Article Index

by Dr. Ros Vallings

IiMEC8—Infection, Immunity and ME—Mainstreaming ME Research

31 May 2013, Westminster, London

I was privileged to attend the 8th IiME conference in London on 31st May 2013. This conference was preceded by a one day symposium gathering together 34 clinicians and researchers from a number of countries. The presentations, brainstorming and discussion will, I am sure, lead to much collaborative research, sharing of ideas and furtherance of understanding of this complex and very serious illness.

History of ME/CFS and the FDA Stakeholders meeting

The conference itself was well attended by delegates from 11 countries, and was opened by Dr Ian Gibson. The conference began with an address by the keynote speaker, Dr Dan Peterson from Nevada, USA. He initially outlined some of the history of ME/CFS and reflected on the past. He explained that criteria for diagnosis were established 25 years ago, and emphasised the fact that a single set of criteria needs to be used internationally. He talked of the history of the illness from 1980 up to the present time. In the UK the prevalence has been estimated as up to 1-2% of the population. There is similarity in the symptoms, levels of severity and course of the illness worldwide. It is costly to treat: 9 billion US dollars in direct costs and 51 billion in indirect costs in the USA. The current accepted model of the illness is genetic vulnerability, an event such as infection, trauma, stress etc and mediators finally leading to a diagnosis of ME. He described 4 steps in management of illness generally: 1) a specific diagnosis, 2) assessment of severity and prognosis, 3) therapy and 4) assessment of effectiveness. This model does not fit ME. There is no biological marker, no definite drug and no endpoint.

He went on to describe the recent FDA stakeholders’ meeting in the USA. Points discussed included the general nature and extent of the disability, lack of treatment and acknowledgement of much research accomplished. The take-home messages were the fact that one does not necessarily need a biomarker, it takes 8-15 years for drug development, a drug can be approved or withdrawn, a drug can be re-purposed, and validated endpoints are needed. Potential solutions can involve computational analysis (genetic, not just biological), work with novel pathogens (samples needed from various tissues), immunological biomarkers (defining subsets), end point evaluation (e.g. approval of ampligen has been denied, but VO2 max approved as a suitable test for ME), drug development (e.g. rituximab needs large trials in multisites). In summary he expressed the importance of the need for worldwide collaboration, definition of the mechanism of the disease and establishment of centres of excellence.