Chronic Fatigue Syndrome (ME/CFS) is going to be the subject of a Grand Rounds presentations at the CDC in February. Grand Rounds presentations are talks given by experts on medical topics of interest. According to the CDC this one will be seen by thousands of providers in and outside the U.S. It's a moment of increased visibility for ME/CFS.
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[/fright] Except for the last (and most intriguing) one, this one, consisting of four talks over an hour, will be lead by familiar faces:
We may have heard much of what the first three presenters will say but then comes a new face: Dr. Avindra Nath. Nath is the Chief of the section on Infections of the Nervous System at the National Institute of Neurological Diseases and Stroke (NINDS) and the intramural clinical director of the NIH's huge Clinical Center.
He's also been tasked with developing a center dedicated to translating new therapies for neurological disorders to clinical use. Nath has co-authored hundreds of research papers. A recent one - published in renowned Lancet journal - focused on central nervous system infections and neuro-immune damage. A short February 2015 paper that called neuroinfectious diseases "a crisis in neurology" called for more action to understand them.
Here he is talking on the research study beginning at the NIH's Clinical Center soon.
Nath has been "internationally recognized" for his contributions to understanding HIV's effects on the central nervous system. He proved that a protein viruses make called Tat could stimulate neurons and activate glial cells. Those activated glial cells then released immune factors called chemokines that recruited immune cells called macrophages into the central nervous system.
Macrophages are activated monocytes. Picture the Hulk before and after his transformation and you have a good picture of what happens to monocytes when they turn into macrophages. Macrophages are killing machines; their entry into the central nervous system sounds like a sure recipe for neuroinflammation - a hot topic in ME/CFS.
According to the NIH Nath has also helped develop several neuroprotective compounds that are in various stages of development and clinical testing.
Central Nervous System Immune Reconstitution Inflammatory Syndrome
Nath also discovered a process that could have some bearing on ME/CFS. He found that some individuals with otherwise excellent responses to retrovirals nonetheless developed a "devastating" case of immune-mediated encephalitis called "central nervous system immune reconstitution inflammatory syndrome" or CEN- IRIS. First described in 1992, it usually occurs in association with an HIV infection but can occur in conjunction with other infections.
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[/fleft]Some researchers believe that different types of CNS-IRIS occur in response to different kinds of pathogens. Importantly, while changes in MRI or CT scans can help solidify the diagnosis, a CNS-IRIS diagnosis is often a diagnosis of exclusion. It's apparently suspected in HIV patients who aren't responding clinically to antiretroviral therapy despite the fact that their viral loads are dropping and their immune system is improving.
Intriguingly, people with HIV/AIDS usually don't develop CNS-IRIS until they go on antiretroviral therapy. Researchers believe that HIV/AIDS infection has reconstituted these patients immune systems in such a way that any immune improvement causes the immune system to over react. At that point the immune system can react even to subclinical infections; e.g. small infections that normally don't bother us.
(That's a fascinating scenario for me because increased energy has generally resulted in what appears to be an immune reaction. My general symptoms are fatigue, muscle stiffness and pains. As I start to improve, however, I tend to experience fluey symptoms. Shortly after I start feeling really good the fluey symptoms manifest themselves and I have to drop the treatment.)
From the very beginning researchers have felt that an immune reaction must play a role in ME/CFS - the symptoms were just too similar, but immune results have lacked consistency. In this scenario, it all appears to take place in the brain.
Conclusion
In short, Nath is not a little or medium wheel at the NIH - he's a big wheel. The fact that he's presenting to the CDC on the NIH's ME/CFS research study suggests the NIH may indeed enlisting some of its best and brightest in an attempt to understand it. Nath's presence is also another sign of the NINDS Institute stepping up to the plate. If a central nervous system infection is present in ME/CFS, Nath might be the guy to find evidence of it.
His talk will probably be a quick one; with four presenters in an hour none of the speakers has time to do much more than provide a short overview of their subject. In that time, though, Nath should be able to tell us much about the NIH's new study to comprehensively analyze a cohort of people with ME/CFS.
It's hard to know what's going on at the NIH. Their response to CFSAC recommendations was disappointing and yet here they are sending one of their top researchers to present on ME/CFS to the medical world. That's certainly good news.
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- Dr. Lapp: "The Clinical Presentation of ME/CFS",
- Dr. Unger: The "Public Health Approach to ME/CFS"
- Dr. Komaroff: “Lessons from the Institute of Medicine and NIH Pathways to Prevention Reports”
We may have heard much of what the first three presenters will say but then comes a new face: Dr. Avindra Nath. Nath is the Chief of the section on Infections of the Nervous System at the National Institute of Neurological Diseases and Stroke (NINDS) and the intramural clinical director of the NIH's huge Clinical Center.
