The ME Association End of Week Research Round-up | 07 February 2020


Charlotte Stephens, Research Correspondent, ME Association.

We show below brief summaries of the research studies about ME/CFS that have been published in the last week, followed by the abstracts from those studies.

This information will be included in the monthly update to the central Research Index which is made freely available as a download at the end of every month.

You can also find the Index in the Research section of the website together with a list of Research Summaries from the ME Association that provide lay explanations of the more important and interesting work that has been published to date.

  • Last week’s round-up featured a brain imaging study from America that identified a pattern of activated neurological regions that differentiate CFS patients from sedentary controls.

ME/CFS Research Published 1st – 7th February 2020

This week, 4 new research studies have been published:

1. The American Autonomic Society reviewed literature relating to Human Papillomavirus (HPV) vaccination and its potential connection to dysautonomia, chronic fatigue, complex regional pain syndrome (CRPS) and postural tachycardia syndrome (POTS). They found that these conditions are prevalent in the same populations that are vaccinated with the HPV vaccine, however, and that this association is insufficient proof of causation. They conclude “At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia.”

2. Dr Keith Geraghty carried out a review of psychological treatment protocols and early treatment data for medically unexplained symptoms, including ME/CFS, under the UK Government initiative ‘Improving Access to Psychological Therapies’ (IAPT). He Identified several failings of the service, including an unproven treatment rationale, a weak and contested evidence-base, biases in treatment promotion, exaggeration of recovery claims and under-reporting of drop-out rates. He concluded “This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints. Psychotherapy should not become a default when patients’ physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part.”

3. Researchers from Kings College London measured cortisol levels in saliva and hair samples taken from patients with ME/CFS and patients with atypical depression and compared them to controls. Saliva cortisol levels (representing daily output) were lower in both the CFS and atypical depression patients compared to controls. Hair cortisol levels (representing the cortisol concentration over the last 3 months) were no different to controls.

4. French researchers measured maximal physical performance, using a cycle ergometer, in 66 patients with ME/CFS and 32 patients with chronic fatigue but no diagnosis of ME/CFS. They then looked at the correlation between maximal physical performance and maximal handgrip strength. They found no significant differences between the patients with or without a diagnosis of ME/CFS. Maximal handgrip strength was significantly and positively correlated with peak oxygen uptake and maximal work rate in all patients with chronic fatigue. The researchers concluded that handgrip strength can predict maximal exercise performance in patients with chronic fatigue.

ME/CFS Research references and abstracts

1. Barboi A et al. (2020)
Human papillomavirus (HPV) vaccine and autonomic disorders: a position statement from the American Autonomic Society.
Clinical Autonomic Research 30 (1): 13-18.

Abstract
Background: Human papillomavirus (HPV) vaccination has been anecdotally connected to the development of dysautonomia, chronic fatigue, complex regional pain syndrome and postural tachycardia syndrome.

Objectives: To critically evaluate a potential connection between HPV vaccination and the above-noted conditions.

Methods: We reviewed the literature containing the biology of the virus, pathophysiology of infection, epidemiology of associated cancers, indications of HPV vaccination, safety surveillance data and published reports linking HPV vaccination to autonomic disorders.

Results: At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia.

Conclusion: Certain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.

2. Geraghty K and Scott MJ (2020)
Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified.
BMC Psychology 8 (1): 13.

Abstract
Improving Access to Psychological Therapies is a UK Government funded initiative to widen access to psychological treatment for a range of common mental health complaints, such as depression and anxiety. More recently, the service has begun to treat patients with medically unexplained symptoms.

This paper reports on a review of treatment protocols and early treatment data for medically unexplained symptoms, specifically the illness myalgic encephalomyelitis/chronic fatigue syndrome.

A series of seven core problems and failings are identified, including an unproven treatment rationale, a weak and contested evidence-base, biases in treatment promotion, exaggeration of recovery claims, under-reporting of drop-out rates, and a significant risk of misdiagnosis and inappropriate treatment.

There is a pressing need for independent oversight of this service, specifically evaluation of service performance and methods used to collect and report treatment outcomes. This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints.

Psychotherapy should not become a default when patients’ physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part. Patients who reject psychotherapy or do not meet selection criteria should be offered appropriate medical and psychological support.

“Dr. Geraghty would like to thank the ME Association for their support.”

3. Herane-Vives A et al. (2020)
Cortisol Levels in Chronic Fatigue Syndrome and Atypical Depression Measured Using Hair and Saliva Specimens.
Journal of Affective Disorders [Epub ahead of print].

Abstract
Background: Several diagnostic criteria for major depressive disorder (MDE) overlap with those of Chronic Fatigue Syndrome (CFS). Furthermore, atypical MDE (A-MDE), a subtype of MDE characterised by profound fatigue and which has frequently been linked with CFS, exhibits similar low cortisol levels to CFS. However, this result has been only found in specimens designed for measuring acute cortisol levels.

In this study, we measure cortisol levels in subjects with CFS and in subjects with atypical MDE (A-MDE), without psychiatric comorbidity, using both hair and saliva specimens, to gain a measure of both short and long-term cortisol levels in these two conditions.

Methods: Hair cortisol concentration, representing the cortisol concentration of the previous three months, and salivary cortisol, measured at six time-points across one day and including the cortisol awakening response (CAR), post-awakening delta cortisol and the total daily output, were assessed in an age and gender matched group of 34 controls, 15 subjects with A-MDE and 17 with CFS.

Results: CFS (92.2 nmol/l.h, s.d=33.2 nmol/l.h) and A-MDE (mean=89.1 nmol/l.h, s.d=22.6 nmol/l.h) subjects both showed lower cortisol total daily output in saliva (AUCg) in comparison to healthy controls (mean=125.5 nmol/l.h, s.d=40.6 nmol/l.h). However, hair cortisol concentration was not lower than that of controls in either patient group. CFS and A-MDE did not differ from one another on any cortisol measures. CFS subjects reported fewer daily hassles and less severe psychic anxiety symptoms in comparison to A-MDE subjects (all p<0.05). However, they did not differ in the severity of somatic anxiety symptoms. There was also no difference in the presence of overlapping symptoms such as fatigability and memory problems between A-MDE and CFS subjects.

Conclusion: Low levels of cortisol found using short-term measures of daily output may be transient, since cortisol levels were normal when a long-term measure (hair) was studied. This might be explained by a potential cortisol rhythm alteration. Although these disorders have their distinctive depressive and somatic features, they may form part of a wider group of Somatic Symptom Disorders (SSD), given the findings of the same pattern of cortisol secretion in both disorders and increased frequency of overlapping clinical features.

4. Jammes Y et al. (2020)
Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue.
Clinical Biomechanics 73: 162-165.

Abstract
Maximal handgrip strength is used to predict exercise performance in healthy older subjects and in patients with chronic obstructive pulmonary disease, breast cancer or cirrhosis. Our objective was to evaluate the ability of maximal handgrip strength to predict maximal exercise performance in patients with chronic fatigue.

Sixty-six patients with myalgic encephalomyelitis/chronic fatigue syndrome and 32 patients with chronic fatigue but no diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome were included. The maximal physical performance was measured on a cycle ergometer to measure the peak oxygen uptake and the maximal work rate. We searched for linear regressions between maximal handgrip strength and maximal performances.

No significant differences in slopes and ordinates of regression lines were noted between patients with or without a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome, allowing to pool the data. Maximal handgrip strength was significantly and positively correlated with peak oxygen uptake and maximal work rate in all patients with chronic fatigue.

We conclude that handgrip strength can predict maximal exercise performance in patients with chronic fatigue.

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