Saturday, June 30, 2012

Mitochondria


A preview of a new mitochondrial study by John McLaren Howard, Sarah Myhill and Norman Booth appeared in the past few days. The study can be found at www.ijcem.com/files/IJCEM1204005.pdf. In the interest of education and information sharing I am posting an older post on this team and their research into mitochondria and ME. 

From June 11, 2011: 
Recent events have gotten me to focus again on mitochondria and its relation to ME. None of the following is presented as medical advice or guidance. I am not a doctor and I do not want to be one. On the other hand, it is worth noting that those with ME are "on their own" when it
comes to medical diagnosis and treatment. The situation for ME sufferers is worse than the 19th century, when physicians at least would ply their trade.

Dr. Sarah Myhill's website, perhaps the most extensive ME website on the internet, has ample information on the critical role that mitochondria play in ME. It is a great starting point. Another informative article is by Dr. David Bell, and can be found in his Lyndonville News here. Dr Bell, an excellent clinician trying to find answers, has had a long-standing interest in the role of mitochondria in ME.

Various clinicians - Dr Joseph Brewer, Dr Sarah Myhill, Dr Paul Cheney - believe that mitochondrial irregularities play a part - perhaps a very large part - in ME/CFS. You can read an article by Dr. Myhill here. In this article Dr. Myhill outlines how mitochondrial failure plays such a very big role in ME. (Incidentally not everyone has caught on to this idea.)

Dr. Myhill collaborated with Dr. John McLaren Howard and Dr. Norman Booth in an important study published in January 2009. This paper, which can be viewed here, was presented by Dr. Booth at the IACFS conference in Reno, NV in 2009. A short article on these three researchers is available here.

Dr. John McLaren Howard is a real unsung hero in ME research. Dr. Howard co-founded Biolab in London (with Dr. Stephen Davies). Prior to retiring from Biolab a few years ago, Dr. Howard pioneered some very important testing in the area of mitochondria and ME. He has continued to do these tests at Acumen lab in Cornwall. His son Mark continues to work as Manager of Biolab.

Dr Myhill's website gives a good explanation of what Acumen is looking for in their testing.

The test itself is relatively easy to do. I believe my daughter was the first person from the US to do this test, back in 2007. In crude terms the test measures ATP function (the rate at which it is recycled into cells) and the efficiency with which ATP is made from ADP. Further testing looks at various blockages to the transport of ATP and ADP. Here is an example of an ATP results page:


The blood test requires one heparanised and one EDTA tube, shipped ambient via Fedex to Acumen lab in the UK. USA Fedex shipments have to be sent to Acumen labs, c/o Cameras Plus, 17A Gold Street, Tiverton, Devon UK EX16 6QB. The samples have to be shipped "international priority" which will get them to Dr. Howard in 48 hours. They need to be shipped in an insulated pack with the proper paperwork. Fedex will help with the international shipping label. They will not help with the packaging in any way. A triplicate copy of an international waybill needs to be filled out in a specific way, the process of which can also be learned through the Fedex site. If the blood is drawn into the correct tubes, if the shipment is packed according to international Fedex procedures, if the paperwork is filled out properly, the sample will breeze through customs to Acumen labs in a timely fashion. Some care has to be taken in these matters.

The test can be done through Dr. Myhill. She will write a particularized summary that is very useful. She has seen hundreds of these tests and works closely with Dr. Howard.

Rich van Konynenburg's thoughts (always welcome) on mitochondria and ME can be seen on the Phoenix Rising forum. This ME/CFS information site was founded by Cort Johnson. This website provides us all with much needed information and connections - and is an ongoing, necessary resource. Not a day goes by that I do not read it.

The big question is, once the specific mitochondria problems are identified, can these deficiencies be rectified? As with all matters with ME, the proof is in the pudding. It is trial and error - but at least the patient has a target, and a means of measurement and tracking. Many people have been helped by this test and its targeted treatment.

Is it possible that such sharp and diverse minds as Myhill, Cheney, Howard, Booth, Bell, and Brewer can be gathered around a subject - mitochondrial failure - and that there be nothing there? No, I do not think so.

