Journal of IiME Volume 5 Issue 1 (May 2011) PRESENTERS at the 6th INVEST in ME INTERNATIONAL ME/CFS CONFERENCE Dr. John Chia Dr John Chia is an infectious disease specialist, Torrance, California, USA. He has published research ("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 analysing samples of stomach tissue from patients with CFS, Dr. Chia's team discovered that high levels 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. Abstract: Clinical & Research Experience of Enteroviral Involvement in ME/CFS. John Chia, Andrew Chia. EV Med Research A number of infectious agents have been implicated in the pathogenesis of ME/CFS. Emerging evidences suggest that enteroviruses can persist in the tissues of ME/CFS patients after acute infections and may be responsible for the various symptoms. Enteroviruses can cause major epidemics of respiratory, gastrointestinal and non-specific flu-like illnesses and disseminated infections including but not limited to meningoencephalitis, myocarditis, pleurodynia, myositis and hand-footmouth diseases. 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. A number of tests can support the clinical diagnosis of chronic enterovirus infection. Significantly elevated neutralizing antibody titer over time suggests persistent immunologic response to specific enterovirus(s) infection in the tissues. 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 transmission. The finding of enteroviral RNA and growth of non-cytopathic viruses from the same tissues support the validity of protein staining. The recent finding of double-stranded RNA(dsRNA) in the stomach tissue supports the mechanism of viral persistence in accessible tissue. Although there is renewed interest in drug development for enteroviruses, clinical studies are still many years away. Presently available therapy is directed toward the continuing immune responses against persistent viral infection. Intravenous immunoglobulin, given monthly or every few months, can ameliorate inflammatory symptoms in less than 1/3 of adult patients, but may be more effective in pediatric patients or patients with severe myalgia. The combination of alpha and gamma interferon can induce short-term remission in about 45% of ME/CFS patients with debilitating myalgia, but is quite expensive and often poorly tolerated. Oxymatrine or Equilibrant have beneficial effects in 52% of 700 ME/CFS patients, but transient increase in pre-existing symptoms are expected in most of the patients. Dose titration improves tolerance. Cytokine gene expression study during therapy demonstrates an increase of IL12/Il10 ratio in responders but not in non-responders. A decrease of Continued page 53 Invest in ME (Charity Nr. 1114035) www.investinme.org Page 52/58

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