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Radio 4: Inside Science -Microclot Clues to Post-Viral Disease

Radio 4 – Inside Science (11.08.22) discuss microclots and say “new evidence for a possible biomarker of ME/Chronic Fatigue Syndrome – a condition associated with debilitating tiredness and brain fog similar to Long Covid. The microclots, described by Professor Doug Kell at the University of Liverpool and Professor Resia Pretorius of University of Stellenbosch, suggest a possible inflammatory cardiovascular element to the disease which might one day forge a path towards new treatments.”

Listen to the broadcast below – starts at approximately 14.03.

Video Credit: Adam – Twitter @ABrokenBattery


Radio Presenter 
In the past few years, we've heard a lot about Long Covid, a debilitating post viral hangover that can leave sufferers with headaches brain fog and fatigue amongst other symptoms and for sufferers of another long-term condition, this will sound all too familiar Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS) has a wide range of symptoms but the most common is extreme tiredness. 
It is estimated that over 250,000 people in the UK have the condition and yet we still know very little about what causes it or crucially how to treat it but a recent study by researchers from the UK, the US and South Africa could pave the way to promising new experimental therapies. 
Our reporter Emily bird has been speaking to the team behind the work then she joins me now. 
Hello Emily, can you tell me a bit more about this research? 
Reporter Emily Bird  
Yeah, so this study is actually the first to uncover clear biomarkers for the disease, so the researchers have been studying the blood of those with M or CFS and found these micro clots in the blood which could be a really exciting development in better understanding the condition. 
Radio Presenter 
Okay, so what is a micro clot? 
 Reporter Emily Bird  
A micro clot is essentially blood clotting in an anomalous way, so there small and they're resistant to being broken down which is part of the problem here. Actually, I spoke to Professor Douglas Kell from the University of Liverpool who described to me what these strange clocks look like down the microscope. 
Professor Douglas Kell 
The elements of the blood clot are fibres which look in an electron microscope like a place of spaghetti except that in the presence of some of these other things such as a bacterial cell wall component the clotting goes to it completely different kind of structure which in electron microscopes looks rather like if you parboil spaghetti and you don't cook it properly and it all sticks together in an unholy mess. 
Radio Presenter 
It has a lot of spaghetti references. Are these strange clocks unique to ME or chronic fatigue? 
Reporter Emily Bird 
No, actually so many other conditions have these types of clots they actually occur anytime there's any sort of information so you see them in diabetes, cardiovascular disease psoriasis even and also neuroinflammatory diseases like Alzheimer's or Parkinson's. But they haven't yet been seen or even actually looked for in ME/CFS and the reason the researchers went looking is an earlier study that they found they found these micro clots in Long Covid.  
So, they actually figured out that the spike protein that causes so many problems in Long Covid actually causes these micro clots and they then decided to look for them in ME/CFS and they saw that they were ten times the concentration of these micro clots in patients than compared to the control.  
Radio Presenter 
So, what are they doing there how, how did they get there and how are they affecting people's symptoms are they causing the disease? 
Reporter Emily Bird 
Well, this is the thing it is still unclear and like you said at the beginning there is still no consensus on exactly what causes ME or CFS but there is a theory about it being a post viral disease, so a dormant virus or bacterial infection could be lying dormant in some part of the body and shedding these inflammatory factors. So similar the spike protein something else is in the blood that perhaps causing these micro clots.  
I spoke to Professor Resia Pretorius easier for tourists at Stellenbosch University in South Africa she worked on the study and she pointed out that there's still a lot that we don't quite know. 
Professor Resia Pretorius 
So, it is more a result of the pathology of the disease, disease specific pathology rather than the micro clots appearing and then being the cause of the disease. But definitely, the micro clots in circulation is not supposed to be there it can cause further clotting dilemmas in the patients suffering from the micro clots so it's not directly the cause of the disease to start off with but it definitely can perpetuate the vascular damage that we see in his patients. 
Radio Presenter 
OK so it's unclear whether they are causing people’s symptoms or not but could they be? 
Reporter Emily Bird,  
Well, Professor Kell was a little more hopeful he says there is a logical mechanism by which these clots could be causing the disease so in chronic fatigue and in Long Covid. So, he says that if you think about a normal blood clot that would block a big artery or vein because they are larger and that can cause problems like stroke or deep vein thrombosis and that’s because they deprive a big area of oxygen. But if you have these micro clots which are much smaller, they can block these smaller blood vessels causing more local areas to be starved for oxygen which could explain the wide variety of symptoms seen in chronic fatigue or in long covid. 
Professor Douglas Kell 
And that precisely can explain things like fatigue and the overall set of the enormous number of symptoms that people with ME/CFS and Long Covid have. So, it's all to do with oxygen not getting to the tissues and what happens depends on the tissue, if it's to the brain you get brain fog, if it's the kidney kidneys don't work, and if it's a skeletal muscle, your muscles don't work properly and you get fatigue. 
Radio Presenter 
Fascinating and still a bit mysterious, but causative or not could these micro clots be a potential target for treatment? 
Reporter Emily Bird. 
Well like you said it's early days and it will be a long time before we know whether we can target them for treatment or not. But some work in Long Covid, has already suggested that stopping these clots from forming or perhaps getting rid of them when they have formed has prevented severe forms of long or acute Covid and there's hope for ME or CFS treatments in the future as well. 
Professor Resia Pretorius 
It is been a significantly neglected disease because so many clinicians and researchers have driven the idea that it is a psychological disease and many of the patients have been suffering really to the extreme levels where they cannot lift their head from the bed and they lie in dark rooms without any help that's the saddest part.

And I hope that this renewed interest in post-viral conditions would give these patients some sort of hope, that it is not ‘all in their head’ it is actually a physical disease was a physical reason and trying to get them out of bed and do exercise and think themselves bigger is definitely not going to work.  Furthermore, I also I'm very excited that Long Covid it will surely have the ability to place more emphasis on post-viral conditions and I hope that we can even visit Alzheimer's and Parkinson's theories on the development of that too 
Professor Resia Pretorius there from the University of Stellenbosch and thank you to Professor Douglas Kell from the University of Liverpool as well, and of course to our own reporter Emily Bird. 

Oxford ME/CFS Conference Report July 2022

Further information that might be of interest can be found here

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