LDN usa:ssa
The Centers for Disease Control and Prevention
highlights studies showing that fibromyalgia patients rate their quality of
life lower than patients with other chronic diseases,
At UAB, Jarred Younger, Ph.D., hopes to establish
Alabama’s first research and clinical care center specializing in fibromyalgia
and related conditions, including chronic fatigue syndrome and Gulf War
Illness. Already, research by Younger and his team in UAB’s new
Neuroinflammation, Pain and Fatigue Lab has revealed possible underlying causes
for the disorders and pointed to treatments that are helping to ease pain and
fatigue – without side effects – in patients.
Younger became interested in fibromyalgia and chronic
fatigue syndrome as a postdoctoral fellow at Stanford University’s medical
school. He had been studying pain more broadly when he realized how poorly
understood these disorders were. “Some used to be athletes, some used to be
business owners, and then their lives are taken over, and I made it my mission
to figure out what is wrong with these patients and how to treat them,” he
says.
Younger spearheaded studies that surveyed immune
molecules in the blood. He homed in on one particular protein called leptin,
released by fat tissue, which appears in greater amounts in the blood of
chronic fatigue patients. In fact, Younger could even gauge the day-to-day
severity of a patient’s symptoms just by tracking his or her leptin levels.
These initial findings spurred him to continue investigating inflammatory
immune molecules – and to start looking at the brain’s role in the diseases.
Leptin has the ability to cross the blood-brain
barrier and affect neural cells, causing pain and fatigue. But exactly how that
happens remains a mystery. Younger thinks it has something to do with
microglia, a type of immune cell found in the brain that normally helps to
protect neurons.
“Microglia defend our brain against everything,”
Younger explains. “When we get the flu, for instance, microglia are activated.
These cells make us want to crawl into bed and do nothing – so our body can devote
its resources to fighting off the flu.”
In both fibromyalgia and chronic fatigue patients,
Younger hypothesizes, the microglia are turned on when they’re not supposed to
be, causing fatigue or pain, a depressed mood and cognitive dysfunction. At
UAB, he is planning follow-up studies to help find evidence supporting this
idea. He faces a crucial challenge, however: Currently, no methods are
available to look directly at the activation or inflammation of microglia in
living humans. But Younger and his colleagues are working on solutions,
including specialized brain scans that measure the temperature of the brain or
the presence of certain chemicals.
“It’s only very recently that people are starting to
explore what sensitizes microglia,” Younger says. “The cells can be in a quiet,
helpful state, or an active, warlike state.” His findings, he hopes, will help
reveal the difference.
Small gains, big impact
At the same time that Younger began studying the
pathways underlying inflammation, he also started investigating alternative
medicine and off-label treatments that had been used by patients with chronic
fatigue and fibromyalgia. In 2009, he first reported the effectiveness of
low-dose naltrexone – a drug normally used to treat opioid and alcohol
addiction. Women who took 4.5 milligrams per day of the drug reported less pain
throughout the weeks that they received it.
Interestingly, the naltrexone linked back to Younger’s
other studies: The drug is known to stop activated microglia from producing
inflammatory chemicals.
Chain of events
Younger’s discoveries about leptin, microglia and
naltrexone have already begun to change the face of fibromyalgia and chronic
fatigue research and treatment. But his work is just beginning, he says. “It’s
essential that we have a fuller understanding of what’s wrong before we’re able
to find the best treatments,” Younger says.
So while he’s conducting further studies on low-dose
naltrexone – as well as other compounds, including the spice curcumin, that are
known to affect microglia – he’s guiding the efforts of the Neuroinflammation,
Pain, and Fatigue Lab toward uncovering the mechanisms behind the diseases. He
would like to understand what triggers an increase in leptin production, what
leptin activates, and what fires up microglia. He also wants to know how
everything connects. “There’s a chain of events, and we don’t know where leptin
falls in that chain,” he says.
Younger, is satisfied with the small bits of progress
so far, but says that the treatment of chronic fatigue syndrome and
fibromyalgia is a decade or two behind other inflammatory diseases. “Twenty
years ago, rheumatoid arthritis absolutely wrecked people’s bodies, and there
wasn’t a lot that could be done about it,” he says. “Over time, researchers
discovered the parts of the immune system that were involved, and that helped
them develop better treatments.”
“These patients are not well understood, their
families and often their doctors think they’re lazy or making up their
symptoms. Being able to say, ‘here’s some of the science behind my illness’
certainly makes them more hopeful.”
