Abnormalities of AMPK Activation and Glucose Uptake in Cultured Skeletal Muscle Cells from Individuals with Chronic Fatigue Syndrome, 2015, Brown+

I agree, I don't think academics necessarily have it harder than anyone else and that's not the discussion I'm trying to invoke here.
Apologies, I got a bit off track with my own thoughts!
More specifically trying to answer the question of why you see so many seemingly promising findings never get followed up on in ME/CFS research. That's where I think the difficulty in attracting the interest of others has to be invoked. IMO it's the more plausible explanation than assuming that the group did keep trying to keep investigating in earnest but the findings just didn't hold up.
I agree that it sounds plausible. Although we’ve also seen plenty of research with shoddy methodology or just very small sample sizes, so a lot of it is probably just noise.
Also you wouldn't believe how allergic many academics are to looking back through older literature to see if this exact situation happened and there's an interesting thread that hasn't been fully explored.
This is a bit of a paradox to me. If science is about creating new knowledge, you would assume that it would be paramount to know what we already know!
 
More specifically trying to answer the question of why you see so many seemingly promising findings never get followed up on in ME/CFS research. That's where I think the difficulty in attracting the interest of others has to be invoked. IMO it's the more plausible explanation than assuming that the group did keep trying to keep investigating in earnest but the findings just didn't hold up.

I'm not too sure about that. Most ME/CFS research groups, as seen elsewhere in medicine/biomedical sciences, only publish positive results and most of the promising findings in ME/CFS research probably tend to also have some fairly basic methodological problems. I do think for most of the results we have seen they probably haven't been replicatable or even meaningful rather than anything else, but that doesn't mean that there also aren't a few instances, of possibly important work, where bottlenecks simply prevented further work.
 
I'm not too sure about that. Most ME/CFS research groups, as seen elsewhere in medicine/biomedical sciences, only publish positive results and most of the promising findings in ME/CFS research probably tend to also have some fairly basic methodological problems. I do think for most of the results we have seen they probably haven't been replicatable or even meaningful rather than anything else, but that doesn't mean that there also aren't a few instances, of possibly important work, where bottlenecks simply prevented further work.
I think that is probably the case for some groups, though generally when I've seen this phenomenon I've also observed that the authors didn't have any more publications (at least in ME/CFS) for several years after that point, which to me indicates that they weren't able to continue in the field rather than they couldn't verify one finding and gave up. Hard to gauge from occassional anecdotes though.

I've seen plenty of non-replicable results in other fields (RA being the most recent one I'm familiar with) and in those situations the authors still published in the field. They simply pivoted to other hypotheses after one of their promising golden sheep didn't turn out to be replicable. I think we also have to account for failure to get further grants even if previous results were promising

At least for this particular case, seeing that AMPK repeatedly came up in their later publications, I feel more comfortable assuming that there were other reasons preventing follow up rather than it's a dead end.
 
'Muscle fatigue' has been a defining feature of ME for at least 50 years. I am sometimes a bit perplexed how even very well educated people researching this condition seem to be unaware of this. Even MDs working with ME patients regularly sometimes seem to be oblivious to the fact. Newton's findings made total sense from a patient's experience perspective. Last I heard from Newton, if I remember correctly, was that she more or less gave up ME/CFS because of a lack of funding opportunities. There was also always some kind of issue re Fukuda, again I might be wrong, but I think she was adamant about using it.
 
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At least for this particular case, seeing that AMPK repeatedly came up in their later publications, I feel more comfortable assuming that there were other reasons preventing follow up rather than it's a dead end.
Others here will have more knowledge but I remember press that Julia Newton stopped the work because of lack of grants. I seem to remember that some of the funding they had came from a general research center grant at Newcastle (details will be in the papers). There was also a political fall out in the UK (perhaps CMRC = UK CFS/ME Research Collaborative related, can't remember) and that team, and others that worked with them were shunned by part of the community. e.g. not invited to certain conferences.
 
So what exactly is 'muscle fatigue'? I can understand fatiguability - which is post-exertional weakness. I can understand muscle pain. But I am unclear what 'muscle fatigue' would be.
Quite similar for me to complete muscle exhaustion, such as doing supersets, i.e. doing a series of weight lift sets to the point of being unable to continue.

The muscles feel weak, grip is weak, they shake and feel a bit tingly. There's just nothing left in them.

Specifically this feeling right after you just dropped the weights, it lasts only for a minute or so, as, I guess, energy 'replenishes', however that happens with exhausted muscles.
 
