Could Minocycline be a "Magic Bullet" for the Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome?, 2021, Numata

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease of unknown etiology that causes severe general malaise and a wide range of systemic symptoms, including pain, sore throat, a mild fever, difficulty standing, sleep disturbance, depressive state, and slowness of thought, in previously healthy individuals. In 2019, a report was published that disappointed both ME/CFS patients and the clinicians and researchers involved in its treatment worldwide. The results of a phase III double-blinded randomized clinical trial of B-lymphocyte depletion therapy with rituximab, which had earlier appeared promising for the treatment of ME/CFS patients, concluded that rituximab did not contribute to symptomatic improvement in the treatment group (1).

However, the results of a clinical trial by Miwa on minocycline, a tetracycline antibiotic for ME/CFS merit attention, despite the fact that it was a prospective open-label study without a comparative control group (2), for it is no easy task to improve the performance status score in 27% of subjects by 2 points within 6 weeks with oral medication alone. Studies have shown that minocycline can attenuate microglial activation and exert anti-inflammatory, immunomodulatory, and neuroprotective effects (3). The presence of microglial activation, which is believed to indicate the presence of neuroinflammation, has also been identified in the brains of ME/CFS patients (4). Based on these reports, Miwa hypothesized that minocycline’s mechanism of action in inhibiting neuroinflammation may have helped improve the symptoms of ME/CFS patients. Further placebocontrolled, exploratory clinical studies on minocycline are desirable, in addition to more extensive research on the pathogenesis of neuroinflammation.

Open access, https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7182-21/_article

 

But...I thought that a decree had been passed down from the gods of medicine that pwME don't have any neuroinflammation, that any assertion that they do was absurd and merely showed the biomedical ignorance of whomever asserted that pwME might have neuroinflammation?

 

Probably not, but do a randomized trial instead of dreaming about it