1 00:03:37,935 --> 00:03:42,506 I WAS HAVING DÉJÀ VU IN MY 2 00:03:42,506 --> 00:03:47,144 EARLIER DAYS AS AN HIV ACTIVIST 3 00:03:47,144 --> 00:03:50,715 WATCHING THIS HAPPEN TO MY 4 00:03:50,715 --> 00:03:51,849 FRIENDS WITH HIV. 5 00:03:51,849 --> 00:03:53,951 DURING THE 10 WEEKS SENSE MY 6 00:03:53,951 --> 00:03:56,854 DIAGNOSIS I RECEIVED A CRASH 7 00:03:56,854 --> 00:03:59,223 COURSE ON THE HISTORY OF THE 8 00:03:59,223 --> 00:04:03,094 DISEASE OF ME, THE STIGMA AND 9 00:04:03,094 --> 00:04:04,762 DISCRIMINATION I PREPARED MYSELF 10 00:04:04,762 --> 00:04:06,063 TO FACE. 11 00:04:06,063 --> 00:04:07,932 THE FACT THERE WAS NO FDA 12 00:04:07,932 --> 00:04:10,301 APPROVED DRUG, NO SOCIAL 13 00:04:10,301 --> 00:04:15,306 SERVICES AND NO COORDINATED 14 00:04:15,306 --> 00:04:21,846 HEALTH CARE AND REALIZED QUICKLY 15 00:04:21,846 --> 00:04:24,982 HOW SCREWED WE ALL WERE. 16 00:04:24,982 --> 00:04:32,623 I'M GOING FAST FORWARD TO NOW 17 00:04:32,623 --> 00:04:35,526 AND I HAD ME AND LONG COVID AND 18 00:04:35,526 --> 00:04:38,262 HELPED PASS STATE LEGISLATION IN 19 00:04:38,262 --> 00:04:40,131 NEW YORK, I'VE DEVELOPED ME 20 00:04:40,131 --> 00:04:41,899 CLINICAL EDUCATION COURSES AND 21 00:04:41,899 --> 00:04:43,768 I'VE ALSO PROTESTED AGAINST 22 00:04:43,768 --> 00:04:48,105 ANYONE WHO GOT IN OUR WAY AND 23 00:04:48,105 --> 00:04:49,807 SPECIFICALLY LOOKING AT. 24 00:04:49,807 --> 00:04:51,409 YOU SHOWED UP AT COLUMBIA 25 00:04:51,409 --> 00:04:52,543 UNIVERSITY ONE DAY. 26 00:04:52,543 --> 00:04:58,249 I WAS NOT HAVING THAT IN BACK 27 00:04:58,249 --> 00:04:58,449 YARD. 28 00:04:58,449 --> 00:05:02,353 RIGHT NOW I'M ON IVIG EVERY FOUR 29 00:05:02,353 --> 00:05:09,126 WEEKS AND TAKING NALTREXON AND 30 00:05:09,126 --> 00:05:11,796 WANING MYSELF OFF SOMBALTA AND 31 00:05:11,796 --> 00:05:16,367 TAKING SOMETHING FOR SLEEP AND 32 00:05:16,367 --> 00:05:17,401 STARTED CORTIZONE. 33 00:05:17,401 --> 00:05:19,303 THESE TREATMENTS HELPED ME AND 34 00:05:19,303 --> 00:05:21,105 KNOW HOW LUCKY I AM TO HAVE 35 00:05:21,105 --> 00:05:21,339 ACCESS. 36 00:05:21,339 --> 00:05:23,841 NOT EVERYONE CAN GET ACCESS TO 37 00:05:23,841 --> 00:05:25,843 THESE TREATMENTS, CAN TOLERATE 38 00:05:25,843 --> 00:05:28,679 THEM OR EVEN RESPOND TO THEM. 39 00:05:28,679 --> 00:05:32,516 YOU KNOW, IN 2016 I WAS SURE MY 40 00:05:32,516 --> 00:05:33,351 PARENTS WERE GOING TO BURY ME BY 41 00:05:33,351 --> 00:05:35,553 THE END OF THE YEAR. 42 00:05:35,553 --> 00:05:36,721 I WAS SO SICK. 43 00:05:36,721 --> 00:05:39,490 I LITERALLY THOUGHT I WAS DYING. 44 00:05:39,490 --> 00:05:40,992 I HAD NEVER BEEN THAT SICK IN MY 45 00:05:40,992 --> 00:05:41,325 LIFE. 46 00:05:41,325 --> 00:05:43,661 I'M GRATEFUL THAT MY SYMPTOMS 47 00:05:43,661 --> 00:05:46,230 ARE NOT AS SEVERE AS THEY WERE 48 00:05:46,230 --> 00:05:46,630 BACK THEN. 49 00:05:46,630 --> 00:05:49,266 IT HORRIBLE. 50 00:05:49,266 --> 00:05:51,168 I WOULD LAY IN BED AND CRY. 51 00:05:51,168 --> 00:05:54,105 MY CURRENT TREATMENT NOT 52 00:05:54,105 --> 00:05:55,272 APERFECT TREATMENT PLAN BUT IT'S 53 00:05:55,272 --> 00:05:57,408 GIVEN ME SOME OF MY LIFE BACK. 54 00:05:57,408 --> 00:05:58,709 I'M STILL WAITING FOR MY BRAIN 55 00:05:58,709 --> 00:06:01,612 TO COME CAN BACK. 56 00:06:01,612 --> 00:06:03,414 PEOPLE NEED TREATMENT OPTIONS. 57 00:06:03,414 --> 00:06:07,918 WHEN I SAY PEOPLE, I MEAN ALL 58 00:06:07,918 --> 00:06:09,887 PEOPLE NEED TREATMENT OPTIONS. 59 00:06:09,887 --> 00:06:13,190 EVERY SINGLE PERSON WHO HAS THIS 60 00:06:13,190 --> 00:06:13,424 DISEASE. 61 00:06:13,424 --> 00:06:17,895 A FEW WEEKS AGO I POSTED A 62 00:06:17,895 --> 00:06:19,397 MESSAGE ON SOCIAL MEDIA THE 63 00:06:19,397 --> 00:06:21,332 MESSAGE SAID AND I'LL QUOTE, 64 00:06:21,332 --> 00:06:25,403 I'VE BEEN INVITED TO SPEAK AT 65 00:06:25,403 --> 00:06:28,005 THE NIH DECEMBER MEETING. 66 00:06:28,005 --> 00:06:32,777 WHAT WOULD YOU WANT EARLY CAREER 67 00:06:32,777 --> 00:06:36,447 SCIENTISTS AND MEDICAL STUDENTS 68 00:06:36,447 --> 00:06:39,050 TO LOOK AND I RECEIVED RESPONSE 69 00:06:39,050 --> 00:06:46,690 TO THE QUESTION AND 18,600 70 00:06:46,690 --> 00:06:48,159 RESPONSE TO THE POST. 71 00:06:48,159 --> 00:06:50,494 I'LL SHARE A FEW THAT STOOD OUT 72 00:06:50,494 --> 00:06:51,228 TO ME. 73 00:06:51,228 --> 00:06:56,033 THE MOST PREVALENT ISSUE 74 00:06:56,033 --> 00:07:00,504 ADDRESSED IN THAT POST REVOLVED 75 00:07:00,504 --> 00:07:05,076 AROUND PEM, POST EXERTION 76 00:07:05,076 --> 00:07:08,312 MALAISE AND PATHOPHYSIOLOGY AND 77 00:07:08,312 --> 00:07:11,582 RESPONDENTS EMPHASIZED THE 78 00:07:11,582 --> 00:07:12,817 IMPORTANCE OF RECOGNIZING AND 79 00:07:12,817 --> 00:07:14,952 STUDYING PEM IN ANY RESEARCH. 80 00:07:14,952 --> 00:07:20,324 THEY STRESS THE NEED TO STOP 81 00:07:20,324 --> 00:07:21,992 ADVOCATING EXERCISE FOR THOSE 82 00:07:21,992 --> 00:07:25,329 EXPERIENCING PEM AS IT 83 00:07:25,329 --> 00:07:26,430 EXACERBATES SYMPTOMS AND THE 84 00:07:26,430 --> 00:07:27,932 IMPACT ON PEOPLE WITH ME. 85 00:07:27,932 --> 00:07:30,101 THE SECOND THING BROUGHT UP WE 86 00:07:30,101 --> 00:07:32,770 THE URGENT NEED FOR RESEARCH ON 87 00:07:32,770 --> 00:07:33,137 TREATMENTS. 88 00:07:33,137 --> 00:07:35,406 THE URGENCY FOR INCREASED 89 00:07:35,406 --> 00:07:37,875 RESEARCH EFFORTS AND ACCELERATED 90 00:07:37,875 --> 00:07:40,211 METHODOLOGIES TO FIND TREATMENT 91 00:07:40,211 --> 00:07:41,645 WAS A SIGNIFICANT THING. 92 00:07:41,645 --> 00:07:43,280 RESPONDENTS HIGHLIGHTED THE NEED 93 00:07:43,280 --> 00:07:45,950 TO SPEED UP RESEARCH DUE TO THE 94 00:07:45,950 --> 00:07:48,185 LONG STANDING LACK OF EFFECTIVE 95 00:07:48,185 --> 00:07:49,220 TREATMENTS. 96 00:07:49,220 --> 00:07:51,856 AND ONE PERSON WROTE, QUOTE, ADD 97 00:07:51,856 --> 00:07:54,925 AN ARM TO THE LONG COVID STUDY 98 00:07:54,925 --> 00:07:57,995 BEING CONDUCTED BY THE NIH. 99 00:07:57,995 --> 00:07:59,563 WE ASKED FOR THIS MANY TIMES AND 100 00:07:59,563 --> 00:08:01,999 THEY SAID NO. 101 00:08:01,999 --> 00:08:04,168 IT'S INHUMANE TO EXCLUDE US. 102 00:08:04,168 --> 00:08:06,871 AND THE THIRD THEME WAS THE NEED 103 00:08:06,871 --> 00:08:08,806 FOR A NECESSARY PARADIGM SHIFT 104 00:08:08,806 --> 00:08:10,841 IN HEALTH CARE AND THE 105 00:08:10,841 --> 00:08:12,877 IMPORTANCE OF COMMUNITY 106 00:08:12,877 --> 00:08:16,580 INVOLVEMENT EMERGED PROMINENTLY. 107 00:08:16,580 --> 00:08:20,918 MANY ADVOCATED FOR ACKNOWLEDGING 108 00:08:20,918 --> 00:08:22,319 OUR EXPERTISE IN DEVELOPMENT OF 109 00:08:22,319 --> 00:08:23,888 SYMPTOMS OF CARE. 110 00:08:23,888 --> 00:08:30,294 WE ARE THE EXPERTS AFTER ALL. 111 00:08:30,294 --> 00:08:32,897 ALSO THEY STRESS THE NEED FOR 112 00:08:32,897 --> 00:08:34,932 FRESH PERSPECTIVES AND OVERHAUL 113 00:08:34,932 --> 00:08:38,602 AT HOW HEALTH CARE PROFESSIONALS 114 00:08:38,602 --> 00:08:39,069 APPROACH THE DISEASE. 115 00:08:39,069 --> 00:08:40,371 ONE PERSON WROTE, QUOTE, THEY 116 00:08:40,371 --> 00:08:45,709 SHOULDN'T BE AFRAID TO TRY 117 00:08:45,709 --> 00:08:49,747 OFF-LABEL MEDS IF NEEDED. 118 00:08:49,747 --> 00:08:51,482 THERE MAY BE SECONDARY AFFECTS 119 00:08:51,482 --> 00:08:52,616 BUT WE CAN'T STAND THE 120 00:08:52,616 --> 00:08:55,052 SUFFERING. 121 00:08:55,052 --> 00:08:58,422 I'M GOING TO LET YOU SIT WITH 122 00:08:58,422 --> 00:09:00,024 THAT FOR A MINUTE. 123 00:09:00,024 --> 00:09:02,893 BEFORE I CLOSE I WANT TO MENTION 124 00:09:02,893 --> 00:09:03,661 TWO MORE THINGS. 125 00:09:03,661 --> 00:09:07,498 ANY RELATED STIGMA IS CAUSING 126 00:09:07,498 --> 00:09:07,731 HARM. 127 00:09:07,731 --> 00:09:09,767 PEOPLE DON'T BELIEVE US WHEN WE 128 00:09:09,767 --> 00:09:11,702 SAY WE'RE SICK AND PEOPLE MAKE 129 00:09:11,702 --> 00:09:14,405 FUN OF US AND MISPERCEPTIONS 130 00:09:14,405 --> 00:09:14,672 EXIST. 131 00:09:14,672 --> 00:09:16,373 YESTERDAY SOMEONE ON SOCIAL 132 00:09:16,373 --> 00:09:19,143 MEDIA QUESTIONED WHY THERE 133 00:09:19,143 --> 00:09:22,179 WEREN'T PEOPLE WITH SEVERE 134 00:09:22,179 --> 00:09:22,813 DISEASE SHARING THEIR LIVED 135 00:09:22,813 --> 00:09:25,149 EXPERIENCE AT THIS MEETING WHEN 136 00:09:25,149 --> 00:09:27,451 I SAW PEOPLE WITH SEVERE DISEASE 137 00:09:27,451 --> 00:09:28,752 SHARING THEIR STORIES. 138 00:09:28,752 --> 00:09:30,421 LIVING WITH SEVERE DISEASE IS 139 00:09:30,421 --> 00:09:31,855 NOT ONE SIZE FITS ALL. 140 00:09:31,855 --> 00:09:33,023 PEOPLE WITH SEVERE DISEASE IS 141 00:09:33,023 --> 00:09:37,061 NOT A MONOLITH AND MUST STOP 142 00:09:37,061 --> 00:09:38,829 STIGMATIZING EACH OTHER BY 143 00:09:38,829 --> 00:09:39,997 MAKING JUDGMENTS AND ASSUMPTIONS 144 00:09:39,997 --> 00:09:41,265 ABOUT EACH OTHER'S HEALTH AND 145 00:09:41,265 --> 00:09:41,732 LIVED EXPERIENCE. 146 00:09:41,732 --> 00:09:43,968 IT'S NOT FAIR AND IT NEEDS TO 147 00:09:43,968 --> 00:09:44,201 STOP. 148 00:09:44,201 --> 00:09:48,672 I PROMISE I'M WRAPPING UP NOW. 149 00:09:48,672 --> 00:09:52,276 I TURNED 56 YEARS OLD TWO MONTHS 150 00:09:52,276 --> 00:09:52,443 AGO. 151 00:09:52,443 --> 00:09:56,647 IN MY DAY JOB I WORK ON HIV AND 152 00:09:56,647 --> 00:09:57,881 HIV POLICY TO IMPROVE THE LIVES 153 00:09:57,881 --> 00:09:59,283 OF PEOPLE AGING WITH HIV. 154 00:09:59,283 --> 00:10:01,452 THOSE 50 AND OLDER AND THOSE 155 00:10:01,452 --> 00:10:03,754 LIFE TIME SURVIVORS WHO HAVE 156 00:10:03,754 --> 00:10:05,222 BEEN LIVING WITH IT IS SINCE 157 00:10:05,222 --> 00:10:06,290 BIRTH. 158 00:10:06,290 --> 00:10:08,892 THIS JOB I THINK ABOUT SOCIAL 159 00:10:08,892 --> 00:10:11,095 SERVICES, HEALTH CARE SYSTEMS, 160 00:10:11,095 --> 00:10:12,630 THE OLDER AMERICANS ACT, FEDERAL 161 00:10:12,630 --> 00:10:14,965 AGENCIES THAT CAN BE DOING A 162 00:10:14,965 --> 00:10:16,400 BETTER JOB AND RESEARCH THAT IS 163 00:10:16,400 --> 00:10:18,335 BEING DONE OR COULD BE DONE TO 164 00:10:18,335 --> 00:10:20,170 LOOK AT WHAT HAPPENS TO THE BODY 165 00:10:20,170 --> 00:10:24,375 WHEN A PERSON AGES WITH HIV. 166 00:10:24,375 --> 00:10:26,343 HOW DOES HIV IMPACT AGING AND 167 00:10:26,343 --> 00:10:27,945 VICE VERSA. 168 00:10:27,945 --> 00:10:30,447 DOES IT ACCELERATE IT, 169 00:10:30,447 --> 00:10:30,814 COMPLICATE IT? 170 00:10:30,814 --> 00:10:33,784 WHY DO MY FRIENDS WITH HIV HAVE 171 00:10:33,784 --> 00:10:37,888 SO MANY COMORBIDITIES AND AGE 172 00:10:37,888 --> 00:10:38,489 YOUNGER THAN ONE WOULD EXPECT. 173 00:10:38,489 --> 00:10:41,191 THERE'S A COHORT OF PEOPLE WITH 174 00:10:41,191 --> 00:10:44,461 ME WHO GOT SICK IN THE 1980s AND 175 00:10:44,461 --> 00:10:45,429 1990s. 176 00:10:45,429 --> 00:10:48,365 IN THE PRIME OF THEIR LIFE. 177 00:10:48,365 --> 00:10:51,769 THEY'RE OLDER NOW, MUCH OLDER. 178 00:10:51,769 --> 00:10:54,338 THEY HAVE WAITED DECADES FOR 179 00:10:54,338 --> 00:10:55,973 SCIENTIFIC DISCOVERY. 180 00:10:55,973 --> 00:10:57,441 THEY DREAMED OF A DAY WHEN THERE 181 00:10:57,441 --> 00:10:59,243 WOULD BE A MAJOR ANNOUNCEMENT 182 00:10:59,243 --> 00:11:01,345 SHARING A TREATMENT BEEN 183 00:11:01,345 --> 00:11:02,513 DISCOVERED TO TAKE AWAY THE 184 00:11:02,513 --> 00:11:04,715 SUFFERING OF THIS DISEASE. 185 00:11:04,715 --> 00:11:09,119 THEY KEEP WAITING AND WAITING 186 00:11:09,119 --> 00:11:10,521 YEAR AFTER YEAR MISSING MORE AND 187 00:11:10,521 --> 00:11:11,655 MORE OF THEIR LIFE WITH EACH 188 00:11:11,655 --> 00:11:15,359 PASSING DAY. 189 00:11:15,359 --> 00:11:17,795 SO YOU MAY COME TO THIS MEETING 190 00:11:17,795 --> 00:11:19,963 A COMMITMENT TO ATTEND TO PAY 191 00:11:19,963 --> 00:11:21,799 ATTENTION, TO NETWORK, TO EXPAND 192 00:11:21,799 --> 00:11:24,902 YOUR KNOWLEDGE, TO LEARN A NEW 193 00:11:24,902 --> 00:11:26,337 SKILL. 194 00:11:26,337 --> 00:11:28,305 YOU TRAVELED FROM YOUR HOME 195 00:11:28,305 --> 00:11:32,343 WHERE YOU LOGGED IN VIA ZOOM. 196 00:11:32,343 --> 00:11:35,312 SO WHETHER IT WAS A 30 MINUTE 197 00:11:35,312 --> 00:11:36,480 COMMUTE OR TWO MINUTE COMMUTE OR 198 00:11:36,480 --> 00:11:42,720 HOURS TRAVELED BY AIR LANE -- 199 00:11:42,720 --> 00:11:44,722 AIRPLANE I HAVE A QUESTION FOR 200 00:11:44,722 --> 00:11:44,888 YOU. 201 00:11:44,888 --> 00:11:46,724 WHAT ARE YOU GOING DO DIFFERENT 202 00:11:46,724 --> 00:11:48,325 THAN WHAT YOU'RE DOING TODAY TO 203 00:11:48,325 --> 00:11:50,327 MAKE THE DREAM OF A MAJOR 204 00:11:50,327 --> 00:11:51,829 DISCOVERY IN TREATMENT COME TRUE 205 00:11:51,829 --> 00:11:53,330 FOR THE FOLKS WHO HAVE BEEN 206 00:11:53,330 --> 00:11:54,665 WAITING DECADES AND DECADES AND 207 00:11:54,665 --> 00:11:57,735 DECADES. 208 00:11:57,735 --> 00:11:58,902 WE'RE ALL DEPENDING ON YOU. 209 00:11:58,902 --> 00:12:09,079 THANK YOU. 210 00:12:11,014 --> 00:12:12,082 >> THANK YOU, TERRI. 211 00:12:12,082 --> 00:12:13,951 >> IT'S MY PLEASURE TO INTRODUCE 212 00:12:13,951 --> 00:12:18,489 THE MODERATOR FOR THE NEXT 213 00:12:18,489 --> 00:12:21,525 NUMBER OF TALKS DR. ALAIN MOREAU 214 00:12:21,525 --> 00:12:24,294 WHO HAS BEEN A TREMENDOUS 215 00:12:24,294 --> 00:12:26,130 COLLEAGUE AND PARTNER FROM 216 00:12:26,130 --> 00:12:27,998 MONTREAL AND EXPERT IN LONG 217 00:12:27,998 --> 00:12:30,367 COVID AND ME/CFS AND THE VERY 218 00:12:30,367 --> 00:12:32,269 END OF THIS LONGER SESSION HE'LL 219 00:12:32,269 --> 00:12:34,405 TELL US ABOUT HIS WORK BUT FIRST 220 00:12:34,405 --> 00:12:35,072 WILL HELP MOVE THINGS ALONG. 221 00:12:35,072 --> 00:12:39,276 THANK YOU. 222 00:12:39,276 --> 00:12:40,310 >> THANK YOU, JOE. 223 00:12:40,310 --> 00:12:42,146 GOOD MORNING, EVERYONE. 224 00:12:42,146 --> 00:12:45,449 IT'S MY EXTREME PLEASURE TO BE 225 00:12:45,449 --> 00:12:46,617 THE MODERATOR OF THIS SESSION 226 00:12:46,617 --> 00:12:48,652 THIS MORNING. 227 00:12:48,652 --> 00:12:53,590 SO, I WOULD LIKE TO INTRODUCE 228 00:12:53,590 --> 00:12:57,428 OUR SECOND SPEAKER, DR. CINDY 229 00:12:57,428 --> 00:12:59,563 BATEMAN USING RECOVER TO 230 00:12:59,563 --> 00:13:05,269 UNDERSTAND ME/CFS AND LONG 231 00:13:05,269 --> 00:13:05,469 COVID. 232 00:13:05,469 --> 00:13:13,710 CINDY. 233 00:13:13,710 --> 00:13:15,612 >> THANK YOU FOR THE OPPORTUNITY 234 00:13:15,612 --> 00:13:17,347 TO COME SHARE SOME RESEARCH WITH 235 00:13:17,347 --> 00:13:17,514 YOU. 236 00:13:17,514 --> 00:13:20,951 I'LL TALK ABOUT USING RECOVER 237 00:13:20,951 --> 00:13:23,053 ADULT STUDY DATA TO ANALYZE THE 238 00:13:23,053 --> 00:13:25,823 NUMBER OF PEOPLE WITH ME/CFS. 239 00:13:25,823 --> 00:13:29,693 AS BACKGROUND, THE BATEMAN HORN 240 00:13:29,693 --> 00:13:32,663 CENTER I HELPED FORM IS A 241 00:13:32,663 --> 00:13:33,297 NONPROFIT ORGANIZATION IN SALT 242 00:13:33,297 --> 00:13:34,998 LAKE CITY THAT FOCUSES ON 243 00:13:34,998 --> 00:13:36,567 CLINICAL CARE FACILITATION OF 244 00:13:36,567 --> 00:13:39,703 RESEARCH AND DISSEMINATION OF 245 00:13:39,703 --> 00:13:41,872 EDUCATIONAL RESOURCES. 246 00:13:41,872 --> 00:13:43,640 PRIMARILY WE USED TO DO HEAVY 247 00:13:43,640 --> 00:13:49,413 WORK WITH FIBROMYALGIA AND HAD A 248 00:13:49,413 --> 00:13:54,885 FOCUS ON ME/CFS AND NOW 249 00:13:54,885 --> 00:13:57,120 EXTENDING TO LONG COVID AND THE 250 00:13:57,120 --> 00:14:00,757 GOAL IS TO COMPARE LONG COVID 251 00:14:00,757 --> 00:14:02,759 WHICH IS AN EARLY VIRAL ILLNESS 252 00:14:02,759 --> 00:14:05,128 TO ME/CFS A LONG-STANDING 253 00:14:05,128 --> 00:14:09,199 ILLNESS GENERALLY KNOWN TO BE A 254 00:14:09,199 --> 00:14:10,334 POST-VIRAL CLINICIAN. 255 00:14:10,334 --> 00:14:12,135 WE WANTED TO LEARN ABOUT THE 256 00:14:12,135 --> 00:14:13,003 CLINICAL PRESENTATION AND 257 00:14:13,003 --> 00:14:15,105 DETERMINE WHAT WAS CAUSING IT 258 00:14:15,105 --> 00:14:17,140 AND DETERMINING IF UNDERSTANDING 259 00:14:17,140 --> 00:14:19,643 LONG COVID CAN IMPROVE ME/CFS 260 00:14:19,643 --> 00:14:21,912 DIAGNOSIS AND TREATMENT. 261 00:14:21,912 --> 00:14:26,183 BECAUSE OF THIS GOAL AND OUR 262 00:14:26,183 --> 00:14:27,551 AWARENESS OF LONG COVID IN 2021 263 00:14:27,551 --> 00:14:31,021 WE INVITED MORE THAN 100 LONG 264 00:14:31,021 --> 00:14:32,956 COVID PATIENTS TO BATEMAN HORN 265 00:14:32,956 --> 00:14:34,558 CENTER CLINIC FOR EVALUATION 266 00:14:34,558 --> 00:14:37,394 BASED ON CERTAIN CHARACTERISTICS 267 00:14:37,394 --> 00:14:40,564 BY SCREENING QUESTIONNAIRE. 