Review The gastrointestinal microbiota in the development of ME/CFS: a critical view and potential perspectives, 2024, Andreas Stallmach et al

Conclusion
In patients with ME/CFS, various studies have yielded inconclusive results regarding changes in the gastrointestinal processes where microbiota is involved. Whether these divergent findings are due to different molecular phenotypes of patients with ME/CFS remains speculative. Presently, dysbiosis in ME/CFS is to be understood as an association; causality is not proven from a critical perspective. Nevertheless, the growing comprehension of the interactions between the microbiome and the host presents an intriguing pathophysiological concept, forming the foundation for rational future therapeutic approaches. A randomized controlled study involving well-defined ME/CFS patients, encompassing post-exertional malaise (PEM), and employing repeated and long-term faecal microbiota transplantation (FMT), appears to be the most promising approach to establish causality. Such understanding of interactions will lead to concepts that help overcome therapeutic nihilism.

https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1352744/full

 

Wow, a suggestion of a rational approach for therapy and experimentation. That seems so rare.

 

I wish Invest In ME would work with their research collaborators to implement a "a higher number and duration of FMT cycle". I understood the Norwich research group funded by Invest In ME would only do one transfer.

 

Such studies would happen more with better funding!!!

 

Abstract

Like other infections, a SARS-CoV-2 infection can also trigger Post-Acute Infection Syndromes (PAIS), which often progress into myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS, characterized by post-exercise malaise (PEM), is a severe multisystemic disease for which specific diagnostic markers or therapeutic concepts have not been established. Despite numerous indications of post-infectious neurological, immunological, endocrinal, and metabolic deviations, the exact causes and pathophysiology remain unclear. To date, there is a paucity of data, that changes in the composition and function of the gastrointestinal microbiota have emerged as a potential influencing variable associated with immunological and inflammatory pathways, shifts in ME/CFS. It is postulated that this dysbiosis may lead to intestinal barrier dysfunction, translocation of microbial components with increased oxidative stress, and the development or progression of ME/CFS.

In this review, we detailed discuss the findings regarding alterations in the gastrointestinal microbiota and its microbial mediators in ME/CFS. When viewed critically, there is currently no evidence indicating causality between changes in the microbiota and the development of ME/CFS. Most studies describe associations within poorly defined patient populations, often combining various clinical presentations, such as irritable bowel syndrome and fatigue associated with ME/CFS. Nevertheless, drawing on analogies with other gastrointestinal diseases, there is potential to develop strategies aimed at modulating the gut microbiota and/or its metabolites as potential treatments for ME/CFS and other PAIS. These strategies should be further investigated in clinical trials.