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Neurovascular Dysregulation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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[Technical Report, Annual Report]

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Rationale Myalgic encephalomyelitischronic fatigue syndrome MECFS is a common and clinically devastating disorder whose pathogenesis is poorly understood. MECFS may affect as many as 2.5 million people in the United States. Veterans who were deployed to the Persian Gulf during the Gulf War have a higher prevalence of MECFS and the related condition fibromyalgia FM compared to nondeployed Veterans. Furthermore, almost a quarter of the Veterans of the Gulf War developed chronic multisystem illnessGulf War illness CMIGWI, which has many overlapping symptoms with MECFS. The underestimated direct and indirect cost of MECFS to society may approach 23 billion per year. There is substantial clinical overlap among FM, postural orthostatic tachycardia syndrome POTS and MECFS. Both FM and POTS have ahigh prevalence of small fiber neuropathy SFN diagnosed by epidermal biopsy, which may be responsible for symptoms. The prevalence of SFN in MECFS is not known. Using a maximum invasive upright exercise test iCPET, which simultaneously measures ventilation, pulmonary and systemic gas exchange and hemodynamics, we have found that vascular dysregulation and exertional intolerance are highly prevalent in patients with MECFS. The purpose of this project is to link vascular dysregulation during exercise to small fiber autonomic neuropathy and exercise intolerance in a large cohort of MECFS compared to normal controls. Hypothesis Exertional intolerance in MECFS is related to neurovascular dysregulation. Innovative aspects This will be the first study of MECFS to link vascular dysregulation during exercise to SFN. Our innovative approach will attempt to link abnormal neuroanatomy SFN by epidermal biopsy to vascular dysregulation by iCPET as an underlying mechanism for exercise intolerance for MECFS. Furthermore, we aim to deep phenotype MECFS, with particular attention to diagnostic vascular and neural subgroups.


Subject Categories:

  • Medicine and Medical Research
  • Medicine and Medical Research

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[A, Approved For Public Release]