The interesting thing about mitochondria dysfunction or illness in general is that it is viewed as a disease - as opposed to ME, which is viewed as nothing. At the moment there is broad attention being paid to mitochondrial diseases and mitochondrial dysfunction, and this reality opens up an entire area on to which ME might be able to piggyback. One of the greatest hopes for ME patients is that something will slop over from another research area - HIV, cancer, mitochondria, MS, stem cell - and inadvertantly land in the lap of ME.

Several national mitochondrial disease websites can be viewed here and here.

The proposed intervention, tailored by the physician to the particular needs of the patient, revolve around what is know as the "mitochondria cocktail". Dr. Myhill stumbled upon mitochondria support through the research of Dr. Stephen Sinatra, the American metabolic cardiologist. The mitochondrial cocktail consists of various supplements. These include NAD, Co-Q10, d-ribose, carnitine, Idebenone, b2 (riboflavin), b1 (thiamine), creatine, and magnesium and b12 injections. A good webpage that covers some of these supplements is this Medscape article. Each patient's cocktail is particularized - either by a physician or by trial and error. The experienced patient, whether with lyme or ME or both, will be able to tell what works for them, and what doesn't, thus devising their own balanced protocol.


4 comments:

  1. I've taken co q-10, l-carnitine, and magnesium daily for at least three years, specifically for mitochondrial support. My muscles fail even more easily than usual, without them, and if I take extra during a lot of activity (say if I had to go to a doctor visit that day) it can help prevent a relapse.

    If you ask me, the mitochondrial dysfunction is at the heart of this disease. And if I had to pick one, I'd say co q-10 is indispensible if someone has M.E., and like you said, a lot of patients with Lyme & co. find it helps them also.

    If someone has M.E. and exhibits the muscle failure, they need to figure out what combination of these can help them. It's been a life saver for me and others.

    ReplyDelete
  2. I wondered about the possibility of conflicts of interest in the authors' first paper as well as this follow-up one but never bothered checking. However I've read posts online stating that indeed several of the authors of the two mito papers have direct involvement in the labs doing the testing, which seems like something that should most certainly have been mentioned in a conflict of interest disclosure. The fact that no CoI disclosure was made is kind of disconcerting.

    ReplyDelete
  3. Thank you from the bottom of my heart for this, and all, your posts. I have been ill nearly 2and 1/2 decades, worsening gradually.
    (I am posting alot this moring, as I am having one of those Oliver Sachs moments, like in the movie, Awakenings, in which the neurological patients suddenly come to life and are able to move, but then sink back into their foggy abyss later, which is where I usually am.)
    My last home health PT acknowledged my concern about mitochondrial dysfunction and deep, core, postural muscle weakness and early fatigue and its correlation to my severe spinal hypermobility and pain. I would love to see PT and MD do research on this ( or volunteer, if I were able, as I am a physical therapist myself) I wonder how I could get in contact with Dr. Peter Lowe and the PT, Rich Violand(?) he has working with him on the neural tension and ME/CFS research? Or Dr. Alan Pocinki who wrote something about the association between ME/cFS, dysautonomia and hypermobility. Or I could forward it to Staci Stevens and the PT's at Pacific Fatigue Lab, or CFIDS.org. I am posting this because often I am not thinking this clearly due to the brain fog, and may forget these ideas/ this sequence of steps. Perhaps someone will pick it up and run with it. Please. This is the sort of thing I would pursue if I were still physically and cognitively able to return to school for a PhD. Pity the waste.

    ReplyDelete
  4. I got worse taking Q10, despite reading from so many people that it helped. I doubted my feelings the first time I tried it so I took q10 in another form and repeated it twice. I found it definitely worsened things. It made my blood pressure too low and weakened me. I also had a bad experience with Dr Myhill. Her EPD injections together with her diet and supplements in combination made me worse.
    I want to thank the person who made the point about lab connections and papers. I am taking this paper with a pinch of salt, although I do strongly believe the mitochondria are involved in this illness.

    ReplyDelete