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Excited by a renewed focus on viruses, Dr. Klimas hopes to open a Center of Excellence to study and treat viral reactivation.
The Dr. Klimas interview is the next in a series of “What’s Up, Doc?” video interviews where I ask experts in the ME/CFS/FM and long-COVID fields what’s exciting them right now.
You can watch the video here. (I forgot to turn off the recording, leaving the last five minutes of it scanning the ceiling of my trailer… Whoops! I could not edit that part because the video sits on the Nova Southeastern University website.)
The blog below goes over the talk and adds in things here and there…
You’re always guaranteed a stimulating conversation with Nancy Klimas. It’s not just that she’s a researcher – she’s also a doctor and longtime chronic fatigue syndrome (ME/CFS) advocate. From the IACFS/ME to CFSAC – the former federal ME/CFS Advisory Panel – to many working groups, she’s participated in just about everything possible. It came as no surprise that when I asked her about what’s exciting now in the ME/CFS/long COVID field, she focused not on her work but on the field at large.
Taking the long-range view, she returned to her first ME/CFS paper from 34 years ago (at the time of the interview), “Immunologic abnormalities in chronic fatigue syndrome”. Chronic immune activation, NK cell defects, viral reactivation – we’re still talking about all of those (and have now added immune senescence – a new term).
THE GIST
From researcher to doctor, to serving on many ME/CFS panels and working groups, Dr. Nancy Klimas has been in the thick of things for decades. Given that, it wasn’t all that surprising that when asked about what’s exciting her now in the ME/CFS field, she focused not on her work but on the field at large.
Taking a long-range view, she returned to her first ME/CFS paper from 34 years ago, which found chronic immune activation, immune cell exhaustion, and viral reactivation – all of which researchers are still studying but in much greater depth now.
As Nancy talked, the failure of the NIH, in particular, to provide sufficient funding came into focus. Stephen Strauss’s determination, after his small trial of acyclovir – which is not particularly effective against the Epstein-Barr virus – failed, that the Epstein-Barr virus (EBV) was not involved in ME/CFS effectively shut down research into viral reactivation for years at the NIH.
Consistent findings of EBV reactivation during the early stages of a coronavirus infection, and its consistent emergence in long COVID, have changed the picture dramatically, however. EBV is now a big deal, and that’s good, but Dr. Klimas also pointed out that HHV-6 – which is reactivated as much, if not more, in her patients – is hardly being studied.
Chronic viral reactivation means chronic immune overdrive, and Dr. Klimas said that if any diseases exhibited chronic immune overdrive, they were ME/CFS and long COVID. That chronic immune activation comes at a cost, and that’s immune senescence – a steady degradation of the immune system’s ability to cope.
So, what makes Dr. Klimas excited is the renewed focus on viruses and the immune system as treatment targets. She hopes to create a “Center of Excellence for Viral Reactivation and Human Disease” that can research viral reactivation and treat it and that brings us to Dr. Klimas’s biggest need for ME/CFS – a clinical trials network for ME/CFS.
A clinical trials network for ME/CFS is Dr. Klimas’s top choice in her “Desperately Needed” category. It would fit in the “let’s finally get serious about treating ME/CFS approach” category.
Clinical trial networks are designed to produce an optimal blend of rigor and efficiency. They are the antidote to the small, underpowered, disorganized clinical trials that have pervaded ME/CFS research and have not provided much help. The benefits are voluminous: improved patient recruitment, a streamlined approach, the need for only one placebo group, better data quality, centralized databases, and shared best practices mean reduced costs and more reliable outcomes.
A clinical trials network would mean “smart trials”: trials that target subsets instead of ME/CFS patients at large – something Dr. Klimas believes is the key to success in this disease. A Rituximab trial, for instance, would focus on ME/CFS patients with signs of autoimmunity instead of taking all comers.
Dr. Klimas said that if she had a great benefactor, she “would slam some serious dollars” into creating a clinical trials network. 🙂
With that, we turned to her long-delayed ME/CFS trial and found out that it isn’t a duplicate of her GWI trial. First, note that the trial is designed to be curative; i.e., it was what supercomputer modeling suggested could return people with ME/CFS to homeostasis or health.
With the high rates of testosterone deficiency she sees in men with ME/CFS, she will first normalize the sex hormones, then attempt to stop brain inflammation with etanercept (Enbrel), then reset the HPA axis and stop the inflammation using mifepristone. The trial either has begun or will begin soon.
Dr. Klimas is taking a staggered three-drug approach to ME/CFS, but she’s leaving open the possibility that the right antiviral could do the trick…
If ME/CFS is like HIV, caused by a pathogen that persists in the body, theoretically, it could simply be cured by eliminating the virus. Antiviral trials have been few and far between, but Martin Lerner’s and Jose Montoya’s work suggests antivirals can be helpful. Despite all the interest in herpesviruses, the past 30 or 40 years have not brought us any randomized, placebo-controlled clinical trials.
While the current crop of antiherpesvirus drugs is not particularly effective, some drug candidates are being tested for other diseases. Dr. Klimas’s monoclonal antibody (mAB) case series produced incredible results with long COVID – and at least 10 mAB studies targeting EBV are underway. Another drug Dr. Klimas finds particularly enticing is Moderna’s anti-EBV vaccine, which is in phase I testing now – and which she hopes, at some point, to try testing in her patients.
A model produced by Dr. Klimas’s chief computational biologist, Travis Craddock, found that combining Rituximab with a herpesvirus drug was able to knock down EBV for long periods of time. Attempts to use antivirals alone allowed EBV to quickly roar back.
Dr. Klimas also looks forward to the breakthroughs she believes artificial intelligence and other means of complex data analysis will bring. Her team’s supercomputer assesses data randomly and in every direction possible using chaos theory so that no possibility escapes it.
An email today indicated that the Institute for Neuro-Immune Medicine has teamed up with Conquer CFS to provide people with ME/CFS with two months of free access to the Conquer CFS Emergency Reset course created by Max Kennedy – a former person with ME/CFS – in conjunction with Dr. Jenny Jin, an CFS/Fibromyalgia and Pain Management Expert. Find out how at the bottom of the blog.
(Yes, 35 years later, we’re talking about a similar paradigm, but look how far this still very small field has come. NK cells are no longer the big focus, but now the really heavy hitters of the adaptive immune response—T and B cells—are. Researchers now believe that the failure of these cells may have caused the innate and more inflammatory arm of the immune system to step in and attempt to compensate.