268 00:14:40,564 --> 00:14:44,535 THEY WERE NOT HOSPITALIZED AND 269 00:14:44,535 --> 00:14:46,470 REQUIRES -- AND CANDIDATE TO BE 270 00:14:46,470 --> 00:14:48,438 A NOBEL LAUREATE. 271 00:14:48,438 --> 00:14:50,607 THAT MEANS WE'RE GOING TO SPEAK 272 00:14:50,607 --> 00:14:52,609 RAPIDLY AND THE COMMITTEE DOES 273 00:14:52,609 --> 00:14:55,212 NOT HAVE TIME TO REVERSE THEIR 274 00:14:55,212 --> 00:15:05,389 DECISIONS. 275 00:15:33,383 --> 00:15:43,727 [TECHNICAL DIFFICULTIES] 276 00:19:28,318 --> 00:19:32,455 -- THEY MET THE CRITERIA FOR 277 00:19:32,455 --> 00:19:34,291 POST-COVID ME/CFS AND THEY WERE 278 00:19:34,291 --> 00:19:36,293 ME/CFS LIKE WHO DIDN'T MEET THE 279 00:19:36,293 --> 00:19:38,094 FUEL CRITERIA FOR ME/CFS AND 280 00:19:38,094 --> 00:19:39,262 THERE WAS A GROUP THAT HAD NO 281 00:19:39,262 --> 00:19:39,529 SYMPTOMS. 282 00:19:39,529 --> 00:19:44,301 I WANT TO POINT OUT THAT GROUP 2 283 00:19:44,301 --> 00:19:46,469 THEY WERE PEOPLE ACUTE INFECTED, 284 00:19:46,469 --> 00:19:48,572 THAT MEANS WHEN THEY WERE 285 00:19:48,572 --> 00:19:50,240 ENROLLED IT HAD ONLY BEEN 30 286 00:19:50,240 --> 00:19:51,274 DAYS SINCE THEIR INFECTION AT 287 00:19:51,274 --> 00:19:54,544 THE TIME THEY WERE ENROLLED IN 288 00:19:54,544 --> 00:19:55,846 THE STUDY AND THEN THE 289 00:19:55,846 --> 00:19:58,315 POST-ACUTE INFECTED WHO HAD 290 00:19:58,315 --> 00:19:59,616 LONGER PERIOD OF TIME SINCE 291 00:19:59,616 --> 00:20:00,350 THEY'VE BEEN SICK WITH COVID 292 00:20:00,350 --> 00:20:06,857 WHEN THEY WERE ENROLLED. 293 00:20:06,857 --> 00:20:08,792 IN THE UNINFECTED GROUPS WE'LL 294 00:20:08,792 --> 00:20:14,264 CALL THEM GROUPS 5, 6, 7, 8 AND 295 00:20:14,264 --> 00:20:15,632 PRE-EXISTING ME/CFS AND SAY MORE 296 00:20:15,632 --> 00:20:20,370 BECAUSE I WON'T GO INTO THEM 297 00:20:20,370 --> 00:20:23,740 MUCH, 1.5% AND A GROUP THAT MET 298 00:20:23,740 --> 00:20:26,776 CRITERIA AFTER ENROLLING 2.8%. 299 00:20:26,776 --> 00:20:30,714 GROUP 7 WAS THE ME/CFS-LIKE 41% 300 00:20:30,714 --> 00:20:35,051 AND GROUP 8 WAS THOSE WITH NO 301 00:20:35,051 --> 00:20:38,488 ME/CFS SYMPTOMS 54.6%. 302 00:20:38,488 --> 00:20:40,090 A LITTLE BIT SURPRISING BUT IT'S 303 00:20:40,090 --> 00:20:41,124 VERY MESSY. 304 00:20:41,124 --> 00:20:42,826 SO MANY PEOPLE HAVE BEEN EXPOSED 305 00:20:42,826 --> 00:20:47,831 TO COVID THROUGHOUT THIS TIME. 306 00:20:47,831 --> 00:20:50,300 SO LET ME GO INTO A LITTLE MORE 307 00:20:50,300 --> 00:20:50,834 DETAIL. 308 00:20:50,834 --> 00:20:54,838 OF THOSE 10,711 INFECTED 309 00:20:54,838 --> 00:20:58,108 PARTICIPANTS THAT WERE STUDIED 310 00:20:58,108 --> 00:21:00,110 INFECTED ARM HAVE BEEN SIX MORE 311 00:21:00,110 --> 00:21:01,211 THAN SIX MONTHS. 312 00:21:01,211 --> 00:21:04,948 GROUP 1 WAS THOSE WITH 313 00:21:04,948 --> 00:21:06,216 PRE-EXISTING ME/CFS WHO ALSO GOT 314 00:21:06,216 --> 00:21:09,819 INFECTED AND THAT WAS 1.7% OF 315 00:21:09,819 --> 00:21:11,988 THE TOTAL PARTICIPANTS. 316 00:21:11,988 --> 00:21:14,024 BUT GROUP 2 IS THE GROUP WE'RE 317 00:21:14,024 --> 00:21:15,458 MOST INTERESTED IN. 318 00:21:15,458 --> 00:21:23,266 THE PEOPLE WHO MET CRITERIA FOR 319 00:21:23,266 --> 00:21:24,601 POST-COVID ME/CFS AND THAT 320 00:21:24,601 --> 00:21:28,638 EQUALLED 9.5% OF PARTICIPANTS 321 00:21:28,638 --> 00:21:32,108 WHO MET ME/CFS CRITERIA MORE 322 00:21:32,108 --> 00:21:34,177 THAN SIX MONTHS FOLLOWING THE 323 00:21:34,177 --> 00:21:35,178 SARS COV2 INFECTION. 324 00:21:35,178 --> 00:21:36,546 THIS MAY SEEM DISAPPOINTING TO 325 00:21:36,546 --> 00:21:37,447 SOME PEOPLE BUT REMEMBER IT'S 326 00:21:37,447 --> 00:21:40,050 NOT A GROUP OF PATIENTS WHO GO 327 00:21:40,050 --> 00:21:43,520 TO A CLINIC -- A LONG COVID 328 00:21:43,520 --> 00:21:44,020 CLINIC. 329 00:21:44,020 --> 00:21:46,022 IT'S NOT A POPULATION-BASED 330 00:21:46,022 --> 00:21:47,524 CLINIC BUT SOMEWHERE IN BETWEEN. 331 00:21:47,524 --> 00:21:49,759 WE'LL SEE DIFFERENT NUMBERS. 332 00:21:49,759 --> 00:21:51,761 GROUP 3 IS IMPORTANT ALSO. 333 00:21:51,761 --> 00:21:53,596 THIS IS A VERY LARGE GROUP, 56% 334 00:21:53,596 --> 00:21:56,967 OF PATIENTS WHO MET AT LEAST ONE 335 00:21:56,967 --> 00:21:58,535 OF THE ME/CFS CRITERIA AND MANY 336 00:21:58,535 --> 00:22:00,537 OF THEM MET MORE BUT THEY HAD TO 337 00:22:00,537 --> 00:22:02,739 MEET ALL THE CRITERIA TO GET 338 00:22:02,739 --> 00:22:04,007 INTO GROUP 2. 339 00:22:04,007 --> 00:22:06,509 AND THEN THERE WAS A GROUP 33% 340 00:22:06,509 --> 00:22:11,614 WHO REALLY NEVER MET ANY OF THE 341 00:22:11,614 --> 00:22:12,048 CRITERIA. 342 00:22:12,048 --> 00:22:17,253 THIS SLIDE IS REALLY TO 343 00:22:17,253 --> 00:22:19,122 HIGHLIGHT THE APPROXIMATION OF 344 00:22:19,122 --> 00:22:20,824 INCIDENT CASES. 345 00:22:20,824 --> 00:22:22,559 SO OF THOSE -- IF YOU LOOK ON 346 00:22:22,559 --> 00:22:27,097 THE LEFT SIDE, THOSE WHO HAD 347 00:22:27,097 --> 00:22:31,101 BEEN LESS THAN 30 DAYS SINCE 348 00:22:31,101 --> 00:22:32,736 THEIR INFECTION WHEN THEY 349 00:22:32,736 --> 00:22:36,172 ENROLLED IN THE STUDY, 3.5% MET 350 00:22:36,172 --> 00:22:37,774 ME/CFS CRITERIA. 351 00:22:37,774 --> 00:22:39,109 SO THESE ARE PEOPLE VERY EARLY 352 00:22:39,109 --> 00:22:43,413 IN THE COURSE OF THEIR DISEASE, 353 00:22:43,413 --> 00:22:45,315 3.5% MET CRITERIA DURING THAT 354 00:22:45,315 --> 00:22:51,488 FIRST YEAR AND OF THOSE WHO HAD 355 00:22:51,488 --> 00:22:53,556 BEEN SICK WITH SYMPTOMS MORE 356 00:22:53,556 --> 00:22:56,192 THAN 30 DAYS WAS MORE THAN 13.2% 357 00:22:56,192 --> 00:22:57,560 THAT MET ME/CFS CRITERIA AND YOU 358 00:22:57,560 --> 00:22:59,796 SEE THE FOUR CATEGORIES ACROSS. 359 00:22:59,796 --> 00:23:01,898 THIS IS A COMPARISON TO THE 360 00:23:01,898 --> 00:23:04,100 UNINFECTED GROUP DOWN AT THE 361 00:23:04,100 --> 00:23:05,835 BOTTOM THAT WE TALKED ABOUT 362 00:23:05,835 --> 00:23:09,472 WHERE 2.8% OF PATIENTS ENDED UP 363 00:23:09,472 --> 00:23:10,340 MEETING ME/CFS CRITERIA BASED ON 364 00:23:10,340 --> 00:23:14,611 THESE CRITERIA. 365 00:23:14,611 --> 00:23:18,314 SO I WANT TO JUST PAUSE AND 366 00:23:18,314 --> 00:23:21,818 REFLECT BACK ON A RECENT PAPER 367 00:23:21,818 --> 00:23:24,354 THAT WAS IN JAMA. 368 00:23:24,354 --> 00:23:26,890 A VERY IMPORTANT PAPER I THINK 369 00:23:26,890 --> 00:23:28,391 THAT LOOKED AT SYMPTOMS AND 370 00:23:28,391 --> 00:23:29,859 SYMPTOM PRESENTATION IN THE 371 00:23:29,859 --> 00:23:31,561 RECOVER ADULT COHORT. 372 00:23:31,561 --> 00:23:36,766 THEY LOOKED AT 9,764 SUBJECTS 373 00:23:36,766 --> 00:23:39,702 SICK AT LEAST SIX MONTHS SINCE 374 00:23:39,702 --> 00:23:40,937 ACUTE COVID AND THEY IDENTIFIED 375 00:23:40,937 --> 00:23:43,106 AND THERE WAS REFERENCE FOR 376 00:23:43,106 --> 00:23:44,541 THIS -- I WON'T GO TOO MUCH INTO 377 00:23:44,541 --> 00:23:47,010 THE PAPER BUT IDENTIFIED THE 378 00:23:47,010 --> 00:23:49,913 MOST DISTINGUISHING SYMPTOMS 379 00:23:49,913 --> 00:23:51,748 THAT SEPARATED PEOPLE WHO HAD 380 00:23:51,748 --> 00:23:53,216 HAD SARS COV2 AND THERE WAS A 381 00:23:53,216 --> 00:23:54,451 LIST OF 12 WEIGHTED. 382 00:23:54,451 --> 00:23:56,453 I DON'T KNOW IF YOU REMEMBER, 383 00:23:56,453 --> 00:23:58,254 LOSS OF SMELL WAS THE TOP AND 384 00:23:58,254 --> 00:24:03,259 EIGHT POINTS FOR LOSS OF SMELL 385 00:24:03,259 --> 00:24:03,726 AND IT WENT DOWN. 386 00:24:03,726 --> 00:24:09,866 IF YOU HAD A SCORE OF 12 THEY 387 00:24:09,866 --> 00:24:13,970 CALLED YOU POST-ACUTE SEQUELAE 388 00:24:13,970 --> 00:24:14,337 COVID. 389 00:24:14,337 --> 00:24:17,040 AS DEFINED IN THE STUDY. 390 00:24:17,040 --> 00:24:19,275 OF THOSE WHO MET PASC CRITERIA 391 00:24:19,275 --> 00:24:24,447 IN THE PAPER, THE MOST COMMON 392 00:24:24,447 --> 00:24:26,850 SYMPTOMS WERE POST-EXERTIONAL 393 00:24:26,850 --> 00:24:28,751 MALAISE, FATIGUE, BRAIN FOG, 394 00:24:28,751 --> 00:24:30,186 DIZZY , G.I. SYMPTOMS AND 395 00:24:30,186 --> 00:24:32,388 PALPITATIONS. 396 00:24:32,388 --> 00:24:34,691 JUST POKE THOSE INTO YOUR BRAIN 397 00:24:34,691 --> 00:24:37,427 AND ALSO FROM THIS PAPER AND 398 00:24:37,427 --> 00:24:38,661 PEOPLE HAVE SEEN THIS BEFORE. 399 00:24:38,661 --> 00:24:44,134 THEY DID A CLUSTER ANALYSIS OF 400 00:24:44,134 --> 00:24:54,811 THOSE PEOPLE WHO MET CRITERIA. 401 00:24:54,811 --> 00:24:58,681 CLUSTER 1 WAS LOSS OR CHANGE OF 402 00:24:58,681 --> 00:25:01,518 SMELL OR TASTE AND THOSE WITH 403 00:25:01,518 --> 00:25:03,219 POST-EXERTIONAL MALAISE AND 404 00:25:03,219 --> 00:25:06,356 FATIGUE AND CLUSTER 3 WAS BRAIN 405 00:25:06,356 --> 00:25:06,956 FOG. 406 00:25:06,956 --> 00:25:10,293 100% HAD BRAIN FOG IN THAT 407 00:25:10,293 --> 00:25:12,462 CLUSTER AND POST-EXERTIONAL 408 00:25:12,462 --> 00:25:15,098 MALAISE AND FATIGUE AND CLUSTER 409 00:25:15,098 --> 00:25:17,400 4 REALLY SICK PEOPLE WE MAY 410 00:25:17,400 --> 00:25:20,103 RECOGNIZE WITH FATIGUE, 411 00:25:20,103 --> 00:25:21,304 DIZZINESS, BRAIN FOG AND G.I. 412 00:25:21,304 --> 00:25:23,806 AND PALPITATIONS. 413 00:25:23,806 --> 00:25:27,377 THAT FOURTH COLUMN HAS THE DARK 414 00:25:27,377 --> 00:25:28,811 BANDS BECAUSE THEY GET DARKER 415 00:25:28,811 --> 00:25:30,880 THE HIGHER THE PERCENT. 416 00:25:30,880 --> 00:25:38,254 THERE WERE APPROXIMATELY 2,031 417 00:25:38,254 --> 00:25:40,023 IN THE PASC GROUP AND ROUGHLY A 418 00:25:40,023 --> 00:25:42,025 FOURTH OF EACH PATIENT BUT THERE 419 00:25:42,025 --> 00:25:46,029 WERE 562 WHO MET THE CLUSTER 420 00:25:46,029 --> 00:25:48,031 FOUR OF THE 2000 PATIENTS. 421 00:25:48,031 --> 00:25:50,733 SO BACK TO OUR RESULTS. 422 00:25:50,733 --> 00:25:52,969 AND THIS IS THE SAME SLIDE I 423 00:25:52,969 --> 00:25:56,706 SHOWED YOU BUT WE TOOK THE PASC 424 00:25:56,706 --> 00:25:58,174 CRITERIA AND APPLIED THEM TO OUR 425 00:25:58,174 --> 00:26:01,911 GROUP OF PATIENTS WHO MET THE 426 00:26:01,911 --> 00:26:03,213 I.O.M. CRITERIA FOR ME/CFS TO 427 00:26:03,213 --> 00:26:04,948 SEE WHAT THE OVERLAP WAS. 428 00:26:04,948 --> 00:26:07,850 SO THAT IS GROUP 2 AND I ADDED 429 00:26:07,850 --> 00:26:10,987 THE NEW OBSERVATION IN RED. 430 00:26:10,987 --> 00:26:14,257 SO THOSE PEOPLE WHO HAD 431 00:26:14,257 --> 00:26:15,992 POST-COVID ME/CFS MEETING THE 432 00:26:15,992 --> 00:26:19,128 IOM CRITERIA, 84% OF THOSE 433 00:26:19,128 --> 00:26:24,567 PEOPLE MET THE DEFINITION IT 434 00:26:24,567 --> 00:26:26,536 FROM THE MAY PAPER. 435 00:26:26,536 --> 00:26:28,204 YOU CAN WRAP YOUR MIND ABOUT 436 00:26:28,204 --> 00:26:29,439 THAT AND I'LL BEND YOUR MIND A 437 00:26:29,439 --> 00:26:30,039 LITTLE BIT MORE HERE. 438 00:26:30,039 --> 00:26:31,975 YOU HAVE TO READ THE PAPER. 439 00:26:31,975 --> 00:26:33,543 SOMETIMES THE PAPERS ARE 440 00:26:33,543 --> 00:26:34,711 COMPLICATED AND YOU HAVE TO TAKE 441 00:26:34,711 --> 00:26:36,613 SOME TIME TO READ THEM. 442 00:26:36,613 --> 00:26:39,816 BUT LET ME WALK YOU THROUGH 443 00:26:39,816 --> 00:26:40,350 THIS. 444 00:26:40,350 --> 00:26:42,919 SO THE FIRST PIE CHART, THIS IS 445 00:26:42,919 --> 00:26:44,854 FROM FIGURE 2 IN THE PAPER. 446 00:26:44,854 --> 00:26:47,090 THE FIRST PIE CHART IS THAT 447 00:26:47,090 --> 00:26:47,824 GROUP 2. 448 00:26:47,824 --> 00:26:52,729 THESE ARE THE PEOPLE THAT WE 449 00:26:52,729 --> 00:26:54,097 DEFINED AS HAVING POST-COVID 450 00:26:54,097 --> 00:26:55,198 ME/CFS BASED ON THE CRITERIA AND 451 00:26:55,198 --> 00:26:57,000 THE PIE CHART IS HOW OFTEN DID 452 00:26:57,000 --> 00:27:02,605 THEY FALL INTO THE CLUSTERS. 453 00:27:02,605 --> 00:27:08,077 SO CLUSTER 1 IS MEETING THE PASC 454 00:27:08,077 --> 00:27:10,780 CRITERIA FROM THE JAMA PAPER. 455 00:27:10,780 --> 00:27:13,416 LIGHT BLUE IS CLUSTER 1 AND NEXT 456 00:27:13,416 --> 00:27:15,985 IS CLUSTER 2 AND MEDIUM BLUE IS 457 00:27:15,985 --> 00:27:17,253 CLUSTER 3 AND THE DARK BLUE AREA 458 00:27:17,253 --> 00:27:18,755 IS CLUSTER 4. 459 00:27:18,755 --> 00:27:21,491 THE VERY LIGHT GROUP IS NOT 460 00:27:21,491 --> 00:27:23,293 MEETING THE PASC SCORE OF 12. 461 00:27:23,293 --> 00:27:26,362 THEN THERE'S A GROUP OF MISSING 462 00:27:26,362 --> 00:27:26,596 DATA. 463 00:27:26,596 --> 00:27:28,398 CAN SEE BY FAR AND THIS IS THE 464 00:27:28,398 --> 00:27:30,900 SAME NUMBER THAT WAS IN THE 465 00:27:30,900 --> 00:27:33,069 SLIDE BEFORE ABOUT 84% OF PEOPLE 466 00:27:33,069 --> 00:27:35,605 WE DEFINED AS HAVING ME/CFS 467 00:27:35,605 --> 00:27:38,374 BASED ON THE I.O.M. CRITERIA MET 468 00:27:38,374 --> 00:27:39,876 THE PASC CRITERIA. 469 00:27:39,876 --> 00:27:44,213 NOW, IF YOU LOOK AT B, B IS 470 00:27:44,213 --> 00:27:45,515 GROUP 3. 471 00:27:45,515 --> 00:27:50,887 THIS IS THE PEOPLE WHO WERE 472 00:27:50,887 --> 00:27:52,622 ME/CFS LIKE ON OUR APPLICATION 473 00:27:52,622 --> 00:27:54,424 OF THE I.O.M. CRITERIA AND YOU 474 00:27:54,424 --> 00:27:56,826 CAN SEE ABOUT A FOURTH OF THEM 475 00:27:56,826 --> 00:27:58,394 MET PASC CRITERIA IS ALL. 476 00:27:58,394 --> 00:28:00,763 SO THE BLUE ONES. 477 00:28:00,763 --> 00:28:02,465 IT'S EVENLY SPREAD OUT WHICH 478 00:28:02,465 --> 00:28:03,199 CLUSTER THEY FELL INTO. 479 00:28:03,199 --> 00:28:06,836 BY FAR THE MAJORITY OF PEOPLE IN 480 00:28:06,836 --> 00:28:09,439 THAT ME/CFS-LIKE GROUP DID NOT 481 00:28:09,439 --> 00:28:12,141 HAVE A PASC SCORE OF MORE THAN 482 00:28:12,141 --> 00:28:14,877 12 BASED ON THE JAMA PAPER. 483 00:28:14,877 --> 00:28:19,115 THE LAST ONE IS REALLY OF ALL 484 00:28:19,115 --> 00:28:24,153 THE PEOPLE WHO MET PASC CRITERIA 485 00:28:24,153 --> 00:28:29,859 IN OUR STUDY, WHAT GROUPS DID 486 00:28:29,859 --> 00:28:33,229 THEY FALL INTO AND THE LARGEST 487 00:28:33,229 --> 00:28:35,098 PIECE OF ME/CFS-LIKE. 488 00:28:35,098 --> 00:28:36,866 THE LIGHT BLUE AND THE SLIVER OF 489 00:28:36,866 --> 00:28:42,705 DARK BLUE IS THOSE WITH 490 00:28:42,705 --> 00:28:44,941 PREEXISTING ME/CFS THE NEXT 491 00:28:44,941 --> 00:28:47,076 MEDIUM BLUE ARE THOSE WHO 492 00:28:47,076 --> 00:28:48,478 DEVELOP POST-COVID ME/CFS BASED 493 00:28:48,478 --> 00:28:50,313 ON OUR I.O.M. APPLICATION 494 00:28:50,313 --> 00:29:00,490 CRITERIA. 495 00:29:53,943 --> 00:29:58,414 SOME HAD A SCORE OF 12 OR 496 00:29:58,414 --> 00:30:01,684 GREATER AND MARK INCREASE AMONG 497 00:30:01,684 --> 00:30:03,085 SARS COVID RECOVER ADULT 498 00:30:03,085 --> 00:30:07,089 PARTICIPANTS AND THE CONCLUSION 499 00:30:07,089 --> 00:30:09,659 OF THE PAPER IS ME/CFS IS A 500 00:30:09,659 --> 00:30:10,660 SEQUELAE OF SARS COV2 AND SHOULD 501 00:30:10,660 --> 00:30:12,595 BE INCLUDED IN TRIALS AND 502 00:30:12,595 --> 00:30:16,466 RECOVER PROVIDES WHAT WE'VE 503 00:30:16,466 --> 00:30:18,568 ALWAYS SUSPECTED AND ASSUMED 504 00:30:18,568 --> 00:30:20,369 THAT RECOVER PROVIDES THE 505 00:30:20,369 --> 00:30:22,505 OPPORTUNITY TO STUDY THE BIOLOGY 506 00:30:22,505 --> 00:30:24,140 MECHANISMS AND NATURAL HISTORY 507 00:30:24,140 --> 00:30:27,443 OF POST-VIRAL ME/CFS AND 508 00:30:27,443 --> 00:30:28,511 ME/CFS-LIKE POST-VIRAL ILLNESS 509 00:30:28,511 --> 00:30:29,745 AND WE DON'T KNOW HOW MANY OF 510 00:30:29,745 --> 00:30:31,881 THOSE PEOPLE WILL GO ON TO 511 00:30:31,881 --> 00:30:35,384 DEVELOP ALL THE FULL CRITERIA 512 00:30:35,384 --> 00:30:38,087 FOR THE I.O.M. CRITERIA FOR 513 00:30:38,087 --> 00:30:38,321 ME/CFS. 514 00:30:38,321 --> 00:30:40,656 WE ALL HOPE THE STUDY LONG COVID 515 00:30:40,656 --> 00:30:42,758 CAN BRING US CLOSER TO 516 00:30:42,758 --> 00:30:45,828 UNDERSTANDING THE CAUSE AND 517 00:30:45,828 --> 00:30:46,929 UNDERLYING PATHOPHYSIOLOGY OF 518 00:30:46,929 --> 00:30:49,565 ME/CFS, IDENTIFY BIOMARKERS AND 519 00:30:49,565 --> 00:30:51,701 DIAGNOSTIC TESTS AND USE THE 520 00:30:51,701 --> 00:30:52,802 INFORMATION TO MOVE TOWARD A 521 00:30:52,802 --> 00:30:55,104 TREATMENT TRIALS FOR LONG COVID 522 00:30:55,104 --> 00:30:56,339 AND ME/CFS. 523 00:30:56,339 --> 00:30:58,140 SO THANK YOU TO SUSAN AND THE 524 00:30:58,140 --> 00:30:59,909 TEAM AT THE UNIVERSITY OF UTAH 525 00:30:59,909 --> 00:31:03,079 AND ALL THE MANY RECOVER AUTHOR 526 00:31:03,079 --> 00:31:05,581 WHO'S CONTRIBUTED THEIR TWO BITS 527 00:31:05,581 --> 00:31:07,917 TO THE PAPER AND WE ARE FINGERS 528 00:31:07,917 --> 00:31:08,451 CROSSED WE CAN GET THIS 529 00:31:08,451 --> 00:31:10,720 PUBLISHED. 