Suzanne Vernon's Take on Two XMRV Studies

Dr. Suzanne Vernon, scientific director of the CFIDS Association, recently penned a commentary on three recent XMRV studies.  Two of them—the Barnes study in England and the Henrich study in the U.S.—failed to find XMRV.  Only the Donaldson study at Baylor College of Medicine in Houston found XMRV, in prostate cancer patients. 

Henrich looked at several groups of immunocompromised patients, including those with CFS, HIV, transplants and rheumatoid arthritis.  Barnes examined the blood of patients with HIV or hepatitis C.  

By email, I asked Vernon to expound on these two XMRV negative studies.  Her comments are in green.

CFS Central:  In the Henrich and Barnes studies—unlike the Lombardi 2009 Science study—the researchers calibrated the PCR assay with a synthetic clone instead of a clinically positive sample.  Synthetic clones have been used to calibrate PCR assays in other studies, including Dr. Myra McClure’s XMRV study done in England last winter. As you know, McClure is also one of the authors on the new Barnes study.  Do you believe using a synthetic clone may have contributed to Barnes and Henrich not finding XMRV? Why or why not?

Suzanne Vernon:  Negative results could indicate that assays are not sensitive enough. Positive controls and gold standards for XMRV detection in peripheral blood are needed.

 
CFS Central:  In addition, Henrich and Barnes examined HIV patients for XMRV—and didn’t find it. There is significant evidence to suggest that infection with two retroviruses is unlikely, that infection with one retrovirus helps prevent infection by another, a phenomenon known as retroviral superinfection resistance (http://www.retrovirology.com/content/2/1/52).  Would you comment on the possible role of retroviral superinfection resistance and negative XMRV findings in these patients?  

Suzanne Vernon:  The immune response to viruses that express similar antigens may help prevent dual infection. However, the role of superinfection resistance as it relates to XMRV has not been extensively explored.

 
CFS Central:  Moreover, some of the HIV patients studied had been on ARV [antiretroviral] therapy.  Do you believe being on ARVs could have made it more difficult to find XMRV in these patients?
 

Suzanne Vernon:  It is possible although the chronic HIV cohort had not received highly active antiretroviral therapy for an average of 14 months.

 
CFS Central:  Concerning the Henrich study, your article states that 32 patients met the Fukuda definition of CFS. However, in actuality these patients didn’t meet the Fukuda definition; they met the Empirical definition. The work of Dr. Leonard Jason has shown that 38 percent of patients who meet the Empirical definition actually have major depression. I think it’s an important point that Henrich is studying patients who don’t meet the Canadian or Fukuda definition, and who may be suffering from depression, not CFS.  Would you explain your point of view concerning the CFS definition in this study?

Suzanne Vernon:  Henrich et al used the 1994 CFS case definition criteria which is considered the revision of the 1988 CFS case definition published by Holmes.  We have confirmed use of the 1994 criteria with the investigators.  No one other than CDC has used the empiric approach in research.

 
CFS Central:  You mentioned in your review that investigators should seek to replicate “as much as possible the features of the CFS patients found to be positive for XMRV and related MLVS in the studies published in Science and Proceedings of the National Academy of Sciences.”  Shouldn’t a replication study replicate the patient group selected for the Science or PNAS studies precisely, by using the same definition—particularly in light of the divergent findings published and the resulting confusion that patients and researchers have been grappling with for a year?  Thus, in these XMRV studies, shouldn’t patients meet the 1994 Fukuda definition and/or the Canadian definition of CFS, while weeding out the Empirical patients used in the Henrich study? Why or why not?

Suzanne Vernon:  Study subjects in replication studies should be as similar as possible to those studied by Lombardi et al and Lo et al and should meet 1994 and/or Canadian.

Month Five of Dr. Michael Snyderman's Antiretroviral Boilermaker

Dr. Michael Snyderman, an oncologist with Chronic Lymphocytic Leukemia and ME/CFS, started the HIV drug AZT five months ago to treat both diseases.  Five days after beginning AZT, he added another HIV drug, raltegravir (Isentress).  The third FDA-approved HIV drug shown in test-tube studies to be effective against XMRV is tenofovir (Viread), which he plans on adding to the mix next month.  "I haven't started tenofovir yet because I want to collect enough data to sort out what is happening," Snyderman explains.  He calls his cocktail a boilermaker.