(Why these immune cells have failed is no longer such a mystery, either. Studies suggest that an inability to produce sufficient amounts of energy may be the cause—a nice finding given the overall energy production problems in ME/CFS. Plus, there’s a new player in town. Immune senescence/exhaustion wasn’t a thing back in the 90s, but it is now and has been found in NK, T, and B cells in ME/CFS.)
As Nancy talked, the failure of the NIH, in particular, to provide sufficient funding came into focus. Anthony Fauci played a prominent role in that when he cast the small ME/CFS research program out into the wilderness and closed down its three small centers—one of which was led by Nancy.
While Stephen Strauss was one of the first researchers to push for a serious study of ME/CFS, Strauss’s determination, after his small acyclovir trial failed, that Epstein-Barr virus was not involved in ME/CFS effectively shut down research into viral reactivation for years at the NIH. (At one point, the NIH flat-out stated it would not support any research into pathogens in ME/CFS.)
Dr. Klimas noted that acyclovir is not particularly effective against EBV but that more effective drugs have more safety issues. (The current crop of EBV drugs (acyclovir, valacyclovir, and ganciclovir) only affect the virus when it is replicating; i.e. when it’s in its “lytic phase”. Even in its latent phase, however, EBV can cause cancer and autoimmune disease.)
Consistent findings of EBV reactivation during the early stages of a coronavirus infection and its consistent emergence in long COVID have changed the picture dramatically. EBV is now a bigger focus. With the big bug’s ability to mess up immune functioning, induce autoimmunity, and cause cancer, and its long history in ME/CFS, Dr. Klimas wondered why its reactivation in long COVID has come as a surprise.
Dr. Klimas finds that HHV-6 is as often reactivated in her patients as EBV. It has only rarely been studied…
HHV-6 is another matter. Dr. Klimas finds a lot of HHV-6 reactivation in ME/CFS – perhaps more than EBV – yet it has been virtually ignored in both ME/CFS and long COVID. (My lab tests showed high levels of HHV-6 but no EBV reactivation.) In the past year, several studies have linked HHV-6 to ME/CFS and a couple to long COVID. John Chia’s enterovirus findings present another intriguing pathogen possibility that has not received its due.
Noting that our immune systems have backup upon backup systems, Dr. Klimas said anytime you see a virus escape, you know things are broken. We’re learning more about viral reactivation all the time. The coronavirus was never thought to produce a latent infection, but gut studies suggest that in some people, the coronavirus is indeed still present.
A broken immune system doesn’t mean the immune system stops trying to get at the virus. In fact, at least for a time, it may be trying harder than ever. Dr. Klimas said if there were ever illnesses in chronic immune overdrive, they were ME/CFS and long COVID. That chronic immune activation comes at a cost, and that’s immune senescence.
Immune senescence has typically been associated with aging, but some findings (T, B, and NK cell dysregulation, viral reactivation, chronic inflammation, telomere shortening) suggest that the immune systems in people with ME/CFS are aging more rapidly than normal as well.
So, what makes Dr. Klimas excited is the renewed focus on viruses and the immune system as treatment targets. She hopes to create a “Center of Excellence for Viral Reactivation and Human Disease” that can research viral reactivation and treat it – which brings us to Dr. Klimas’s biggest need for ME/CFS.
“Desperately Needed”- A Clinical Trials Network
A clinical trials network for ME/CFS is Dr. Klimas’s top choice in her “Desperately Needed” category. It would fit in the “let’s finally get serious about treating ME/CFS approach” category.
Clinical trial networks are designed to produce an optimal blend of rigor and efficiency. They’re not easy to build – it took Klimas and company three years to produce the protocols, criteria, primary/secondary outcomes, etc., needed for the Gulf War Illness clinical trials network. Once they were done, though, the trials could move forward effectively and efficiently.
Improved patient recruitment, a streamlined approach, the need for only one placebo group, better data quality, centralized databases, and shared best practices mean reduced costs and more reliable outcomes. With that comes more funding opportunities, as public institutions, private foundations, and pharmaceutical companies are more likely to fund trials in that setting.
They are the antidote to the small, underpowered, disorganized clinical trials that have pervaded ME/CFS research and have not provided much help. No one can count on – or knows what to make of – a small clinical trial that uses different criteria from other trials to choose its patients, different outcome measures to assess them, and is underpowered to boot.
In a clinical trials network, antiviral trials would target people with signs of viral reactivation.
A clinical trials network for ME/CFS would, Dr. Klimas said, design smart trials – i.e., trials that target subsets instead of ME/CFS patients at large – something that Dr. Klimas believes will be the key to success in this disease.
Instead of taking all comers, as the past Rituximab trial did, a new Rituximab trial would target ME/CFS patients with signs of autoimmunity. Similarly, an antiviral trial would target patients with signs of viral reactivation, etc.
Dr. Klimas said that if she had a great benefactor, she “would slam some serious dollars” into creating a clinical trials network. It could use the infrastructure produced in the Gulf War Illness clinical trials network that was funded by the DOD.
When asked, “If a clinical trials network had been recommended for ME/CFS,” ChatGPT stated one has been “strongly recommended” by “advocacy groups, researchers, and governmental advisory bodies.” While ME/CFS is “severely underfunded,” a “clinical trials network could dramatically improve the pace of ME/CFS research and potentially lead to the discovery of effective treatments.”
Dr. Klimas’s 2-Stage – No, Make That 3-Stage – ME/CFS Clinical Trial
For now, we have what we have, and I had to ask Dr. Klimas about her long-delayed ME/CFS clinical trial, and when she answered, something new popped up – the ME/CFS trial is not a duplicate of the GWI illness trial. Given the testosterone deficiency she often sees in men with ME/CFS, it wasn’t surprising to see the model say first normalize the sex hormones, then stop brain inflammation with etanercept (Enbrel), then reset the HPA axis and stop the inflammation using mifepristone.
With her model showing that testosterone is protective in men and often deficient, Dr. Klimas added testosterone to her ME/CFS clinical trial.
We’ll see how the trial turns out, but note that it’s one of the few trials designed to be curative, i.e., to return ME/CFS patients’ systems to homeostasis, or normalcy. I suspect it won’t be – that’s a lot to ask (!) – but since Dr. Klimas will feed the data from the trial back into the computer to strengthen the next model, it should move the needle forward.