530 00:31:10,720 --> 00:31:19,862 THANK YOU. 531 00:31:19,862 --> 00:31:21,931 >> WE HAVE TIME FOR A FEW 532 00:31:21,931 --> 00:31:22,198 QUESTIONS. 533 00:31:22,198 --> 00:31:23,399 PLEASE COME UP TO THE MIC. 534 00:31:23,399 --> 00:31:24,734 >> DO YOU HAVE ANY SENSE TO WHAT 535 00:31:24,734 --> 00:31:28,704 THE RISK IS IS WITH DIFFERENT 536 00:31:28,704 --> 00:31:28,971 VARIANTS? 537 00:31:28,971 --> 00:31:30,172 DOES THAT CHANGE? 538 00:31:30,172 --> 00:31:34,544 >> UM, WE DIDN'T LOOK AT THAT 539 00:31:34,544 --> 00:31:36,746 BUT THE INCIDENT GROUP WERE 540 00:31:36,746 --> 00:31:39,081 REALLY PEOPLE LATER PROBABLY 541 00:31:39,081 --> 00:31:44,220 MORE LIKELY TO BE VACCINATED AND 542 00:31:44,220 --> 00:31:44,587 POST-OMICRON. 543 00:31:44,587 --> 00:31:47,156 IT'S HARD TO COMPARE OVER TIME 544 00:31:47,156 --> 00:31:49,058 PERIODS IN COVID AND WE'D HAVE 545 00:31:49,058 --> 00:31:50,593 TO DIG A LOT DEEPER TO BE ABLE 546 00:31:50,593 --> 00:31:52,061 TO DO THAT. 547 00:31:52,061 --> 00:31:55,197 >> YOU COULD USE SEROLOGY FOR 548 00:31:55,197 --> 00:31:55,765 THAT. 549 00:31:55,765 --> 00:31:57,033 >> SORRY? 550 00:31:57,033 --> 00:31:59,101 >> YOU CAN USE SEROLOGY FOR 551 00:31:59,101 --> 00:31:59,302 THAT. 552 00:31:59,302 --> 00:32:01,904 >> HONESTLY WE HAD A BIT OF A 553 00:32:01,904 --> 00:32:03,439 TIME GETTING HOLD OF THE RECOVER 554 00:32:03,439 --> 00:32:07,176 DATA AND WE MIGHT HAVE AN EVEN 555 00:32:07,176 --> 00:32:08,544 HARDER TIME GETTING HOLD OF THE 556 00:32:08,544 --> 00:32:11,047 SAMPLES BUT IT'S DEFINITELY 557 00:32:11,047 --> 00:32:13,215 POSSIBLE AND IT MIGHT COME OUT 558 00:32:13,215 --> 00:32:20,823 IN A RECOVER STUDY. 559 00:32:20,823 --> 00:32:24,894 >> HI, MY NAME IS BRYN CONRAD AN 560 00:32:24,894 --> 00:32:26,062 UNDERGRADUATE RESEARCHER WITH 561 00:32:26,062 --> 00:32:27,897 VASSAR COLLEGE. 562 00:32:27,897 --> 00:32:29,999 I HAD A QUESTION ON CRITERIA FOR 563 00:32:29,999 --> 00:32:32,602 ME/CFS BECAUSE I KNOW THERE'S A 564 00:32:32,602 --> 00:32:34,804 LOT OF DIFFERENT METHODS OF 565 00:32:34,804 --> 00:32:37,907 DIAGNOSING ME WITH DIFFERENT 566 00:32:37,907 --> 00:32:40,476 CRITERIA AND SOME PEOPLE FIT 567 00:32:40,476 --> 00:32:42,178 INTO ONE CATEGORY AND WONDERING 568 00:32:42,178 --> 00:32:44,513 WHAT LED YOU AND YOUR TEAM TO 569 00:32:44,513 --> 00:32:46,716 CHOOSE THE I.O.M. CRITERIA 570 00:32:46,716 --> 00:32:48,884 VERSUS A CANADIAN CONSENSUS AND 571 00:32:48,884 --> 00:32:49,719 CDC AND HOW THEY COMPARE. 572 00:32:49,719 --> 00:32:53,055 >> THAT'S A GOOD QUESTION. 573 00:32:53,055 --> 00:32:56,559 I LIKE THE I.O.M. CRITERIA AS A 574 00:32:56,559 --> 00:32:57,326 CLINICIAN BECAUSE THEY'RE 575 00:32:57,326 --> 00:32:58,127 SCREENING CRITERIA AND THE FIRST 576 00:32:58,127 --> 00:32:59,595 STEP IN TRYING TO UNDERSTAND. 577 00:32:59,595 --> 00:33:01,631 THEY'RE THE CORE PRESENTING 578 00:33:01,631 --> 00:33:02,298 SYMPTOMS. 579 00:33:02,298 --> 00:33:04,266 THEY'RE NOT ALL THE SYMPTOMS, 580 00:33:04,266 --> 00:33:05,301 RIGHT, BUT THE CORE COMMON 581 00:33:05,301 --> 00:33:15,978 SYMPTOMS AND THIS ISEE -- THIS S 582 00:33:16,912 --> 00:33:19,181 EVIDENCE BASED IN THE STUDY AND 583 00:33:19,181 --> 00:33:20,783 THE RECOVER PROTOCOL HAD ALREADY 584 00:33:20,783 --> 00:33:24,120 BEEN DESIGN AND IMPLEMENTED IN 585 00:33:24,120 --> 00:33:25,287 THE DATA GATHERED. 586 00:33:25,287 --> 00:33:27,089 AND DIDN'T PUT IN SPECIFIC 587 00:33:27,089 --> 00:33:28,724 QUESTIONS TO DETERMINE IF PEOPLE 588 00:33:28,724 --> 00:33:33,529 MET ME/CFS CRITERIA. 589 00:33:33,529 --> 00:33:35,331 AND THE CRITERIA WERE THE 590 00:33:35,331 --> 00:33:37,800 CLOSEST WE COULD COME TO 591 00:33:37,800 --> 00:33:38,934 APPROXIMATING THE I.O.M. 592 00:33:38,934 --> 00:33:39,769 CRITERIA AND WOULD HAVE BEEN 593 00:33:39,769 --> 00:33:42,938 CLOSE TO IMPOSSIBLE TO TRY TO 594 00:33:42,938 --> 00:33:44,507 USE CANADIAN CRITERIA OR ONE OF 595 00:33:44,507 --> 00:33:48,778 THE OTHER MORE COMPLICATED 596 00:33:48,778 --> 00:33:53,649 CRITERIAS FOR THIS PURPOSE. 597 00:33:53,649 --> 00:33:55,384 BUT EVERY PERSON SHOULD BE 598 00:33:55,384 --> 00:33:57,486 TRACKED AND STUDIED AND HAVE 599 00:33:57,486 --> 00:33:58,721 MANY END CASE DEFINITIONS 600 00:33:58,721 --> 00:34:01,290 APPLIED TO THEM INCLUDING ALL 601 00:34:01,290 --> 00:34:03,092 THE OTHER COMORBIDITIES DONE. 602 00:34:03,092 --> 00:34:13,335 >> THANK YOU. 603 00:34:17,873 --> 00:34:21,944 >> MY PLEASURE TO INTRODUCE OUR 604 00:34:21,944 --> 00:34:25,181 THIRD SPEAKER DR. NANCY CLI MASS 605 00:34:25,181 --> 00:34:26,849 FROM NOVA SOUTHEASTERN 606 00:34:26,849 --> 00:34:31,087 UNIVERSITY AND PRESENT COVID-19 607 00:34:31,087 --> 00:34:34,757 UNDERSTANDING THE POST-VIRAL 608 00:34:34,757 --> 00:34:36,692 PHASE COVID UPP. 609 00:34:36,692 --> 00:34:38,928 >> IT'S AN HONOR TO REPRESENT 610 00:34:38,928 --> 00:34:40,730 THIS AMAZING GROUP THAT HAS 611 00:34:40,730 --> 00:34:44,767 ASSEMBLED TO TRY TO PUT THE 612 00:34:44,767 --> 00:34:55,244 STUDY UP AND GET NICE DATA. 613 00:35:02,118 --> 00:35:04,620 IT'S A GREAT OPPORTUNITY TO IN 614 00:35:04,620 --> 00:35:08,390 INVOLVED IN THIS GROUP AND OUR 615 00:35:08,390 --> 00:35:10,726 GODSEND IN TRYING TO GET THE 616 00:35:10,726 --> 00:35:11,727 NEUROCOGNITIVE THERAPY TO WORK 617 00:35:11,727 --> 00:35:15,097 AND THE OUTSTANDING TEAM AT THE 618 00:35:15,097 --> 00:35:20,136 CDC UNDER THE LEADERSHIP OF GENE 619 00:35:20,136 --> 00:35:20,369 BERTOLI. 620 00:35:20,369 --> 00:35:22,805 WE DON'T HAVE ANY CONFLICTS. 621 00:35:22,805 --> 00:35:24,874 SO THE OBJECTIVE OF THE STUDY IS 622 00:35:24,874 --> 00:35:26,041 A LITTLE DIFFERENT. 623 00:35:26,041 --> 00:35:30,246 IT WAS TO UNDERSTAND WHERE THE 624 00:35:30,246 --> 00:35:31,514 ME/CFS AND LONG COVID OVERLAP 625 00:35:31,514 --> 00:35:32,648 AND WHERE THEY DIFFER. 626 00:35:32,648 --> 00:35:38,020 THAT'S THE BASIC OBJECTIVE. 627 00:35:38,020 --> 00:35:40,156 WE HAD A TREMENDOUS ADVANTAGE. 628 00:35:40,156 --> 00:35:42,024 I KNOW YOU UNDERSTAND NOW IT'S 629 00:35:42,024 --> 00:35:45,161 HARD TO DO PROSPECTIVE ME/CFS 630 00:35:45,161 --> 00:35:48,330 STUDIES THAT DON'T HAVE THE 631 00:35:48,330 --> 00:35:49,865 CONFOUND OF COVID INFECTION. 632 00:35:49,865 --> 00:35:53,636 IT'S HARD TO FIND NON-COVID 633 00:35:53,636 --> 00:35:55,070 TRIGGERED ME/CFS NOW THAT WE 634 00:35:55,070 --> 00:35:57,673 DON'T HAVE VERY GOOD TESTING. 635 00:35:57,673 --> 00:36:00,709 PEOPLE AREN'T BOTHERING TO TEST 636 00:36:00,709 --> 00:36:01,744 FOR COVID AND THEY'RE ASSUMING 637 00:36:01,744 --> 00:36:04,780 ALL THEIR INFECTIONS ARE COVID 638 00:36:04,780 --> 00:36:06,348 SO IT'S JUST A DIFFICULT TIME TO 639 00:36:06,348 --> 00:36:08,083 DO A PROSPECTIVE STUDY. 640 00:36:08,083 --> 00:36:10,486 WE WERE SO LUCKY WE HAD JUST 641 00:36:10,486 --> 00:36:13,956 COMPLETED THIS GREAT BIG STUDY 642 00:36:13,956 --> 00:36:21,330 WITH THE CDC WITH SEVEN SITES 643 00:36:21,330 --> 00:36:27,069 AND THERE'S A GREAT GROUP OF 644 00:36:27,069 --> 00:36:37,613 PEOPLE THAT DID THIS STUDY AND 645 00:36:38,681 --> 00:36:43,452 WE LOOKED AT THE DATA SET AND 646 00:36:43,452 --> 00:36:45,120 PROCEEDED TO DO COMPARABLES AND 647 00:36:45,120 --> 00:36:47,389 THERE'S A PHENOTYPING COMPONENT 648 00:36:47,389 --> 00:36:48,157 TO IT. 649 00:36:48,157 --> 00:36:51,360 I DON'T NEED TO TELL YOU COVID 650 00:36:51,360 --> 00:36:52,928 IS VERY FREQUENT AND THE RATE OF 651 00:36:52,928 --> 00:36:56,365 COVID INFECTION IS IS TOPPING 652 00:36:56,365 --> 00:36:58,734 77% LIFE TIME COVID, 19 653 00:36:58,734 --> 00:37:03,405 INFECTION IN THE U.S. 654 00:37:03,405 --> 00:37:13,949 AND SO YOU HEARD PEOPLE TALKING 655 00:37:21,457 --> 00:37:26,595 SO MUCH OVER THE PAST TWO DAYS 656 00:37:26,595 --> 00:37:31,033 ABOUT THE IMPORTANCE OF BEING 657 00:37:31,033 --> 00:37:33,869 THOROUGH IN OUR INFORMATION AND 658 00:37:33,869 --> 00:37:34,770 TRYING TO DEVELOP 659 00:37:34,770 --> 00:37:36,038 DEMOGRAPHICALLY REPRESENTED 660 00:37:36,038 --> 00:37:36,272 COHORT. 661 00:37:36,272 --> 00:37:40,509 THAT WAS A CHALLENGE OF OUR 662 00:37:40,509 --> 00:37:40,910 STU 663 00:37:40,910 --> 00:37:41,110 STUDY. 664 00:37:41,110 --> 00:37:44,914 WE ARE IN SOUTH FLORIDA AND 665 00:37:44,914 --> 00:37:45,547 PREDOMINANTLY HISPANIC COMMUNITY 666 00:37:45,547 --> 00:37:48,317 AND LOOKING FOR DEMOGRAPHICALLY 667 00:37:48,317 --> 00:37:52,187 RICH SETS AS IT TURNED OUT TO 668 00:37:52,187 --> 00:37:52,721 BE. 669 00:37:52,721 --> 00:38:01,530 THE STUDY HAS A DATA SET OF 47 670 00:38:01,530 --> 00:38:07,002 PATIENTS CHARACTERIZED IN WEB 671 00:38:07,002 --> 00:38:13,075 BASED AND ONSITE STUDY AND 14 672 00:38:13,075 --> 00:38:16,011 PAPERS HAVE -- 12 OR 14 FROM THE 673 00:38:16,011 --> 00:38:18,147 DATA SET I THINK YOU SAW AN 674 00:38:18,147 --> 00:38:21,216 E-MAIL COME THROUGH THERE'S A 675 00:38:21,216 --> 00:38:24,019 RELATIONSHIP NOW WITH THE CDC 676 00:38:24,019 --> 00:38:28,724 AND THE NIH DATA AND BIO 677 00:38:28,724 --> 00:38:30,159 REPOSITORY TO DIRECT IT FOR A 678 00:38:30,159 --> 00:38:32,861 BROADER GROUP OF INVESTIGATORS. 679 00:38:32,861 --> 00:38:34,697 LONG COVID AS YOU'VE HEARD BY 680 00:38:34,697 --> 00:38:36,165 MULTIPLE INVESTIGATORS IS 681 00:38:36,165 --> 00:38:36,465 COMPLICATED. 682 00:38:36,465 --> 00:38:38,367 IT HAS A HOST OF SYMPTOMS. 683 00:38:38,367 --> 00:38:40,169 MANY SYMPTOMS ARE OVERLAPPING 684 00:38:40,169 --> 00:38:43,072 BUT BY FAR THE MOST COMMON 685 00:38:43,072 --> 00:38:46,608 SYMPTOM IS FATIGUE. 686 00:38:46,608 --> 00:38:49,044 AND IT CASE DEFINITION ISSUES 687 00:38:49,044 --> 00:38:50,546 AND THERE WAS THE FIRST ONE THAT 688 00:38:50,546 --> 00:38:54,650 WAS WIDELY ACCEPT THE WORLD 689 00:38:54,650 --> 00:38:56,185 HEALTH ORGANIZATION CASE 690 00:38:56,185 --> 00:38:59,188 DEFINITION IT HAD BEEN PUBLISHED 691 00:38:59,188 --> 00:39:03,092 AND NOW THERE'S A NASEM LARGE 692 00:39:03,092 --> 00:39:04,093 CASE DEFINITION EVIDENCE-BASED 693 00:39:04,093 --> 00:39:05,961 CASE DEFINITION EFFORT UNDERWAY. 694 00:39:05,961 --> 00:39:07,629 SO WE HAD TO DECIDE HOW WE WERE 695 00:39:07,629 --> 00:39:10,332 GOING TO APPROACH THIS WITH THE 696 00:39:10,332 --> 00:39:11,066 COMPLICATION OF NOT KNOWING 697 00:39:11,066 --> 00:39:13,068 EXACTLY HOW TO DEFINE THE 698 00:39:13,068 --> 00:39:13,302 ILLNESS. 699 00:39:13,302 --> 00:39:15,070 THE RECRUITMENT IS SOUTH FLORIDA 700 00:39:15,070 --> 00:39:17,339 RECRUITMENT WHICH FOR US IS WEST 701 00:39:17,339 --> 00:39:19,141 PALM BEACH DOWN TO THE END OF 702 00:39:19,141 --> 00:39:21,210 THE KEYS. 703 00:39:21,210 --> 00:39:24,279 AND THE PEOPLE IN THE STUDY THAT 704 00:39:24,279 --> 00:39:25,781 ARE ENROLLED ARE RECOVERED AND 705 00:39:25,781 --> 00:39:30,686 UNRECOVERED AND WE HAVE TO HAVE 706 00:39:30,686 --> 00:39:32,921 A TEST NOT AN ASSUMPTION. 707 00:39:32,921 --> 00:39:36,358 AND THE RECOVER GROUP HAS TO 708 00:39:36,358 --> 00:39:37,893 HAVE NO NEW SYMPTOMS OR CHANGE 709 00:39:37,893 --> 00:39:42,097 IN OLD SYSTEMS THAT HAVE 710 00:39:42,097 --> 00:39:43,432 PERSISTED BEYOND THE RECOVERY 711 00:39:43,432 --> 00:39:46,702 PERIOD AND UNRECOVERED HAS TO 712 00:39:46,702 --> 00:39:49,038 HAVE PERSISTENT FATIGUE IN 713 00:39:49,038 --> 00:39:50,572 SYMPTOMS THREE MONTHS AFTER 714 00:39:50,572 --> 00:39:52,708 INFECTION. 715 00:39:52,708 --> 00:39:55,844 THE COMPARATIVE GROUP IS THE M 716 00:39:55,844 --> 00:39:58,080 CAM COHORT WAS NOT RECRUITED BY 717 00:39:58,080 --> 00:39:58,514 CASE DEFINITION. 718 00:39:58,514 --> 00:40:02,351 IT WAS RECRUITED BY HAVING SEVEN 719 00:40:02,351 --> 00:40:05,788 WELL REGARDED EXPERTS PICK FROM 720 00:40:05,788 --> 00:40:06,822 THEIR CLINIC THEY WERE SURE HAD 721 00:40:06,822 --> 00:40:07,056 ME/CFS. 722 00:40:07,056 --> 00:40:09,024 IT WAS A DIFFERENT WAY TO GO 723 00:40:09,024 --> 00:40:10,492 EXPERT CONSENSUS ON WHO HAD 724 00:40:10,492 --> 00:40:14,396 ME/CFS. 725 00:40:14,396 --> 00:40:16,732 THE EXCLUSION CRITERIA WERE 726 00:40:16,732 --> 00:40:21,503 BASICALLY ORGAN DAMAGE FROM 727 00:40:21,503 --> 00:40:25,808 ACUTE COVID AND THE CRITERIA AND 728 00:40:25,808 --> 00:40:27,176 THE COMMON DATA ELEMENTS 729 00:40:27,176 --> 00:40:28,477 RECOMMENDATION FOR UNDERSTANDING 730 00:40:28,477 --> 00:40:30,679 HOW TO GO FORWARD WITH 731 00:40:30,679 --> 00:40:31,280 EXCLUSIONS AND ME/CFS RELATED 732 00:40:31,280 --> 00:40:33,916 RESEARCH. 733 00:40:33,916 --> 00:40:36,819 IT'S A PROSPECTIVE STUDY. 734 00:40:36,819 --> 00:40:40,722 IT HAS -- I WON'T GO INTO THE 735 00:40:40,722 --> 00:40:43,358 RECRUITMENT STRUGGLES AND IT'S 736 00:40:43,358 --> 00:40:44,960 BEEN EDUCATIONAL FOR ME TO LEARN 737 00:40:44,960 --> 00:40:47,563 HOW TO RECRUIT THE COHORT. 738 00:40:47,563 --> 00:40:50,432 BASICALLY THERE'S A LONGITUDINAL 739 00:40:50,432 --> 00:40:52,201 COMPONENT WITH ASSESSMENT UP TO 740 00:40:52,201 --> 00:40:53,202 THREE YEARS ON A PLATFORM THAT 741 00:40:53,202 --> 00:40:57,940 LOOKS AT ALL THE DOMAINS OF 742 00:40:57,940 --> 00:40:58,207 ILLNESS. 743 00:40:58,207 --> 00:41:01,844 AND THE RECOVER FROM THAT GROUP 744 00:41:01,844 --> 00:41:04,713 AND THIS IS GOING TO BE A BROAD 745 00:41:04,713 --> 00:41:07,883 GROUP DEFINED BY FATIGUE PLUS 746 00:41:07,883 --> 00:41:08,517 ONE SYMPTOMS. 747 00:41:08,517 --> 00:41:10,719 IT'S A BROAD GROUP AND THEN FROM 748 00:41:10,719 --> 00:41:14,623 THAT WE PICK PEOPLE WHO HAVE A 749 00:41:14,623 --> 00:41:16,725 PROMISE 29 SCORE THAT PUTS THEM 750 00:41:16,725 --> 00:41:18,127 IN THE MODERATE TO SEVERELY ILL 751 00:41:18,127 --> 00:41:19,094 AND PUTS THEM IN THE PHENOTYPING 752 00:41:19,094 --> 00:41:22,664 STUDY. 753 00:41:22,664 --> 00:41:25,200 THE LONGITUDE YAL COHORT HAS A 754 00:41:25,200 --> 00:41:25,667 LOT OF QUESTIONS. 755 00:41:25,667 --> 00:41:26,969 THESE ARE ALL FROM THE COMMON 756 00:41:26,969 --> 00:41:29,571 DATA ELEMENTS IMPRESSIVE FRANKLY 757 00:41:29,571 --> 00:41:32,040 BECAUSE THEY'RE ALSO FROM THE 758 00:41:32,040 --> 00:41:34,743 MCAM STUDY WHICH PROCEEDED THE 759 00:41:34,743 --> 00:41:36,778 COMMON DATA ELEMENT DECISIONS 760 00:41:36,778 --> 00:41:37,613 THEY WERE BASED ON THE 761 00:41:37,613 --> 00:41:39,681 EVIDENCE-BASED DATA SET. 762 00:41:39,681 --> 00:41:42,184 IT ALSO HAS COVID RELATED THINGS 763 00:41:42,184 --> 00:41:43,886 AND AN IMPORTANT SET OF 764 00:41:43,886 --> 00:41:45,954 QUESTIONS AND THE PATIENT OWN 765 00:41:45,954 --> 00:41:50,659 PER SECTION OF OF THEIR 766 00:41:50,659 --> 00:41:50,959 TRAJECTORY. 767 00:41:50,959 --> 00:41:51,760 SOCIAL DETERMINATES OF HEALTH 768 00:41:51,760 --> 00:41:53,061 AND SOMETHING WE TEND TO EXCLUDE 769 00:41:53,061 --> 00:41:58,600 IN OUR ME/CFS AND SHOULD BE 770 00:41:58,600 --> 00:42:08,777 INCLUDED. 771 00:42:52,854 --> 00:43:03,298 YOU CAN SEE THE EXAM AND THE 772 00:43:06,668 --> 00:43:09,972 LEAN TEST AND COGSTATE BATTERY 773 00:43:09,972 --> 00:43:11,073 AND AN AUSTRALIAN GROUP 774 00:43:11,073 --> 00:43:12,140 DEVELOPED THIS AND IT'S BEEN A 775 00:43:12,140 --> 00:43:18,013 LABOR OF LOVE TO MAKE SURE WE 776 00:43:18,013 --> 00:43:28,557 CLOSELY ALIGN TO THE MCAM STUDY. 777 00:43:29,825 --> 00:43:31,493 BIOMARKERS, MUCH OF THIS IS 778 00:43:31,493 --> 00:43:32,527 BATCHED WORK. 779 00:43:32,527 --> 00:43:40,702 I WON'T SHARE THE BIOMARKER WORK 780 00:43:40,702 --> 00:43:51,246 TODAY AND YOU CAN SEE THE IMMUNE 781 00:43:53,815 --> 00:43:56,351 MARKERS AND THE CYTOKINE 782 00:43:56,351 --> 00:44:04,259 PLATFORM THAT'S INTENSIVE AND 783 00:44:04,259 --> 00:44:06,128 SEROLOGIC MARKERS AND DAMAGE 784 00:44:06,128 --> 00:44:09,097 STRESS MARKERS AND MICROBIAL 785 00:44:09,097 --> 00:44:12,000 TRANS LOCATION AND PERMEABILITY 786 00:44:12,000 --> 00:44:12,968 MARKERS. 