In medical science, we often know something is wrong before we know what that something actually is. With fibromyalgia, also known as myalgic encephalomyelitis, the notion that inflammation and our immune systems played a role in this debilitating disease has long been present, at least in those suffering from it. Thankfully, over recent years, more researchers have been willing to look further into this notion and shine light on how the immune system might be malfunctioning in fibromyalgia. With more and more explanations of the mechanisms underlying fibromyalgia, those struggling with it can feel justified in their earlier claims that their immune system was malfunctioning all along.
Millions across the globe suffer from this condition. Besides the primary symptoms of exhaustion and pain, they experience cognitive challenges, GI issues, waxing and waning flu-like episodes, difficulties with upright posture, and worsening of the fatigue after exertion (Post-exertional fatigue). Despite multiple studies of fibromyalgia outbreaks, the exact etiology has been elusive. However, the growing consensus is that immune dysregulation plays some role in the disease process. Other studies have suggested a variety of immune cells and immune processes in the pathway. The present study examined a particular type of immune cell called CD8+ T cells although other cells like classical monocytes as well as other T cells have been implicated also.
Ultimately, the researchers describe their findings that these CD8+ T cells become exhausted although they don’t know what causes that exhaustion. By using a variety of experimental methods including epigenetic studies and gene expression studies, they can see that the number of exhausted CD8+ T cells is increased in the patients.
While describing these T cells as ‘exhausted’ might sound like an oversimplification, the label does fit the biochemical picture quite well. It is well-known that various types of T cells can alter their metabolism and their function when chronically stimulated by infections or oxidative stress. After a period of over-stimulation, they down-regulate their use of glucose and shift to using more fatty acids for energy. This also changes what protein markers are placed on their cell membrane surfaces as well as what immune messengers they release. Coming back to a simple explanation, they just don’t respond as actively or effectively to infectious or inflammatory stimuli anymore.
These functional results arise from changes in what genes are expressed by the CD8+ T cells just like in any other cells. By tracing the various steps in what changes these functional expressions (surface proteins, released messengers, and gene products), researchers are tracing the multiple pathways back upstream. Hopefully, this backtracking will eventually lead to the first trigger, the source of the whole domino chain. We want to know what set the boulder rolling down the hill in the first place.
While a deeper understanding and recognition can help remove the stigma many suffered when providers dismissed their symptoms as psychosomatic, eventually we hope research like this article in focus will lead to prevention and therapies. At this point, conventional medicine (meaning FDA approved) does not offer much beyond symptom management. In functional medicine, having recognized that chronic immune stimulation from chronic infections, hidden toxins, and general inflammation seem to precede the development of fibromyalgia, we have been working to address these factors for years. We also recognize the potential for life stress to increase oxidative stress on top of the other factors, something that even the authors of this article admit.
With the help of such research and a continued open mind to all the potential root causes of our patient’s diseases, we hope to restore healthier, more abundant lives in those that the FDA cannot offer any present options. Finding means to retrain or prevent these exhausted immune cells will likely play a role in that restoration.
Original Article:
David S. Iu, Jessica Maya, Luyen T. Vu, Elizabeth A. Fogarty, Adrian J. McNairn, Faraz Ahmed, Carl J. Franconi, Paul R. Munn, Jennifer K. Grenier, Maureen R. Hanson, Andrew Grimson. Transcriptional reprogramming primes CD8+ T cells toward exhaustion in Myalgic encephalomyelitis/chronic fatigue syndrome. Proceedings of the National Academy of Sciences, 2024; 121 (50) DOI: 10.1073/pnas.2415119121
Thanks to Science Daily:
Cornell University. “Immune T cells become exhausted in chronic fatigue syndrome patients.” ScienceDaily. ScienceDaily, 3 December 2024. <www.sciencedaily.com/releases/2024/12/241203154219.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
