Dr Clive Carter, Dr Philip Wood and colleagues
Leeds NHS Teaching Hospital NHS Trust, St James’s University Hospital, Leeds
Background & aims
There is great debate about the underlying causes of ME/CFS, a debilitating illness which affects approximately 200,000 people in the UK but which is not well understood nor, in many cases, properly recognised. Early symptoms include severe fatigue, sore throat, raised lymph nodes, and pain in joints, similar to those associated with viral infections, so it is possible that an abnormal immune response to the initial viral infection is responsible for the continued symptoms. The immune system of ME/CFS patients has been the target of medical researchers for many years, and the abnormalities found have included reduced natural killer cells, and increases in various types of ‘cytokines’ (which regulate the immune system) such as interleukins and interferons. There is still much more to learn however, and an immunological ‘smoking gun’ remains to be found.
Immunity in ME/CFS can also be studied in comparison with other chronic illness in which patients suffer from similar related symptoms such as debilitating fatigue and pain. For instance, 70–90% of breast cancer patients treated with chemotherapy have fatigue that can, in some cases, be severe and persist long after treatment, greatly affecting their quality of life. No-one is quite sure why this chemotherapy-induced fatigue happens, but chemotherapy is known to cause widespread alterations to lymphocytes (white blood cells that fight infections), and this may play a role. Could it be that changes in white blood cells populations underlie the fatigue experienced by ME/CFS patients AND post-chemotherapy breast cancer patients?
Given this possibility, the investigation by the team at St James’s University Hospital, Leeds involves a range of complex immune tests to assess the type and functional competence of lymphocytes, focusing on activated and regulatory cells (T and B cells). In particular, the team plans to recruit 25 ME/CFS patients and 40 breast cancer patients to observe how lymphocyte ‘surface proteins’ (and the cytokines released by lymphocytes) change before and after treatment. In the case of breast cancer patients, treatment refers to chemotherapy; for ME/CFS patients, treatment centres around their clinical care. All participants will be requested to complete outcomes questionnaires pre- and post-treatment, and ME/CFS patients will additionally be requested to complete the DePaul Symptom Questionnaire.
The main aim of the investigation is to shed light on any major common immunological mechanisms that might be responsible for the catalogue of symptoms shared by people with cancer or ME/CFS. The study could well reveal novel and immunologically important information, leading to new treatment options to protect against fatigue and increase the quality of life, particularly for the ME/CFS patients who presently have few treatments available to them.