For the year before he began the HIV meds, Snyderman experienced lower extremity neuropathic pain but couldn't figure out why.  And for a few weeks before beginning treatment he became more fatigued than usual and couldn't concentrate by the end of the workday, "which isn't good if you are taking care of sick people, so I started thinking I would have to retire." In addition, his pain had become "agonizing."

During the first two weeks of treatment, there was no improvement, and the only drug side effect was mild nausea. At the third week, however, the pain resolved completely and his concentration and energy began to improve.  "I am still tired though maybe 25 percent better," Snyderman says.  "I believe it must take a long time to heal the damage done directly by the virus and done by the elevated cytokines. Stopping the virus and lowering the cytokines must be important and should be our initial goal, but there are other issues like dealing with the deconditioning. I am not an expert on CFS so I can't go beyond that."

On the HIV drugs, Snyderman's elevated cytokines have normalized, and his cancer markers have improved as well.

Link to Snyderman's most recent posters here: http://www.scribd.com/doc/40929474  or here:  http://www.scribd.com/doc/40933222

New British ME/CFS Print Ad

The British advocacy organization Action Now begins its new “Policy Change: NOW” campaign today.  The campaign, which will run for two weeks, was inspired by the “Time for Action” campaign started by three ME/CFS patients in the U.S.

The U.K. campaign dovetails with today’s demonstration at the Department of Health in London. Today marks the first day that British ME/CFS patients are banned from donating blood.

A spokesperson says that today’s protest was organized in response to the government position that there is no infectious pathogen associated with ME/CFS and that the British ban is in place for only one reason: to prevent patients’ health from getting worse. For more information on the campaign, click here.

Action Now has developed a foreboding two-color print ad campaign:

British.ad

ME/CFS STAUNCH SUPPORTER HARRY REID VERSUS TEA-PARTY CHALLENGER SHARRON ANGLE, WHO DOESN’T BELIEVE IN AUTISM OR SOCIAL SECURITY

Senator Harry Reid of Nevada is in the fight of his senatorial life.  But ME/CFS patients and the families of children with autism can reelect him on November 2

by W. L. Karns

The tight and nasty race between U.S. Senate Majority Leader Harry Reid and Tea-Party Republican challenger Sharron Angle is down to the wire in Nevada. The race may come down to a few hundred votes. Harry Reid is one of the few politicians willing to stand up for ME/CFS patients, and we help ourselves by voting for him and supporting his campaign.

Voting in Nevada began last Saturday, and loyal Republicans are already turning out in disproportionate numbers. Voter turnout is critical for Reid—and his campaign wants Nevadans to cast their votes by Friday. After Friday, early voting stops, and voters have to wait until Election Day.

Reid has long been a staunch supporter of ME/CFS research and healthcare reform. Angle hasn’t weighed in on ME/CFS research, but here are her views on key health issues: She doesn’t believe that insurance companies should be mandated to cover mammograms and colonoscopy screenings. She also believes that insurance companies shouldn’t have to cover autism treatments. Indeed, she questions whether autism really exists.

In other areas, she wants Social Security to be phased out, and she doesn’t believe in global warming or that the U.S. Constitution mandates a separation of church and state.  She believes same-sex marriage should be banned on the federal level. She doesn’t believe in abortion—even in cases of rape and incest. 

Donations of time or money and calling voters to increase turnout may reelect Harry Reid, the senior and rational senator from the silver state—and keep Sharron Angle out.

Reporter Llewellyn King has this to say about Harry Reid,"... to CFS sufferers he is a figure of hope. He has stood up for CFS research. Harry Reid, and others, there is more work to be done."

Harry Reid understands ME/CFS and personally knows Annette and Harvey Whittemore, who founded the Whittemore Peterson Institute (WPI) in Reno, Nevada. Reid was instrumental in getting federal funding for WPI.

In Nevada, ME/CFS patients and parents of autistic children need to call upon friends, relatives and neighbors to vote as well. If ME/CFS patients and families of autistic children can make a difference in this election, other politicians will, no doubt, sit up and take notice.

W. L. Karns has lived with ME/CFS for 23 years and is XMRV positive.