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The microbiome is the ecological community of commensal, symbiotic and pathogenic microorganisms that live on the skin and genitals and in the nose, ears, mouth and gut. Dysbiosis or an imbalance in this community may play a role in the pathophysiology of chronic fatigue syndrome.

Anatomical areas[edit | edit source]

Gut flora[edit | edit source]

The gut microbiome is a complex community of trillions of microorganisms residing in the intestines. 99% of bacteria in the gut are anaerobes.

Skin flora[edit | edit source]

Nose flora[edit | edit source]

Oral flora[edit | edit source]

Chronic fatigue syndrome[edit | edit source]

A growing body of evidence suggests that an altered microbiome; mucosal barrier dysfunction;[1] the translocation or crossing of bacteria from the gut into the bloodstream; and subsequent immune response may pay a role in the pathophysiology of chronic fatigue syndrome.

Immune response[edit | edit source]

A study of 128 ME/CFS patients found significantly increased IgA response to lipopolysaccharides from the cell walls of commensal bacteria. Increased IgA response was associated with increased serum IL-1, TNFα, neopterin and elastase. The study concluded that increased translocation of commensal bacteria may be responsible for the disease activity in some ME/CFS patients.[2]

Dysbiosis[edit | edit source]

There is strong evidence that dysbiosis or an imbalance in the microbial ecology of the gut plays a role in the symptoms of ME/CFS. ME/CFS patients have higher levels of D-lactic acid bacteria,[3] decreased levels of Bifidobacteria,[4] and may suffer from small intestinal bacterial overgrowth (SIBO) at higher rates.[citation needed]

Exercise[edit | edit source]

A small study of ten CFS patients found significant changes in the composition of the microbiome and increased bacterial translocation (movement from the intestine into the bloodstream following exercise). In the blood, the study found increased Clostridium fifteen minutes after exercise and increased Bacilli 48 hours later.[5][6]

Sleep[edit | edit source]

In a very small study, CFS patients treated with erythromycin who had clinical response (i.e., reduced streptococcus) had improved sleep. Higher lactobacillus was associated with poorer mood.[7]

Gender[edit | edit source]

A study of 274 ME/CFS patients found sex-specific interactions between Firmicutes (Clostridium, Streptococcus, Lactobacillus and Enterococcus) and ME/CFS symptoms (including neurological, immune and mood symptoms) and symptoms in spite of similar overall composition across sexes.[8]

Factors affecting microbiome[edit | edit source]

Diet[edit | edit source]

The food we eat has a considerable effect on the composition of the intestinal microbiota.[9]

Viral infection[edit | edit source]

Viral infection can cause shifts in the gut microbiome.

In mice, the influenza virus leads to injury of both the lungs (the primary site of infection) and the intestinal tract, even when there is no evidence of viral replication in the gut, and causes decreases Lactobacillus and Lactococcus species and increases in Enterobacteriaceae.[10]

Pregnancy[edit | edit source]

Gut microbiota change dramatically from the first trimester to the third trimester of pregnancy. During the first trimester, there is an overrepresentation of 18 bacterial groups, mainly Faecalibacterium, a butyrate producer that has been shown to improve symptoms of inflammatory bowel disease.[11]

During the third trimester, populations of pro-inflammatory bacteria species such as proteobacteria and actinobacteria increase and there is a reduction in diversity. Populations of Faecalibacterium decrease.[11] Overall bacterial load increases over the course of pregnancy.[12]

Nervous system[edit | edit source]

The intestinal microbiota play a major role in the gut-brain axis with consequences for both neurological development and host behavior.

Stress[edit | edit source]

There is growing evidence that the microbiome plays an important role in the stress response. Animals raised in a germ-free environment show an exaggerated HPA response to psychological stress which normalizes when Bifidobacterium infantis is introduced. Escherichia coli can activate the HPA.[13]

Stress also increases intestinal permeability.

Planned studies[edit | edit source]

British patient charity Invest in ME is raising funds for a gut microbiome study at the University of East Anglia in the United Kingdom led by professor Simon Carding.[14]

Funds are being raised by patients (originally led by the late Vanessa Li) for Ian Lipkin and Mady Hornig of Columbia University in the United States to perform a study, called the ME/CFS Monster Study, looking at many areas including the gut microbiome in ME/CFS patients. Fundraising efforts are led by the Microbe Discovery Project.

