368 - Relation of Immune Profile to Exercise-Induced Pain and Fatigue in [ME/CFS] and Post-acute Sequelae of SARS-CoV-2 Infection, 2025, Berardi et al

368 - Relation of Immune Profile to Exercise-Induced Pain and Fatigue in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-acute Sequelae of SARS-CoV-2 Infection

Giovanni Berardi, Adam Janowski, Samuel McNally, Gregorius Bernhard, Alpana Garg, Kathleen Sluka

Abstract
Individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and postacute sequelae of SARS-CoV-2 infection (PASC) experience exercise-induced pain and fatigue (EIPF). EIPF can occur during and after exercise and is a barrier to participation in daily activities and exercise. While mechanisms of pain and fatigue are likely multifactorial, several studies suggest a prominent role of the immune system.

This study examined pain, fatigue, and immune cell profiles before and after an exercise task in 30 individuals with PASC, ME/CFS, and controls. Pain and fatigue were assessed prior to and for 7-days following exercise using 0-10 numerical rating scales.

PBMCs were isolated and monocyte, T-cell, natural killer cell, and B-cell phenotypes were characterized using flow cytometry before and after exercise. EIPF was defined as a composite change score for pain and fatigue over 72-hours following exercise and ranged from -4.0-5.3/10 in individuals with ME/CFS and PASC.

There were no differences in monocyte, T-cell, natural killer cell, or B-cell phenotypes at baseline or changes in phenotype following exercise among groups (p>.05).

Cluster analysis identified two distinct groups based on the baseline monocyte phenotype, an inflammatory group (classical monocytes>non-classical monocytes) and a non-inflammatory group (classical monocytes<non-classical monocytes).

The inflammatory group reported higher EIPF (inflammatory: 2.3, non-inflammatory: 0.9, p<.05), and the classical to non-classical monocyte ratio correlated with EIPF (r=.342,p=.05).

These data suggest immune function can drive the pain and fatigue response to an acute bout of exercise and may have implications for future development of anti-inflammatory therapeutics to address EIPF.

Link (The Journal of Pain) [Paywall]

 

Interesting to see classical monocytes come up again as the main differentiator. Classical monocytes were the type highlighted as most related to disease severity in the Grimson single cell transcriptomics study.

https://www.s4me.info/threads/singl...om-provocation-2022-ahmed-hanson-et-al.30170/

 

Link also includes these codes which might link to more information about the study
NIH: R01AR077418, R01AR077418-S1, U24NS112873-S1.

 

5R01AR077418 = Metabolic Biomarkers for Fibromyalgia
There are 4 publications
https://reporter.nih.gov/search/5-TV32A2Yky37o9D9bvx1w/project-details/10916213#publications

This seems the most relevant publication for ME/CFS - it included 707 individuals with Long Covid, fibromyalgia and CFS with a thought that BPS treatment might help.
Thread : A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study

U24NS112873 = Clinical Coordinating Center for the Acute to Chronic Pain Signatures Program

 

These look to be from the same team.

Post-Exertional Malaise in ME/CFS and Post-Acute Sequelae of Severe Acute Respiratory Syndrome 2 Infection, 2024, Sluka

Impact of an Individualized Low-to-Moderate Exercise Task on Post-Exertional Malaise in Post-Acute Sequelae of SARS-CoV-2...and ME/CFS, 2024, Berardi

 

First one:

Second one:

Given the first one, I had hoped that they realised that you have to account for more than pain and fatigue.

 

Not really, if they are basing their understanding on the DSQ-PEM questionnaire. If I recall correctly, there are only four questions which ask about fatigue, tiredness and soreness.

 

Fair enough!

 

Bragging rights? Maybe they're hoping for an award for "inventing a new term"? There might also be a benefit by sidestepping arguments against their study based on PEM. "Your arguments about PEM don't apply, since our study is about EIPF."