The testosterone issue illuminates the sometimes shocking holes found in ME/CFS research. Even though sex hormones must, it seems, play a role in the female predominance seen in ME/CFS (and fibromyalgia and long COVID), the role testosterone may be playing in men has been almost completely ignored. Dr. Klimas’s 2014 study was the first to mention it at all (the study found testosterone was protective against ME/CFS), and only one other paper – published last year – has.
Speaking of her staggered three-drug approach to ME/CFS – Dr. Klimas said you’re probably not going to cure this illness by touching one target – you’re going to have to touch several. There was a proviso to that, though. She’s leaving open the possibility that the right antiviral could do the trick…
An Antiviral Approach
If ME/CFS is like HIV, caused by a pathogen that persists in the body, theoretically, it could simply be cured by eliminating the virus, but antiviral trials have been few and far between.
Martin Lerner, whom she called “a beautiful man” and who cured his own ME/CFS, “worked like hell to get EBV out of ME/CFS patients’ systems,” she said. Instead of relying solely on less effective but safer antivirals, Lerner used some big-gun antivirals, rotated his antivirals – and had some good treatment results to boot.
If ME/CFS and long COVID are caused by persistent viruses, then antivirals could be curative.
(Lerner’s published studies produced good results but were, I was told, wanting statistically. Lerner often used long-duration treatments – up to a year or more – and required his patients to pay close attention to pacing. Health Rising has several Lerner recovery stories on its website. In a video interview coming up, Dr. Henderson in Denver told me that antivirals took a minimum of three months to work in ME/CFS.)
Jose Montoya at Stanford, in what Dr. Klimas called a very underpowered prospective chart review study, found that 81% of patients responded cognitively and, importantly, that the longer a person was treated – the better the response he/she had. An earlier, very small (n=12) study found that 9/12 patients experienced a near resolution of their symptoms. Note that both of these trials used a drug – valganciclovir (Valcyte) – which Dr. Klimas characterized as being not particularly effective with EBV.
Despite some promising results, a larger, placebo-controlled phase II trial was never done – something Dr. Klimas found shocking. Halting EBV reactivation would not have been able to die on the vine, she thought, if ME/CFS had a clinical trials network and a way to get phase II trials (n=50-500 people) funded. (Phase II trials test both the efficacy and the optimum dose of a drug.)
The long and the short of it is that despite all the interest in EBV and other herpesviruses in ME/CFS, we’ve hardly begun to start assessing the role antivirals could play.
Knocking EBV Down with a 2-Drug Combo
Another question is: why would we expect one drug to knock out such a complex and persistent virus? Dr. Pridgen’s two-drug approach to herpesviruses in fibromyalgia is in stage three trials, and Pridgen’s early data suggested that adding Paxlovid to it could do well in long COVID.
Dr. Klimas did not mention Travis Craddock’s model of EBV reduction, but it was fascinating. Craddock found that if EBV was present in both epithelial and B-cells (it’s latent in both), that while Rituximab could knock down EBV-infected B-cells, the virus would soon re-emerge from EBV-infected epithelial cells. The only way to get long-term EBV suppression with one drug was to use such high doses that it would be toxic.
Adding a timed B-cell treatment to an antiviral drug was different – it flatlined the virus for quite a while. Craddock was continuing to refine the approach but said, theoretically, it could produce a long-term reduction in viral load.
Future EBV Drugs
Given Dr. Klimas’s rather spectacular early success with monoclonal antibodies (mAB) for long COVID (another trial should have begun by now), I had to ask if mABs exist for Epstein-Barr virus. Monoclonal antibodies can be effective against viruses because they can lock onto a virus, target it for the immune system, and keep it from entering cells. mWhile no mABs have, at least ten trials assessing EBV mAB effectiveness against cancer are underway.
Dr. Klimas was interested in trying out a new mRNA vaccine for EBV.
Dr. Klimas was particularly interested in Moderna’s mRNA vaccine for EBV, that is in phase I (safety) trials right now. Moderna is using the same technology it used in its coronavirus vaccine to alert the immune system to the presence of EBV and attack it: that is, it triggers the cell to produce proteins associated with EBV so that the immune system will quickly recognize EBV when it shows up and attack it. Both the mRNA and the proteins produced by the vaccine are quickly broken down, leaving the immune system on the lookout for any viral reactivation.
Dr. Klimas said that as soon as the trial was done, she would be knocking on Moderna’s door to see if they’re interested in working with her.
N of I trials – the Personalized Medicine Approach and the AI Juggernaut
Dr. Klimas wants to see big, well-organized clinical trials in ME/CFS, but she also wants to do big, comprehensive N=1 studies. Since every person is different, if you gather enough data, artificial intelligence can provide treatment plans – first fix this, then do this, and then do that – for individuals.
Speaking of artificial intelligence, data mining and computational biology – it will only get more effective. The sky is the limit with regard to data. The 3 million bits of data per timepoint she and her team gave the computational biologists during the exercise study didn’t impress them at all – they wanted more (and if I have the right study, that was ten years ago).
Dr. Klimas’s team uses chaos theory to look at data from every possible angle.
Klimas’s team uses chaos theory in their supercomputer to come up with answers. The program assesses the data randomly and in every direction possible so that no possibility escapes it – and then provides models her team can assess and test.
One reason we need more NIH-funded studies is that about ten years ago, the NIH required that if they paid for a study, the raw data had to be made public – so Dr. Klimas is pouring NIH-funded ME/CFS study data into her dataset. Since Nath’s intramural study assessed things no one else has done, the data from that study will be quite helpful.
Dr. Klimas said she tried to become a long-COVID RECOVER clinical center but apparently failed because her plans included comparing long COVID and ME/CFS – and that was a no-no. She is in the midst, though, of a large CDC-funded study comparing long COVID and ME/CFS. (If you are in South Florida and have long COVID, please contact her – she needs more participants.)
Institute of Neuro-Immune Medicine Embraces Mind/Body Approach
Lastly, Dr. Klimas didn’t mention it, but an email today indicated that the Institute for Neuro-Immune Medicine is branching out and has teamed up with Conquer CFS to provide people with ME/CFS two months of free access to the Conquer CFS Emergency Reset course created by Max Kennedy – a former person with ME/CFS – in conjunction with Dr. Jenny Jin, an CFS/Fibromyalgia and Pain Management Expert.
