Rachel Fieldhouse WHAT does long COVID have in common with chronic fatigue syndrome ?

First , there is the constellation of overlapping symptoms , including post-exertional malaise , brain fog , fatigue , gastrointestinal issues , palpitations and dizziness .

Then , there is the absence of an overarching treatment or cure .

But immunologist Professor Sonya Marshall-Gradisnik — who has been studying myalgic encephalomyelitis / chronic fatigue syndrome ( ME / CFS ) for more than a decade and has helped define the clinical criteria for the condition — has found another shared feature that could unlock a new treatment .

There is no known cause of ME / CFS , but impaired functioning of natural killer cells has been shown to be a consistent feature of this condition , she says .

And her team , at Griffith University in Brisbane , has slowly been uncovering why .

Across numerous studies , it has found that the ion channel receptors TRPM3 and TRPM7 — molecular ‘ locks and keys ’ that control the movement of calcium in and out of natural killer cells — malfunction in those with ME / CFS .

And when looking at patients with long COVID , the team has found a similar issue in TRPM3 receptors .

“ I am not saying that viruses are the cause ; I am saying that the origin is potentially because these particular receptors are not firing to bring calcium inside the cell ,” Professor Marshall-Gradisnik tells Australian Doctor .

Having identified the “ faulty ” mechanism , her team has also tested ways to fix it , including the use of low-dose naltrexone .

“ We used naltrexone in the laboratory and found it indirectly acted on the key and opened the lock ,” she says .

“ It improved the influx of calcium inside the cells and made the lock restored in function .

“ That gave us the impetus to test low-dose naltrexone in a clinical trial and , hopefully , depending on the results , be able to use it for an intervention for ME / CFS .”

Professor Marshall-Gradisnik says the lock-and-key mechanism , which is also found on muscle cells , could explain why patients prescribed graded exercise

therapy have poor outcomes .

“ If you have not got enough ability to bring calcium inside the cell , then you are going to have problems with muscle contraction , relaxation , and that could then cause pain , which is what ME / CFS patients report .”

She adds that pacing activity , or working within a patient ’ s ‘ energy envelope ’, is now the preferred self-management option .

‘ It improved the influx of calcium inside the cells .’

Although this is reflected in guidance in the US , the UK and even the state of Victoria , where health authorities no longer advise graded exercise therapy because of a lack of clinical evidence , the approach is still recommended in the RACGP ’ s Handbook of Non-Drug Interventions .

Professor Mark Morgan , chair of the RACGP Expert Committee — Quality Care , stresses that the handbook contains the appropriate precautions for clinicians to consider .

Professor Sonya Marshall- Gradisnik .

“ It is a very carefully written guide ,” says the Gold Coast GP academic .

“ There are many caveats and a lot of caution about how that should be applied , in whom and when .”

But he says there is a need to update the guidance with the emergence of new evidence . He also stresses that diagnosing ME / CFS remains a lengthy and complicated process .

“ Standard approaches to diseases are based on identifying a particular medicine or therapy that works for a single disease state , but I do not think CFS or long COVID fits comfortably in that paradigm .”

However , he believes the emergence of long COVID has led to greater awareness of ME / CFS because of the clinical overlap .

This is echoed by Professor Marshall-Gradisnik , who hopes her team ’ s work understanding ME / CFS could also fast-track research into long COVID .

“ We are only in the infancy of long COVID , and we did not have a case definition until very recently ,” she says .

“ But that better informs how we can differentiate people who have long COVID and how we can investigate … potential therapeutic interventions .”

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HIGH STRENGTH NOW PBS LISTED FOR SEVERE

ASTHMA 1

FROM PAGE 1 non-compliant VAD documentation .

According to the tribunal , Dr Carr told the medical board he felt “ an extra onus of responsibility to get it right ” because Victoria was the first state to legalise VAD .

“[ This ] is one reason I feel so mortified that ... I ’ ve got an aspect of it wrong ,” he said .

In finding Dr Carr guilty of

professional misconduct and fining him $ 12,000 , the tribunal factored in a caution he received almost a decade ago .

That case stemmed from a coronial inquiry , which found a patient used pentobarbital to end her life but that Dr Carr wrote on the death certificate that the

‘ I feel so mortified that I got an aspect of it wrong .’

cause of death was MI .

It was revealed the patient asked Dr Carr to change the cause of death to avoid any “ fuss ”, including an autopsy .

The tribunal said Dr Carr , who is a board member of Dying with Dignity

Victoria , had shown “ clear remorse and insight ”; however , the previous case and a need for “ general deterrence ” meant a $ 12,000 fine was necessary .

Dr Carr submitted he was “ anxious that the outcome in this case support , rather than undermine , the importance of strict compliance ” with VAD legislation . The tribunal agreed . “ We note Dr Carr is knowledgeable about , and involved in , the regime created by the VAD Act ,” it said .

“ He is invested in ensuring its successful operation .

“[ He ] rightly recognises the importance of sending an emphatic message that scrupulous compliance with the requirements of the VAD Act is essential .” For more , see Letters , page 15

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References : 1 . Pharmaceutical Benefits Scheme ( PBS ). Available at : www . pbs . gov . au . 2 . Approved Trimbow Product Information . Chiesi Australia Pty Ltd , Hawthorn East , VIC . 3123 . Tel : + 61 3 9077 4486 ; Email : medicalaffairs . au @ chiesi . com ; Website : www . chiesi . com . au . Copyright © Chiesi 2022 . All rights reserved . Date of preparation : January 2023 . AU-TRI-2200169 . CHIE00042o .