787 00:44:12,968 --> 00:44:14,670 A LOT OF YOU HEARD ABOUT 788 00:44:14,670 --> 00:44:16,071 YESTERDAY IN THE ME/CFS 789 00:44:16,071 --> 00:44:17,105 LITERATURE SO WE'LL HAVE 790 00:44:17,105 --> 00:44:17,506 COMPARABLE DATA. 791 00:44:17,506 --> 00:44:19,608 SO RECRUITMENT. 792 00:44:19,608 --> 00:44:22,144 THIS HAS BEEN SUCH A BUGABOO. 793 00:44:22,144 --> 00:44:25,781 THAT'S A SCIENCE WORD. 794 00:44:25,781 --> 00:44:28,250 WE STARTED THE STUDY WITH THE 795 00:44:28,250 --> 00:44:29,318 FLORIDA DEPARTMENT OF HEALTH AND 796 00:44:29,318 --> 00:44:32,020 WHEN WE WENT TO PULL IT OFF 797 00:44:32,020 --> 00:44:33,689 LOGISTICALLY IT FELL APART. 798 00:44:33,689 --> 00:44:37,359 WE GET TO DO THAT PERFECT DESIGN 799 00:44:37,359 --> 00:44:39,461 WE HAD INTENDED. 800 00:44:39,461 --> 00:44:41,396 IT TURNED OUT TO BE A GOOD THING 801 00:44:41,396 --> 00:44:43,332 AS TIME EVOLVED NO ONE'S 802 00:44:43,332 --> 00:44:46,001 REPORTING RESULT TO THE PUBLIC 803 00:44:46,001 --> 00:44:47,369 HEALTH DEPARTMENT ANYMORE AND 804 00:44:47,369 --> 00:44:48,804 WOULD HAVE MISSED THE NEW YORK 805 00:44:48,804 --> 00:44:51,073 CASES AND WOULD HAVE ONLY BEEN 806 00:44:51,073 --> 00:44:52,541 ABLE TO GET INTO THE ONLY 2022 807 00:44:52,541 --> 00:44:53,675 AND BEFORE CASES BUT AT THE TIME 808 00:44:53,675 --> 00:45:00,215 IT WAS HEARTBREAKING. 809 00:45:00,215 --> 00:45:04,786 WE CAME UP WITH A PLAN AND 810 00:45:04,786 --> 00:45:05,620 ENGAGED THE LARGEST MENTAL 811 00:45:05,620 --> 00:45:07,756 HEALTH SYSTEMS IN THE COUNTIES 812 00:45:07,756 --> 00:45:08,657 AND ASKED THEM TO HELP US FIND 813 00:45:08,657 --> 00:45:12,761 THE STUDY SUBJECTS. 814 00:45:12,761 --> 00:45:15,130 I'LL BELABOR THIS BECAUSE WE 815 00:45:15,130 --> 00:45:17,399 DON'T HAVE DEMOGRAPHICALLY 816 00:45:17,399 --> 00:45:19,835 REPRESENTED DATA EXCEPT IN THE 817 00:45:19,835 --> 00:45:21,269 POPULATION-BASED STUDIES BY THE 818 00:45:21,269 --> 00:45:24,439 DEPAUL GROUP AND CDC IN THIS 819 00:45:24,439 --> 00:45:24,673 COUNTRY. 820 00:45:24,673 --> 00:45:28,310 WE HAVE LIMITED DEMOGRAPHICALLY 821 00:45:28,310 --> 00:45:28,877 REPRESENTATIVE DATA. 822 00:45:28,877 --> 00:45:34,716 AS YOU HEARD FROM OUR LIVED 823 00:45:34,716 --> 00:45:35,817 EXPERIENCE FOLKS. 824 00:45:35,817 --> 00:45:37,552 WE STARTED OFF WITH THIS IS 825 00:45:37,552 --> 00:45:38,019 GOING TO BE EASY. 826 00:45:38,019 --> 00:45:40,722 WE'LL MAKE A CONTRACT WITH THE 827 00:45:40,722 --> 00:45:40,989 HOSPITALS. 828 00:45:40,989 --> 00:45:46,661 THAT WAS HYSTERICAL. 829 00:45:46,661 --> 00:45:47,429 STOP ME RIGHT THERE. 830 00:45:47,429 --> 00:45:49,598 THEN THEY'LL GO OUT AND SEND 831 00:45:49,598 --> 00:45:51,066 E-MAILS TO ALL THESE PEOPLE AND 832 00:45:51,066 --> 00:45:52,901 PEOPLE WILL READ THEIR E-MAILS. 833 00:45:52,901 --> 00:45:54,903 THAT WAS REALLY HYSTERICAL. 834 00:45:54,903 --> 00:45:58,340 THAT WAS JUST A HYSTERICAL 835 00:45:58,340 --> 00:45:59,408 ASSUMPTION THEY'LL CLICK AND GET 836 00:45:59,408 --> 00:45:59,574 IN. 837 00:45:59,574 --> 00:46:03,078 IN THE END WE HAD TO KEEP ON AT 838 00:46:03,078 --> 00:46:05,847 IT UNTIL WE FOUND WAYS TO REACH 839 00:46:05,847 --> 00:46:07,082 PEOPLE. 840 00:46:07,082 --> 00:46:09,017 SO RECRUITING THROUGH THE LARGE 841 00:46:09,017 --> 00:46:11,353 HOSPITAL SYSTEMS, BAPTIST HEALTH 842 00:46:11,353 --> 00:46:17,959 IN MIAMI-DADE AND JACKSON AND 843 00:46:17,959 --> 00:46:25,901 BROWARD HEALTH IN Ft. LAUDERDALE 844 00:46:25,901 --> 00:46:27,869 AND WE HAVE APPOINTMENTS AND 845 00:46:27,869 --> 00:46:32,274 DR. PALACIO HAS A LARGE COVID 846 00:46:32,274 --> 00:46:34,709 CLINIC. 847 00:46:34,709 --> 00:46:43,785 WE WENT FROM THERE. 848 00:46:43,785 --> 00:46:46,521 667 PEOPLE WENT TO OUR SITE. 849 00:46:46,521 --> 00:46:48,056 THAT'S GREAT. 850 00:46:48,056 --> 00:46:49,157 200 READ SOMETHING THERE AND 851 00:46:49,157 --> 00:46:51,092 CLICKED THE CONSENT WHICH IS 852 00:46:51,092 --> 00:46:52,727 AMAZING BECAUSE MOST OF THOSE 853 00:46:52,727 --> 00:46:54,329 ACTUALLY STAYED IN THE STUDY. 854 00:46:54,329 --> 00:46:55,964 IF WE LOOK AT THE DEMOGRAPHICS 855 00:46:55,964 --> 00:46:57,532 THEY'RE FANTASTIC. 856 00:46:57,532 --> 00:47:00,368 JUST FANTASTIC. 857 00:47:00,368 --> 00:47:03,538 16% NON-HISPANIC BLACK. 858 00:47:03,538 --> 00:47:07,008 23% NON-HISPANIC WHITE AND THEN 859 00:47:07,008 --> 00:47:09,010 56% HISPANIC IS REALLY 860 00:47:09,010 --> 00:47:09,878 REPRESENTATIVE COHORT EXACTLY 861 00:47:09,878 --> 00:47:12,147 WHAT WE WERE TRYING TO ACHIEVE. 862 00:47:12,147 --> 00:47:12,514 WE'LL TAKE THAT. 863 00:47:12,514 --> 00:47:22,724 IT WAS HARD. 864 00:47:31,867 --> 00:47:34,302 STUDENTS HAD TO DO THE TEXT FROM 865 00:47:34,302 --> 00:47:38,507 BEHIND THE FIRE WALLS WHICH WAS 866 00:47:38,507 --> 00:47:39,641 CHALLENGING AND WE GOT ANOTHER 867 00:47:39,641 --> 00:47:42,577 BUMP IN RECRUITMENT. 868 00:47:42,577 --> 00:47:44,513 FIRST THE V.A. HEALTH SYSTEM 869 00:47:44,513 --> 00:47:47,148 WOULD NOT LET US E-MAIL OR TEXT. 870 00:47:47,148 --> 00:47:50,185 WE HAD TO TALK TO THE PATIENTS 871 00:47:50,185 --> 00:47:52,220 AND BECAUSE WE'RE PROVIDERS WE 872 00:47:52,220 --> 00:47:53,255 WERE ALLOWED TO AND REACHED OUT 873 00:47:53,255 --> 00:47:55,357 TO MORE THAN 1700 PEOPLE. 874 00:47:55,357 --> 00:47:59,027 THAT WAS OUR BEST RECRUITMENT. 875 00:47:59,027 --> 00:48:03,632 WE GOT MORE PEOPLE TO BE 876 00:48:03,632 --> 00:48:04,599 INCLINED. 877 00:48:04,599 --> 00:48:06,301 ADVOCACY GROUPS SENT E-MAILS 878 00:48:06,301 --> 00:48:07,502 THAT SAID IF YOU'RE IN THE 879 00:48:07,502 --> 00:48:08,336 HEALTH CARE SYSTEMS YOU'RELY 880 00:48:08,336 --> 00:48:09,404 ELIGIBLE FOR OUR STUDY. 881 00:48:09,404 --> 00:48:12,007 YOU SHOULD GO TO OUR SITE AND 882 00:48:12,007 --> 00:48:13,575 HAVE A QR CODE AND THAT HELPED. 883 00:48:13,575 --> 00:48:15,677 WE GOT ANOTHER BUMP FROM THAT. 884 00:48:15,677 --> 00:48:16,044 . 885 00:48:16,044 --> 00:48:18,613 THEN FINALLY, JUST IN THE LAST 886 00:48:18,613 --> 00:48:24,352 MONTH, WE WENT TO TWO HUGE 887 00:48:24,352 --> 00:48:26,788 EMPLOYERS NOVA AND UNIVERSITY OF 888 00:48:26,788 --> 00:48:27,055 MIAMI. 889 00:48:27,055 --> 00:48:30,125 THEY'RE NOT PEOPLE WHO WERE 890 00:48:30,125 --> 00:48:31,126 NECESSARILY COVID POSITIVE. 891 00:48:31,126 --> 00:48:33,828 THAT WOULD BE EVERYBODY. 892 00:48:33,828 --> 00:48:38,099 55,000 PEOPLE RECEIVED AN E-MAIL 893 00:48:38,099 --> 00:48:42,037 AND NOT THAT MANY CLICKS. 894 00:48:42,037 --> 00:48:44,839 BUT THE PEOPLE THAT CLICKED WERE 895 00:48:44,839 --> 00:48:46,474 A BETTER RATE OF ENROLLMENT. 896 00:48:46,474 --> 00:48:47,442 SO IT'S BEEN INTERESTING. 897 00:48:47,442 --> 00:48:48,543 IT'S BEEN A CHALLENGE. 898 00:48:48,543 --> 00:48:50,211 THE STUDY ITSELF ALSO HAD TO 899 00:48:50,211 --> 00:48:52,647 CHANGE OVER TIME TO ACKNOWLEDGE 900 00:48:52,647 --> 00:48:54,583 THE CHANGING KNOWLEDGE OF WHAT 901 00:48:54,583 --> 00:48:55,483 IT MEANT TO HAVE COVID. 902 00:48:55,483 --> 00:48:58,720 SO WE DESIGN A STUDY THREE YEARS 903 00:48:58,720 --> 00:49:00,589 AGO WE WERE TRYING TO CATCH 904 00:49:00,589 --> 00:49:02,958 PEOPLE WITHIN FIRST SIX MONTHS 905 00:49:02,958 --> 00:49:03,925 OF POST-INFECTION. 906 00:49:03,925 --> 00:49:05,827 THAT WAS A GREAT CONCEPT BUT 907 00:49:05,827 --> 00:49:07,996 WHEN WE ACTIVATED THE STUDY IT 908 00:49:07,996 --> 00:49:10,298 WAS AT THE BEGINNING OF OMICRON 909 00:49:10,298 --> 00:49:13,602 AND WE WERE GOING TO MISS ALL 910 00:49:13,602 --> 00:49:14,569 THE INFORMATION AND IMPORTANT 911 00:49:14,569 --> 00:49:18,139 INFORMATION THAT WOULD MAKE OUR 912 00:49:18,139 --> 00:49:20,308 STUDY GENERALIZABLE FROM EARLY 913 00:49:20,308 --> 00:49:20,542 COHORTS. 914 00:49:20,542 --> 00:49:22,711 HALF OUR COHORTS WAS ENROLLED 915 00:49:22,711 --> 00:49:25,380 WITHIN SIX MONTHS OF ILLNESS AND 916 00:49:25,380 --> 00:49:27,682 ROUGHLY HALF AT THIS POINT IS 917 00:49:27,682 --> 00:49:30,986 BASICALLY ALL COMERS THAT HAVE 918 00:49:30,986 --> 00:49:32,787 LONG COVID OR RECOVERED. 919 00:49:32,787 --> 00:49:35,790 THERE WAS A SERIES OF BUMPS IN 920 00:49:35,790 --> 00:49:39,060 OUR RECRUITMENT AS WE CHANGED 921 00:49:39,060 --> 00:49:40,061 THE CRITERIA. 922 00:49:40,061 --> 00:49:45,000 AGAIN, I'M EXCEEDINGLY PROUD OF 923 00:49:45,000 --> 00:49:48,803 HOW THIS COHORT REPRESENTS AGES, 924 00:49:48,803 --> 00:49:57,579 SEXES AND RACES. 925 00:49:57,579 --> 00:49:58,747 IT'S AN EXCELLENT REPRESENTATION 926 00:49:58,747 --> 00:50:01,383 OF OUR COMMUNITY. 927 00:50:01,383 --> 00:50:02,350 THAT'S FANTASTIC. 928 00:50:02,350 --> 00:50:06,254 THE SYMPTOMS AND WE HAD A 929 00:50:06,254 --> 00:50:07,389 BROADER FATIGUE PLUS 1 SYSTEM 930 00:50:07,389 --> 00:50:11,226 CRITERIA VERSUS AN EXPERT GROUP 931 00:50:11,226 --> 00:50:15,397 OF ME/CFS DOCTORS THINKING YOU 932 00:50:15,397 --> 00:50:17,165 HAVE THIS DISEASE. 933 00:50:17,165 --> 00:50:19,901 ON THE MCAM COHORT LOOK 934 00:50:19,901 --> 00:50:20,802 CIRCUMSTANCE AND MORE 935 00:50:20,802 --> 00:50:22,737 SYMPTOMATIC THAN OUR COHORT 936 00:50:22,737 --> 00:50:23,571 WHICH IS BROADER. 937 00:50:23,571 --> 00:50:26,675 AGAIN, YOU'LL SEE FATIGUE IS THE 938 00:50:26,675 --> 00:50:28,743 MOST COMMON AND POST-EXERTIONAL 939 00:50:28,743 --> 00:50:32,847 FATIGUE IS EXCEEDINGLY COMMON IN 940 00:50:32,847 --> 00:50:34,749 THE COVID GROUP AS WELL THE 941 00:50:34,749 --> 00:50:45,193 OTHER SYMPTOMS OF ME/CFS. 942 00:50:49,164 --> 00:50:51,566 THIS IS ALSO TRUE IN THE 943 00:50:51,566 --> 00:50:54,335 SELF-REPORT OF COGNITIVE 944 00:50:54,335 --> 00:50:55,737 FUNCTIONING AND THEIR PROMISE 29 945 00:50:55,737 --> 00:50:58,773 WHICH IS LIKE THE SF36 SCORE OF 946 00:50:58,773 --> 00:51:01,843 FUNCTION. 947 00:51:01,843 --> 00:51:06,247 BOTH SOCIAL AND PHYSICAL. 948 00:51:06,247 --> 00:51:08,550 WHEN YOU TRY TO COMPARE SOME OF 949 00:51:08,550 --> 00:51:10,819 THIS TO THE MCAM STUDY AND WE'RE 950 00:51:10,819 --> 00:51:12,387 HALFWAY THROUGH OUR RECRUITMENT 951 00:51:12,387 --> 00:51:15,090 BUT YOU CAN SEE THIS IS COMPARED 952 00:51:15,090 --> 00:51:20,628 TO THE PUBLISHED MCAM DATA THAT 953 00:51:20,628 --> 00:51:22,564 THE COVID RECOVERED IS THE 954 00:51:22,564 --> 00:51:24,132 HEALTHY GROUP IS THE BOTTOM LINE 955 00:51:24,132 --> 00:51:25,800 THERE AND COVID UP IS THE MIDDLE 956 00:51:25,800 --> 00:51:27,869 LINE AND THEN THE WHITE LINE IS 957 00:51:27,869 --> 00:51:29,304 THE MCAM COHORT. 958 00:51:29,304 --> 00:51:34,075 YOU CAN SEE THE PHYSICAL 959 00:51:34,075 --> 00:51:37,579 FUNCTIONING SCORE ON BETWEEN THE 960 00:51:37,579 --> 00:51:39,481 UNRECOVERED COVID PATIENTS AND 961 00:51:39,481 --> 00:51:41,549 THE MCAM PATIENTS IS PRETTY 962 00:51:41,549 --> 00:51:41,983 CLOSE. 963 00:51:41,983 --> 00:51:44,219 THERE WASN'T A GOOD COGNITIVE 964 00:51:44,219 --> 00:51:48,323 DATA SET TO COMPARE IN THE MCAM. 965 00:51:48,323 --> 00:51:50,725 WE DIDN'T SEUSS THE SAME 966 00:51:50,725 --> 00:51:54,963 ASSESSMENT TOOL BUT THE SOCIAL 967 00:51:54,963 --> 00:51:59,701 PARTICIPATION ON THE PREMISE 29 968 00:51:59,701 --> 00:52:03,872 COMPARISON THE MCAM IS A LITTLE 969 00:52:03,872 --> 00:52:04,205 WORSE. 970 00:52:04,205 --> 00:52:06,541 AND SOME OF THIS ISN'T READY FOR 971 00:52:06,541 --> 00:52:10,345 PUBLICATION BUT I KNOW YOU GUYS 972 00:52:10,345 --> 00:52:15,316 WANTED TO HEAR SOMETHING AND THE 973 00:52:15,316 --> 00:52:17,619 DIASTOLIC DYSFUNCTION AND IT'S 974 00:52:17,619 --> 00:52:19,087 NOT WELL PUBLISHED. 975 00:52:19,087 --> 00:52:21,289 IT'S IN A COUPLE PAPERS BUT YOU 976 00:52:21,289 --> 00:52:24,025 DON'T SEE IT AS SOMETHING WE 977 00:52:24,025 --> 00:52:29,330 TALK A LOT ABOUT BUT WHEN THE 978 00:52:29,330 --> 00:52:31,065 AFTERNOON GROUP WAS TALKING 979 00:52:31,065 --> 00:52:34,803 ABOUT HYPOXIA AND PRE-LOAD 980 00:52:34,803 --> 00:52:37,205 FAILURE, DIASTOLIC DYSFUNCTION 981 00:52:37,205 --> 00:52:42,744 IS HAPPENING IN THE ATRIUM WHEN 982 00:52:42,744 --> 00:52:45,079 IT'S FILLING SO MAY OR MAY NOT 983 00:52:45,079 --> 00:52:47,582 BE EXACTLY PERFECT FOR PRE-LOAD 984 00:52:47,582 --> 00:52:50,051 FAILURE AND BASICALLY SHOWING IN 985 00:52:50,051 --> 00:52:51,653 THE UNRECOVERED GROUP ALMOST 986 00:52:51,653 --> 00:52:56,558 HALF OF THE SUBJECTS THAT HAVE 987 00:52:56,558 --> 00:53:01,196 GOTTEN THEIR ECO DATA HAVE 988 00:53:01,196 --> 00:53:02,330 DIASTOLIC DYSFUNCTION AND IT'S 989 00:53:02,330 --> 00:53:04,332 AN INTERESTING MARKER AND SPEAKS 990 00:53:04,332 --> 00:53:07,168 TO A COMMONALITY BETWEEN LONG 991 00:53:07,168 --> 00:53:14,242 COVID AND ME/CFS. 992 00:53:14,242 --> 00:53:17,612 AND THE STUDY IS ONE YOU CAN DO 993 00:53:17,612 --> 00:53:19,414 IN THE CLINIC AND HAVE PEOPLE 994 00:53:19,414 --> 00:53:20,982 LEAN AGAINST THE WALL AND DO 995 00:53:20,982 --> 00:53:28,623 BLOOD PRESSURE AND PULSE FOR 10 996 00:53:28,623 --> 00:53:30,692 MINUTES AND TRY TO USE THIS IN 997 00:53:30,692 --> 00:53:32,260 OUR STUDIES AND HAVE THE DATA IN 998 00:53:32,260 --> 00:53:35,597 THE MCAM STUDY. 999 00:53:35,597 --> 00:53:37,899 YOU SEE 20 OF THE PATIENTS OF 21 1000 00:53:37,899 --> 00:53:40,802 PHENOTYPING PATIENTS HAVE A 1001 00:53:40,802 --> 00:53:42,136 POSITIVE BUT YOU ALSO SEE A 1002 00:53:42,136 --> 00:53:43,004 FAIRLY HIGH NUMBER IN THE 1003 00:53:43,004 --> 00:53:44,772 RECOVER GROUP. 1004 00:53:44,772 --> 00:53:47,909 THE TEST IS NOT THAT GREAT A 1005 00:53:47,909 --> 00:53:48,376 DISCRIMINATOR. 1006 00:53:48,376 --> 00:53:53,581 THE TILT TABLE SAY BETTER 1007 00:53:53,581 --> 00:54:04,125 MEASURE FOR DYSOMONIA AND I DID 1008 00:54:05,627 --> 00:54:16,104 IT FOR THE PULSE OF 20 AND IF I 1009 00:54:22,343 --> 00:54:27,982 USED 20 I PICKED MORE UP IN THE 1010 00:54:27,982 --> 00:54:36,925 RECOVERED GROUP. 1011 00:54:36,925 --> 00:54:39,060 NEXT WAS AN ANALYSIS TO SEE IF 1012 00:54:39,060 --> 00:54:41,162 WE CAN CLUSTER THE POSTCOVID 1013 00:54:41,162 --> 00:54:42,597 UNRECOVERED PEOPLE INTO CLASSES. 1014 00:54:42,597 --> 00:54:44,032 THIS IS DONE A TRADITIONAL WAY 1015 00:54:44,032 --> 00:54:48,069 WITH THE LATENT CLASSIFICATION 1016 00:54:48,069 --> 00:54:48,369 STRATEGY. 1017 00:54:48,369 --> 00:54:51,906 WE LOOKED AT THESE PROSPECTIVES 1018 00:54:51,906 --> 00:54:54,709 FROM THE LONGITUDINAL COHORTS 1019 00:54:54,709 --> 00:54:55,376 BASELINE ASSESSMENT AND LOOKED 1020 00:54:55,376 --> 00:54:57,545 AT SOCIAL DETERMINATES OF HEALTH 1021 00:54:57,545 --> 00:55:02,917 AND VARIOUS SYMPTOMS AND THE 1022 00:55:02,917 --> 00:55:03,918 DEMOGRAPHICS THEN COMORBIDITIES 1023 00:55:03,918 --> 00:55:07,088 AND TRIED TO BREAK IT OUT AND 1024 00:55:07,088 --> 00:55:11,192 THE METHOD AND THIS IS THE 1025 00:55:11,192 --> 00:55:16,397 ANALYSIS FRESH OFF THE PRESS AND 1026 00:55:16,397 --> 00:55:22,070 INTERIM AND LOOK AT STATISTICS 1027 00:55:22,070 --> 00:55:29,577 AND DO THE BIVARIANT LABEL AND 1028 00:55:29,577 --> 00:55:32,613 SUMMARY STATISTICS SHOWS NO REAL 1029 00:55:32,613 --> 00:55:36,551 DIFFERENCE FROM RECOVERED AND 1030 00:55:36,551 --> 00:55:38,086 UNRECOVERED IN DEMOGRAPHICS 1031 00:55:38,086 --> 00:55:38,920 EXCEPT COMORBIDITY. 1032 00:55:38,920 --> 00:55:41,289 THAT'S NOT A SURPRISE. 1033 00:55:41,289 --> 00:55:43,825 WHEN YOU GO INTO THE 1034 00:55:43,825 --> 00:55:44,726 MULTI-VARIANT YOU'LL SEE THE 1035 00:55:44,726 --> 00:55:51,833 SYMPTOMS ARE WORSE IN THE 1036 00:55:51,833 --> 00:55:54,702 UNRECOVERED VERSUS RECOVERED 1037 00:55:54,702 --> 00:55:57,572 WITH THE EXCEPTION OF ANXIETY 1038 00:55:57,572 --> 00:56:00,508 AND THE FINANCIAL HARDSHIP AND 1039 00:56:00,508 --> 00:56:01,976 FOOD INSECURE WAS WELL BALANCED 1040 00:56:01,976 --> 00:56:05,146 BETWEEN THE CONTROL GROUP AND 1041 00:56:05,146 --> 00:56:05,880 THE SICK GROUP. 1042 00:56:05,880 --> 00:56:09,717 SO WE DIDN'T PICK UP IN A 1043 00:56:09,717 --> 00:56:11,452 MULTIVARIABLE REGRESSION A 1044 00:56:11,452 --> 00:56:12,420 DIFFERENCE IN SOCIAL 1045 00:56:12,420 --> 00:56:13,221 DETERMINATES OF HEALTH. 