More and more ME/CFS experts are including mind/body/neuroplasticity practices in their treatment protocols. To get 2 months of free access:
- Click this link: https://conquercfs.com/courses.
- Select “Emergency Reset Course.”
- Please fill out the form details (including the ‘payment method’ section). Note that the link above provides you with two months of free access. A credit card is needed in case you decide to subscribe for longer.
- Please email mcarr1@nova.edu if you’d like to receive an email reminder at the two-month mark. At this time, you can decide whether to continue with a paid subscription or cancel once the free access expires.
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Being able to talk to ME/CFS/FM and long-COVID experts is an important feature of Health Rising. Our legacy of rigorous and objective reporting has had a nice side benefit – experts in these fields are willing to talk to us!
Thus far, our “What’s Up, Doc?” series has included interviews with Lauren Stiles (Dysautonomia International), Eleanor Stein MD, Wenzhong Xiao (Open Medicine Foundation), and Nancy Klimas (Institute for Neuroimmune Medicine). Talks with Dr. Natelson (neurologist) and Dr. Thomas Henderson will be up shortly, and more are planned. If there’s anyone you want Health Rising to talk to, please let us know. 🙂
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Thanks Cort for a great article.
It’s depressing and disturbing that we knew immune exhaustion is a central fatigue in ME/CFS 35 years ago.
Looking forward positively, let’s hope / pray that PolyBio’s antiviral trials are a success:
https://polybio.org/projects/a-clinical-trial-of-repurposed-hiv-antivirals-in-longcovid/
Also that the rapamycin trials are successful. It could well be that at least part of rapamycin’s value is antiviral
Gotta love PolyBio! 🙂
Do you know by any chance when we can expect the results of the polybio trials?
I don’t know for sure, but I think it will be 2026
Thank you. It is so hard to be patient.
2026 will mark ten yrs of my mecfs.
I know many are unwell for much longer…
Who knows if I will need an antiviral against zika as it was my trigger.
33 years for me…. Although I have been ‘mild’ for the past 30. But it’s so hard seeing my daughter come down with it
Let’s really hope we see their antiviral trial come through. Fingers crossed for the Rapamycin trials too. I believe results are not far away in Simmaron’s trial of it. They said recently that early results were ‘very promising’, so that’s kind if hopeful
I hope I can get to „mild“ some day…
I hope your daughter will get better too.
I dont feel too hopeful about any trials as long as they dont determine which subsets profit. We are so diverse. SFN, POTS, auto immunity, diverse triggers, reactived hhv6 or ebv.
I wish they would accumulate more data and look for who got better.
As far as I understand that is what happened in the BC007 trial and edgartigimod trial for POTS. A subset of People got better but the design over all did not account for it and as many did not profit the overall data shows its not better as placebo.
I have just posted Matthias of my experience which goes back to 1979 and so I sympathise with your points of view and I so hope something concrete comes along for your daughter and of course you too.
Frustrating isn’t the word for how we feel!!
It’s interesting how some treatments seem to work well for certain subsets. It seems pretty clear that ME/CFS comprises either several diseases, or at least several very different manifestations.
Latest results from Carmen S. et al:
https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00330-2/fulltext?uuid=uuid%3Afa264381-5db2-447d-87ab-4fc7bcca6ccf
Thanks! It makes sense that subsets are the answer does it not?
I think so…but one can never be sure with this conundrum of an illness!
Do you know what symptomology Carmen’s autoimmune subset display?
Thanks Cort. Nancy Klimas is an ME rock goddess! I would also love to see Jarrod Younger’s work featured on Health Rising.
I think Carmen e.a. are seeing more POTS and autonomic problems in her ME patiënts.
And they are still hanging on to the Auto immunity idea and are screening for ab in all patients as far as I know…
I don’t know…
I think this is super important. Every trial should think of subsets!
Thank you Cort.
Nancy is right on the money.
Chronic immune activation, immune cell exhaustion, EBV reactivation and even low testosterone are all the main symptoms that I continue to suffer with after 30 years of M.E.
In fact I have had SEVEN EBV reactivations in the last seven years. My immune system is definitely on the decline as I age.
What’s the best test to determine the testosterone deficiency and how to normalize it ?
Great! Ebv is what got me, caught it off my 14 yrold daughter, 10 days of extreme hell, and then straight to cfs. Viruses enter through calcium ion channels to get into the body, in some people these channels then become compromised, a body without calcium cannot function normally, that’s why I’m Thankful everyday for naltrexone, it blocks the opiod receptor which then opens the calcium ion channels! These channels are in yr brain, heart, spleen, muscles,eyes, everywhere, but some places have more, the pain in my legs before ldn was a 9 if I tried to function, I couldn’t stand long either, cramps so bad at night all because I wasn’t getting calcium, now I can stand like a normal person and literally zero pain or cramps. It’s a treatment, but it has to be used unconventionally to work, I discovered it through bravery, chance and love, see my fb page
Multi -dose naltrexone for cfs/ME
Putting ebv back to sleep hopefully now with many modalities.
Ebv also attacks gilgal cells, but ldn fortunately covers that too.
Hi, can you please attach a link to your page? I can’t seem to find it. Thank you
Try this, then you should be able to get to the group I hope.
https://www.facebook.com/share/p/19t76LF45x/
Otherwise type into fbs search
Multi-dosing Naltrexone for Myalgic encephalomyelitis ME/cfs
Hi Cort.
I would like to comment on a few of tge key points in this blog.
What I read recently about Long Covid is that as it weakens/tires the immune sytstem, the time becomes right for EBV. People talk vaguely about EBV being “dormant” until the “right conditions arise” but I dont recall anyone defining the comditions. I would say, yes, when the immune system is weakened.
If brain inflammation is central to CFS then I would lije to know tge cause of it. It seems to me that a leaky BBB is the top candidate. Do you perceive a different source: either virus fragments remaining or say flu/covid/Herpes virus continuing to reproduce? The past year’s research does show that even non-long-covid patients are seen to still harbour viable covid virus montgs later, that it takes a long time to fully clean up.
On the topic of the female-gender dominance in CFS numbers, I do know from reading physiology that just to *be a woman, (owing to the demand for monthly ebb and flow if certain hormones, women use A LOT more cortisol than men do *when healthy*. How much that may change owing to menopause I have not read.
