
Antibody wipeout relieves symptoms of chronic fatigue syndrome - jhartmann
http://www.newscientist.com/article/mg22730284.000-antibody-wipeout-relieves-symptoms-of-chronic-fatigue-syndrome.html#.VZrJf3N3mbk
======
reasonattlm
There is considerable support for destroying and recreating immune cell
populations to deal with autoimmune diseases and some aging effects. For
example, for B cells:

\----

1) Reversing B cell aging

[http://www.impactaging.com/papers/v3/n4/full/100313.html](http://www.impactaging.com/papers/v3/n4/full/100313.html)

2) Long-lived autoreactive plasma cells drive persistent autoimmune
inflammation.

[http://dx.doi.org/10.1038/nrrheum.2011.1](http://dx.doi.org/10.1038/nrrheum.2011.1)

3) B-cell depletion reactivates B lymphopoiesis in the BM and rejuvenates the
B lineage in aging

[http://dx.doi.org/10.1182/blood-2010-09-307983](http://dx.doi.org/10.1182/blood-2010-09-307983)

\----

Then for treatment of autoimmune disorders such as MS, more comprehensive
destruction:

[http://www.eurekalert.org/pub_releases/2009-01/nu-
sct012909....](http://www.eurekalert.org/pub_releases/2009-01/nu-
sct012909.php)

This was also tried for rheumatoid arthritis with mixed results before the
development of biologics, and everyone gave up on the immune reboot with
chemotherapy in favor of controlling the condition for some patients.

\----

Then there are the prospects for destroying T cells specialized to
herpesviruses like CMV (you probably have CMV, near everyone has CMV by time
old age rolls around, it's very prevalent) that are thought to cause a large
degree of immunosenescence by overloading the repertoire of immune cells with
memory T cells for CMV and the like - too many of those and not enough naive T
cells to deal with new threats and cancer surveillance. That isn't a going
concern yet, but it certainly could be soon.

~~~
danieltillett
Yes the problem with the CMV (and EBV) T cells is too often ignored. Once
these T-cells become more than 80% T-cell population your life expectancy is
less than a year. You pretty much have leukaemia.

In my opinion we should be testing all people over the age of 65 for CMV and
EBV and putting them on anti-herpies virus drugs to suppress the chronic low
level viral turnover that is driving this T-cell clonal expansion.

~~~
DaniFong
I would really appreciate any references on this.

~~~
danieltillett
Have a look at this paper

Cytomegalovirus-seropositivity has a profound influence on the magnitude of
major lymphoid subsets within healthy individuals

S Chidrawar, N Khan, W Wei, A McLarnon, N Smith, L Nayak, and P Moss

Clinical & Experimental Immunology 2009 vol. 155 (3) pp. 423-432

[http://doi.wiley.com/10.1111/j.1365-2249.2008.03785.x](http://doi.wiley.com/10.1111/j.1365-2249.2008.03785.x)

~~~
DaniFong
Thanks!

------
snowpanda
I am hoping someone can help here because it has been affecting my life every
day. I have been extremely fatigued for the past 2.5 years and I've lost so
many things due to it. I sleep the majority of every day away. How do I know
if this is CFS?

I guess what I'm asking is, where do I start to cross out other possible
causes? Considering so many things can cause fatigue.

Thank you

~~~
Erik816
I have lived with CFS for about six years now. Step one is to see your primary
care doctor and rule out all the things they can test you for. That will take
a while. I remember hoping I would have MS because then that would at least
explain things. :)

Step two, if you have CFS, is to come up with a plan to manage your energy
levels and think about how you are going to live your life. For me, not
overdoing it is key. You cannot recover like a healthy person, and often each
crash makes your baseline even lower.

Step three, think about how you want to try to treat the underlying issue.
Since it's not clear what the underlying issue is, there's a lot of paths
here. I was conservative and didn't try a lot of experimental things. I worked
with Doctor Jose Montoya at Stanford
([http://med.stanford.edu/chronicfatiguesyndrome.html](http://med.stanford.edu/chronicfatiguesyndrome.html))
who is an amazing doctor. He's highly recommended if you can make it to Palo
Alto. My health has slowly improved over the years and is much better now than
it was say 3 years ago.

Best of luck!

~~~
j-pb
Trust me you don't want MS. The only case where that's the "better thing",is
when you have to pick between MS and a brain turmor. (Lymphoma can look
surprisingly similar in MRI.)

------
refurb
Very interesting! It didn't work for everyone, but it did work for a majority
it looks like.

CFS is a pretty nasty condition, so I'm glad they've found something that
works. My only concern would be the side effects from Rituxan. It's a well
studied drug, but it really knocks down your immune system.

~~~
JoshTriplett
> Very interesting! It didn't work for everyone, but it did work for a
> majority it looks like.

Given that they didn't know what caused CFS (and without further study they
still don't know for sure), they don't necessarily have a reliable test that
_distinguishes_ CFS from other things that present with similar symptoms. So
it's entirely possible that CFS _is_ an immune disorder, this treatment worked
on people with CFS, and the remaining cases didn't actually have CFS. It's
also possible that some fraction of those it didn't work on have CFS and the
drug is not entirely effective, or that some fraction of those it _did_ "work"
on are experiencing a placebo effect or a treatment for a different disease
that responds to the same treatment.

~~~
philwelch
CFS, like most "syndromes", isn't really a well understood disease but rather
a cluster of related symptoms that might indicate a currently unknown disease
should a cause or mechanism be discovered. Are you chronically fatigued and
the doctors can't diagnose an understood cause? Must be Chronic Fatigue
Syndrome. Did your infant suddenly die and the doctors can't figure out how?
Must be Sudden Infant Death Syndrome.