Notable studies[edit | edit source]

Commercial testers[edit | edit source]

Academic projects[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.01.1 Lakhan, Shaheen E; Kirchgessner, Annette (Oct 12, 2010), "Gut inflammation in chronic fatigue syndrome", Nutrition & Metabolism, 7: 79, doi:10.1186/1743-7075-7-79, ISSN 1743-7075, PMID 20939923, retrieved Dec 13, 2016 
  2. 2.02.1 Maes, Michael; Twisk, Frank N. M.; Kubera, Marta; Ringel, Karl; Leunis, Jean-Claude; Geffard, Michel (February 2012), "Increased IgA responses to the LPS of commensal bacteria is associated with inflammation and activation of cell-mediated immunity in chronic fatigue syndrome", Journal of Affective Disorders, 136 (3): 909–917, doi:10.1016/j.jad.2011.09.010, ISSN 1573-2517, PMID 21967891 
  3. 3.03.1 Sheedy, John R.; Wettenhall, Richard E. H.; Scanlon, Denis; Gooley, Paul R.; Lewis, Donald P.; McGregor, Neil; Stapleton, David I.; Butt, Henry L.; DE Meirleir, Kenny L. (August 2009), "Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome", In Vivo (Athens, Greece), 23 (4): 621–628, ISSN 0258-851X, PMID 19567398 
  4. Logan, Alan C.; Venket Rao, A.; Irani, Dinaz (June 2003), "Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value", Medical Hypotheses, 60 (6): 915–923, ISSN 0306-9877, PMID 12699726 
  5. 5.05.1 Shukla, Sanjay K.; Cook, Dane; Meyer, Jacob; Vernon, Suzanne D.; Le, Thao; Clevidence, Derek; Robertson, Charles E.; Schrodi, Steven J.; Yale, Steven; Frank, Daniel N. (Dec 18, 2015), "Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)", PLOS ONE, 10 (12): –0145453, doi:10.1371/journal.pone.0145453, ISSN 1932-6203, retrieved Dec 13, 2016 
  6. Johnson, Cort (Dec 21, 2015), "Exercise Triggers Gut Changes in Chronic Fatigue Syndrome (ME/CFS)", HealthRising, Houston, retrieved Dec 12, 2016 
  7. 7.07.1 Jackson, Melinda L; Butt, Henry L; Ball, Michelle; Lewis, Donald P; Bruck, Dorothy (Oct 23, 2015), "Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study", Sleep Science, 2015 Nov;8(3): 124-33, doi:10.1016/j.slsci.2015.10.001, PMID 26779319 
  8. 8.08.1 Wallis, Amy; Butt, Henry L; Ball, Michelle; Lewis, Donald P; Bruck, Dorothy (Jan 13, 2016), "Support for the Microgenderome: Associations in a Human Clinical Population", Scientific Reports, volume 6; article 19171, doi:10.1038/srep19171, PMID 26757840 
  9. Maslowski, Kendle M.; Mackay, Charles R. (January 2011), "Diet, gut microbiota and immune responses", Nature Immunology, 12 (1): 5–9, doi:10.1038/ni0111-5, ISSN 1529-2916, PMID 21169997 
  10. Racaniello, Vincent (Dec 10, 2014), "How influenza virus infection might lead to gastrointestinal symptoms", Virology Blog, New York, retrieved Dec 12, 2016 
  11. 11.011.1 Koren, Omry; Goodrich, Julia K.; Cullender, Tyler C.; Spor, Aymé; Laitinen, Kirsi; Bäckhed, Helene Kling; Gonzalez, Antonio; Werner, Jeffrey J.; Angenent, Largus T.; Knight, Rob; Bäckhed, Fredrik; Isolauri, Erika; Salminen, Seppo; Ley, Ruth E. (Aug 3, 2012), "Host remodeling of the gut microbiome and metabolic changes during pregnancy", Cell, 150 (3): 470–480, doi:10.1016/j.cell.2012.07.008, ISSN 1097-4172, PMID 22863002 
  12. http://www.scopus.com/record/display.uri?eid=2-s2.0-53849104768&origin=inward&txGid=B73C4858FB9D5F216C9F222F22386A44.iqs8TDG0Wy6BURhzD3nFA%3a2