So you can look at female-gender dominance as an estrogen problem, which doesnt to me account for the men, or you can instead look at CFS as a cortisol problem, where women needing much more total cortisol could suffer much more when hypercortisolism becomes hypo.
Not to imply at all that men’s CFS is less severe than women’s. I doubt it.
Normal cortisol volumes for women probably have not much bearing on the *severity of CFS (and LC), But I am suggesting that the female dependence (in a healthy sense) being higher may correlate to what I understand as the 8:1 ratio of female to male patients.
And I *have found, in four years of reading that its not only CFS (or LC) that is stacked 8:1 like this, but also MS and Lupus.
The brain inflammation is caused from closed calcium Ion channels, I have zero of that now, see my comment here.
I have not been diagnosed, but have had CFS since 2015. I’m in Phoenix. Can anyone recommend where to go in Phoenix for a diagnosis?
Hi Elizabeth, Four Peaks Healthcare Associates in Flagstaff, AZ was recommended to me in a ME/CFS online patient support group. I do not have personal experience with them myself, but they may offer a virtual appointment option if travel isn’t possible. I don’t believe they take insurance either, but you could check to know for sure.
Actually I think she does all virtual appointments. She does not take insurance. She’s really good!
Thank you.
There’s Theresa Dowell in Flagstaff – has ME/CFS herself – keeps up with all the latest. Health Rising will have a physician review map up soon!
Cort, will this physician map be U.S.A only?
No, no, no! Worldwide! 🙂
You’re amazing, Cort. Thank you so much
Thanks for this information, Cort. On a personal note, I first became a patient of Dr. Klimas in 1992 so have been able to witness so much of her work in the ME/CFS field. She’s an amazing physician, advocate for her patients and the entire ME/CFS community, and a truly amazing and wonderful human being. We’re so lucky to have her with us.
I agree!
She’s amazingly energetic, a great communicator and a great advocate. But if we are being objective about things, she’s underwhelmed on the treatment trial side of things. Lots of talk but not always much to back it up
Agree completely yet again Matthias.
Do you know where we can get tested for the antibodies that Carmen finds as I definitely have OI but I am in the UK so probably very limited as to where I could get tested?
I have the greatest respect for Dr. Klimas and was particularly interested to read that she is interested in reactivation of herpes viruses in ME/CFS.
According to this study, this may be a factor in Long Covid as well and the simple measure in saliva is a ground breaker.
“Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome”
Results: At 3-6 months after mild/asymptomatic SARS-CoV-2 infection, virus-specific antibodies in saliva were substantially induced signifying a strong reactivation of latent viruses (EBV, HHV6 and HERV-K) in both cohorts.
Nice! Thanks again, Betty!
I showed my HV-6 test to Kristin Loomis of the HHV-6 Foundation and she was pleasantly surprised. She said Dr. Klimas was one of the few doctors who did it right.
Why is no one looking at other retroviruses that may be similar to HIV? Nancy Klimas is saying that CFS is a form of acquired immune deficiency. I wish I had a way to directly contact Nancy Klimas via email and I would ask her this question. I’ve posted this before (below link) which is a patent describing the HIAP-II retrovirus that is found in autoimmunity and ICL patients by scientists at Tulane University, I believe that in at least some cases of ME/CFS, this could be the cause as individuals eventually progress to very weak immune systems.
https://patents.google.com/patent/WO1995031531A1/en
This newsletter https://drlapp.com/news/me-letter-june-2014/ on ME covers some treatments that I have used with success and others not so much. Early on I was treated with Transfer Factor which was helpful, but not available after my doctor died.
There is a company that is now in the process of making off the shelf preparations of Transfer Factor which would be effective against EBV and HHV6. I have not been able to find out when this may be available.
I have been on Nexavir for many years and it is very helpful and now available in a cream form from the Nexco Company without a prescription. Nexavir is an antiviral.
Dr. Cheney used Inosine. I haven’t tried it.
Low dose naltrexone didn’t work for me, but has for others.
I have also not tried gammaglobulin or Ampligen. But, they were very helpful to other patients. Unfortunately, gammaglobulin is not widely available and Ampligen was never approved.
There must be some powerful herbs that are antiviral. I know this because I knew a fellow that reversed his early stage cfs by simply visiting a herbalist. That was 35 years ago.im no longer in touch with this fellow so I’m unsure of which herbs he was on
And yes…i believe she is correct in that finding and treating the subgroups is key.
Heck, there are lots of us that got tipped over the edge by tetracycline…or at least it seems that tetracycline had a role in our demise.
Being on a broad spectrum antibiotic for 1.5 years straight can’t be good. Nowadays they won’t prescribe any antibiotics long term and are very diligent to be sure there is an infection present rather than a virus.
I often wonder if the large pockets of infection (acne) all over my upper back may be hiding elsewhere in the body and began growing somewhere along the bodies exit pathways.
I can imagine an infection trying to leave the body and all of a sudden runs into a area in the body…re:inflammation (EBV)and has its
Flow halted.Yeppers, a real scientific view
😆
I’m off today to buy some fenbendozole from the feed store
I really don’t have time to wait another 35 years for another invention of a tractor wheel.
While I really did enjoy the interview. The bonus sideways view of Corts trailer kept me too the end hoping I’d see Cort running by in his gotch lol. Gotta have humor or your sunk before the race even begins
Before I go down a rabbit hole on testosterone…
Cort I can’t see any evidence of reduced testosterone levels in those two studies you quote. Am I missing something?
No. You didn’t really miss anything.
The 2014 study found reduced testosterone in men with GWI (but apparently not ME/CFS…)
“Experimental data for endocrine-immune markers measured in male GWI subjects showed the greatest alignment with predictions of a naturally occurring alternate steady state presenting with hypercortisolism, low testosterone and a shift towards a Th1 immune response.”
I didn’t actually say low testosterone was found in the 2024 study (:)). I said it was one of the few studies that looked for it.
I see.
Although the article says that Nancy often sees low testosterone in male ME/CFS patients.
Yes! That’s what she said in the interview – apparently referring to her clinical experience, I guess. It’s a bit confusing because the GWI trial did not include testosterone. Maybe her model is now saying to do that and it did not before.