What this indicates is that, for a subset of people who are chronically
fatigued for no reason that the doctors can figure out, there might be some
kind of underlying autoimmune reaction that responds to this kind of
treatment. If the mechanism is better understood and can be diagnosed, tested,
and treated, then it's not Chronic Fatigue Syndrome anymore, but rather an
actual disease.

------
xefer
"A 150-person study is now under way, and includes a control group."

I'm curious, the latest study which is presumably what triggered this story,
involved no control group, yet they mention a smaller study from 2011 which
did use a control.

If this really does hint at a breakthrough, why did it take so long to follow
up on the first study, and why did this one not use a control group?

~~~
steve-howard
From the study at
[http://journals.plos.org/plosone/article?id=10.1371/journal....](http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129898)
:

"According to protocol for the previous randomized KTS-1-2008 study, patients
assigned to the placebo group should be given the opportunity to participate
in a new open-label study with rituximab. The protocol for the present study
was designed to learn about the therapeutic efficacy of rituximab maintenance
treatment, for response rates and response durations. Also, the experiences
could form the basis for design of a future randomized, double-blind and
placebo-controlled trial."

------
trhway
so, it is possible that some infection is an original cause for the elevated
antibody level. It reminds the history of stomach ulcers where bacteria, not
the stress, happened to be the primary reason. Matter over mind once again :)

~~~
zik
Most cases of CFS seem to start out as a "post-viral syndrome". Basically
people get a virus, recover from the virus but are left with ongoing fatigue
symptoms. After six months it's declared to be CFS (CFS isn't a specific
disease, it just declares that you've been fatigued for over six months).

So yes, I think many people who've had CFS would say it's a no-brainer that it
was related to an infection. In my case I got "mono" (or glandular fever as we
call it here) and it turned into CFS for about seven years. But in the end I
recovered and I've been fine for nearly a decade now.

~~~
stordoff
Pretty much mirrors the experience of one of my family members. She contracted
mumps and pneumonia in a fairly short time period, then was left with ongoing
fatigue. A year on, she's definitely improving, but doing too much leaves her
fatigued for days and she sleeps for 18+ hours some days.

A cure (or even treatments to shorten the recovery time) would be wonderful.

------
lugg
> This would prevent people from getting enough oxygen, explaining their
> extreme fatigue, but the team caution that their theory is just speculation
> for now.

Caution, in scientific journalism; sadly, I'm kind of impressed.

------
marvin
This is pretty solid evidence that CFS is not psychosomatic, given the
difference in response between the control group and the group that received
treatment. In case anyone was still unsure.

~~~
glup
I think there's a flaw in your logic here: the fact that a drug that is
targeting the immune system helps so much _does not_ invalidate a
psychological component in the etiology. It could be upstream (psychological
stress could trigger the immune response that leads to CFS), it could be
downstream (CFS leads to mental anguish given a patient's deviation from
normative life-course, perceived isolation, and the historically-contested
nature of the malady), or it could be both.

That said, a psychological / psychosomatic component wouldn't undermine its
legitimacy in any way. Thankfully, I think we are entering an era in which
psychological aspects of ailments are recognized as critical, beyond the
control of the patient (e.g. not reflecting a lack of virtue or wherewithal on
their part), and treatable.

~~~
jpravetz
Or it could be that what causes CFS also affects brain chemistry in a way that
can result in depression. That's where my money is.

------
rollthehard6
As for any autoimmune disease, have a read up on Naltrexone (Papers that is,
not pseudo science blogs and advocacy sites that are generally poorly
substantiated)

One on an MS model in mice :
[http://www.ncbi.nlm.nih.gov/pubmed/25906771](http://www.ncbi.nlm.nih.gov/pubmed/25906771)

~~~
rollthehard6
On the patient experience, i.e. entirely anecdotal side :
[https://creator.zoho.com/ldndatabase/all-others/view-
perma/C...](https://creator.zoho.com/ldndatabase/all-others/view-
perma/CFS_ME/S3tZJB9TumzZu3eDJ4gF20ZDAxuNnpEF414UPASukuCrdub97JyR11Fd2rnvaCFNHSXjm80sb48tPHCG34hbCTQxqZ8eFR9fy6f2)

from :

[http://www.ldndatabase.com/cfs.html](http://www.ldndatabase.com/cfs.html)

------
MichaelCrawford
I have a close friend who has chronic fatigue. It is commonly stigmatized as
many regard those who are chronically fatigued as lazy, just making excuses.

But my friend is one of the hardest-working, most productive people I have met
and is quite wealthy as a result at first of her code, then as a result of her
management expertise.

Even so she feels like crap 24/7 and it just won't go away. Nothing helps.

She can be a little hard to get along with, though.

~~~
cpncrunch
Research tends to show the opposite, that CFS patients tend to be over-active
(pre-illness) and have "action-prone" personalities.

------
gosmart4u
Rather than defaulting to drugs for CFS, I would much rather find the core
cause of it? Oftentimes it is an infection, stress or even the food we put
into our bodies. You would be amazed at how better you can feel and how much
more energy you have by simply changing your diet and lifestyle.

~~~
watersb
Sounds like you found something that works for you. Excellent!

Diet and exercise were certainly where I started. That was seven years ago.
Still no joy.

Infections eventually go away. Maybe. Or we treat them with drugs, diet etc.
Stress can be reduced, managed, eliminated. We can change the food we put in
our bodies.

When nothing works, then what? Keep looking.

~~~
sosuke
I can sympathize, my wife is asleep next to me and I'm sure she will be
excited to hear some progress is being made on CFS. CFS isn't a sexy thing to
research, it doesn't get a lot of funding, same thing with a lot of other
conditions and syndromes. No idea what causes it, but taking x/y/x unrelated
medication seems to alleviate the symptoms.

