Andy
Retired committee member
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
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
