Journal of IiME Volume 4 Issue 1 www.investinme.org SPEAKERS and ABSTRACTS of the 5th INVEST in ME INTERNATIONAL ME/CFS CONFERENCE persistent infection by a group of enteroviruses, the coxsackievirus B viruses (CVBs), is due to the continued but low level infection by defective CVBs. These defective viruses have a defect which lowers the level of enterovirus RNA but does not preclude the expression of the viral proteins. This mode of persistent infection normally occurs in tissues which do not have a high level of cell division. The defective enteroviruses are selected by the absence of a nuclear protein in the cytoplasm of non dividing cells. This mode of persistent infection leads to a number of conclusions: (1) persisting defective enterovirus can only be detected by assays for viral protein or RNA, not by cytopathic assays, (2) (3) if enterovirus is persisting, the level of viral RNA per cell will be low, leading to a requirement for a high level of sensitivity and the effects of an enterovirus infection can persist for a period of months. As enteroviruses infect a number of tissues, muscular or neurologic effects of this infection may be associated with some of the symptoms of ME/CFS but confirmation of this type of persistence requires sensitive assays. Dr John Chia MD Dr Chia is an infectious disease specialist practicing in Torrance, California, USA and has published research recently (Chronic fatigue syndrome associated with chronic enterovirus infection of the stomach) on the role of enteroviruses in the aetiology of ME/CFS – an area which has been implicated as one of the causes by a number of studies. There are more than 70 different types of enteroviruses that can affect the central nervous system, heart and muscles, all of which is consistent with the symptoms of ME/CFS. By analyzing samples of stomach tissue from 165 patients with CFS, Dr. Chia's team discovered that 82% of these individuals had high levels of enteroviruses in their digestive systems. Dr Chia's research may result in the development of antiviral drugs to treat the debilitating symptoms of ME/CFS. Invest in ME (Charity Nr. 1114035) Dr. John Chia – Abstract: Enterovirus Infection in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Diagnosis and Treatment. John Chia, Andrew Chia. EV Med Research ME/CFS is an elusive illness without a clear etiology and treatment. Emerging evidences suggest that enteroviruses can persist in the tissues of ME/CFS patients and may be responsible for the various symptoms. Enteroviruses are common causes of respiratory, gastrointestinal and non-specific flu-like illnesses. Major epidemics of enterovirus infections including but not limited to meningoencephalitis, myocarditis, pleurodynia, myositis and handfoot-mouth diseases have been well-documented in the past decades. In some cases, acute enterovirus infections can cause CD8+ T lymphocytopenia predisposing to reactivation of endogenous herpes viruses. Initial isolation of enteroviruses from patients with acute infections followed by demonstration of persistent viral infection in tissues years after the patients developed chronic symptoms lends support to the pathogenic role of enteroviruses in ME/CFS. Presumptive clinical diagnosis of chronic enterovirus infection requires a high index of suspicion, familiarity with the protean manifestations of acute infections and understanding of chronic viral persistence. There is not yet a specific diagnostic test for ME/CFS. Significantly elevated neutralizing antibody titer over time suggests persistent immunologic response to specific enterovirus(s) infection in the tissues. Neutralizing antibody test for non-polio enteroviruses is not widely available. In contrast to other types of viremic infections, EV RNA levels in whole blood of ME/CFS patients are extremely low, which likely explain the discrepancy of results reported from different research laboratories over the past two decades. Immunoperoxidase staining for viral protein in the stomach biopsies is more sensitive than the neutralizing antibody test or EV RNA detection, and furthermore, demonstrates the antigens in tissues where viruses are expected to replicate and persist based on the route of Page 47/56

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