He's also been tasked with developing a center dedicated to translating new therapies for neurological disorders to clinical use. Nath has co-authored hundreds of research papers. A recent one - published in renowned Lancet journal - focused on central nervous system infections and neuro-immune damage. A short February 2015 paper that called neuroinfectious diseases "a crisis in neurology" called for more action to understand them.
Here he is talking on the research study beginning at the NIH's Clinical Center soon.
- Dr. Avindra Nath: “Post-Infectious Chronic Fatigue Syndrome: Intramural Research at the National Institutes of Health”
Nath has been "internationally recognized" for his contributions to understanding HIV's effects on the central nervous system. He proved that a protein viruses make called Tat could stimulate neurons and activate glial cells. Those activated glial cells then released immune factors called chemokines that recruited immune cells called macrophages into the central nervous system.
Macrophages are activated monocytes. Picture the Hulk before and after his transformation and you have a good picture of what happens to monocytes when they turn into macrophages. Macrophages are killing machines; their entry into the central nervous system sounds like a sure recipe for neuroinflammation - a hot topic in ME/CFS.
According to the NIH Nath has also helped develop several neuroprotective compounds that are in various stages of development and clinical testing.
Central Nervous System Immune Reconstitution Inflammatory Syndrome
Nath also discovered a process that could have some bearing on ME/CFS. He found that some individuals with otherwise excellent responses to retrovirals nonetheless developed a "devastating" case of immune-mediated encephalitis called "central nervous system immune reconstitution inflammatory syndrome" or CEN- IRIS. First described in 1992, it usually occurs in association with an HIV infection but can occur in conjunction with other infections.
[fleft]
Intriguingly, people with HIV/AIDS usually don't develop CNS-IRIS until they go on antiretroviral therapy. Researchers believe that HIV/AIDS infection has reconstituted these patients immune systems in such a way that any immune improvement causes the immune system to over react. At that point the immune system can react even to subclinical infections; e.g. small infections that normally don't bother us.
(That's a fascinating scenario for me because increased energy has generally resulted in what appears to be an immune reaction. My general symptoms are fatigue, muscle stiffness and pains. As I start to improve, however, I tend to experience fluey symptoms. Shortly after I start feeling really good the fluey symptoms manifest themselves and I have to drop the treatment.)
From the very beginning researchers have felt that an immune reaction must play a role in ME/CFS - the symptoms were just too similar, but immune results have lacked consistency. In this scenario, it all appears to take place in the brain.
Conclusion
In short, Nath is not a little or medium wheel at the NIH - he's a big wheel. The fact that he's presenting to the CDC on the NIH's ME/CFS research study suggests the NIH may indeed enlisting some of its best and brightest in an attempt to understand it. Nath's presence is also another sign of the NINDS Institute stepping up to the plate. If a central nervous system infection is present in ME/CFS, Nath might be the guy to find evidence of it.
His talk will probably be a quick one; with four presenters in an hour none of the speakers has time to do much more than provide a short overview of their subject. In that time, though, Nath should be able to tell us much about the NIH's new study to comprehensively analyze a cohort of people with ME/CFS.
It's hard to know what's going on at the NIH. Their response to CFSAC recommendations was disappointing and yet here they are sending one of their top researchers to present on ME/CFS to the medical world. That's certainly good news.
The Grand Rounds Presentation
The presentation will be webcast "to thousands of providers, researchers, and the public." Details and previous programs can be viewed at http://www.cdc.gov/cdcgrandrounds/.
The presentation will be archived and viewable after 48 hours. The CDC gave this link for those wanting to watch the presentation live.
The presentation will be webcast "to thousands of providers, researchers, and the public." Details and previous programs can be viewed at http://www.cdc.gov/cdcgrandrounds/.
The presentation will be archived and viewable after 48 hours. The CDC gave this link for those wanting to watch the presentation live.
CDC’s Public Health Grand Rounds Presents:
“Chronic Fatigue Syndrome: Advancing Research and Clinical Education”
Tuesday, February 16, 2016
1:00 p.m. – 2:00 p.m. ET
Global Communications Center (Building 19)
Alexander D. Langmuir Auditorium
Roybal Campus
“Chronic Fatigue Syndrome: Advancing Research and Clinical Education”
Tuesday, February 16, 2016
1:00 p.m. – 2:00 p.m. ET
Global Communications Center (Building 19)
Alexander D. Langmuir Auditorium
Roybal Campus
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....Want a big challenge - this is one. Thanks for your nice words and good luck!