  13. Dinan, Timothy G.; Cryan, John F. (September 2012), "Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology", Psychoneuroendocrinology, 37 (9): 1369–1378, doi:10.1016/j.psyneuen.2012.03.007, ISSN 0306-4530, retrieved Dec 13, 2016 
  14. Invest in ME – UK gut microbiota research
  15. Borody, Thomas J.; Nowak, Anna; Finlayson, Sarah (December 2012), "The GI microbiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy", Journal of the Australasian College of Nutritional and Environmental Medicine, 31 (3): 3, ISSN 1328-8040, retrieved Dec 13, 2016 
  16. Frémont, Marc; Coomans, Danny; Massart, Sebastien; De Meirleir, Kenny (August 2013), "High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients", Anaerobe, 22: 50–56, doi:10.1016/j.anaerobe.2013.06.002, ISSN 1095-8274, PMID 23791918 
  17. Morris, Gerwyn; Berk, Michael; Carvalho, A.F.; Caso, J.R.; Sanz, Y.; Maes, Michael (2016), "The role of microbiota and intestinal permeability in the pathophysiology of autoimmune and neuroimmune processes with an emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome.", Current Pharmaceutical Design, PMID 27634186 
  18. Giloteaux, Ludovic; Goodrich, Julia K.; Walters, William A.; Levine, Susan M.; Ley, Ruth E.; Hanson, Maureen R. (Dec 2016). "Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome". Microbiome. 4 (1). doi:10.1186/s40168-016-0171-4. ISSN 2049-2618. PMC 4918027Freely accessible. PMID 27338587. 
  19. Nagy-Szakal, Dorottya; Williams, Brent L.; Mishra, Nischay; Che, Xiaoyu; Lee, Bohyun; Bateman, Lucinda; Klimas, Nancy G.; Komaroff, Anthony L.; Levine, Susan; Montoya, Jose G.; Peterson, Daniel L.; Ramanan, Devi; Jain, Komal; Eddy, Meredith L.; Hornig, Mady; Lipkin, W. Ian (2017), "Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome", Microbiome, 5 (44), doi:10.1186/s40168-017-0261-y 
  20. Newberry, F.; Hsieh, S.-Y.; Wileman, T.; Carding, S. R. (2018), "Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?", Clinical Science, 132 (5): 523–542, doi:10.1042/CS20171330 
  21. Wang, Taiwu; Yu, Lei; Xu, Cong; Pan, Keli; Mo, Minglu; Duan, Mingxiang; Zhang, Yao; Xiong, Hongyan (Sep 11, 2018). "Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function". PLOS ONE. 13 (9): e0203503. doi:10.1371/journal.pone.0203503. ISSN 1932-6203. 
  22. Proal, Amy; Marshall, Trevor (Nov 2018). "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the era of the human microbiome: persistent pathogens drive chronic symptoms by interfering with host metabolism, gene expression and immunity". Frontiers in Pediatrics. doi:10.3389/fped.2018.00373. 
  23. Bakalar, Nicholas (Jul 7, 2016), "Gut Bacteria Are Different in People With Chronic Fatigue Syndrome", The New York Times, retrieved Dec 13, 2016 
  24. Cha, Ariana Eunjung (Jun 30, 2016), "New study shows chronic fatigue syndrome may have to do with gut microbes", The Washington Post, retrieved Dec 13, 2016 
  25. Ramanujan, Krishna (Jun 24, 2016), "Indicator of chronic fatigue syndrome found in gut bacteria", Cornell Chronicle, New York, retrieved Dec 13, 2016 
  26. Johnson, Cort (Feb 21, 2016), "Gender Gut Wars: Australian ME/CFS Study Suggests Different Gut Treatment Protocols Needed For Men and Women", HealthRising, Houston, retrieved Dec 13, 2016 

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.