator dilution technique using simultaneous 51-chromium labelling of red blood cells and 125-iodine labelling of serum albumin.
The CFS group length of history (mean±SD) was 14±10 years. Patients with CFS had significantly reduced end-systolic and end-diastolic volumes together with reduced end-diastolic wall masses (all p<0.0001). Mean±SD RCV was 1565±443 mL with 26/41 (63%) having values below 95% of expected. PV was 2659±529 mL with 13/41 (32%) <95% expected. There were strong positive correlations between TV, RCV and PV and cardiac end-diastolic wall mass (all p<0.0001; r2=0.5). Increasing fatigue severity correlated negatively with lower PV (p=0.04; r2=0.2). There were no relationships between any MR or volume measurements and length of history, suggesting that deconditioning was unlikely to be the cause of these abnormalities. CONCLUSIONS This study confirms an association between reduced cardiac volumes and blood volume in CFS. Lack of relationship between length of disease, cardiac and plasma volumes suggests findings are not secondary to deconditioning. The relationship between plasma volume and severity of fatigue symptoms suggests a potential therapeutic target in CFS. KEY QUESTIONS
What is already known about this subject?
* Chronic fatigue syndrome (CFS) has been shown to be associated with a range of cardiac abnormalities.
* Studies, to date, have suggested that these abnormalities probably arise because of deconditioning.
What does this study add?
* This study has confirmed in a large cohort that there are reductions in cardiac volume in CFS measured using cardiac MRI.
* The degree of these end-diastolic and end-systolic volume abnormalities associates with blood volume.
* The abnormalities seen are not arising secondary to deconditioning.
* Reductions in plasma volume associate with fatigue severity.
How might this impact on clinical practice?
* This study reinforces, using state-of-the art MRI, previous findings that there is a cardiac abnormality in those with CFS.
* The finding of hypovolaemia in association with cardiac structural abnormalities and fatigue severity represents a potential therapeutic target.