The AMPK-related findings seemed to be corroborated in other work by this group, in 2018 and 2020

I wouldn't say so, to be honest

Study 1) AMPK activity not found to be increased after exercise
Study 2) AMPK is activatable pharmacologically (one would expect this in the absence of concrete evidence of a defect)
Study 3) Differences in phenotypes when provisioned with different substrates. Messing with AMPK doesn't, to my eye (an eye that has performed enough seahorse assays over a decade to know how to do multi-day protocols, start to finish, with different tissues without referencing instructions) seem to do anything unique, mitochondrially, in the ME vs HC samples. The no treatment/treatment trends in the seahorse data look the same to me, just moved upwards with AMPK activation in both groups which you'd expect.

These are all pretty different angles.

Back to study 1, the phospho AMPK westerns have been done in only a small sample (7 controls 8 ME/CFS) and haven't been replicated. I don't see anything about technical replicates within the experiments here either, for even reliable assays you want to do things at least 3 times and westerns are notoriously variable and tricky. Given:

-the blot images (the uneven intensity in phospho band 4 in 2A for example is indicative that optimisation is needed, could be issues during either transfer or development. It's particularly notable because the increase in phospho AMPK at the previous time point disappears before this final time point band, and you can see in the band that what signal is there is thick and bright as with the previous but looks like it hasn't developed or transferred well because the rest of the lane is giving no signal)
-and the apparent lack of replicates (Again, I can't see any info about replicates) it doesn't look too compelling

For what it's worth we have done phospho ACC (a key AMPK substrate) assays in hundreds of cell lines across multiple tissues from pwME + HC and nothing clear has stood out from it iirc

If I had to give a comment on where we are at with current knowledge relating to a potential role of AMPK in ME/CFS I would say that we know very little. Main things sticking out in my memory from the literature where relevant differences were found:

1) Study 1 above where electrical pulse stimulated muscle cells in small cohort didn't show detectable AMPK activation (with all the caveats mentioned)
2) Consistency of reports of abnormal fatty acid usage by different ME/CFS immune cells suggests AMPK is involved, but as cause or consequence of something else is is unclear
3) The idea of a glucose metabolism bottleneck from this group's work and some other stuff, particularly Chris Armstrong's work, is an area to explore further

Basically we don't know much, yet. There could be something, but I am not convinced that we can see anything specific about AMPK itself based on current evidence. Maybe there's something in its downstream targets relating to fatty acid and glucose usage for making energy. That's the only sensible guess I can give. But as with anything relating to energy metabolism this is highly cell type specific, even down to different types of immune cells let alone different tissues. So it is also hard to generalise anything systemic here.

While I agree with JE's recent comments that musings are important (else I wouldn't be here) I think we really just need more data to say anything much about AMPK.

Also relating to the discussion of whether this got followed up or not, didn't this group run out funding? I remember hearing that some years ago, probably on here. Correct me if I am wrong. I know that Cara moved on to industry.
 
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I wouldn't say so, to be honest

Study 1) AMPK activity not found to be increased after exercise
Study 2) AMPK is activatable pharmacologically (one would expect this in the absence of concrete evidence of a defect)
Study 3) Differences in phenotypes when provisioned with different substrates. Messing with AMPK doesn't, to my eye (an eye that has performed enough seahorse assays over a decade to know how to do multi-day protocols, start to finish, with different tissues without referencing instructions) seem to do anything unique, mitochondrially, in the ME vs HC samples. The no treatment/treatment trends in the seahorse data look the same to me, just moved upwards with AMPK activation in both groups which you'd expect.

These are all pretty different angles.

Back to study 1, the phospho AMPK westerns have been done in only a small sample (7 controls 8 ME/CFS) and haven't been replicated. I don't see anything about technical replicates within the experiments here either, for even reliable assays you want to do things at least 3 times and westerns are notoriously variable and tricky. Given:

-the blot images (the uneven intensity in phospho band 4 in 2A for example is indicative that optimisation is needed, could be issues during either transfer or development. It's particularly notable because the increase in phospho AMPK at the previous time point disappears before this final time point band, and you can see in the band that what signal is there is thick and bright as with the previous but looks like it hasn't developed or transferred well because the rest of the lane is giving no signal)
-and the apparent lack of replicates (Again, I can't see any info about replicates) it doesn't look too compelling

For what it's worth we have done phospho ACC (a key AMPK substrate) assays in hundreds of cell lines across multiple tissues from pwME + HC and nothing clear has stood out from it iirc

If I had to give a comment on where we are at with current knowledge relating to a potential role of AMPK in ME/CFS I would say that we know very little. Main things sticking out in my memory from the literature where relevant differences were found:

1) Study 1 above where electrical pulse stimulated muscle cells in small cohort didn't show detectable AMPK activation (with all the caveats mentioned)
2) Consistency of reports of abnormal fatty acid usage by different ME/CFS immune cells suggests AMPK is involved, but as cause or consequence of something else is is unclear
3) The idea of a glucose metabolism bottleneck from this group's work and some other stuff, particularly Chris Armstrong's work, is an area to explore further

Basically we don't know much, yet. There could be something, but I am not convinced that we can see anything specific about AMPK itself based on current evidence. Maybe there's something in its downstream targets relating to fatty acid and glucose usage for making energy. That's the only sensible guess I can give. But as with anything relating to energy metabolism this is highly cell type specific, even down to different types of immune cells let alone different tissues. So it is also hard to generalise anything systemic here.