1046 00:56:13,221 --> 00:56:15,623 HOWEVER, WHEN WE DO THE LATENT 1047 00:56:15,623 --> 00:56:17,358 PROFILE ANALYSIS AND CLUSTER 1048 00:56:17,358 --> 00:56:18,993 INTO THREE GROUPS YOU'LL SEE 1049 00:56:18,993 --> 00:56:21,929 THERE'S A HEALTHY MODERATE AND 1050 00:56:21,929 --> 00:56:23,097 SICKEST GROUP AND THIS BREAK 1051 00:56:23,097 --> 00:56:26,067 DOWN AND HERE YOU START SEEING 1052 00:56:26,067 --> 00:56:28,736 SOME DEMOGRAPHIC DIFFERENCES AND 1053 00:56:28,736 --> 00:56:31,072 THE SOCIAL DETERMINATES OF 1054 00:56:31,072 --> 00:56:32,173 HEALTH BEING A FACTOR IN THE WAY 1055 00:56:32,173 --> 00:56:33,775 THESE THINGS CLUSTERED. 1056 00:56:33,775 --> 00:56:37,612 SO THE SICKEST GROUP WAS 1057 00:56:37,612 --> 00:56:41,282 HISPANIC MALE AND FINANCIALLY 1058 00:56:41,282 --> 00:56:45,019 INSECURE AND OLDER. 1059 00:56:45,019 --> 00:56:51,492 THE OLDER GROUP WAS PROMINENTLY 1060 00:56:51,492 --> 00:56:54,162 FEMALE AND THE IN THE SOUTH 1061 00:56:54,162 --> 00:56:55,096 FLORIDA COHORT AND HISPANIC 1062 00:56:55,096 --> 00:56:58,032 FEMALE OLDER MIDDLE AGE. 1063 00:56:58,032 --> 00:57:02,170 FOOD INSECURE AND THE HEALTHIEST 1064 00:57:02,170 --> 00:57:04,138 GROUP WAS THE NON-HISPANIC 1065 00:57:04,138 --> 00:57:06,240 WHITES AND YOUNGER AND ALSO HAVE 1066 00:57:06,240 --> 00:57:10,745 FOOD INSECURITY AND THE 1067 00:57:10,745 --> 00:57:21,389 COMORBIDITIES VARIED BY AMOUNT. 1068 00:57:24,192 --> 00:57:26,494 AND STRUGGLED ON RECRUITMENT 1069 00:57:26,494 --> 00:57:29,197 CAUSED A SPINOFF OF QUALITATIVE 1070 00:57:29,197 --> 00:57:29,597 STUDY. 1071 00:57:29,597 --> 00:57:37,638 THIS IS DR. PALACIO'S BABY AND 1072 00:57:37,638 --> 00:57:40,675 WITH THE CDC INVESTIGATORS AND 1073 00:57:40,675 --> 00:57:44,812 BASICALLY WAS A QUALITATIVE 1074 00:57:44,812 --> 00:57:46,180 STUDY WHERE YOU INTERVIEWED 1075 00:57:46,180 --> 00:57:48,149 PATIENTS THAT DECLINED TO BE IN 1076 00:57:48,149 --> 00:57:50,485 OUR STUDY AND ASKED THEM 1077 00:57:50,485 --> 00:57:51,519 QUESTIONS ABOUT WHAT WOULD HAVE 1078 00:57:51,519 --> 00:57:54,422 MADE THAT MORE LIKELY AND WHY 1079 00:57:54,422 --> 00:57:57,191 DID THEY DECLINE. 1080 00:57:57,191 --> 00:57:59,861 YOU'LL SEE THE BARRIERS THE 1081 00:57:59,861 --> 00:58:02,430 BIGGEST BARRIERS WERE LONG COVID 1082 00:58:02,430 --> 00:58:03,965 PERCEPTIONS, PATIENT'S OWN 1083 00:58:03,965 --> 00:58:07,702 UNDERSTANDING OF WHAT LONG COVID 1084 00:58:07,702 --> 00:58:11,372 IS AND THEIR OWN WILLINGNESS TO 1085 00:58:11,372 --> 00:58:13,608 EMBRACE THAT MIGHT BE THEIR 1086 00:58:13,608 --> 00:58:15,543 ILLNESS AND THEN UNCERTAINLY 1087 00:58:15,543 --> 00:58:17,011 ABOUT THE INSTITUTIONS OF 1088 00:58:17,011 --> 00:58:21,015 SKEPTICISM ABOUT WHETHER OR NOT 1089 00:58:21,015 --> 00:58:22,550 THEY COULD TRUST US AND THEIR 1090 00:58:22,550 --> 00:58:25,920 OWN PERSONAL PRIORITIES. 1091 00:58:25,920 --> 00:58:27,088 THEY INFORMED US ABOUT MESSAGING 1092 00:58:27,088 --> 00:58:28,723 AND WE CHANGED OUR MESSAGING 1093 00:58:28,723 --> 00:58:32,560 BASED ON THIS AND THE IACFS 1094 00:58:32,560 --> 00:58:34,095 WORKSHOP WE DID LAST SUMMER 1095 00:58:34,095 --> 00:58:36,964 WHERE WE HAD FEEDBACK FROM 1096 00:58:36,964 --> 00:58:37,899 ME/CFS PEOPLE WHAT WOULD HAVE 1097 00:58:37,899 --> 00:58:39,433 BROUGHT THEM IN IF WE CHANGE THE 1098 00:58:39,433 --> 00:58:47,074 WAY WE WERE REACHING OUT AND SO 1099 00:58:47,074 --> 00:58:48,809 THERE WAS QUITE A BIT OF LESSONS 1100 00:58:48,809 --> 00:58:52,713 LEARNED IN THE QUALITATIVE STUDY 1101 00:58:52,713 --> 00:58:54,248 THAT WAS HELPFUL AND YOU SEE THE 1102 00:58:54,248 --> 00:58:57,818 SKEPTICISM AND UNDERSTANDING OF 1103 00:58:57,818 --> 00:59:00,087 THE ILLNESS AND DISTRUST BEING A 1104 00:59:00,087 --> 00:59:01,088 REASON WHY THEY DIDN'T 1105 00:59:01,088 --> 00:59:03,524 PARTICIPATE AND THE PATIENTS WHO 1106 00:59:03,524 --> 00:59:04,659 SAID THEY'D PARTICIPATED THE 1107 00:59:04,659 --> 00:59:06,327 THING THAT BROUGHT THEM IN THE 1108 00:59:06,327 --> 00:59:07,862 BEST WAS IF THEIR OWN DOCTOR 1109 00:59:07,862 --> 00:59:09,730 ASKED THEM OR SOMEBODY THEY KNEW 1110 00:59:09,730 --> 00:59:10,865 ASKED THEM TO BE IN SO THAT 1111 00:59:10,865 --> 00:59:12,066 BUSINESS OF BEING ABLE TO CLICK 1112 00:59:12,066 --> 00:59:15,203 AN E-MAIL FROM A STRANGER VERSUS 1113 00:59:15,203 --> 00:59:17,004 HAVING SOMEONE YOU KNEW. 1114 00:59:17,004 --> 00:59:20,608 WE SENT THE E-MAIL IN MY 1115 00:59:20,608 --> 00:59:25,346 UNIVERSITY FIRST FROM THE DEAN 1116 00:59:25,346 --> 00:59:29,016 OF RESEARCH AND THE SECOND ONE 1117 00:59:29,016 --> 00:59:33,454 FROM ME, MY NAME WAS THERE AND I 1118 00:59:33,454 --> 00:59:34,855 GOT 450 OUT OF OFFICE MESSAGES 1119 00:59:34,855 --> 00:59:39,060 IN LESS THAN FIVE MINUTES. 1120 00:59:39,060 --> 00:59:40,728 THAT WAS FUN. 1121 00:59:40,728 --> 00:59:43,364 WE HAD FAR MORE PEOPLE OPEN ON 1122 00:59:43,364 --> 00:59:44,832 THE E-MAIL BECAUSE I'D BEEN 1123 00:59:44,832 --> 00:59:46,033 AROUND THE UNIVERSITY LONGER AND 1124 00:59:46,033 --> 00:59:50,471 KNOW WHO I AM AND I TALK A LOT. 1125 00:59:50,471 --> 00:59:52,073 CONCLUSIONS, THE CLINICAL 1126 00:59:52,073 --> 00:59:54,375 PRESENTATION OF LONG COVID AND 1127 00:59:54,375 --> 00:59:56,744 ME/CFS IS SIMILAR. 1128 00:59:56,744 --> 00:59:58,679 EFFORTS TO REPRESENT THE COHORT 1129 00:59:58,679 --> 01:00:00,114 HAS BEEN SUCCESSFUL WHICH IS 1130 01:00:00,114 --> 01:00:01,549 EXCITING IF SLOW. 1131 01:00:01,549 --> 01:00:02,783 WE'VE LEARNED A LOT AS WE'VE 1132 01:00:02,783 --> 01:00:03,284 WENT ALONG. 1133 01:00:03,284 --> 01:00:05,453 SO FAR WE'VE SEEN NO DIFFERENCES 1134 01:00:05,453 --> 01:00:08,756 IN GENERAL BETWEEN AGE, SEX AND 1135 01:00:08,756 --> 01:00:11,058 RACE BY SYMPTOMS BUT THE LATENT 1136 01:00:11,058 --> 01:00:13,294 CLASS ANALYSIS ALLOWED US TO SEE 1137 01:00:13,294 --> 01:00:15,062 THERE ARE GROUPINGS AND THERE'S 1138 01:00:15,062 --> 01:00:18,733 CONCERN THE HISPANIC MEN AND 1139 01:00:18,733 --> 01:00:21,769 WOMEN ARE GROUPING INTO THE MORE 1140 01:00:21,769 --> 01:00:24,972 SEVERE ILL GROUP AND FOOD AND 1141 01:00:24,972 --> 01:00:27,341 HOUSING INSECURITY WEIGHT IN THE 1142 01:00:27,341 --> 01:00:28,743 PREDICTORS OF SEVERITY. 1143 01:00:28,743 --> 01:00:31,112 THE PHENOTYPING STUDY IS 1144 01:00:31,112 --> 01:00:33,914 UNDERWAY AND GOING WELL AND 1145 01:00:33,914 --> 01:00:34,849 IDENTIFIED DYSFUNCTION AS A 1146 01:00:34,849 --> 01:00:35,116 CONCERN. 1147 01:00:35,116 --> 01:00:36,217 THIS WILL CONTINUE. 1148 01:00:36,217 --> 01:00:37,652 WE HAVE QUITE A BIT MORE DATA TO 1149 01:00:37,652 --> 01:00:41,389 GO IN THE STUDY. 1150 01:00:41,389 --> 01:00:44,258 AND MAYBE A LITTLE BIT MORE AND 1151 01:00:44,258 --> 01:00:45,960 THE QUALITATIVE STUDIES WERE 1152 01:00:45,960 --> 01:00:47,094 HELPFUL AND HELPED US DEVELOP 1153 01:00:47,094 --> 01:00:49,764 MORE EFFECTIVE TOOLS AND FINALLY 1154 01:00:49,764 --> 01:00:52,767 THE STUDY WILL KEEP ON GOING AND 1155 01:00:52,767 --> 01:00:55,102 WE'LL GET IT DONE, BY GOSH. 1156 01:00:55,102 --> 01:01:04,645 THANK YOU VERY MUCH. 1157 01:01:04,645 --> 01:01:15,189 >> WE HAVE TIME FOR ONE OR TWO 1158 01:01:16,257 --> 01:01:16,457 QUESTION. 1159 01:01:16,457 --> 01:01:23,764 >> AND I'M CURIOUS IF THE STUDY 1160 01:01:23,764 --> 01:01:32,940 YOU'VE BEEN ABLE TO INCLUDE 1161 01:01:32,940 --> 01:01:35,543 BILIRUBIN OR BODY TEMPERATURE. 1162 01:01:35,543 --> 01:01:40,648 >> THERE WAS A STUDY WE PROPOSED 1163 01:01:40,648 --> 01:01:43,217 YEARS AGO AND WE CAN EVOLVE THE 1164 01:01:43,217 --> 01:01:45,152 STUDY AND CHANGE THE PLATFORM AS 1165 01:01:45,152 --> 01:01:46,754 LONG AS WE CAN AFFORD TO DO IT 1166 01:01:46,754 --> 01:01:49,523 WITHIN OUR BUDGET. 1167 01:01:49,523 --> 01:01:52,193 WE HAVE OUR STORIED SAMPLES THAT 1168 01:01:52,193 --> 01:01:53,861 ARE EXTREMELY WELL CARED FOR AND 1169 01:01:53,861 --> 01:01:55,930 STORED IN A WAY WE CAN DO THAT 1170 01:01:55,930 --> 01:01:59,033 TYPE OF THING IN BACHZ AT THE 1171 01:01:59,033 --> 01:01:59,300 END. 1172 01:01:59,300 --> 01:02:00,935 I'D LOVE TO HEAR. 1173 01:02:00,935 --> 01:02:02,370 WE CAN TALK ABOUT WHAT'S 1174 01:02:02,370 --> 01:02:03,938 IMPORTANT AND KNOW WHAT IT IS 1175 01:02:03,938 --> 01:02:05,840 BUT I ALSO KNOW THE OXIDATIVE 1176 01:02:05,840 --> 01:02:07,041 STRESS MARKERS SHOULD BE 1177 01:02:07,041 --> 01:02:08,109 INCLUDED AND WE HAVE A COLLEAGUE 1178 01:02:08,109 --> 01:02:10,010 IN OUR GROUP THAT IS AN EXPERT 1179 01:02:10,010 --> 01:02:10,911 IN THAT THAT. 1180 01:02:10,911 --> 01:02:13,180 I THINK WE'LL BE ENGAGING HIM. 1181 01:02:13,180 --> 01:02:17,551 >> AND DO YOU KNOW IF THE 1182 01:02:17,551 --> 01:02:22,990 SAMPLES INCLUDE VENUS AND 1183 01:02:22,990 --> 01:02:23,357 ARTERIAL BLOOD. 1184 01:02:23,357 --> 01:02:27,027 >> THERE'S AN ECHO ON THE 1185 01:02:27,027 --> 01:02:27,261 STABLE. 1186 01:02:27,261 --> 01:02:27,595 I'M SORRY. 1187 01:02:27,595 --> 01:02:30,030 WE DO NOT HAVE ARTERIAL BLOOD 1188 01:02:30,030 --> 01:02:30,264 SAMPLE. 1189 01:02:30,264 --> 01:02:31,098 I'M SORRY. 1190 01:02:31,098 --> 01:02:34,769 THAT WOULD HAVE KILLED 1191 01:02:34,769 --> 01:02:44,979 RECRUITMENT. 1192 01:02:45,346 --> 01:02:50,785 >> OUR NEXT SPEAKER IS PROFESSOR 1193 01:02:50,785 --> 01:02:53,821 MAUREEN HANSON FROM CORNELL 1194 01:02:53,821 --> 01:02:55,089 UNIVERSITY AND PRESENT ON ME/CFS 1195 01:02:55,089 --> 01:02:57,191 AND LONG COVID SIMILARITIES AND 1196 01:02:57,191 --> 01:02:58,759 DIFFERENCES. 1197 01:02:58,759 --> 01:03:08,903 MAUREEN. 1198 01:03:12,673 --> 01:03:13,474 >> THANKS. 1199 01:03:13,474 --> 01:03:17,578 SO I'M GOING TO GIVE A BIT OF A 1200 01:03:17,578 --> 01:03:19,380 DIFFERENT TALK AND IT'S 1201 01:03:19,380 --> 01:03:20,848 DIFFERENT THAN MY USUAL KIND OF 1202 01:03:20,848 --> 01:03:21,048 TALK. 1203 01:03:21,048 --> 01:03:24,418 I'LL HAVE LESS DATA TO SHOW YOU 1204 01:03:24,418 --> 01:03:25,953 AND WANT TO GIVE HISTORICAL 1205 01:03:25,953 --> 01:03:28,789 BACKGROUND I THINK IS QUITE 1206 01:03:28,789 --> 01:03:31,392 RELEVANT ESPECIALLY IN THE DAYS 1207 01:03:31,392 --> 01:03:32,927 OF COVID. 1208 01:03:32,927 --> 01:03:37,031 SO WHAT ARE SOME MAJOR 1209 01:03:37,031 --> 01:03:39,500 SIMILARITIES OF ME/CFS AND LONG 1210 01:03:39,500 --> 01:03:39,767 COVID? 1211 01:03:39,767 --> 01:03:41,168 BOTH ARE CAUSED BY VIRUSES. 1212 01:03:41,168 --> 01:03:44,004 NOT EVERYBODY WILL BELIEVE ME 1213 01:03:44,004 --> 01:03:44,939 BUT I BELIEVE THEY'RE BOTH 1214 01:03:44,939 --> 01:03:46,073 CAUSED BY VIRUSES. 1215 01:03:46,073 --> 01:03:48,809 AND THE VIRUSS INSIDE THEM CAN 1216 01:03:48,809 --> 01:03:52,379 CAUSE OUTBREAKS AND PANDEMICS 1217 01:03:52,379 --> 01:03:56,484 AND THE PRE-2020 OUTBREAKS WERE 1218 01:03:56,484 --> 01:04:02,857 LIKELY CAUSED BY ENTEROVIRUSES 1219 01:04:02,857 --> 01:04:04,425 AND POLIO CAUSED AN EPIDEMIC IN 1220 01:04:04,425 --> 01:04:08,362 THE PAST AND SARS COV2 IS A PLUS 1221 01:04:08,362 --> 01:04:09,563 STRAND RNA VIRUS. 1222 01:04:09,563 --> 01:04:12,867 A LOT OF PEOPLE ARE UNAWARE OF 1223 01:04:12,867 --> 01:04:17,271 HOW MUCH EVIDENCE THERE IS THAT 1224 01:04:17,271 --> 01:04:19,507 ENTEROVIRUS CAUSED PAST 1225 01:04:19,507 --> 01:04:22,076 OUTBREAKS OF ME/CFS. 1226 01:04:22,076 --> 01:04:26,714 THESE FOUR BOOKS HERE THAT I'M 1227 01:04:26,714 --> 01:04:31,085 SHOWING ON THE EDGES DOCUMENT 1228 01:04:31,085 --> 01:04:39,093 THE ENTERO INVOLVEMENT OF 1229 01:04:39,093 --> 01:04:42,730 ME/CFS AND YOU CAN'T READ THEM 1230 01:04:42,730 --> 01:04:46,066 WITHOUT THINKING THEY CAUSED IT 1231 01:04:46,066 --> 01:04:51,539 HIT AN OSLER'S WEB MEASURED THE 1232 01:04:51,539 --> 01:04:53,407 OUTBREAKS AND I'M SHOWING A LIST 1233 01:04:53,407 --> 01:04:58,779 OF THE MANY OUTBREAKS DOCUMENT 1234 01:05:08,322 --> 01:05:08,522 ED. 1235 01:05:08,522 --> 01:05:10,324 ONE TIME I WAS AT A CONFERENCE 1236 01:05:10,324 --> 01:05:12,459 AND HAD A PATIENT SAY I GOT 1237 01:05:12,459 --> 01:05:15,462 ME/CFS ON A SCHOOL TRIP TO CHINA 1238 01:05:15,462 --> 01:05:19,099 IN THE MID-80s AND A LOT OF OUR 1239 01:05:19,099 --> 01:05:20,234 GROUP BECAME ILL. 1240 01:05:20,234 --> 01:05:22,903 WE SAW A CHINESE DOCTOR WHO 1241 01:05:22,903 --> 01:05:24,305 IMMEDIATELY DIAGNOSED US BECAUSE 1242 01:05:24,305 --> 01:05:29,710 THEY WERE HAVING AN OUTBREAK OF 1243 01:05:29,710 --> 01:05:33,147 ME/CFS IN THE TOWN. 1244 01:05:33,147 --> 01:05:34,715 INCIDENTALLY IF THAT PERSON IS 1245 01:05:34,715 --> 01:05:35,983 LISTENING, I'D LIKE TO YOU GET 1246 01:05:35,983 --> 01:05:37,585 IN TOUCH WITH ME. 1247 01:05:37,585 --> 01:05:38,752 A NUMBER OF THE OUTBREAKS 1248 01:05:38,752 --> 01:05:40,554 OCCURRED AT THE SAME TIME OF 1249 01:05:40,554 --> 01:05:41,822 POLIO OUTBREAKS. 1250 01:05:41,822 --> 01:05:44,058 THE 1934 OUTBREAK IN A LOS 1251 01:05:44,058 --> 01:05:45,392 ANGELES HOSPITAL AND 1946 1252 01:05:45,392 --> 01:05:48,929 ICELAND OUTBREAK AND 1949 1253 01:05:48,929 --> 01:05:51,832 AUSTRALIAN OUTBREAK. 1254 01:05:51,832 --> 01:05:56,337 THE FIRST POLIO VACCINE BECAME 1255 01:05:56,337 --> 01:06:01,842 AWARE IN 1964 BUT THE POLIO 1256 01:06:01,842 --> 01:06:04,812 VIRUS WAS STILL CIRCULATING AND 1257 01:06:04,812 --> 01:06:07,848 SOME REMEMBER GETTING A SHUG 1258 01:06:07,848 --> 01:06:10,818 CUBE WITH A PINK DOT ON IT THAT 1259 01:06:10,818 --> 01:06:13,087 WAS THE ORAL VACCINE. 1260 01:06:13,087 --> 01:06:16,690 POLIO WAS ERADICATED IN THE '70 1261 01:06:16,690 --> 01:06:18,025 IN THE U.S. BUT WE HAVE SOME 1262 01:06:18,025 --> 01:06:19,627 CASES NOW. 1263 01:06:19,627 --> 01:06:21,962 MANY OCCURRED WHEN POLIO WAS 1264 01:06:21,962 --> 01:06:25,933 STILL CIRCULATING ALL THE ONES 1265 01:06:25,933 --> 01:06:26,367 ON THE RIGHT. 1266 01:06:26,367 --> 01:06:28,902 WHY DID ME/CFS OUTBREAKS OCCUR 1267 01:06:28,902 --> 01:06:31,739 AT THE SAME TIME AS POLIO 1268 01:06:31,739 --> 01:06:32,339 OUTBREAKS? 1269 01:06:32,339 --> 01:06:33,774 THE POSSIBLE EXPLANATION IS THE 1270 01:06:33,774 --> 01:06:35,909 POLIO IS SPREAD BY CONTAMINATED 1271 01:06:35,909 --> 01:06:38,212 WATER AND THE FECAL/ORAL ROUTE. 1272 01:06:38,212 --> 01:06:39,947 I REMEMBER NOT BEING ALLOWED TO 1273 01:06:39,947 --> 01:06:41,982 GO TO THE SWIMMING POOL BECAUSE 1274 01:06:41,982 --> 01:06:43,717 I MIGHT GET POLIO. 1275 01:06:43,717 --> 01:06:46,053 OTHER ENTEROVIRUSES ARE FOUND IN 1276 01:06:46,053 --> 01:06:47,321 CONTAMINATED WATER AND IT COULD 1277 01:06:47,321 --> 01:06:51,091 HAVE BEEN CONTAMINATED WITH 1278 01:06:51,091 --> 01:06:54,028 VIRUSS AND THERE'S A 1279 01:06:54,028 --> 01:06:54,328 COINCIDENCE. 1280 01:06:54,328 --> 01:06:55,429 HOWEVER, IT'S ALSO POSSIBLE 1281 01:06:55,429 --> 01:06:59,733 BECAUSE ENTEROVIRUSES CAN 1282 01:06:59,733 --> 01:07:02,569 RECOMBINE MAYBE THE OUTBREAKS 1283 01:07:02,569 --> 01:07:09,009 THEN CALLED TYPICAL POLIO WAS A 1284 01:07:09,009 --> 01:07:11,945 RECOMBINATION VIRUS AND WITHOUT 1285 01:07:11,945 --> 01:07:14,448 SAMPLE WE'LL NEVER KNOW WHAT 1286 01:07:14,448 --> 01:07:15,516 VIRUS CAUSED THEM. 1287 01:07:15,516 --> 01:07:17,985 ONE THING THAT'S INTERESTING IS 1288 01:07:17,985 --> 01:07:24,191 SOME OF THE EARLY ME OUTBREAKS 1289 01:07:24,191 --> 01:07:31,165 COINCIDED WITH SOMETHING CALLED 1290 01:07:31,165 --> 01:07:34,968 BORNHOLM DISEASE AND KNOWN TO BE 1291 01:07:34,968 --> 01:07:38,972 CAUSED BY COX B ENTEROVIRUSES OR 1292 01:07:38,972 --> 01:07:44,712 COX A AND CAUSES LOW PAIN IN THE 1293 01:07:44,712 --> 01:07:46,246 CHEST AND ATTACKS THAT ARE 1294 01:07:46,246 --> 01:07:52,720 CRIPPLING AND TACHYCARDIA AND 1295 01:07:52,720 --> 01:07:57,191 RASHES AND SOMETIMES CAUSES 1296 01:07:57,191 --> 01:07:59,460 DISSEMINATED INTRAVASCULAR 1297 01:07:59,460 --> 01:08:03,097 COAGULATION, DIC AND YOU CAN 1298 01:08:03,097 --> 01:08:08,669 PLEAD -- BLEED FROM THAT AND YOU 1299 01:08:08,669 --> 01:08:11,538 CAN GET BLOOD CLOTS IF FACTOR 5 1300 01:08:11,538 --> 01:08:12,773 IS HIGH. 1301 01:08:12,773 --> 01:08:15,476 YOU CAN SEE STUDIES DESCRIBED 1302 01:08:15,476 --> 01:08:15,976 HERE. 1303 01:08:15,976 --> 01:08:19,113 THAT'S A COMMONALITY THAT 1304 01:08:19,113 --> 01:08:19,880 COAGULATION DISTURBANCES HAVE 1305 01:08:19,880 --> 01:08:22,483 BEEN DETECTED IN LONG COVID AND 1306 01:08:22,483 --> 01:08:22,816 ME/CFS. 1307 01:08:22,816 --> 01:08:26,220 THIS WORK IS LARGELY DONE BY THE 1308 01:08:26,220 --> 01:08:27,855 LAB IN SOUTH AFRICA. 