2023-10-07 08:10:49
by Anna Fregonara
Re-establishing the body’s microbiota allows us to “reset” the immune system which, if altered, would give rise to this disease
In the intestinal microbiota there could be the key to a possible cure, which for now does not exist, for chronic fatigue syndrome (CFS from the English Chronic Fatigue Syndrome) which in Italy affects between 200 thousand and 300 thousand people. Worldwide, it is estimated that 857 people per 100,000 inhabitants suffer from it. It cannot therefore be considered a rare disease. It occurs mainly between the ages of 20 and 40, is more frequent among women, but can affect children and adolescents.
Also known as myalgic encephalomyelitis (ME from the English Myalgic encephalomyelitis), an expression that indicates inflammation of the brain and spinal cord with muscle pain, the predominant symptom is continuous tiredness, different from the one we all know and which usually resolves with a good sleep. It is, in fact, a chronic, persistent and pathological tiredness that is felt even just when carrying out banal gestures such as brushing your teeth or taking a shower and is so disabling that it puts work, social and personal activities at risk. It is often underestimated so much so that patients are heard making comments such as: “It’s all in your head”, “If you moved more you would have more energy”. Yet ME was recognized as a disease by the World Health Organization in 1969.
Probiotics: why we hope
Today a new hope for therapy could come from the microbiota. Tamara Romanuk, a former biology teacher, told The Guardian that after taking antibiotics prescribed to treat another infection and probiotics to help the microbiota recover, she experienced a brief remission of symptoms. By sharing her experience online, she discovered that she wasn’t the only one who had had this “remission event,” as she called it. Tess Falor, an engineer with a PhD, also experienced the same thing, so much so that the two started a research project called RemissionBiome.
Their hypothesis is to reset the immune system by working on the intestinal microbiota.
«The role of the microbiota could prove important because the microorganisms present in the oral cavity and at the gastrointestinal level could undergo a modification (dysbiosis) following infections of a different nature, with repercussions on the immune system which, if altered, would give the clinical symptoms of CFS», explains Lorenzo Lorusso, director of the Neurology and Stroke Unit of the Merate hospital, Neuroscience department of the ASST Lecco, member of the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome research consortium.
How to intervene on the microbiota
«There are various therapeutic interventions, to be pursued only on medical advice, to try to re-establish the body’s microbiota: use of probiotics and prebiotics (in particular containing Lactobacillus and Bifidobacterium), by modulating the microbiota there is an improvement in gastrointestinal symptoms; Transplantation of the intestinal microbiota seems to be promising even if the studies are few and need further confirmation.
The colonoscopic infusion of bacteroids (Clostridia and E.Coli) provided benefits, especially on gastrointestinal and neurological symptoms, up to a remission of approximately 90%; change of diet, particularly in patients with hypersensitivity to certain foods: it appears to reduce the fatigue symptom in approximately 50% of patients; treatment with high doses of vitamin B1 (thiamine) seems to re-establish the gastric microbiota having repercussions on the improvement of fatigue. These are approaches that require further studies to confirm their benefit so that they can be used on the majority of patients even if, as in other diseases, the therapy must be personalized”, explains Lorusso.
Other treatments under study
In addition to considering a role for the microbiota, researchers are evaluating other possibilities. «Norwegian doctors are trying treatment with monoclonal antibodies while in Berlin the path to immunoglobulins is being tested. All these interventions are signs of hope for the sick and their families”, adds Lorusso.
Because there is no therapy
Since the mechanisms underlying the disease are not known, it is difficult to identify a precise therapeutic approach which is essentially symptomatic, i.e. addressing the symptoms complained of by the patient. «Among scholars, the prevailing hypothesis is an immunological alteration triggered by an infection. Many studies, in fact, highlight that in the clinical history there has been a previous infection, generally viral, or a reactivation of latent or opportunistic viruses. This is the reason for the recent inclusion of the pathology in a new medical classification called Post-Acute Infection Syndrome (PAIS) which also includes long-COVID”, comments the expert.
Symptoms
«This immune hypothesis could explain the variety of clinical symptoms. To arrive at the diagnosis it is important to take into account the clinical history reported by the patient who complains above all of persistent fatigue at minimal effort (feeling of exhaustion) for which he does not benefit from rest. Persistent fatigue must be present for more than 6 months associated with a significant reduction in functional activities and the appearance of malaise after physical or mental exercise that increases after minimal effort and lasts for days or weeks. Generally, many other symptoms of various nature are associated: cardiovascular, such as delayed orthostatic hypotension or tachycardia; neurological including sleep disorders, difficulty concentrating, dysautonomic headache, i.e. at the level of the nervous system, associated with other systems such as the cardiac and gastrointestinal systems; arthro-muscular, associated with pain; neuroendocrine, with alterations in body temperature, intolerance to external temperatures, appetite disorders; gastrointestinal. The clinical picture is characterized by a cyclical trend in the sense that there are periods of remission and periods of relapses with variations in symptoms”, continues Lorusso.
How to reach the diagnosis
It is not easy to formulate the diagnosis as there are no markers that allow it to be identified. «CFS patients generally do not receive adequate attention from the medical-scientific community due to the absence of specific diagnostic markers of the pathology. The diagnosis is essentially clinical and is one of exclusion as the symptom of fatigue is associated with many other pathologies such as in cases of anemia, tumors, metabolic alterations, neurological pathologies and psychiatric disorders such as depression. Does it heal? It is a chronic pathology with a fluctuating course. There are, therefore, cases of recovery, but also cases that persist over time with outcomes that can be mild or serious to the point of having to abandon work”, concludes Lorusso.
October 7, 2023 (changed October 7, 2023 | 08:10)
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