While I agree with JE's recent comments that musings are important (else I wouldn't be here) I think we really just need more data to say anything much about AMPK.

Also relating to the discussion of whether this got followed up or not, didn't this group run out funding? I remember hearing that some years ago, probably on here. Correct me if I am wrong. I know that Cara moved on to industry.
Thanks for the input @DMissa, I appreciate your methodological expertise here. Definitely agree with you about lack of technical replicates. I think my sense was more “there is something here” given the glucose bottleneck you noted in study 3, but would definitely like to see more investigation here.

Though it’s only speculation and I wouldn’t say anything definitive based on this: a failure to appropriately upregulate glycolysis or something else in metabolism in the midst of activity feels quite aligned with my experience.

[Edit: also I think it’s important to note that in the 2020 study they didn’t do electrical stimulation of the samples like they did in 2015 (which they couldn’t have done with seahorse). I think this skews the interpretation somewhat between their first and third paper—if there is something happening with failure to upregulate AMPK specifically to meet increased metabolic demand during activity, I wouldn’t expect it to show up strongly in the 2020 study without that stimulation, though the glucose bottleneck they note does provide hints.]
 
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Differences in phenotypes when provisioned with different substrates. Messing with AMPK doesn't, to my eye (an eye that has performed enough seahorse assays over a decade to know how to do multi-day protocols, start to finish, with different tissues without referencing instructions) seem to do anything unique, mitochondrially, in the ME vs HC samples. The no treatment/treatment trends in the seahorse data look the same to me, just moved upwards with AMPK activation in both groups which you'd expect
Also just to clarify, I don’t think that the story between all three findings has to do with mitochondrial function, specifically. It’s the opposite story—that mitochondria function fine on their own—that is interesting to me here. The studies are not direct validations of each other but each present a piece to show that there is also no defect [edit: in AMPK pathways in terms of AMPK levels or downstream of pAMPK], however, artificial activation seems to be required to match healthy controls (when glucose is the primary substrate).

Taking care not to overstate shaky evidence, it seems like what this potentially hints at (subject to further verification), is something which [edit: mildly, not prohibitively] negatively regulates AMPK activation to pAMPK and may result in only a decreased glucose uptake rate. Or, rather, failure to adequately increase glucose uptake to meet demand with glucose as primary substrate. So, to your point, the fact that AMPK doesn’t change anything mitochondrially except basically shift everything up is in line with that story.
 
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“there is something here”

For sure.

Though it’s only speculation and I wouldn’t say anything definitive based on this: a failure to appropriately upregulate glycolysis or something else in metabolism in the midst of activity feels quite aligned with my experience.

Yep and I think the evidence that comes to mind supports this too, at least in tissues that have been looked at directly

Also just to clarify, I don’t think that the story between all three findings has to do with mitochondrial function, specifically. It’s the opposite story—that mitochondria function fine on their own—that is interesting to me here. The studies are not direct validations of each other but each present a piece to show that there is also no defect [edit: in AMPK pathways in terms of AMPK levels or downstream of pAMPK], however, artificial activation seems to be required to match healthy controls (when glucose is the primary substrate).

Taking care not to overstate shaky evidence, it seems like what this potentially hints at (subject to further verification), is something which [edit: mildly, not prohibitively] negatively regulates AMPK activation to pAMPK and may result in only a decreased glucose uptake rate. Or, rather, failure to adequately increase glucose uptake to meet demand with glucose as primary substrate. So, to your point, the fact that AMPK doesn’t change anything mitochondrially except basically shift everything up is in line with that story.

Yep, possibly a story of signalling upstream of the mitochondria. May also not be, but we are testing this atm. (also could be interplay between both, and also where do we draw the line on what a "defect" means, right? Is it the underlying upstream cause or is it everything that becomes broken and feeds back into the clinical picture?)

We do have PhD projects manipulating things by a variety of approaches (genetic or pharma or nutritionally) targeted to components of the mitochondria or signalling mechanisms upstream such as TOR, so we will see what they say. The project involving manipulations directly to Complex V is further along and has produced some genuinely fascinating results

PS: the top two threads right now are AMPK and TOR. What a time to be alive
 
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