Estrogen deficit that happens with menopause need to be looked at more seriously. The WHI study in 2002 scared a lot of people about hormone replacement therapy (HRT). In retrospect, I really associate developing ME exactly when I became menopausal. I was prescribed progestine but recently switched to body identical progesterone. Within three weeks my sleep improved dramatically. My doctors and I lost precious time trying different molecules. HRT is certainly not THE cure but it could maybe level the field between men and women?
Dramatically improved sleep? That’s pretty darn good!
I know someone who’s 10/10 migraines disappeared after she was given female hormones.
I thought we could already be cured with some simple emotional freedom tapping stuff or something? What happened that?
Nothing. Health Rising has a wide variety of recovery stories but outside of HR I would say that virtually all the recovery stories I’ve seen are using mind/body neuroplasticity techniques. Some of them are just astonishing…
Raeylan Agle has youtube videos of hundreds of recovery stories.
What I don’t understand about Raelan Agle is ,she is fully recovered but barely mentions,if at all , that she has recovered by diet. Instead if focusing her and her
Interviews on brain retraining etc.
Nobody on her videos ever mention diet.
It’s puzzling to me
Did she recover by diet or brain retraining or both? Dan Neuffer includes diet in his ANS program – it’s an important part – but brain retraining is the core.
This article was really good until it mentioned mind/body/neuroplasticity pseudoscience.
We can’t fix ImmunoBiological problems with mind/body protocols. We can’t fix viral reactivation, viral persistence, autoimmunity, and B and T Cell immunology with this snake oil crap.
The only reason mind/body/neuroplasticity are even on the table is because ME/CFS patients are 80% women.
Men would never stand for it. Men don’t stand for it. Michael J Fox would not accept it for Parkinsons and Brian Wallach would not accept for ALS so why does anyone think I have to accept it for ME/CFS?
I don’t accept it.
The standard for mind/body/neuroplasticity protocols is the same and it does not meet the objective evidence requirements.
Demand the objective evidence for proof of improvement before you believe these charlatans who are only preying upon you because they believe you are a weak woman not worthy of pharmacological care.
Let’s not confuse ME/CFS with a neurodegenerative disease that is actively destroying neurons.
There’s little evidence thus far that the brain or nerves in ME/CFS have been physically damaged, Instead – at least for right now – ME/CFS and fibromyalgia appear to be more “signaling” or brain connectivity diseases where the pathways between the different parts of the brain are “off”.
The pathways that are off are those that cause pain, fatigue, brain fog and affect autonomic nervous system functioning.
Comparing ME/CFS to diseases which cause overt brain damage such as Parkinson’s, Alzheimer’s, multiple sclerosis doesn’t really work.
I assume Nancy is doing this because she’s found that it’s helpful for some people. Otherwise why would she do it?
You rock, Cort!
Thanks!
Stop using Dr Klimas Name in this. You explicitly mentioned she didn’t bring this up in your conversation. Just don’t.
From the email from the Institute for Neuroimmune Medicine – which Dr. Klimas leads
Dear Cort,
To start off 2025, the Institute for Neuro-Immune Medicine has teamed up with Conquer CFS to offer you valuable resources on ME/CFS. This partnership provides our community with two months of free access to the Conquer CFS Emergency Reset course. This course is tailored for ME/CFS help, management, practices and recovery.
It’s very much comparable, all the immune system abnormalities are physical variations too. You’re loosing credibility with defending something for which there’s no evidence basis. You sound like Wessely
Hi Vera two randomized placebo-controlled trials trials of the Gupta method have been done: long COVID – https://onlinelibrary.wiley.com/doi/10.1155/2023/7068326
Fibromyalgia – https://guptaprogram.com/wp-content/uploads/2020/10/jcm-09-03246.pdf
I don’t if I’m just the closest or easiest target or what but the offer for this course came from Dr. Klimas’s Institute for Neuroimmune Science.
you are the one publishing this stuff on your website. so of course we talk to you about it. You are the one that tacks an email effectively selling an expensive think-yourself-well ‘course’ onto the back of an article about biomedical research, and you don’t even discuss it with the person you are interviewing!?
Like Vera says you very much sound like Wessely at the moment.
Re the gupta programme: https://www.asa.org.uk/rulings/harley-street-solutions-ltd-a17-400324.html: “The second study related to both fibromyalgia and CFS. It had been published in a peer reviewed journal which focused primarily on complementary medicine. The single-blinded study compared the efficacy of amygdala retraining alongside ‘standard care’ with ‘standard care’ alone, and so the results would not be able to show the efficacy of amygdala retraining alone. ‘Standard care’ consisted of a 1.5 day course involving cognitive behavioral therapy (CBT) and graded exercise therapy (GET). Over half of participants did not complete the study – of the original 44 participants, 21 completed it, and only seven from the amygdala retraining group did so. This meant that the outcomes for the participants who did not complete it were not accounted for in the results, which was a significant limitation. Although the study reported statistically significant effects in some of the 16 different outcome measures used, given its limitations we did not consider that the study substantiated that the advertised therapy could treat fibromyalgia or CFS.”
Given this is their track record, even an updated RCT without people dropping out, like you seem to have linked, should be received with scepticism and looked at closely by respected people in their field. I certainly don’t have the capacity to read and understand their paper and see if they didn’t potentially skew things some other way.
It would be nice before you accuse me of some dire undertaking if you would think about these things a bit. As the blog noted I got the email as I was finishing up the blog – so I didn’t really the opportunity to ask her about it – did I?
The interview was actually done about 6 months ago. Why didn’t Dr. Klimas mention it when I asked her what she was most excited about? The answer is obvious – she is most excited about other things! That doesn’t mean that she doesn’t think that programs like this might be helpful.
I would not be surprised if there was a high dropout rate- this stuff is not easy but I don’t understand those numbers. The study reported that
So it looks like 58 of the 68 people in the course completed it and answered the followup questionnaires.
Most of the people in the long COVID study appear to have finished it as well.
“Of the remaining 69 who were randomized to CBSM (N = 44) or PE (N = 25), there were 38 participants who received CBSM and 20 who received PE. A total of 11 participants were lost to follow-up (CBSM, N = 6; PE, N = 5) resulting in a final sample of 58 that were used for statistical analyses.”
I have no doubt that given better funding these studies probably could have been done better but these are not the type of studies that big drug companies will fund.
With a high dropout rate, most studies are worthless because you get selection bias. That was also the case with all those CBT/GET studies.
The placebo in that trial GET. I mean come on Cort.
If you want me to respond Timo you have to write a sentence that makes sense.
