Part 8 of 9
Dr Lipkin observes that ME/CFS is highly heterogeneous, which means that he believes there will probably not be a single answer for the whole ME/CFS population. Instead, Dr Lipkin is looking towards personalised medicine, whereby each patient is treated depending on their individual biomedical differences or vulnerabilities. For this, he needs to carry out large studies, collecting large amounts of data. This is why he is proposing a large study involving 100 patients and 100 controls.
Dr Lipkin predicts that his team will identify different ‘endophenotypes’ (i.e. groups of patients who show certain consistencies between them), and suggests that he might find an answer for 10% of patients at a time. Dr Lipkin has involved statisticians to refine the design of the study to support such a hypothesis.
So, for example, some groups of patients might potentially be identified by the presence of a particular virus in the gut microbiome and some might be identified by unusually high levels of a particular fungus, or by an unusual population of a certain type of bacteria within the gut.
Dr Lipkin says once you begin to narrow things down, and to identify groups of patients with a consistent pattern of gut microbes, you can then try to identify individuals who are at risk based on exposures to specific microbes, and you can also begin to think of some sort of a customised treatment.
Dr Lipkin has suggested that potential treatments might involve: various types of drugs; or antibodies directed against specific cytokines; or a course of a certain type of probiotic; or a course of antibiotics followed by probiotics. And he has discussed the possibility of fecal transplants as a potentially beneficial treatment. Although he stresses that such treatments would have to be tested in rigorous trials.
So, depending on the results of the gut microbiome study, Dr Lipkin is thinking along the lines of changing the gut microbial population, or directly treating abnormal levels of cytokines, in order to potentially have a beneficial effect on the abnormal cytokine pattern and the symptoms seen in ME/CFS.
Discussing his plans for what will happen after the gut microbiome study, he says: “we want to initiate some sort of a clinical trial where we either use probiotics, or antibiotics followed by probiotics, or some sort of an antibody directed against specific cytokines to see if we cannot improve, in a blinded trial, the condition and the status and the prognosis of people who have this disease.”
The potential treatments depend on the outcomes of the trial. For example, if high levels of a particular fungus is found in the gut, in a subset of patients, then perhaps an anti-fungal treatment could be in order for that subset. Or if an unusual virus is discovered in a subset of patients, then perhaps an anti-viral treatment could be in order for that subset.
This is a series of blogs based partly on an interview with Dr Ian Lipkin by Simon McGrath in January 2014, in relation to the intended study of the gut microbiome of ME/CFS patients. (To see Simon’s article please click here.)
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