Posts Tagged ‘fibromyalgia’

by CARLY CASSELLA

Scientists are closing in on a blood test for fibromyalgia, and the result could save patients from what is currently a lengthy and vague process of diagnosis.

Researchers at Ohio State University are now aiming to have a diagnostic blood test available for widespread use within the next five years.

Their confidence stems from a recently discovered biomarker – a “metabolic fingerprint” as the researchers put it – traceable in the blood of those with the disorder.

“We found clear, reproducible metabolic patterns in the blood of dozens of patients with fibromyalgia,” says lead author Kevin Hackshaw, a rheumatologist at Ohio State University.

“This brings us much closer to a blood test than we have ever been.”

Fibromyalgia is a common, debilitating, and poorly understood disorder, marked by widespread pain and fatigue, with no known cause and absolutely no cure.

In the United States, it’s the most common cause of chronic widespread pain, and that’s not even counting the thousands of patients who go undiagnosed every year.

Without a reliable way to detect this disorder, it’s estimated that up to three out of four people with the condition remain undiagnosed. And on average it can take five years from when a person’s symptoms first appear to them actually receiving a diagnosis.

In total, the US Centers for Disease Control and Prevention estimates that about two percent of the population – around four million adults – have fibromyalgia, with women making up a disproportionate slice.

Left with few options, many patients are simply forced to live with their pain.With nowhere to go, many become desperate and turn to potentially harmful treatments.

“When you look at chronic pain clinics, about 40 percent of patients on opioids meet the diagnostic criteria for fibromyalgia,” says Hackshaw.

“Fibromyalgia often gets worse, and certainly doesn’t get better, with opioids.”

It was Hackshaw’s goal to intervene sooner. Using vibrational spectroscopy, a technique which measures the energy of molecules, his team analysed blood samples from 50 people with fibromyalgia, 29 with rheumatoid arthritis, 19 with osteoarthritis, and 23 with lupus.

Despite the fact these disorders can present with similar symptoms, the blood of those participants with fibromyalgia was distinct.

Using these unique patterns, the researchers then tried to blindly predict participants’ diagnoses. Even without knowing their true disorder, the researchers were able to accurately diagnose every study participant based on that molecular fingerprint in the blood.

“These initial results are remarkable,” says co-author Luis Rodriguez-Saona, an expert in vibrational spectroscopy at Ohio State University.

“If we can help speed diagnosis for these patients, their treatment will be better and they’ll likely have better outlooks. There’s nothing worse than being in a grey area where you don’t know what disease you have.”

While the sample size is undoubtedly small, the results are promising. If the team can replicate their results on a larger scale, with a couple hundred diverse participants, then a blood test in five years might not seem so far-fetched.

Not to mention what that would mean for treatment. If the researchers can prove they really have identified a biological fingerprint for fibromyalgia, this could give us new drug targets in the future.

“Thus,” the authors conclude, “our studies have great importance both from development of a reproducible biomarker as well as identifying potential new therapeutic targets for treatment.”

This study has been published in the Journal of Biological Chemistry.

https://www.sciencealert.com/scientists-have-devised-a-blood-test-that-can-accurately-diagnose-fibromyalgia


This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers. Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital).

A study by Massachusetts General Hospital (MGH) researchers – collaborating with a team at the Karolinska Institutet in Sweden – has documented for the first time widespread inflammation in the brains of patients with the poorly understood condition called fibromyalgia. Their report has been published online in the journal Brain, Behavior and Immunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” says Marco Loggia, PhD, of the MGH-based Martinos Center for Biomedical Imaging, co-senior author of the report.

“And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

Characterized by symptoms including chronic widespread pain, sleep problems, fatigue, and problems with thinking and memory, fibromyalgia affects around 4 million adults in the U.S., according to the Centers for Disease Control and Prevention.

Previous research from the Karolinska group led by Eva Kosek, MD, PhD, co-senior author of the current study, suggested a potential role for neuroinflammation in the condition – including elevated levels of inflammatory proteins in the cerebrospinal fluid – but no previous study has directly visualized neuroinflammation in fibromyalgia patients.

A 2015 study by Loggia’s team used combined MR/PET scanning to document neuroinflammation – specifically activation of glial cells – in the brains of patients with chronic back pain. Hypothesizing that similar glial activation might be found in fibromyalgia patients as well, his team used the same PET radiopharmaceutical, which binds to the translocator protein (TSPO) that is overexpressed by activated glial cells, in their study enrolling 20 fibromyalgia patients and 14 control volunteers.

At the same time, Kosek’s team at Karolinska had enrolled a group of 11 patients and an equal number of control participants for a similar study with the TSPO-binding PET tracer. Since that radiopharmaceutical binds to two types of glial cells – microglia and astrocytes – they also imaged 11 patients, 6 who had the TSPO imaging and 5 others, and another 11 controls with a PET tracer that is thought to bind preferentially to astrocytes and not to microglia. At both centers, participants with fibromyalgia completed questionnaires to assess their symptoms. When the MGH team became aware of the similar investigation the Karolinska group had underway, the teams decided to combine their data into a single study.

The results from both centers found that glial activation in several regions of the brains of fibromyalgia patients was significantly greater than it was in control participants. Compared to the MGH team’s chronic back pain study, TSPO elevations were more widespread throughout the brain, which Loggia indicates corresponds to the more complex symptom patterns of fibromyalgia. TSPO levels in a structure called the cingulate gyrus – an area associated with emotional processing where neuroinflammation has been reported in patients with chronic fatigue syndrome – corresponded with patients reported levels of fatigue. The Karolinska team’s studies with the astrocyte-binding tracer found little difference between patients and controls, suggesting that microglia were primarily responsible for the increased neuro-inflammation in fibromyalgia patients.

“The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue,” says Loggia, an assistant professor of Radiology at Harvard Medical School. “The ability to join forces with our colleagues at Karolinska was fantastic, because combining our data and seeing similar results at both sites gives confidence to the reliability of our results.”

This article has been republished from materials provided by Massachusetts General Hospital. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference:
Albrecht, D. S., Forsberg, A., Sandström, A., Bergan, C., Kadetoff, D., Protsenko, E., . . . Loggia, M. L. (2018). Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation. Brain, Behavior, and Immunity. doi:10.1016/j.bbi.2018.09.018

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