Cort, honestly including this in the article without even talking to dr Klimas about it baffles me. I know you feel these things may be helpful but does she? Is she even aware of this offer?? I see that the links are redirect links from nova uni – but who is to say she was even involved with this? Do you know if she thinks it is helpful? Did you ask, if she really thinks it is helpful, why isn’t she running trials on it so there may be some actual objective evidence for efficacy?
Frankly speaking i think what you’ve done is at the very least a journalistic no no – you are making it look as if you know she approves of this yet you have not discussed it with her at all.
At the worst it is just pushing more snake oil salesmen onto already vulnerable people.
Especially given the cost – You know a LOT of us have very low income. This course is GBP 2K. And of course the ‘2 months free and then we’ll automatically charge you’ is designed to get your money without you realising. And no, an email from Nova to remind me to cancel isn’t enough. An email which you have to explicitly request in the first place.
And if you then take the cognitive and memory issues pwME can be expected to have into account… I mean I tried clicking on to the link and couldn’t even work out which of these was supposed to be on offer.
Frankly think this whole thing is unethical.
Michiel – I think you’re trying very, very hard not to link this with Dr. Klimas – but the email came straight from her Institute of Neuroimmune Medicine – not NSU. Besides the course offer the email included news on the next INIM conference, and INIM’s Hope & Help for Fatigue & Chronic Illness Podcast! It ended by saying “Sincerely, All of us at the Institute for Neuro-Immune Medicine”.
I think of Dr. Klimas as a doctor and researcher who is, as she should be, open to everything. While she’s obviously laser focused on biology in her research – she’s also from time to time co-authored several papers on stress management – including one all the way back in 2011. I just don’t generally cover them.
Please note that none of these papers suggest that people are suddenly recovering from ME/CFS. They suggest that these techniques can, however, provide help.
A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome
https://pubmed.ncbi.nlm.nih.gov/21414452/
Results suggest that CBSM is beneficial for managing distress, improving quality of life, and alleviating CFS symptom severity.
Videoconference-delivered group Cognitive Behavioral Stress Management for ME/CFS patients who present with severe PEM: A randomized controlled trial
https://pubmed.ncbi.nlm.nih.gov/38736736/
“For highPEM patients, V-CBSM (versus V-HI) demonstrated medium to large effects on follow-up symptom frequency, symptom intensity, fatigue interference, and fatigue intensity (p’s < .05) and trending to significant reductions in perceived stress (p =.07). Differences were not evident for lowPEM patients." Telephone-administered versus live group cognitive behavioral stress management for adults with CFS.
Hall DL, Lattie EG, Milrad SF, Czaja S, Fletcher MA, Klimas N, Perdomo D, Antoni MH.
J Psychosom Res. 2017 Feb;93:41-47. doi:
https://pubmed.ncbi.nlm.nih.gov/?term=klimas+chronic+fatigue+syndrome+antoni&sort=date
Two different formats for delivering group-based CBSM-live and telephone-showed reductions in perceived stress among patients with CFS. However, only the live format was associated with physical symptom improvements, with specific effects on post-exertional malaise, chills, fever, and restful sleep.
That’s all fine and well Cort and of course managing stress is beneficial even if only because being stressed means extra exertion. I use mindfulness and meditation myself in how I manage my illness.
But self-management is NOT how the website linked frames it.
They are very clearly selling a recovery story.
Through mindfulness and brain retraining. At high expense. With one of those nice 2 months free offers so you forget all about it before it starts auto billing you. At GBP39.99 per month. All good and well if you have a decent income but that is not statistically likely for pwME.
TBH that whole website screams snake oil to me. It raises my hackles. My intuition says it is dodgy. I’ve learned to take that seriously. Have you seen the about page?
So if everything is as you say it is, and dr Klimas is aware of all this and still backs this ‘special offer’ email, then THAT should be the story. Or at least part of it. And then I would like to hear dr Klimas explain her reasoning, so that I can take an informed decision.
I understand that it screams snake oil to you and that’s fine! No reason for you to do the program.
The expense is another thing. If you add the first two months to a third month that you inadvertently end up paying for – that’s $41 for 3 months; or $13 a month.
I’m sorry if you can’t afford it – but that’s not bad. By the time you’re into the 3rd month you should have an idea if its working for you. So you get two free months to see if it works and if it doesn’t you can quit or at most you’re on the docket for $13 a month.
How could that have been the story for the blog? I did the interview months ago. If I get a chance, though, I promise I will ask her about it.
…..
Your reply is good, but it still doesn’t answer the objective evidence question. Are there statistically significant studies supporting brain retraining?
Why can’t any of our universities focus on developing safe and effective peptides similar to this? Apparently it’s not rocket science and sounds promising!
https://www.sciencedaily.com/releases/2019/03/190325080445.htm#:~:text=Whether%20they%20gave%20the%20peptide,in%20the%20journal%20Kidney%20International.
I’m pretty sure everyone would gladly accept this virtually zero side effect profile over that of a JAK-stat inhibitor like Rinvoq
Shea…that would be to simple,cost effective and put a halt to all these small studies that seem to be spit out by the hundreds and end up at another dead end.im convinced once funding reaches better heights $,they must burn up the bank so the funding train keeps on chuggin’. So it seems.
Stop pushing those brain retraining courses on people. There’s no objective evidence for any of that stuff. It’s irresponsible and damaging to illnes perception at large.
I certainly understand the perception part. But what to do about all these people who are benefitting. My answer to find ways to scientifically explain them – and I think I can. Health Rising will keep doing both – exploring the biology and providing information on all possible treatments.
We all probably have PTSD to some degree regarding CBT/GET but I don’t think we have to worry about brain retraining sidelining biological work. For one, the two randomized, placebo-controlled trials that have been done did show benefit but the effects were moderate. Check this out from the long COVID trial
The scientific literature – which what researchers pay attention to – does not suggest at this point that these practices commonly cure people.
I am going to do a review of the evidence regarding neuroplasticity. I don’t think its the threat that you think it is.
“approaching a significant difference at month 3 with a small effect size.”
That means results were not significant.
That’s right! At 3 months the effect size was small – and it did not reach significance.
Great article but please stop advertising brain retraining. It’s not scientific, there’s zero evidence it works. It’s insulting to patients to suggest they might just think it away. Seriously don’t until there’s even a sliver of evidence. You have a responsibility with this platform of yours.
