Saturday, 7 January 2012

Stanford's Dr. Jose Montoya Talks About Trial Involving Valganciclovir




Lecture from Stanford University, given in 2008, posted to YouTube March 2011.


The lecture startes with a basic introduction to M.E. Initially, Dr. Jose conveys the impression that not a lot of progress has been made with trying to find out what causes the condition. One very critical point that is made at the beginning, though, is that it's important to have a doctor that believes your illness is real. If your doctor is not taking you seriously, and goes so far as to suggest that it's "all in the mind" CHANGE your doctor.


Dr. Jose goes on to discuss a double-blind randomized clinical trial using the drug VALGANCICLOVIR. (The trial was funded by the company providing the drug.) Results showed favorable improvements among those who took the drug in the trial across time. There were apparently no observable hematologic or hepatic effects, and the drug has been approved by the FDA. However, toward the end, Dr. Jose mentions the inadvisability of taking any drug for an extended length of time. Valganciclovir in high doses has produced cancer in mice. Therefore, what are you supposed to do - suffer from M.E. or dice with a carcinogen?


Getting technical, the cytokine results showed: IL5, IL17F, ENA78, EOTAXIN, IP10 were found to be significantly higher in the treatment when compared to the placebo patients.
ENA78 = epithelial neutrophil-activating peptide
EOTAXIN = eosinophil chemoatractant
IP10 = c-X-C motif chemokine 10 (CXCL10) also known as Interferongamma-induced protein 10kDa (IP10). CXCL10 is secreted by several cell types in response to IFN-Y. These cell types include monocytes, endothelial cells, and fibroblasts.


Interesting that a drug can promote improvement in the symptoms, and in some cases completely cured the person. That some patients did not see improvement lends to the theory that there are subsets of M.E.


There is a co-relation between M.E. and people who have suffered from the following:
Epstein Barr
Herpes simplex
Q virus
Ross River virus
Brucella
Coxiella burnetti
Mycoplasma pneumoniae
Chlamydia pneumoniae
A lot of these relate to a retrovirus, a virus that becomes chromosomally integrated/intracellular, and 'hides' in the cells.


XMRV was also covered. XMRV is believed to have originated in mice and is the first agent of its class to be identified in humans. There has been detection of an infectious retrovirus, XMRV (xenotropic murine leukemia virus), in blood cells of M.E. patients. However, this detection has only been made in a couple of US labs, and has not been detected at all in any European lab. Dr. Jose makes an important comment in that there are plenty of inter-laboratory differences that could result in different observations being made for the same study. For example, there are differences in antigen selection, specimen type, specimen preparation, specimen storage.


Carriers of XMRV can show no symptoms. It's thought that the virus can lie dormant for a long time. Evidence suggests that it is the immune response against pathogens that is responsible for the CFS symptoms, not the pathogens themselves. IMO, the common flu like symptoms and swelling of the lymph nodes would suggest the immune system kicking into action.


Toward the end, Dr. Jose mentions the PACE study that came out of the UK not so long ago. Findings were published in the Lancet (www.thelancet.com, Feb 18 2011). PACE involved a comparison of the effectiveness of adaptive pacing therapy (pacing by self-judgement), cognitive behavior therapy, graded exercise therapy, and specialist medical care. The findings were that all of these types of 'treatments' offered some benefits to M.E. sufferers, but few people were cured. The conclusion is that more studies to find more effective treatments are needed. Yes, they certainly do.

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