1309 01:08:27,855 --> 01:08:34,828 IT'S INTERESTING PAPERS SHOWING 1310 01:08:34,828 --> 01:08:35,896 HYP 1311 01:08:35,896 --> 01:08:37,965 HYPERCOAGUABILITY AND IN THE 1312 01:08:37,965 --> 01:08:39,733 NEXT TALK YOU MAY HEAR SOMETHING 1313 01:08:39,733 --> 01:08:40,601 ABOUT PLATELETS. 1314 01:08:40,601 --> 01:08:43,103 ONE THING THAT HER LAB DID FIND 1315 01:08:43,103 --> 01:08:53,547 IS AND TWO CLINICIANS SAW 1316 01:09:10,164 --> 01:09:11,965 PATIENT AND TESTIFIED THERE WAS 1317 01:09:11,965 --> 01:09:16,370 A FIVE TO EIGHTFOLD INCREMENT 1318 01:09:16,370 --> 01:09:20,474 WORLDWIDE BETWEEN 1980 AND 1989. 1319 01:09:20,474 --> 01:09:22,142 I'M SHOWING THE LIST OF THE 1320 01:09:22,142 --> 01:09:24,044 OUTBREAKS DURING THAT PERIOD OF 1321 01:09:24,044 --> 01:09:24,244 TIME. 1322 01:09:24,244 --> 01:09:26,780 AND THEN FROM HILARY JOHNSON'S 1323 01:09:26,780 --> 01:09:30,284 BOOK OSLER'S WEB SHE TURNED UP 1324 01:09:30,284 --> 01:09:31,552 INFORMATION FROM A DISABILITY 1325 01:09:31,552 --> 01:09:33,253 INSURANCE COMPANY SHOWING THAT 1326 01:09:33,253 --> 01:09:35,923 CLAIMS FOR DISABILITY CAUSED BY 1327 01:09:35,923 --> 01:09:39,092 WHAT WAS THEN CALLED CHRONIC 1328 01:09:39,092 --> 01:09:40,861 FATIGUE SYNDROME INCREASED 500% 1329 01:09:40,861 --> 01:09:43,530 FROM 1989 TO 1993. 1330 01:09:43,530 --> 01:09:45,766 THIS WAS A BIGGER INCREASE THAN 1331 01:09:45,766 --> 01:09:48,202 AN OTHER CATEGORY OF DISABILITY. 1332 01:09:48,202 --> 01:09:50,037 WHAT HAPPENED IN THE MID 80s I 1333 01:09:50,037 --> 01:09:52,239 BELIEVE WAS A HIDDEN PANDEMIC. 1334 01:09:52,239 --> 01:09:57,611 TO EMPHASIZE THIS WAS A 1335 01:09:57,611 --> 01:10:05,786 PANDEMIC, I WANT TO TELL YOU 1336 01:10:05,786 --> 01:10:08,589 MORE INFORMATION FROM OSLER'S 1337 01:10:08,589 --> 01:10:10,958 WEB AND SHE FOUND AN EMPLOYEE AT 1338 01:10:10,958 --> 01:10:13,493 CDC TO INTERVIEW WHEN SHE 1339 01:10:13,493 --> 01:10:17,064 VISITED CDC AND FOND OUT IN 1999 1340 01:10:17,064 --> 01:10:20,234 THERE WERE 1,000 CALLS PER MONTH 1341 01:10:20,234 --> 01:10:21,802 ABOUT CHRONIC FATIGUE SYNDROME 1342 01:10:21,802 --> 01:10:24,538 BEING RECEIVED AT CDC AND THIS 1343 01:10:24,538 --> 01:10:26,874 OUTNUMBERED CALLS ABOUT AIDS AT 1344 01:10:26,874 --> 01:10:27,941 THE TIME. 1345 01:10:27,941 --> 01:10:29,109 IN 1990 THE CDC WAS RECEIVING 1346 01:10:29,109 --> 01:10:36,316 OVER 7,000 CALLS A MONTH AND A 1347 01:10:36,316 --> 01:10:38,252 HUNDRED LETTERS A DAY AND THEY 1348 01:10:38,252 --> 01:10:44,191 HAD TO HIRE A FULL-TIME EMPLOYEE 1349 01:10:44,191 --> 01:10:45,926 TO CONTACT THESE PEOPLE SAYING 1350 01:10:45,926 --> 01:10:47,961 THERE WAS NO EVIDENCE ME/CFS WAS 1351 01:10:47,961 --> 01:10:50,998 CONTAGIOUS AND A SMALL NUMBER OF 1352 01:10:50,998 --> 01:10:53,267 PATIENTS HAD MODEST IMMUNE 1353 01:10:53,267 --> 01:10:54,301 DIFFERENCES. 1354 01:10:54,301 --> 01:10:56,169 THIS IS UNFORTUNATE GIVEN IF 1355 01:10:56,169 --> 01:10:58,005 THESE OUTBREAKS HAD BEEN 1356 01:10:58,005 --> 01:10:58,639 INVESTIGATED PROPERLY THEN WE 1357 01:10:58,639 --> 01:11:04,311 WOULD KNOW MORE TODAY. 1358 01:11:04,311 --> 01:11:05,846 WHY WERE ALL THESE OUTBREAKS IN 1359 01:11:05,846 --> 01:11:08,115 THE 1980s AND WHAT WOULD RESULT 1360 01:11:08,115 --> 01:11:10,384 IN THESE OUTBREAKS? 1361 01:11:10,384 --> 01:11:12,486 WE NEED TO REMEMBER IN THE 1980s 1362 01:11:12,486 --> 01:11:14,655 OUTBREAKS OCCURRED AT THE SAME 1363 01:11:14,655 --> 01:11:16,290 TIME AIDS WAS UNCONTROLLED. 1364 01:11:16,290 --> 01:11:18,358 THIS SOMETHING NOTED BY A LOT OF 1365 01:11:18,358 --> 01:11:24,765 THE PHYSICIANS SUCH AS DAN 1366 01:11:24,765 --> 01:11:26,700 PETERSON WHO PRESIDED OVER ONE 1367 01:11:26,700 --> 01:11:31,238 OF THE OUTBREAKS AND DURING THE 1368 01:11:31,238 --> 01:11:33,740 SAME PERIOD THE OUTBREAKS WERE 1369 01:11:33,740 --> 01:11:37,811 OCCURRING THERE WAS A SEVERELY 1370 01:11:37,811 --> 01:11:38,445 IMMUNOCOMPROMISED POPULATION IN 1371 01:11:38,445 --> 01:11:40,414 THE U.S. 1372 01:11:40,414 --> 01:11:46,219 WHAT COULD BE THE CONSEQUENCE 1373 01:11:46,219 --> 01:11:49,489 AND ENTEROVIRUS HAVE HIGHER 1374 01:11:49,489 --> 01:11:50,557 MUTATION RATES THAN CORONAVIRUS 1375 01:11:50,557 --> 01:11:52,326 AND WE HEAR ALMOST DAILY ABOUT 1376 01:11:52,326 --> 01:11:54,494 SOME NEW VARIANT OF THE 1377 01:11:54,494 --> 01:11:55,729 CORONAVIRUS BECAUSE THERE'S SO 1378 01:11:55,729 --> 01:11:58,899 MANY PEOPLE INFECTED OUT THERE 1379 01:11:58,899 --> 01:12:02,869 GENERATING NEW VARIANTS BUT 1380 01:12:02,869 --> 01:12:05,238 ENTEROVIRUSES ALSO HAVE THE 1381 01:12:05,238 --> 01:12:07,441 PROPENSITY TO MUTATE AND A 1382 01:12:07,441 --> 01:12:10,944 GREATER PROPENSIPROPENSITY, ACT. 1383 01:12:10,944 --> 01:12:15,048 THE CURRENT ESTIMATES OF 1384 01:12:15,048 --> 01:12:18,852 IMMUNOCOMPROMISE VARY 9% TO 18% 1385 01:12:18,852 --> 01:12:22,789 AND MANY ARE IMMUNOCOMPROMISED 1386 01:12:22,789 --> 01:12:26,293 DUE TO MEDICATION OR DISEASE AND 1387 01:12:26,293 --> 01:12:28,095 ONE DOCUMENTED IMMUNOCOMPROMISED 1388 01:12:28,095 --> 01:12:30,697 PATIENTS ARE INCUBATING SARS 1389 01:12:30,697 --> 01:12:37,637 COV2 AND CREATING VARIANTS AND 1390 01:12:37,637 --> 01:12:39,406 COVID-19 CAN RESULT IN A WEAK 1391 01:12:39,406 --> 01:12:40,140 IMMUNE RESPONSE. 1392 01:12:40,140 --> 01:12:42,109 I THINK AND THIS IS JUST AN 1393 01:12:42,109 --> 01:12:45,846 OPINION, LIKE THE ORIGINAL SARS 1394 01:12:45,846 --> 01:12:48,782 COV2 THE 1980s OUTBREAK ENT 1395 01:12:48,782 --> 01:12:52,019 ENTEROVIRUS IS NO LONGER 1396 01:12:52,019 --> 01:12:53,453 CIRCULATING AND THE SPORADIC 1397 01:12:53,453 --> 01:12:56,523 CASES WE'RE SEEING NOW ARE 1398 01:12:56,523 --> 01:12:57,824 RISING FROM AN OCCASIONAL 1399 01:12:57,824 --> 01:13:00,660 VARIANT INFECTS A SUSCEPTIBLE 1400 01:13:00,660 --> 01:13:00,961 INDIVIDUAL. 1401 01:13:00,961 --> 01:13:02,362 WHAT'S INTERESTING AND SCARY IS 1402 01:13:02,362 --> 01:13:03,864 THE CONDITIONS ARE NOW FAVORABLE 1403 01:13:03,864 --> 01:13:08,735 FOR EMERGENCE OF NOVEL VARIANTS 1404 01:13:08,735 --> 01:13:11,638 THAT CAN INSIGHT BUT HOW WILL WE 1405 01:13:11,638 --> 01:13:14,541 DETECT THESE ME/CFS OUTBREAKS? 1406 01:13:14,541 --> 01:13:16,076 WE RIGHT NOW CANNOT DISTINGUISH 1407 01:13:16,076 --> 01:13:19,112 ME/CFS FROM LONG COVID UNLESS 1408 01:13:19,112 --> 01:13:20,814 THE PERSON OBVIOUSLY HAS LOVES 1409 01:13:20,814 --> 01:13:26,553 SENSE OF SMELL OR TASTE. 1410 01:13:26,553 --> 01:13:29,589 -- LOST SENSE OF SMELL OR TASTE. 1411 01:13:29,589 --> 01:13:35,095 THE PERSISTENCE OF DNA VIRUS IS 1412 01:13:35,095 --> 01:13:36,897 IS WELL KNOWN. 1413 01:13:36,897 --> 01:13:39,099 SARS COV2 PERSISTS LONG AFTER 1414 01:13:39,099 --> 01:13:40,500 THE ACUTE INFECTION. 1415 01:13:40,500 --> 01:13:42,335 WE HAD A CONVINCING TALK 1416 01:13:42,335 --> 01:13:45,539 DESCRIBING SOME OF THE 1417 01:13:45,539 --> 01:13:46,406 INFORMATION THOUGH THERE'S 1418 01:13:46,406 --> 01:13:51,078 CONTROVERSY ABOUT PERSISTENCE 1419 01:13:51,078 --> 01:13:54,548 AND TWO PAPERS INDICATE SARS 1420 01:13:54,548 --> 01:13:57,951 COV2 CAN BE FOUND TO PERSIST 1421 01:13:57,951 --> 01:13:59,519 AFTER A LONG PERIOD OF TIME. 1422 01:13:59,519 --> 01:14:02,989 SO A QUESTION ARISES DO 1423 01:14:02,989 --> 01:14:05,959 ENTEROVIRUS PERSIST IN 1424 01:14:05,959 --> 01:14:07,227 INDIVIDUALS WITH ME/CFS? 1425 01:14:07,227 --> 01:14:08,462 THERE'S EVIDENCE THAT IT DOES 1426 01:14:08,462 --> 01:14:10,363 PERSIST IN SOME INDIVIDUALS. 1427 01:14:10,363 --> 01:14:13,767 WE DON'T KNOW HOW MANY 1428 01:14:13,767 --> 01:14:15,102 INDIVIDUALS WITH ME/CFS HAVE 1429 01:14:15,102 --> 01:14:16,870 PERSISTENT VIRUS BUT I BELIEVE 1430 01:14:16,870 --> 01:14:19,106 THERE'S EVIDENCE AT LEAST SOME 1431 01:14:19,106 --> 01:14:29,015 INDIVIDUALS DO. 1432 01:14:29,015 --> 01:14:32,886 ENTEROVIRUSES CAN BE STUDIED IN 1433 01:14:32,886 --> 01:14:40,093 PEOPLE WITH CARDIO MYOPATHY AND 1434 01:14:40,093 --> 01:14:42,596 TYPE 1 DIABETES AND THEY CAN BE 1435 01:14:42,596 --> 01:14:43,663 STUDIED AND MAINTAINED IN CELL 1436 01:14:43,663 --> 01:14:45,398 CULTURE FOR LONG PERIOD OF TIME. 1437 01:14:45,398 --> 01:14:47,100 THE ADAPTATIONS OF THE VIRUS 1438 01:14:47,100 --> 01:14:49,936 THAT ALLOW IT TO DO THIS ARE 1439 01:14:49,936 --> 01:14:52,739 REASONABLY WELL KNOWN AND HAVE 1440 01:14:52,739 --> 01:14:54,608 AN ALTERATION IN THEIR 1441 01:14:54,608 --> 01:14:57,978 TRANSLATED REGION ALLOWS THEM TO 1442 01:14:57,978 --> 01:14:58,211 PERSIST. 1443 01:14:58,211 --> 01:15:01,348 SO I'LL MENTION ONE STUDIO IN 1444 01:15:01,348 --> 01:15:05,719 WHICH ENTEROVIRAL SEQUENCES WERE 1445 01:15:05,719 --> 01:15:08,822 DETECTED IN MUSCLE. 1446 01:15:08,822 --> 01:15:10,891 THOUGH THE PCR HADN'T BEEN 1447 01:15:10,891 --> 01:15:15,495 AROUND A LONG TIME THEY GOT 1448 01:15:15,495 --> 01:15:16,396 SEQUENCES. 1449 01:15:16,396 --> 01:15:18,031 THIS IS CALLED CFS PATIENTS 1450 01:15:18,031 --> 01:15:20,100 REFERRED TO A HOSPITAL IN THE 1451 01:15:20,100 --> 01:15:25,672 U.K. OVER A 10 YEAR PERIOD AND 1452 01:15:25,672 --> 01:15:35,148 10 OF THE 48 MUSCLE BIOPSIES HAD 1453 01:15:35,148 --> 01:15:37,250 A SEQUENCE IDENTICAL COX B 1454 01:15:37,250 --> 01:15:47,661 STRAIN ISOLATED IN 1949. 1455 01:15:49,763 --> 01:15:54,634 THREE CONSEQUENCES ARE IDENTICAL 1456 01:15:54,634 --> 01:16:00,941 TO COXSACKIE B AND IT TELLS ME 1457 01:16:00,941 --> 01:16:04,644 IT'S NOT JUST CONTAMINATION AND 1458 01:16:04,644 --> 01:16:09,282 THEY GOT DIFFERENT -- THEY 1459 01:16:09,282 --> 01:16:10,550 DETECTED DIFFERENT SEQUENCES IN 1460 01:16:10,550 --> 01:16:10,984 THE PATIENTS. 1461 01:16:10,984 --> 01:16:12,953 IF YOU WANT TO LEARN MORE ABOUT 1462 01:16:12,953 --> 01:16:16,423 THIS, I SUGGEST YOU SEE MY TALK 1463 01:16:16,423 --> 01:16:18,959 IN THE CHRONIC INFECTIONS NIH 1464 01:16:18,959 --> 01:16:21,194 ROAD MAP WEBINAR SERIES NOT YET 1465 01:16:21,194 --> 01:16:22,862 RELEASED BUT SHOULD BE IN THE 1466 01:16:22,862 --> 01:16:24,564 NEXT WEEKS AND WILL SEE MORE 1467 01:16:24,564 --> 01:16:26,366 DOUGH TAILED INFORMATION ABOUT 1468 01:16:26,366 --> 01:16:26,933 ENTEROVIRUSES. 1469 01:16:26,933 --> 01:16:28,868 I WOULD LIKE TO HIGHLIGHT ONE 1470 01:16:28,868 --> 01:16:34,274 PAPER DONE BY A LAB BECAUSE IN 1471 01:16:34,274 --> 01:16:36,142 THE LATER DAYS HE'S DONE THE 1472 01:16:36,142 --> 01:16:39,613 MOST RECENT STUDIES OF ENT 1473 01:16:39,613 --> 01:16:40,313 ENTEROV 1474 01:16:40,313 --> 01:16:40,647 ENTEROVIRUSES. 1475 01:16:40,647 --> 01:16:42,515 THE ONE PAPER PUBLISHED IN 2008 1476 01:16:42,515 --> 01:16:46,653 AMAZE LIG HE WAS ABLE TO GET A 1477 01:16:46,653 --> 01:16:50,690 LARGE NUMBER OF UPPER G.I. 1478 01:16:50,690 --> 01:16:56,162 ENDOSSCOPIES DONE TO GET HOLD OF 1479 01:16:56,162 --> 01:16:57,597 STOM 1480 01:16:57,597 --> 01:16:58,598 STOM 1481 01:16:58,598 --> 01:16:59,099 STOM 1482 01:16:59,099 --> 01:17:00,834 STOM 1483 01:17:00,834 --> 01:17:07,073 STOMACH BIOPSIES AND DOING THE 1484 01:17:07,073 --> 01:17:10,277 MONOCLONAL ANTIBODY 135 OF THE 1485 01:17:10,277 --> 01:17:13,613 165 SAMPLE WERE POSITIVE AND 1486 01:17:13,613 --> 01:17:15,982 ONLY 31 CONTROL BUT NOTICE SOME 1487 01:17:15,982 --> 01:17:16,883 CONTROLS ACTUALLY HAD GASTRIC 1488 01:17:16,883 --> 01:17:19,552 DISEASE. 1489 01:17:19,552 --> 01:17:21,988 SO WHEN I REREAD THIS PAPER LAST 1490 01:17:21,988 --> 01:17:23,490 WEEK IN PREPARATION FOR THE TALK 1491 01:17:23,490 --> 01:17:27,394 I REALIZED HE MENTIONED THEY HAD 1492 01:17:27,394 --> 01:17:35,735 GOTTEN RNA SEQUENCES FROM THE 1493 01:17:35,735 --> 01:17:39,706 VIRUS AND HE STILL HAD THEM THE 1494 01:17:39,706 --> 01:17:40,940 DATABASE WAS SMALLER THAN IT IS 1495 01:17:40,940 --> 01:17:41,141 NOW. 1496 01:17:41,141 --> 01:17:43,310 I GOT SEQUENCES FROM HIM AND 1497 01:17:43,310 --> 01:17:46,780 USED BLAST TO SEE WHAT THEY WERE 1498 01:17:46,780 --> 01:17:50,917 AND MY RECENT BLAST OF THIS 156 1499 01:17:50,917 --> 01:17:54,054 NUCLEOTIDE UTR SEQUENCE SHOWED 1500 01:17:54,054 --> 01:17:58,425 98% IDENTICAL TO ECO VIRUS 18 1501 01:17:58,425 --> 01:18:02,896 AND ALSO TO ECHO VIRUS 6. 1502 01:18:02,896 --> 01:18:04,964 IT DOESN'T MEAN THEY WERE 18 OR 1503 01:18:04,964 --> 01:18:07,734 6 BECAUSE WITH SUCH A SHORT 1504 01:18:07,734 --> 01:18:09,769 SEQUENCE IF WE HAD MORE IT MAY 1505 01:18:09,769 --> 01:18:11,971 BE A DIFFERENT ENTEROVIRUS BUT 1506 01:18:11,971 --> 01:18:14,808 CLEARLY IT'S AN ENTERO VIRUS 1507 01:18:14,808 --> 01:18:15,408 SEQUENCE THERE. 1508 01:18:15,408 --> 01:18:17,510 SO NEXT THING I'D LIKE TO TALK 1509 01:18:17,510 --> 01:18:19,679 ABOUT IS THE FACT THAT BOTH SARS 1510 01:18:19,679 --> 01:18:22,882 COV2 AND ENTEROVIRUSES CAUSE 1511 01:18:22,882 --> 01:18:24,951 ASYMPTOMATIC INFECTIONS AS THE 1512 01:18:24,951 --> 01:18:26,586 EXAMPLE FROM THE NEW YORK TIMES 1513 01:18:26,586 --> 01:18:31,091 AND THERE'S A REFERENCE TO A 1514 01:18:31,091 --> 01:18:34,194 SCIENTIFIC PAPER ABOUT IT. 1515 01:18:34,194 --> 01:18:37,063 MOST THE 15 TO 30 MILLION 1516 01:18:37,063 --> 01:18:37,997 ENTEROVIRUSES MENTIONED ON THE 1517 01:18:37,997 --> 01:18:39,132 CDC WEBSITE ANNUALLY ON THE 1518 01:18:39,132 --> 01:18:41,000 U.S. ARE ASYMPTOMATIC OR MILD. 1519 01:18:41,000 --> 01:18:43,103 YOU MAY THINK YOU HAD A COLD FOR 1520 01:18:43,103 --> 01:18:44,204 A DAY. 1521 01:18:44,204 --> 01:18:46,172 SO LONG COVID FOLLOWING 1522 01:18:46,172 --> 01:18:47,774 ASYMPTOMATIC INFECTION SUGGESTS 1523 01:18:47,774 --> 01:18:50,210 TO ME THE ONSET OF ME/CFS MAY 1524 01:18:50,210 --> 01:18:54,514 NOT BE DUE TO SOME COINCIDENTAL 1525 01:18:54,514 --> 01:18:56,049 MENTAL TRAUMA OR ENVIRONMENTAL 1526 01:18:56,049 --> 01:18:58,618 EXPOSURE BUT COULD RESULT FROM 1527 01:18:58,618 --> 01:18:59,552 AN ENTEROVIRAL INFECTION AND 1528 01:18:59,552 --> 01:19:01,988 WHEN YOU'RE TRYING TO FIGURE OUT 1529 01:19:01,988 --> 01:19:04,858 WHY I GOT SICK, YOU MAY THINK, 1530 01:19:04,858 --> 01:19:06,359 OH, I WAS IN THE CAR ACCIDENT 1531 01:19:06,359 --> 01:19:09,129 BUT YOU MAY HAVE HAD AN 1532 01:19:09,129 --> 01:19:11,164 ASYMPTOMATIC INFECTION AND 1533 01:19:11,164 --> 01:19:12,665 STRESS CAN IMPAIR IMMUNE 1534 01:19:12,665 --> 01:19:16,603 RESPONSE AND COULD PLAY A ROLE 1535 01:19:16,603 --> 01:19:17,504 IN THE DEVELOPMENT OF ME/CFS 1536 01:19:17,504 --> 01:19:19,472 FOLLOWING AN INFECTION. 1537 01:19:19,472 --> 01:19:21,341 YOU HAVE AN INFECTION AND LOST 1538 01:19:21,341 --> 01:19:22,776 YOUR JOB OR SOMETHING HAPPENED 1539 01:19:22,776 --> 01:19:24,744 AND THE STRESS COULD INCREASE 1540 01:19:24,744 --> 01:19:25,745 YOUR CHANCES. 1541 01:19:25,745 --> 01:19:28,248 AND I'D LIKE TO A THOUGHT 1542 01:19:28,248 --> 01:19:30,784 EXPERIMENT FROM A CORONAVIRUS 1543 01:19:30,784 --> 01:19:31,451 OUTBREAK. 1544 01:19:31,451 --> 01:19:32,852 THERE'S FOUR COMMON COLD 1545 01:19:32,852 --> 01:19:34,354 CORONAVIRUSES PROBABLY ALL OF US 1546 01:19:34,354 --> 01:19:35,922 HAVE HAD. 1547 01:19:35,922 --> 01:19:38,491 SUPPOSE INSTEAD OF SARS COV2 1548 01:19:38,491 --> 01:19:40,527 INFECTING THE WORLD IN 2020 A 1549 01:19:40,527 --> 01:19:41,661 COMMON COLD CORONAVIRUS MUTATED 1550 01:19:41,661 --> 01:19:45,365 AND RESULTED IN INFECTIONS THAT 1551 01:19:45,365 --> 01:19:46,833 LED TO LONG COVID. 1552 01:19:46,833 --> 01:19:48,435 WELL, THE INITIAL INFECTION 1553 01:19:48,435 --> 01:19:51,070 WOULD BE ASYMPTOMATIC OR MILD 1554 01:19:51,070 --> 01:19:53,907 JUST A LITTLE COLD OR FLU-LIKE 1555 01:19:53,907 --> 01:19:55,909 ILLNESS AND PEOPLE WOULDN'T BE 1556 01:19:55,909 --> 01:19:56,976 HOSPITALIZED OR DYING AND THEN 1557 01:19:56,976 --> 01:19:58,077 WHAT WOULD HAPPEN? 1558 01:19:58,077 --> 01:19:59,813 PEOPLE WOULDN'T KNOW WHAT CAUSED 1559 01:19:59,813 --> 01:20:03,750 THEIR PERSISTENT ILLNESS AND NOT 1560 01:20:03,750 --> 01:20:06,853 BE BELIEVED UNTIL THEY HAD A 1561 01:20:06,853 --> 01:20:07,921 PSYCHOLOGICAL ILLNESS AND 1562 01:20:07,921 --> 01:20:09,322 THOUGHT TO BE FAKING TO AVOID 1563 01:20:09,322 --> 01:20:10,523 WORK OR SCHOOL. 