Please see my reply to other comments showing that a few studies have been done.
Stop promoting brain retraining before there’s any evidence for it working for anything at all.
Hi Jacob, two randomized placebo-controlled trials trials of the Gupta method have been done: long COVID – https://onlinelibrary.wiley.com/doi/10.1155/2023/7068326
Fibromyalgia – https://guptaprogram.com/wp-content/uploads/2020/10/jcm-09-03246.pdf
but that’s not the only evidence. Scientifically you gather all the data that you – and I just checked – there are over 1000 recovering/recovery stories out there. That’s data as well.
Just in perspective. It is estimated that there are 15 to 30 million ME/CFS patients worldwide. About 2% of people worldwide suffer from chronic pain or fibromyalgia. And in Europe there are 36 million people with long Covid. These recovery stories of 1000 people do not mean much statistically.
HHV-6 A and B are two distinct viruses. In fact, there are scientists who believe that HHV-6 A is not a subtype of HHV-6, but an entirely different virus.
Quest can test for HHV-6B which is ubiquitous in the population and a common cause of childhood roseola. This is not true for HHV-6 A. I was positive through a test ordered by Dr. Paul Cheney from a specialty lab. Our daughter was positive through a uterine biopsy sent to Coppe Labs affiliated with the HHV-6 Foundation.
No one knows the prevalence of HHV-6 A, because tests are not offered to the public. Yet, at one time fingernail testing was discussed on the HHV-6 Foundation website.
I find it interesting that researchers are exploring the possibility that Metformin can inhibit HHV-6 A.
I believe that testing patients for HHV-6 A and running a full battery of immune tests (like I had in the beginning) would give us important answers that could lead to effective treatments, not cures. You are never completely cured of a herpes virus which lives in your body forever. Your best hope is to suppress it.
This brings me to artesunate, an antimalarial that has, according to the HHV-6 Foundation, been effective as antiviral for HHV-6 with few side effects. https://hhv-6foundation.org/research/hhv-6-antiviral-drug-resistance
Why are there no clinical studies on artesunate?
The testosterone aspect is interesting.
Young men with ME are not a large group – of 240 members of the ME support group I help run, just four are young men (teens – mid-20s). However, in the 10 years my partner has had ME I’ve also known (through their parents) of four other young men with ME. Of these four, I understand that three eventually recovered to the point of being able to return to school or further education – one now works in the ME research field. The ‘teens to mid-20s’ years coincide with the
leap in testosterone shown in the ‘Sex hormone production’ chart in the article.
I don’t know if three of four improving enough to return to education is just happenstance, but if young men with ME do eventually get significantly better at anything like that rate then surely it would be possible to do a full medical analysis of a relatively small group of teenage boys while they’re ill and again, a few years later, comparing before and after and those who are now better or much improved to those who are not. This could give indications of what has changed in the body between illness and better health.
It has always seemed to me that research into what changes when people with ME get better is so difficult because so few do get better, and it’s not possible to predict who will. Although I know the ‘getting better’ rate is higher among young people, if the improvement rate among young men is over half, or anything like that, then that could enable a ‘before and after’ study which might not need to be huge in terms of numbers of participants, yet could yield valuable information.
I’ve suggested this to a couple of ME researchers & neither replied that any study of this sort has been done. Has it? Could it be?
I personally get immune activation symptoms when I over do it, even get runny eyes, nose, sore throat, sneezing, just like ive got a virus, yet I’m totally homebound not seen anyone and havent had a virus in 13 years due to being homebound and not having many visitors and being very careful. No one come into my home if they have any sign of of a sniffle, and if anyone has been poorly with a virus they dont come in until they have been a minimum of two weeks symptom free.
So, I’ve had no virus for 13 years, but push myself and I get symptoms of having one, clear symptoms, and they can go next day if I not over done it it too much, but if I over do kt too much they can act several says, or longer. The trick is not to over do it. But once immune system symptoms are activated, I feel really bad.
I never know whether the symptoms are mimicking virus symptoms or they are due to a virus lodge in my body being reactivated.
So, my immune system is big part of my M.E I am severely affected.
This is so pertinent to me and my form of ME/CFs. It started in 1979 after 2 weeks of what I thought was flu but i couldn’t recover. Severe vertigo attack/migraines followed around 2 weeks or so after being infected and my life changed forever although I did have some recovery to a degree but vertigo was never far from my life for the next 21 years when I went into full blown ME aged 52.
I was fortunate in that my thyroid and adrenals were treated here in the UK by a knowledgeable doctor, not NHS though as my GP insulted me by implying it was psychological which I knew was rubbish. The thyroid/adrenal medication did give me some life back but I definitely have OI which severely restricts what I do to around 30 minutes maximum before I have to lie down and recover.
I manage to go to a chair yoga class but inevitably during the winter months virtually every other week I pick up a respiritory virus and suffer for around 3 day,s only improving by taking Andrographis and spraying my throat every few hours with Echinacea and Sage. If I don’t do this at the first sign of a virus (usually a sore throat with a swollen left lymph gland under my ear), then I will go on and be very unwell for ages.
I am now 76 years old and I am so frustrated what researchers/doctors like Dr Kilmas sayi regarding our immune systems and I know she has been saying this since the 90s.
Obviously I am pleased yet more studies are to be done but I would ask why hasn’t more antiviral type medications been tried in studies during all this time? It is just so frustrating for somebody like me who picks up a virus during the winter months whenever I mix with a group of “normals”?
One weird thing is that I have never had Covid despite my family and friends all having it and I did have the RSV virus 2 years ago which was awful but my partner recently had it badly and yet I was only affected for 2 days and got over it so my immune system does do something right but cannot seem to stop me from catching viruses in the first place which makes me very unwell whilst my immune system fights to get me well again till the next one comes along.
Thanks to Cort for keeping us informed but I would love it if more could be written about this very obvious problem of viruses and ME.
Exactly. As you say, Nancy has been talking about the immune system and ME/CFS since the 90s. She has been talking about trials which never seem to come to anything for 6-7 years. Yet PolyBio seem to get trials happening comparably quickly.
It is puzzling and frustrating.
I kind of gave up on her quite a while back.
She obviously means very well.
But my hope lies with a new generation of researchers.
Come on PolyBio!
I will have to get up to date on Poly Bio. Fingers crossed they find some actual TREATMENTS 🙏