Beyond the Symptom: The Biology of Fatigue - Virtual workshop, 2021 - Report published 2023

I caught parts of 2 day presentation on biology of fatigue when it first aired but I was able to watch day 1 in more detail this morning. I was particularly interested in Asya Rolls PhD presentation regarding brain immune interactions - how parts of the brain such as the insular cortex perceive changes to immune system during infection (colitis, peritonitis) in mice. Also Dr Andrew Miller’s MD presentation on the effect of cytokines on the brain - specifically on how interferon alpha lowers activation of ventral striatum leading to reduced motivation/dopamine levels)

The question I have is do MECFS patients have higher signaling or amplification of immune perturbations. Is the blood brain barrier affected? Or is some other avenue for brain immune communication hyper active (afferent vagus nerve)? How can we determine whether abnormal inflammation is the driving mechanism (in the gut) vs faulty signaling.

The end effect for us is the same, which is that poisoned, acute flu like state that is post exertional malaise.
 
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Now published
Beyond the Symptom: The Biology of Fatigue, 2023

Abstract
A workshop titled “Beyond the Symptom: The Biology of Fatigue” was held virtually September 27-28, 2021. It was jointly organized by the Sleep Research Society and the Neurobiology of Fatigue Working Group of the NIH Blueprint Neuroscience Research Program. For access to the presentations and video recordings, see: https : //neuroscienceblueprint.nih.gov/about/event/beyond-symptom-biology-fatigue. The goals of this workshop were to bring together clinicians and scientists who use a variety of research approaches to understand fatigue in multiple conditions and to identify key gaps in our understanding of the biology of fatigue. This workshop summary distills key issues discussed in this workshop and provides a list of promising directions for future research on this topic. We do not attempt to provide a comprehensive review of the state of our understanding of fatigue, nor to provide a comprehensive reprise of the many excellent presentations. Rather, our goal is to highlight key advances and to focus on questions and future approaches to answering them.

https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsad069/7177603#
 
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It's good that someone realizes that understanding fatigue (and fatigue-like states) is important.

Hmm, Big Pharma might not like this, since it might reduce the number of customers for "pills for fatigue" if the effectiveness (or lack thereof) can be clinically measured.
 
Creekside said:
It's good that someone realizes that understanding fatigue (and fatigue-like states) is important.

Hmm, Big Pharma might not like this, since it might reduce the number of customers for "pills for fatigue" if the effectiveness (or lack thereof) can be clinically measured.
Click to expand...
I really don't see a market for "fatigue" drugs. It's not a viable target, it's a downstream effect of issues that have to be rooted out and fixed. Especially since fatigue is used to be mean dozens of things that have little to do with one another. There are decades of confusing language and invalid data polluting the whole thing, making any coherent effort impossible. Those whose view is tiredness/sleepiness are just as lost as those who think in terms of motivation, and they won't get anywhere with this perspective either.

Fixing those causes, now there's a huge market for that. But it's not one target, it's potentially hundreds, although likely with a relatively small number of biological factors common to most. And even then, those factors probably have a reason and can't be disturbed without causing cascading issues.

I think that real progress will only occur once immunology is treated with the respect it deserves as the likely driver for most of what we typically call illness. Once root causes are found. Until then, I doubt anything useful at all happens, simply because fatigue is not a target in itself, it's the outcome of a cause that needs to be identified.

Certainly any syndromic perspective, working with symptoms alone, even worse a BPS approach, won't do it. This is a biomedical problem that requires biomedical thinking and solutions to many problems. The rest is pretty much irrelevant.
 
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Free fulltext:
https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsad069/7177603

Beyond the Symptom: The Biology of Fatigue

David M. Raizen1 , Janet Mullington2 , Christelle Anaclet3 , Gerard Clarke4 , Hugo Critchley5 , Robert Dantzer6 , Ronald Davis7 , Kelly L. Drew8 , Josh Fessel9 , Patrick M. Fuller10, Erin M. Gibson11, Mary Harrington12 , W. Ian Lipkin13, Elizabeth B. Klerman14,16, Nancy Klimas15, Anthony L. Komaroff16, Walter Koroshetz17, Lauren Krupp18, Anna Kuppuswamy19, Julie Lasselin20, Laura D. Lewis21, Pierre J. Magistretti22, Heidi Y. Matos17, Christine Miaskowski23, Andrew H. Miller 24, Avindra Nath17, Maiken Nedergaard25, Mark R. Opp26, Marylyn D. Ritchie27, Dragana Rogulja28, Asya Rolls29, John D. Salamone30, Clifford Saper31, Vicky Whittemore17, Glenn Wylie32, Jarred Younger33, Phyllis C. Zee34 , and H. Craig Heller35


Abstract

A workshop titled “Beyond the Symptom: The Biology of Fatigue” was held virtually September 27-28, 2021.

It was jointly organized by the Sleep Research Society and the Neurobiology of Fatigue Working Group of the NIH Blueprint Neuroscience Research Program.

For access to the presentations and video recordings, see: https : //neuroscienceblueprint.nih.gov/about/event/beyond-symptom-biology-fatigue.

The goals of this workshop were to bring together clinicians and scientists who use a variety of research approaches to understand fatigue in multiple conditions and to identify key gaps in our understanding of the biology of fatigue.

This workshop summary distills key issues discussed in this workshop and provides a list of promising directions for future research on this topic.

We do not attempt to provide a comprehensive review of the state of our understanding of fatigue, nor to provide a comprehensive reprise of the many excellent presentations.

Rather, our goal is to highlight key advances and to focus on questions and future approaches to answering them.

Click to expand...
 
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