1564 01:20:10,523 --> 01:20:11,925 DOESN'T THAT SOUND FAMILIAR? 1565 01:20:11,925 --> 01:20:14,327 IT'S TELLING US THE MOST LIKELY 1566 01:20:14,327 --> 01:20:18,765 CAUSE OF THE SPORADIC CASES OF 1567 01:20:18,765 --> 01:20:22,035 ME IS AN INDIVIDUAL WITH A 1568 01:20:22,035 --> 01:20:22,702 VARIANT NOT AN EXOTIC VIRUS OUT 1569 01:20:22,702 --> 01:20:26,973 THERE. 1570 01:20:26,973 --> 01:20:31,177 NOW, OFTEN PEOPLE SAY THEY GOT 1571 01:20:31,177 --> 01:20:34,280 THEIR ME/CFS FROM SOME HERPES 1572 01:20:34,280 --> 01:20:36,115 VIRUS INFECTION OR FOLLOWING 1573 01:20:36,115 --> 01:20:39,719 THAT AND REACTIVATION OF HERPES 1574 01:20:39,719 --> 01:20:41,187 VIRUS OCCURS IN LONG COVID AND 1575 01:20:41,187 --> 01:20:41,554 ME/CFS. 1576 01:20:41,554 --> 01:20:44,424 I WAS SHOWING A FEW PAPERS ABOUT 1577 01:20:44,424 --> 01:20:49,729 LONG COVID AND I WANTED TO 1578 01:20:49,729 --> 01:20:52,065 HIGHLIGHT THE PAPER DONE 1579 01:20:52,065 --> 01:20:52,632 INVESTIGATING THE INCLINE 1580 01:20:52,632 --> 01:20:58,137 VILLAGE OUTBREAK PRESIDED OVER 1581 01:20:58,137 --> 01:21:01,040 BY DAN PETER SSON I THINK IT'S E 1582 01:21:01,040 --> 01:21:02,675 BEST INVESTIGATION OF THAT 1583 01:21:02,675 --> 01:21:06,279 OUTBREAK IN THAT TIME PERIOD AND 1584 01:21:06,279 --> 01:21:12,252 ALREADY IN 1992 THIS GROUP WAS 1585 01:21:12,252 --> 01:21:18,191 ABLE TO SEE THERE WAS 1586 01:21:18,191 --> 01:21:20,760 REACTIVATION OF HPV6 AND THAT'S 1587 01:21:20,760 --> 01:21:21,494 BEEN SEEN SINCE THEN AS WELL. 1588 01:21:21,494 --> 01:21:23,663 AND I THINK AND THIS IS 1589 01:21:23,663 --> 01:21:26,432 SPECULATION AND MY OPINION I 1590 01:21:26,432 --> 01:21:30,603 THINK HERPES VIRUS ACCOMPLICES 1591 01:21:30,603 --> 01:21:37,076 IN LONG COVID BUT I DON'T THINK 1592 01:21:37,076 --> 01:21:38,912 THE EPIDEMIOLOGY OF OUTBREAKS IS 1593 01:21:38,912 --> 01:21:40,880 NOT CONSISTENT WITH THE 1594 01:21:40,880 --> 01:21:45,552 EPIDEMIOLOGY OF INFECTIONS AND 1595 01:21:45,552 --> 01:21:48,588 EBV OR OTHER HERPES VIRUSES AND 1596 01:21:48,588 --> 01:21:51,090 WHETHER THEY'RE INCITED BY THEM 1597 01:21:51,090 --> 01:21:54,561 RECEIVED WITHOUT ANY CASE OF 1598 01:21:54,561 --> 01:21:57,564 ME/CFS IS UNKNOWN AND THE ACTIVE 1599 01:21:57,564 --> 01:21:59,632 HERPES VIRUS MAY MAKE AN 1600 01:21:59,632 --> 01:22:01,100 INDIVIDUAL MORE SUSCEPTIBLE TO 1601 01:22:01,100 --> 01:22:01,968 ANOTHER VIRUS. 1602 01:22:01,968 --> 01:22:06,606 YOU GET MONOAND ARE FATIGUED FOR 1603 01:22:06,606 --> 01:22:08,741 A MONTH AND DON'T KNOW IT'S 1604 01:22:08,741 --> 01:22:12,011 ANYTHING UNUSUAL AND THEN BEGIN 1605 01:22:12,011 --> 01:22:13,479 TO REALIZE IT'S BAD. 1606 01:22:13,479 --> 01:22:16,883 I'M STILL SICK WITH MY MONO. 1607 01:22:16,883 --> 01:22:20,620 NOW I HAVE ME/CFS. 1608 01:22:20,620 --> 01:22:22,889 IT'S TRUE CONTINUED EXPRESSION 1609 01:22:22,889 --> 01:22:24,290 OF HERPES VIRUS PROTEINS DUE TO 1610 01:22:24,290 --> 01:22:26,125 ESCAPE FROM THE CONTROL COULD BE 1611 01:22:26,125 --> 01:22:28,328 CONTRIBUTING TO LONG COVID AND 1612 01:22:28,328 --> 01:22:30,263 PATHOPHYSIOLOGY AND IT'S 1613 01:22:30,263 --> 01:22:31,331 IMPORTANT TO KNOW ABOUT HERPES 1614 01:22:31,331 --> 01:22:34,901 VIRUS INFECTIONS AND THEIR ROLE 1615 01:22:34,901 --> 01:22:39,706 IN ME/CFS. 1616 01:22:39,706 --> 01:22:42,909 AND IN LONG COVID. 1617 01:22:42,909 --> 01:22:47,080 PATIENT SYMPTOMS ARE DIVERSE AND 1618 01:22:47,080 --> 01:22:51,551 A POST-DOCTORAL ASSOCIATE IN MY 1619 01:22:51,551 --> 01:22:52,885 LAB DID CLUSTERING OF PATIENTS 1620 01:22:52,885 --> 01:22:54,921 AND IDENTIFIED FOUR CLUSTERS. 1621 01:22:54,921 --> 01:22:56,422 THIS WORK IS UNPUBLISHED BUT 1622 01:22:56,422 --> 01:23:02,495 PRESENTED ON A POSTER YOU CAN 1623 01:23:02,495 --> 01:23:09,035 SEE AT LUNCH TIME AND THE AUTHOR 1624 01:23:09,035 --> 01:23:12,438 WILL BE AROUND AND SHE WAS ABLE 1625 01:23:12,438 --> 01:23:17,577 TO SEE THERE WERE FOUR CLUSTERS 1626 01:23:17,577 --> 01:23:24,617 AND THERE WAS LOWER ME/CFS 1627 01:23:24,617 --> 01:23:25,952 SEVERITY ACCORDING TO HAVING 1628 01:23:25,952 --> 01:23:33,159 HIGHER FS36 AND LOWER WAKING 1629 01:23:33,159 --> 01:23:37,163 TIME AND SEVERITY SCALE FOR 1630 01:23:37,163 --> 01:23:40,199 POST-EXERTIONAL MALAISE AND SORE 1631 01:23:40,199 --> 01:23:48,074 THROAT AND MIALGIA AND IT WOULD 1632 01:23:48,074 --> 01:23:53,846 BE GOOD TO EXTEND THIS TIE 1633 01:23:53,846 --> 01:24:04,090 LARGER BATCH. 1634 01:24:04,724 --> 01:24:15,168 WE DID THIS AND YOU SAW THIS 1635 01:24:19,105 --> 01:24:21,774 SAME CHART FROM CINDY BATEMAN 1636 01:24:21,774 --> 01:24:24,477 THIS MORNING AND IT SHOWS 1637 01:24:24,477 --> 01:24:25,411 THERE'S THESE FOUR CLUSTERS. 1638 01:24:25,411 --> 01:24:26,913 I THINK WHAT IS AN IMPORTANT 1639 01:24:26,913 --> 01:24:29,315 POINT ABOUT THE FOUR CLUSTERS IS 1640 01:24:29,315 --> 01:24:30,983 THAT THIS PASC STUDIO 1641 01:24:30,983 --> 01:24:32,618 DEMONSTRATES THE SINGLE VIRUS 1642 01:24:32,618 --> 01:24:35,521 TYPE CAN GIVE RISE TO A 1643 01:24:35,521 --> 01:24:37,223 POST-VIRAL ILLNESS POPULATION 1644 01:24:37,223 --> 01:24:39,092 THAT HAS DIVERSE SYMPTOMS. 1645 01:24:39,092 --> 01:24:40,893 THERE'S A DIVERSITY IN THE 1646 01:24:40,893 --> 01:24:42,295 PATIENT GROUP. 1647 01:24:42,295 --> 01:24:44,564 PEOPLE SOMETIMES SAY IT COULD BE 1648 01:24:44,564 --> 01:24:47,467 EASIER TO STUDY LONG COVID 1649 01:24:47,467 --> 01:24:49,368 BECAUSE THEY'RE ALL UNIFORM. 1650 01:24:49,368 --> 01:24:50,803 IT'S NOT THE CASE. 1651 01:24:50,803 --> 01:24:53,039 IN FACT, THE OTHER POINT I'D 1652 01:24:53,039 --> 01:24:57,577 LIKE TO MAKE IS PRE-2020 ME/CFS 1653 01:24:57,577 --> 01:25:00,313 MAY HAVE BEEN CAUSED BY A SINGLE 1654 01:25:00,313 --> 01:25:03,015 VIRUS TYPE RATHER THAN BY 1655 01:25:03,015 --> 01:25:03,416 MULTIPLE VIRUS. 1656 01:25:03,416 --> 01:25:06,185 IT'S AN OFTEN BEEN CLAIMED TO 1657 01:25:06,185 --> 01:25:07,787 EXPLAIN THE DIFFERENCE IN ME/CFS 1658 01:25:07,787 --> 01:25:09,322 SUB GROUPS THEY DO EXIST IN 1659 01:25:09,322 --> 01:25:10,890 TERMS OF SYMPTOMS AND ALSO IN 1660 01:25:10,890 --> 01:25:15,128 TERMS OF SOME OF THE MOLECULAR 1661 01:25:15,128 --> 01:25:17,930 AND BIO CHEMICAL AND 1662 01:25:17,930 --> 01:25:18,765 PHYSIOLOGICAL DATA WE HAVE. 1663 01:25:18,765 --> 01:25:21,768 CAN STUDY OF PRE-2020 ME/CFS BE 1664 01:25:21,768 --> 01:25:24,670 REPLACED BY STUDIES MUCH LONG 1665 01:25:24,670 --> 01:25:28,808 COVID PATIENTS THAT FULFILL THE 1666 01:25:28,808 --> 01:25:30,510 2015 CRITERIA? 1667 01:25:30,510 --> 01:25:33,146 WELL, THE COMMONALITY OF MANY 1668 01:25:33,146 --> 01:25:34,881 SYMPTOMS WE'VE BEEN HEARING 1669 01:25:34,881 --> 01:25:35,681 ABOUT SUGGEST THERE ARE COMMON 1670 01:25:35,681 --> 01:25:40,887 DISRUPTIVE PATHWAYS THAT CAN 1671 01:25:40,887 --> 01:25:43,156 LEAD TO A SYMPTOM. 1672 01:25:43,156 --> 01:25:45,124 THIS COULD RESULT FROM THE 1673 01:25:45,124 --> 01:25:46,959 ME/CFS AGENTS AS WELL AS SARS 1674 01:25:46,959 --> 01:25:48,561 COV2 AND IF YOU HAVE AN 1675 01:25:48,561 --> 01:25:50,530 INTERVENTION AT THIS POINT IN 1676 01:25:50,530 --> 01:25:51,964 THE COMMON DISRUPTED PATHWAY, 1677 01:25:51,964 --> 01:25:55,067 THEN THAT'S GOING TO BENEFIT 1678 01:25:55,067 --> 01:25:58,237 BOTH ME/CFS AND LONG COVID. 1679 01:25:58,237 --> 01:26:00,740 SUPPOSE INSTEAD HAVE YOU AN 1680 01:26:00,740 --> 01:26:02,341 INTERVENTION THAT CAN AFFECT 1681 01:26:02,341 --> 01:26:04,410 THIS EARLIER PART. 1682 01:26:04,410 --> 01:26:06,279 WHAT LEADS TO THAT COMMON 1683 01:26:06,279 --> 01:26:07,079 DISRUPTED PATHWAY. 1684 01:26:07,079 --> 01:26:09,048 AND AN EXAMPLE OF SUCH AN 1685 01:26:09,048 --> 01:26:11,684 INTERVENTION THAT CAN BENEFIT 1686 01:26:11,684 --> 01:26:13,953 ONLY LONG COVID IS TREATMENT OF 1687 01:26:13,953 --> 01:26:18,191 A PERSISTENT LONG COVID 1688 01:26:18,191 --> 01:26:21,828 INFECTION WITH A SARS COV2 DRUG 1689 01:26:21,828 --> 01:26:25,198 AND AN INTERESTING STUDY WHERE 1690 01:26:25,198 --> 01:26:26,866 THREE PEOPLE WERE CURED 1691 01:26:26,866 --> 01:26:31,070 RECEIVING AN ANTIMONOCLONAL 1692 01:26:31,070 --> 01:26:35,208 ANTIBODY THAT AFFECTED THEIR 1693 01:26:35,208 --> 01:26:36,008 INCITING VIRUS. 1694 01:26:36,008 --> 01:26:39,946 IF THERE'S CHRONIC INFECTION 1695 01:26:39,946 --> 01:26:43,082 MAINTAINING AN ME/CFS STATUS WE 1696 01:26:43,082 --> 01:26:46,786 NEED TO HAVE DRUGS THAT WILL 1697 01:26:46,786 --> 01:26:51,023 CURE US OF THAT ENTEROVIRUS 1698 01:26:51,023 --> 01:26:52,792 INFECTION OR OTHER INFECTION. 1699 01:26:52,792 --> 01:26:55,828 ALSO, IT'S QUITE POSSIBLE 1700 01:26:55,828 --> 01:26:59,632 THERE'S AN AUTO ANTIBODY OR 1701 01:26:59,632 --> 01:27:03,069 PATHOGENIC ANTIBODIES INVOLVED 1702 01:27:03,069 --> 01:27:07,907 AND MAY RESULT FROM MOLECULAR 1703 01:27:07,907 --> 01:27:10,142 AGENTS WILL BE DIFFERENT IN LONG 1704 01:27:10,142 --> 01:27:15,047 COVID VERSUS ME/CFS FOR EXAMPLE, 1705 01:27:15,047 --> 01:27:16,582 ENTEROVIRUS AND SARS COV2 DON'T 1706 01:27:16,582 --> 01:27:18,951 SHARE SEQUENCE AMOL GY. 1707 01:27:18,951 --> 01:27:20,052 THERE COULD BE DIFFERENT 1708 01:27:20,052 --> 01:27:21,053 ANTIBODIES RESULTING FROM THE 1709 01:27:21,053 --> 01:27:23,122 TWO AND YOU MAY NEED DIFFERENT 1710 01:27:23,122 --> 01:27:23,856 INTERVENTIONS. 1711 01:27:23,856 --> 01:27:26,025 OF COURSE THERE'S ALSO THE 1712 01:27:26,025 --> 01:27:26,792 POSSIBILITY THERE'S DIFFERENT 1713 01:27:26,792 --> 01:27:29,929 DISRUPTED PATHWAYS THAT OCCUR IN 1714 01:27:29,929 --> 01:27:31,631 ME/CFS VERSUS SARS COV2. 1715 01:27:31,631 --> 01:27:33,132 FOR EXAMPLE, THERE'S LOTS OF 1716 01:27:33,132 --> 01:27:34,433 WAYS OF GETTING A HEADACHE. 1717 01:27:34,433 --> 01:27:36,235 THERE CAN BE DIFFERENT PATHWAYS 1718 01:27:36,235 --> 01:27:37,637 TO GET A HEADACHE. 1719 01:27:37,637 --> 01:27:41,741 WE NEED TO STUDY BOTH ME/CFS AND 1720 01:27:41,741 --> 01:27:43,843 SARS COV2 TO UNDERSTAND THE 1721 01:27:43,843 --> 01:27:45,845 COMMON DISRUPTED PATHWAYS AND 1722 01:27:45,845 --> 01:27:47,079 ARE THERE ANY DIFFERENT 1723 01:27:47,079 --> 01:27:47,880 DISRUPTED PATHWAYS. 1724 01:27:47,880 --> 01:27:50,216 SO WHAT ARE SOME DIFFERENCES 1725 01:27:50,216 --> 01:27:52,818 BETWEEN LONG COVID AND ME/CFS? 1726 01:27:52,818 --> 01:27:54,720 PEOPLE TEND TO EMPHASIZE THE 1727 01:27:54,720 --> 01:27:56,255 SIMILARITIES BECAUSE IT'S VERY 1728 01:27:56,255 --> 01:27:56,522 STRIKING. 1729 01:27:56,522 --> 01:27:58,991 THEY ARE NOT INCITED BY THE SAME 1730 01:27:58,991 --> 01:28:00,826 VIRUS AND THE VIRUS THAT 1731 01:28:00,826 --> 01:28:02,561 ULTIMATELY LEADS TO LONG COVID 1732 01:28:02,561 --> 01:28:04,764 IS A LOT MORE DEADLY THAN THE 1733 01:28:04,764 --> 01:28:06,866 ONES LEADING TO ME/CFS WHICH 1734 01:28:06,866 --> 01:28:10,303 NORMALLY CAUSE MILD FLU-LIKE 1735 01:28:10,303 --> 01:28:10,703 ILLNESS. 1736 01:28:10,703 --> 01:28:12,371 THE VIRUS CAUSING LONG COVID 1737 01:28:12,371 --> 01:28:15,341 MUTATES LESS OFTEN THAN 1738 01:28:15,341 --> 01:28:15,708 ENTEROVIRUSES. 1739 01:28:15,708 --> 01:28:16,909 THERE ARE SOME LONG COVID 1740 01:28:16,909 --> 01:28:19,111 SYMPTOMS YOU DON'T SEE IN 1741 01:28:19,111 --> 01:28:22,848 EMPHASIS AND FOREMOST ARE THE 1742 01:28:22,848 --> 01:28:25,851 LOSS OF SENSE OF SMELL OR TASTE. 1743 01:28:25,851 --> 01:28:36,462 THERE'S COAGULABILITY AND 1744 01:28:58,384 --> 01:29:08,861 CORTISOL WAS STUDIED AND THERE'S 1745 01:29:11,297 --> 01:29:21,707 LONG COVID AND CONTROLS WHO 1746 01:29:22,975 --> 01:29:25,144 RECOVERED AND DON'T HAVE 1747 01:29:25,144 --> 01:29:28,981 CORTISOL AND WE DON'T SEE A 1748 01:29:28,981 --> 01:29:32,952 DIFFERENCE AS IN ANY ME/CFS 1749 01:29:32,952 --> 01:29:34,353 PUBLISHED IN 2022 PAPER. 1750 01:29:34,353 --> 01:29:37,556 THE DATA'S AVAILABLE AND 1751 01:29:37,556 --> 01:29:39,091 SUPPLEMENTARY DATA IN THE PAPER. 1752 01:29:39,091 --> 01:29:40,559 SO THIS ACTUALLY BRINGS THE 1753 01:29:40,559 --> 01:29:43,062 POINT THAT WE NEED TO BE DOING 1754 01:29:43,062 --> 01:29:44,330 STUDIES OF ME/CFS AND LONG COVID 1755 01:29:44,330 --> 01:29:46,932 AT THE SAME TIME SO WE CAN 1756 01:29:46,932 --> 01:29:49,268 USE -- WE DIDN'T USE THE SAME 1757 01:29:49,268 --> 01:29:51,904 PROTOCOL FOR ISOLATING THE BLOOD 1758 01:29:51,904 --> 01:29:53,506 FOR DOING THE ASSAY. 1759 01:29:53,506 --> 01:29:56,709 WE NEED TO DO DIRECT COMPARISONS 1760 01:29:56,709 --> 01:29:58,177 IN ORDER TO KNOW WHETHER THERE 1761 01:29:58,177 --> 01:30:01,247 ARE DIFFERENCES OR SIMILARITIES. 1762 01:30:01,247 --> 01:30:02,481 THIS IS CERTAINLY SUGGESTIVE 1763 01:30:02,481 --> 01:30:04,116 THERE'S A DIFFERENCE HERE. 1764 01:30:04,116 --> 01:30:06,318 AND ALSO A PAPER THAT GOT A LOT 1765 01:30:06,318 --> 01:30:09,522 OF PRESS WAS FOR LOW LEVELS OF 1766 01:30:09,522 --> 01:30:10,122 SEROTONIN OBSERVED IN LONG 1767 01:30:10,122 --> 01:30:10,489 COVID. 1768 01:30:10,489 --> 01:30:14,060 AGAIN, YOU SEE ON THE RIGHT IS 1769 01:30:14,060 --> 01:30:16,929 THE PASC LEVEL OF SEROTONIN AND 1770 01:30:16,929 --> 01:30:19,165 THE RECOVERED PEOPLE HAVE HIGHER 1771 01:30:19,165 --> 01:30:21,667 SEROTONIN AND THE ACUTE CASES 1772 01:30:21,667 --> 01:30:27,373 HAVE LOW SEROTONIN ALSO. 1773 01:30:27,373 --> 01:30:32,378 WHEN WE ASSAYED OUR PATIENT 1774 01:30:32,378 --> 01:30:35,081 COHORT WE DID NOT SEE 1775 01:30:35,081 --> 01:30:38,784 DIFFERENCES IN SEROTONIN LEVEL 1776 01:30:38,784 --> 01:30:41,454 AND NEED TO MAKE DIRECT 1777 01:30:41,454 --> 01:30:41,754 COMPARISONS. 1778 01:30:41,754 --> 01:30:44,723 IN THE LAST MINUTE OR SO I'D 1779 01:30:44,723 --> 01:30:46,692 LIKE TO MENTION ONE OTHER MAJOR 1780 01:30:46,692 --> 01:30:47,793 DIFFERENCE BETWEEN LONG COVID 1781 01:30:47,793 --> 01:30:48,360 AND ME/CFS. 1782 01:30:48,360 --> 01:30:54,366 THIS IS THAT MAJOR DIFFERENCE. 1783 01:30:54,366 --> 01:30:57,269 THERE'S MORE MONEY AVAILABLE FOR 1784 01:30:57,269 --> 01:30:59,638 STUDYING LONG COVID THAN ABE 1785 01:30:59,638 --> 01:30:59,905 ME/CFS. 1786 01:30:59,905 --> 01:31:03,075 IN 2021 WE RECEIVED $13 MILLION 1787 01:31:03,075 --> 01:31:04,510 FROM NIH. 1788 01:31:04,510 --> 01:31:06,645 NOW, NIH DIDN'T HAVE A BILLION 1789 01:31:06,645 --> 01:31:11,817 DOLLARS LYING AROUND TO DEVOTE 1790 01:31:11,817 --> 01:31:16,422 TO PASC IT WAS GIVEN TO NIH BY 1791 01:31:16,422 --> 01:31:17,089 CONGRESS BECAUSE OF THE URGENCY 1792 01:31:17,089 --> 01:31:22,228 OF STUDYING THIS. 1793 01:31:22,228 --> 01:31:26,165 MOST ARE WELL AWARE OF THE UNDER 1794 01:31:26,165 --> 01:31:27,733 FUNDING OF ME/CFS RELATIVE TO 1795 01:31:27,733 --> 01:31:31,070 THE BURDEN OF ILLNESS AND ONE 1796 01:31:31,070 --> 01:31:35,608 BURDEN IS AIDS. 1797 01:31:35,608 --> 01:31:38,444 IT OVERSHADOWED AIDS IN THE '80s 1798 01:31:38,444 --> 01:31:41,747 AND STILL OVERSHADOWING ME/CFS. 1799 01:31:41,747 --> 01:31:44,083 THERE'S 1.2 MILLION INDIVIDUALS 1800 01:31:44,083 --> 01:31:46,118 LIVING WITH HIV IN THE U.S. AND 1801 01:31:46,118 --> 01:31:47,486 OVER 3 MILLION BARELY LIVING 1802 01:31:47,486 --> 01:31:57,897 WITH ME/CFS IN THE U.S. 1803 01:31:58,364 --> 01:31:59,498 WHAT'S PARTICULARLY CRITICAL IS 1804 01:31:59,498 --> 01:32:01,200 IT'S POSSIBLE THE FUTURE FUNDING 1805 01:32:01,200 --> 01:32:04,170 FOR PASC IS IS NOW GOING TO 1806 01:32:04,170 --> 01:32:06,805 DISAPPEAR AND WHAT I WOULD LIKE 1807 01:32:06,805 --> 01:32:08,274 TO SAY TO THE ADVOCATES AND 1808 01:32:08,274 --> 01:32:09,308 PATIENTS AND MEMBERS OF THE 1809 01:32:09,308 --> 01:32:13,512 ADVOCACY ORGANIZATIONS IS WE 1810 01:32:13,512 --> 01:32:15,314 NEED AN INITIATIVE FOR 1811 01:32:15,314 --> 01:32:20,186 POST-ACUTE INFECTION DISEASE 1812 01:32:20,186 --> 01:32:22,454 SYNDR 1813 01:32:22,454 --> 01:32:23,088 SYNDROME. 1814 01:32:23,088 --> 01:32:28,394 THERE NEEDS TO BE A NEW 1815 01:32:28,394 --> 01:32:37,002 INITIATIVE TO STUDIES THESE 1816 01:32:37,002 --> 01:32:38,604 ILLNESSES TO RESTORE THEIR 1817 01:32:38,604 --> 01:32:38,971 HEALTH. 1818 01:32:38,971 --> 01:32:39,905 I'D LIKE TO END WITH THESE 1819 01:32:39,905 --> 01:32:40,940 ACKNOWLEDGEMENTS. 