Open-label pilot for treatment targeting gut dysbiosis in ME/CFS: neuropsychological symptoms and sex comparisons, 2018, Wallis et al

Andy · Feb 8, 2018

Abstract
Background
Preliminary evidence suggests that the enteric microbiota may play a role in the expression of neurological symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Overlapping symptoms with the acute presentation of d-lactic acidosis has prompted the use of antibiotic treatment to target the overgrowth of species within the Streptococcus genus found in commensal enteric microbiota as a possible treatment for neurological symptoms in ME/CFS.

Methods
An open-label, repeated measures design was used to examine treatment efficacy and enable sex comparisons. Participants included 44 adult ME/CFS patients (27 females) from one specialist medical clinic with Streptococcus viable counts above 3.00 × 105 cfu/g (wet weight of faeces) and with a count greater than 5% of the total count of aerobic microorganisms. The 4-week treatment protocol included alternate weeks of Erythromycin (400 mg of erythromycin as ethyl succinate salt) twice daily and probiotic (d-lactate free multistrain probiotic, 5 × 1010 cfu twice daily). 2 × 2 repeated measures ANOVAs were used to assess sex-time interactions and effects across pre- and post-intervention for microbial, lactate and clinical outcomes. Ancillary non-parametric correlations were conducted to examine interactions between change in microbiota and clinical outcomes.

Results
Large treatment effects were observed for the intention-to-treat sample with a reduction in Streptococcus viable count and improvement on several clinical outcomes including total symptoms, some sleep (less awakenings, greater efficiency and quality) and cognitive symptoms (attention, processing speed, cognitive flexibility, story memory and verbal fluency). Mood, fatigue and urine d:l lactate ratio remained similar across time. Ancillary results infer that shifts in microbiota were associated with more of the variance in clinical changes for males compared with females.

Conclusions
Results support the notion that specific microorganisms interact with some ME/CFS symptoms and offer promise for the therapeutic potential of targeting gut dysbiosis in this population. Streptococcus spp. are not the primary or sole producers of d-lactate. Further investigation of lactate concentrations are needed to elucidate any role of d-lactate in this population. Concurrent microbial shifts that may be associated with clinical improvement (i.e., increased Bacteroides and Bifidobacterium or decreased Clostridium in males) invite enquiry into alternative strategies for individualised treatment.
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Open access at https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1392-z

Bob · Feb 8, 2018

This paper has got a helpful and interesting description of the nature of ME and it's symptoms and complications. Is anyone familiar with the authors? I don't recognise them. The lead author works in the psychology department at Victoria University, Melbourne. .

Art Vandelay · Feb 10, 2018

Bob said: ↑

This paper has got a helpful and interesting description of the nature of ME and it's symptoms and complications. Is anyone familiar with the authors? I don't recognise them. The lead author works in the psychology department at Victoria University, Melbourne. .
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Don Lewis is a very well respected ME/CFS doctor in Melbourne and has collaborated with a few members of this team before on publications from memory as well as others like Chris Armstrong. Henry Butt in particular has been involved with CFS research (mainly on the gut) for ages -- his name even cropped up a lot when I got sick in the late 90s.

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Open-label pilot for treatment targeting gut dysbiosis in ME/CFS: neuropsychological symptoms and sex comparisons, 2018, Wallis et al

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Open-label pilot for treatment targeting gut dysbiosis in ME/CFS: neuropsychological symptoms and sex comparisons, 2018, Wallis et al

Andy Committee Member

Bob Established Member

Art Vandelay Senior Member (Voting Rights)

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