1820 01:32:40,940 --> 01:32:45,911 THANK YOU. 1821 01:32:45,911 --> 01:32:48,647 WE HAVE TIME FOR ONE OR TWO 1822 01:32:48,647 --> 01:32:48,914 QUESTIONS. 1823 01:32:48,914 --> 01:32:54,420 PLEASE GO UP TO THE MIC. 1824 01:32:54,420 --> 01:32:57,389 >> WE TALK ABOUT THIS ON THE WAY 1825 01:32:57,389 --> 01:33:02,194 HOME BUT I'D LIKE MORE ANSWERS 1826 01:33:02,194 --> 01:33:03,462 FROM THE AUDIENCE. 1827 01:33:03,462 --> 01:33:06,699 THINKING ABOUT INFECTIONS, 1828 01:33:06,699 --> 01:33:07,866 MICROBACTERIA NEVER GO AWAY 1829 01:33:07,866 --> 01:33:11,403 THOUGH WE CALL IT CURED FROM 1830 01:33:11,403 --> 01:33:15,074 T.B. 1831 01:33:15,074 --> 01:33:16,942 STA 1832 01:33:16,942 --> 01:33:18,644 STAPHAUREUS INFECTIONS YOU'RE 1833 01:33:18,644 --> 01:33:19,411 STILL COLONIZED WITH IT 1834 01:33:19,411 --> 01:33:22,948 AFTERWARDS AND WONDERING IF 1835 01:33:22,948 --> 01:33:23,749 THERE'S ANY KNOWLEDGE ABOUT 1836 01:33:23,749 --> 01:33:27,786 MAYBE WHEN YOU GET A VIRUS IT 1837 01:33:27,786 --> 01:33:31,590 NEVER LEAVES YOUR BODY. 1838 01:33:31,590 --> 01:33:38,163 THIS IS WHAT WE'RE SEEING. 1839 01:33:38,163 --> 01:33:40,933 I'M CURIOUS IF THERE'S 1840 01:33:40,933 --> 01:33:41,700 INFORMATION ABOUT WHAT PEOPLE 1841 01:33:41,700 --> 01:33:42,768 KNOW ABOUT THAT. 1842 01:33:42,768 --> 01:33:45,237 >> I ONLY KNOW ABOUT ENTEROVIRUS 1843 01:33:45,237 --> 01:33:46,872 AND SARS COV2. 1844 01:33:46,872 --> 01:33:49,608 I DON'T KNOW ABOUT OTHER VIRUSES 1845 01:33:49,608 --> 01:33:51,810 AND OF COURSE THERE'S 1846 01:33:51,810 --> 01:33:54,680 CONTROVERSY ON WHAT CHRONIC LYME 1847 01:33:54,680 --> 01:33:55,080 IS. 1848 01:33:55,080 --> 01:33:56,582 SO -- I CAN'T ANSWER THAT 1849 01:33:56,582 --> 01:33:56,982 QUESTION. 1850 01:33:56,982 --> 01:33:57,516 I DON'T KNOW ABOUT OTHER 1851 01:33:57,516 --> 01:34:03,722 VIRUSES. 1852 01:34:03,722 --> 01:34:04,857 >> THANK YOU FOR YOUR TALK. 1853 01:34:04,857 --> 01:34:07,059 I HAVE COMMENTS FROM YOUR WEB 1854 01:34:07,059 --> 01:34:11,730 PEOPLE ONLINE. 1855 01:34:11,730 --> 01:34:15,167 ONE IS AN OBSERVATION THAT A 1856 01:34:15,167 --> 01:34:19,338 PARTICULAR PATIENT WHO HAS NOTED 1857 01:34:19,338 --> 01:34:21,273 THE IMPACT OF NUTRITION ON THEIR 1858 01:34:21,273 --> 01:34:22,941 JOURNEY AND MAKE THE CONNECTION 1859 01:34:22,941 --> 01:34:24,310 YOU WERE SAYING WHAT'S 1860 01:34:24,310 --> 01:34:26,245 DIFFERENCE ABOUT THE 1980s CASES 1861 01:34:26,245 --> 01:34:28,914 AND THEY JUST WANT TO BRING UP 1862 01:34:28,914 --> 01:34:31,817 THAT'S WHEN THE SWITCH TO HIGH 1863 01:34:31,817 --> 01:34:36,088 FRUCTOSE CORN SYRUP AND FOOD 1864 01:34:36,088 --> 01:34:36,655 STUFFS OCCURRED. 1865 01:34:36,655 --> 01:34:40,292 THAT'S A COMMENT NOT A QUESTION. 1866 01:34:40,292 --> 01:34:42,094 >> MAYBE PEOPLE ON ZOOM CAN'T 1867 01:34:42,094 --> 01:34:44,563 HEAR THAT NUTRITION COULD HAVE 1868 01:34:44,563 --> 01:34:45,731 BEEN DIFFERENT IN THE 1980s. 1869 01:34:45,731 --> 01:34:47,800 >> THE OTHER IS TWO SEPARATE 1870 01:34:47,800 --> 01:34:50,169 FOLKS ONLINE HAVE ASKED ABOUT 1871 01:34:50,169 --> 01:34:51,437 THE CONNECTIONS BETWEEN WHAT YOU 1872 01:34:51,437 --> 01:34:56,709 PRESENTED FOR ENTEROVIRUSES AND 1873 01:34:56,709 --> 01:34:57,810 MICROBIOME CHANGES AND IF YOU 1874 01:34:57,810 --> 01:35:03,582 HAVE ANY THOUGHTS ABOUT THAT 1875 01:35:03,582 --> 01:35:05,851 SINCE WE SAW DATA ABOUT 1876 01:35:05,851 --> 01:35:07,486 MICROBIOME CHANGES. 1877 01:35:07,486 --> 01:35:09,021 >> THE QUESTION IS IS THERE 1878 01:35:09,021 --> 01:35:10,122 RELATIONSHIP BETWEEN THE 1879 01:35:10,122 --> 01:35:11,523 ALTERATIONS OF PEOPLE SEE IN THE 1880 01:35:11,523 --> 01:35:13,425 GUT MICROBIOME AND WHAT I'VE 1881 01:35:13,425 --> 01:35:19,498 BEEN TALKING ABOUT ENTER YO -- 1882 01:35:19,498 --> 01:35:19,832 ENTEROVIRUSES. 1883 01:35:19,832 --> 01:35:21,133 THEY ARE CALLED THAT BECAUSE 1884 01:35:21,133 --> 01:35:22,501 THEY GO TO YOUR GUT AND START 1885 01:35:22,501 --> 01:35:22,835 THE INFECTION. 1886 01:35:22,835 --> 01:35:24,937 WE DON'T KNOW WHETHER IN FACT IN 1887 01:35:24,937 --> 01:35:28,340 YOUR GUT YOU STILL HAVE 1888 01:35:28,340 --> 01:35:30,876 ENTEROVIRUSES IF YOU HAVE ME/CFS 1889 01:35:30,876 --> 01:35:32,945 AND THAT COULD BE EXAMINED. 1890 01:35:32,945 --> 01:35:37,282 THAT COULD BE A CONNECTION. 1891 01:35:37,282 --> 01:35:40,018 >> I'M FROM U.C. SAN DIEGO. 1892 01:35:40,018 --> 01:35:44,056 CAN ENTEROVIRAL INFECTION OF 1893 01:35:44,056 --> 01:35:45,224 ANIMAL CAUSE A FATIGUE SYMPTOM 1894 01:35:45,224 --> 01:35:47,426 IN ANIMALS OR PHENOTYPE? 1895 01:35:47,426 --> 01:35:49,962 >> I COULDN'T HEAR -- YOU SAID 1896 01:35:49,962 --> 01:35:51,630 SOMETHING ABOUT ENTEROVIRUS 1897 01:35:51,630 --> 01:35:53,665 INFECTION IN ANIMALS DO WHAT? 1898 01:35:53,665 --> 01:35:58,937 >> INDUCE FATIGUE PHENOTYPE IN 1899 01:35:58,937 --> 01:36:02,474 ANIMALS? 1900 01:36:02,474 --> 01:36:06,645 >> SO DO ANIMALS GET FATIGUED BY 1901 01:36:06,645 --> 01:36:06,979 ENTEROVIRUSES? 1902 01:36:06,979 --> 01:36:10,015 PEOPLE HAVE BEEN STUDYING IN 1903 01:36:10,015 --> 01:36:10,282 MICE. 1904 01:36:10,282 --> 01:36:11,683 I DON'T KNOW DETAILS ON THAT 1905 01:36:11,683 --> 01:36:14,119 DATA WHETHER THEY CAN RUN LESS 1906 01:36:14,119 --> 01:36:15,621 ON THEIR WHEELS BUT IT'S 1907 01:36:15,621 --> 01:36:16,388 PROBABLY KNOWN. 1908 01:36:16,388 --> 01:36:26,198 I JUST DON'T KNOW THAT DATA. 1909 01:36:26,198 --> 01:36:36,475 >> HAVE YOU INCLUDED THE 1910 01:36:36,475 --> 01:36:43,081 HOMOGEASE BILIRUBIN -- DID YOU 1911 01:36:43,081 --> 01:36:49,888 HEAR? 1912 01:36:49,888 --> 01:36:50,989 [INDISCERNIBLE] 1913 01:36:50,989 --> 01:36:59,631 >> THE HEME OXYGENASE AND THE 1914 01:36:59,631 --> 01:37:02,067 BYPRODUCT ARE BILIRUBIN AND SOME 1915 01:37:02,067 --> 01:37:03,936 HAVE BEEN IDENTIFIED AS ELEVATE 1916 01:37:03,936 --> 01:37:06,472 AND ASKED IF YOU LOOKED AT THAT 1917 01:37:06,472 --> 01:37:06,905 AND SEEN THAT? 1918 01:37:06,905 --> 01:37:09,508 >> I COULDN'T HEAR THAT REALLY 1919 01:37:09,508 --> 01:37:10,809 BUT I PROBABLY WOULDN'T KNOW THE 1920 01:37:10,809 --> 01:37:15,080 ANSWER EVEN IF I DID. 1921 01:37:15,080 --> 01:37:15,547 >> THANK YOU. 1922 01:37:15,547 --> 01:37:19,451 >> THANK YOU VERY MUCH, MAUREEN. 1923 01:37:19,451 --> 01:37:22,855 >> SO I THINK WE HAVE AN 1924 01:37:22,855 --> 01:37:23,455 EXCEPTIONAL MORNING. 1925 01:37:23,455 --> 01:37:25,557 PLEASE JOIN ME FOR A BIG ROUND 1926 01:37:25,557 --> 01:37:27,059 OF APPLAUSE FOR OUR SPEAKERS 1927 01:37:27,059 --> 01:37:27,593 THIS MORNING. 1928 01:37:27,593 --> 01:37:30,729 NOW IT'S TIME FOR THE BREAK 1929 01:37:30,729 --> 01:37:31,263 WE'LL COME BACK AT 11:00. 1930 01:37:31,263 --> 01:37:34,449 THANK YOU. 1931 01:40:31,195 --> 01:40:36,635 -- THE REASON IT'S IMPORTANT IS 1932 01:40:36,635 --> 01:40:38,270 WE NEED TO MATCH THE SEQUENCING 1933 01:40:38,270 --> 01:40:40,439 DATA BACK TO THE CELL OF ORIGIN 1934 01:40:40,439 --> 01:40:41,840 AND THE BAR CODE LETS US DO 1935 01:40:41,840 --> 01:40:42,341 THAT. 1936 01:40:42,341 --> 01:40:48,513 THE PLATFORM WE USED IS CALLED A 1937 01:40:48,513 --> 01:40:50,215 10X PLATFORM OR EVERY INDIVIDUAL 1938 01:40:50,215 --> 01:40:51,950 PROFILE MANY THOUSANDS IMMUNE 1939 01:40:51,950 --> 01:40:54,353 CELLS AND WE DETECT THOUSANDS OF 1940 01:40:54,353 --> 01:40:54,586 GENES. 1941 01:40:54,586 --> 01:40:59,124 WE CAN DO THIS ONLY WITH A FEW 1942 01:40:59,124 --> 01:41:03,095 HUNDRED MICROLITERS SO IT'S AN 1943 01:41:03,095 --> 01:41:04,129 EFFICIENT WAY OF USING VALUABLE 1944 01:41:04,129 --> 01:41:04,997 SAMPLES. 1945 01:41:04,997 --> 01:41:06,932 THIS IS A SIMPLE CARTOON OF WHAT 1946 01:41:06,932 --> 01:41:10,502 THE DATA LOOKS LIKE. 1947 01:41:10,502 --> 01:41:14,006 LOOK AT THE UNDERLYING 1948 01:41:14,006 --> 01:41:14,272 SEQUENCES. 1949 01:41:14,272 --> 01:41:15,173 THE DNA CONSEQUENCE TELLS YOU 1950 01:41:15,173 --> 01:41:18,944 THAT GENE WAS EXPRESSED IN A 1951 01:41:18,944 --> 01:41:22,114 CELL AND BECAUSE WE ALSO ALSO 1952 01:41:22,114 --> 01:41:23,749 SEQUENCE THE CELL BAR CODE WE 1953 01:41:23,749 --> 01:41:26,585 KNOW IT WAS EXPRESSED IN A 1954 01:41:26,585 --> 01:41:29,454 PARTICULAR BAR CODE AND CAN PARS 1955 01:41:29,454 --> 01:41:31,990 OUT FROM THOUSANDS OF CELLS FROM 1956 01:41:31,990 --> 01:41:33,258 EACH DIFFERENT BAR CODES. 1957 01:41:33,258 --> 01:41:35,927 THIS IS THE DATA SET. 1958 01:41:35,927 --> 01:41:38,030 WE HAVE 15 BILLION TOTAL 1959 01:41:38,030 --> 01:41:39,798 SEQUENCING READS AND CORRESPONDS 1960 01:41:39,798 --> 01:41:44,069 TO HALF A MILLION CELL 1961 01:41:44,069 --> 01:41:44,703 TRANSCRIPTOMES SPLIT BETWEEN 1962 01:41:44,703 --> 01:41:47,806 ME/CFS AND CONTROL COHORT. 1963 01:41:47,806 --> 01:41:50,676 THE DIAGRAM YOU'RE LOOKING AT IS 1964 01:41:50,676 --> 01:41:52,711 CALLED THE U-MAP. 1965 01:41:52,711 --> 01:41:54,813 A COMMON WAY OF REPRESENTING THE 1966 01:41:54,813 --> 01:41:57,315 DATA EACH DOT IS THE 1967 01:41:57,315 --> 01:41:58,216 TRANSCRIPTOME OF ONE CELL AND IF 1968 01:41:58,216 --> 01:42:00,052 THE CELLS ARE CLOSE TO EACH 1969 01:42:00,052 --> 01:42:03,121 OTHER IT MEANS THEY'RE HIGHLY 1970 01:42:03,121 --> 01:42:06,224 CONGRUENT THE SOFTWARE THEN 1971 01:42:06,224 --> 01:42:09,461 GATHERS HIGHLY CONCORDANT 1972 01:42:09,461 --> 01:42:12,431 TRANSCRIPTOMES AND CALLS THEM 1973 01:42:12,431 --> 01:42:16,268 CLUSTER AND WHAT'S COLORED AND 1974 01:42:16,268 --> 01:42:17,335 NUMBERED. 1975 01:42:17,335 --> 01:42:19,705 THE CLUSTERS WILL CORRESPOND TO 1976 01:42:19,705 --> 01:42:20,839 PARTICULAR CELL TYPES. 1977 01:42:20,839 --> 01:42:22,908 THIS WAS A HUGE TEAM EFFORT 1978 01:42:22,908 --> 01:42:25,944 START FROM THE CLINICIANS, THE 1979 01:42:25,944 --> 01:42:29,414 CLINICAL CORPS, THE PROJECT 1980 01:42:29,414 --> 01:42:31,149 COORDINATOR AND CORNELL AND A 1981 01:42:31,149 --> 01:42:33,418 LOT OF MOLECULAR BIOLOGY AND 1982 01:42:33,418 --> 01:42:35,087 SEQUENCING AND A COMPUTATIONAL 1983 01:42:35,087 --> 01:42:35,754 BIOLOGISTS THAT DID THE ANALYSIS 1984 01:42:35,754 --> 01:42:41,093 I GET TO TALK ABOUT. 1985 01:42:41,093 --> 01:42:42,994 BEFORE THE BIOLOGY A BIT OF 1986 01:42:42,994 --> 01:42:43,895 QUALITY CONTROL DATA WHICH IS 1987 01:42:43,895 --> 01:42:46,431 IMPORTANT FOR THE STUDIES. 1988 01:42:46,431 --> 01:42:48,400 THESE ARE COMMON QC METRICS FOR 1989 01:42:48,400 --> 01:42:48,600 DATA. 1990 01:42:48,600 --> 01:42:51,903 THE NUMBER OF GENES YOU DETECT 1991 01:42:51,903 --> 01:42:56,408 PER CELL AND THE NUMBER OF mRNA 1992 01:42:56,408 --> 01:42:58,777 AND PERCENT MITOCHONDRIAL 1993 01:42:58,777 --> 01:43:00,245 CONTAMINATION PARSED FROM THE 1994 01:43:00,245 --> 01:43:00,746 FOUR GROUPS. 1995 01:43:00,746 --> 01:43:04,850 THE CONTROL COHORTS AT BASELINE 1996 01:43:04,850 --> 01:43:07,252 AND THEN THE ME/CFS INDIVIDUALS 1997 01:43:07,252 --> 01:43:08,720 AT BASELINE AND ALL WE NEED TO 1998 01:43:08,720 --> 01:43:11,790 GET FROM THIS IS THE METRICS ARE 1999 01:43:11,790 --> 01:43:12,357 EQUIVALENT ACROSS THE FOUR 2000 01:43:12,357 --> 01:43:22,768 GROUPS WHICH IS IMPORTANT. 2001 01:43:22,768 --> 01:43:24,169 YOU CAN'T GENERATE ALL THE DATA 2002 01:43:24,169 --> 01:43:27,139 AT ONE TIME AND HAVE TO SPLIT IT 2003 01:43:27,139 --> 01:43:30,208 INTO BATCHES. 2004 01:43:30,208 --> 01:43:32,811 AGAIN THIS LOOKS GOOD. 2005 01:43:32,811 --> 01:43:34,446 WE HAVE TO PUT BIOLOGICAL LABELS 2006 01:43:34,446 --> 01:43:39,384 ON THE CLUSTERS. 2007 01:43:39,384 --> 01:43:41,987 WE LOOK AT DIAGNOSTIC MARKER 2008 01:43:41,987 --> 01:43:43,355 GENES KNOWN TO BE EXPRESSED IN 2009 01:43:43,355 --> 01:43:46,091 IMMUNE CELLS AND COME UP WITH A 2010 01:43:46,091 --> 01:43:49,361 FINAL MAP TO PLACE BIOLOGICAL 2011 01:43:49,361 --> 01:43:58,637 LABELS ON THE CLUSTERS. 2012 01:43:58,637 --> 01:44:05,410 AND IF WE SPLIT IT INTO ME/CFS 2013 01:44:05,410 --> 01:44:10,315 AND LOOK ESSENTIALLY IDENTICAL 2014 01:44:10,315 --> 01:44:11,817 AND SO THE DIFFERENCES WE'RE 2015 01:44:11,817 --> 01:44:13,385 GOING TO LOOK AT ARE MORE 2016 01:44:13,385 --> 01:44:22,460 SUBTLE. 2017 01:44:22,460 --> 01:44:25,597 AND WE SEE SOME SUBTLE CHANGES. 2018 01:44:25,597 --> 01:44:30,535 THE DATA IS SHOWING YOU ANTIGEN 2019 01:44:30,535 --> 01:44:32,337 EXPERIENCED CD8 T CELLS ARE 2020 01:44:32,337 --> 01:44:36,374 SLIGHTLY DEPLETED IN THESE 2021 01:44:36,374 --> 01:44:43,381 PATIENTS BUT SUBTLE, OTHERS ARE 2022 01:44:43,381 --> 01:44:44,583 DIFFERENT AND WE DON'T THINK 2023 01:44:44,583 --> 01:44:47,719 THEY'RE MAJOR FEATURES OF THE 2024 01:44:47,719 --> 01:44:48,086 IMMUNE SYSTEM. 2025 01:44:48,086 --> 01:44:51,089 THEY'RE QUITE SMALL DIFFERENCES. 2026 01:44:51,089 --> 01:44:52,224 YOU CAN SEE THE INDIVIDUAL 2027 01:44:52,224 --> 01:44:54,426 VARIATION EXCEEDS THE DIFFERENCE 2028 01:44:54,426 --> 01:44:55,260 BETWEEN THE GROUPS. 2029 01:44:55,260 --> 01:44:56,895 WHAT WE WANTED TO DO WITH THE 2030 01:44:56,895 --> 01:44:59,497 DATA WAS TO LOOK AT EACH CLUSTER 2031 01:44:59,497 --> 01:45:01,800 AND COMPARE THE GENE EXPRESSION 2032 01:45:01,800 --> 01:45:03,902 PROFILE BETWEEN PATIENTS AND THE 2033 01:45:03,902 --> 01:45:05,303 CONTROLS AND COUNT UP HOW MANY 2034 01:45:05,303 --> 01:45:08,406 GENES ARE DYSREGULATED ACROSS 2035 01:45:08,406 --> 01:45:09,474 EACH IMMUNE CELL TYPE AND THIS 2036 01:45:09,474 --> 01:45:10,976 IS THE RESULT WE GET. 2037 01:45:10,976 --> 01:45:16,381 THE RED BARS ARE NUMBERS OF 2038 01:45:16,381 --> 01:45:17,048 DYSREGULATED GENES AT BASELINE 2039 01:45:17,048 --> 01:45:19,985 COMPARING ME/CFS TO CONTROL. 2040 01:45:19,985 --> 01:45:26,057 THE PURPLE IS POSTPOST AND THE 2041 01:45:26,057 --> 01:45:27,759 OTHER COMPARES CONTROLS BETWEEN 2042 01:45:27,759 --> 01:45:28,927 THE TWO TIME POINTS. 2043 01:45:28,927 --> 01:45:30,161 THERE'S A FEW GENERAL 2044 01:45:30,161 --> 01:45:34,633 CONCLUSIONS FROM THIS. 2045 01:45:34,633 --> 01:45:37,569 THE FIRST IS YOU HAVE A LARGE 2046 01:45:37,569 --> 01:45:43,241 SUBSET OF MONOCYTES THE MOST 2047 01:45:43,241 --> 01:45:44,276 DYSREGULATED TYPE IN THIS ASSAY. 2048 01:45:44,276 --> 01:45:49,414 THE OTHER CLEAR CONCLUSION FROM 2049 01:45:49,414 --> 01:45:52,450 THIS IS THERE'S BROAD 2050 01:45:52,450 --> 01:45:54,019 DYSREGULATION ACROSS IMMUNE 2051 01:45:54,019 --> 01:45:54,219 TYPES. 2052 01:45:54,219 --> 01:46:01,059 THESE ARE T CELL SUBSETS. 2053 01:46:01,059 --> 01:46:04,062 FOR NOW I'LL FOCUS ON MONOCYTES. 2054 01:46:04,062 --> 01:46:06,197 THEY DO A LOT OF THINGS AS DO 2055 01:46:06,197 --> 01:46:08,466 IMMUNE CELLS. 2056 01:46:08,466 --> 01:46:14,306 THEY'RE INVOLVED IN PHAGOCYTOSIS 2057 01:46:14,306 --> 01:46:20,912 AND ANTIGEN PRESENTATION AND 2058 01:46:20,912 --> 01:46:23,281 CYTOKINE PRODUCTION AND SOURCE 2059 01:46:23,281 --> 01:46:25,517 OF MACROPHAGES AND THEY GO INTO 2060 01:46:25,517 --> 01:46:27,686 THE TISSUE IN RESPONSE TO 2061 01:46:27,686 --> 01:46:29,220 STIMULI AND DIFFERENTIATE TO 2062 01:46:29,220 --> 01:46:30,188 MACROPHAGES AND THEY CAN DO 2063 01:46:30,188 --> 01:46:30,722 DIFFERENT THINGS. 2064 01:46:30,722 --> 01:46:32,724 THEY CAN BE INVOLVED IN WOUND 2065 01:46:32,724 --> 01:46:35,093 REPAIR, HEALING BUT THEY CAN 2066 01:46:35,093 --> 01:46:40,332 ALSO BE PRO-INFLAMMATORY. 2067 01:46:40,332 --> 01:46:48,073 I'LL MENTION THERE'S THERE'S 2068 01:46:48,073 --> 01:46:48,807 ASSOCIATION WITH INFLAMMATORY 2069 01:46:48,807 --> 01:46:49,441 AND AUTO IMMUNITY. 2070 01:46:49,441 --> 01:46:52,377 WHAT DO WE SEE WHEN BETWEEN THE 2071 01:46:52,377 --> 01:47:01,286 CONTROLS AND ME/CFS INDIVIDUALS? 2072 01:47:01,286 --> 01:47:04,889 AND WE INTERSECT THE WHOLE 2073 01:47:04,889 --> 01:47:06,791 CHANGE WITH EXTERNALLY CURATED 2074 01:47:06,791 --> 01:47:07,959 SETS OF GENES. 2075 01:47:07,959 --> 01:47:11,997 THAT'S WHAT IS SHOWN ON THE Y 2076 01:47:11,997 --> 01:47:13,999 AXIS CALLED GENE SET ENRICHMENT 2077 01:47:13,999 --> 01:47:15,567 ANALYSIS AND THE DOTS ON THE FAR 2078 01:47:15,567 --> 01:47:17,702 RIGHT OF THE PLOT ARE SETS OF 2079 01:47:17,702 --> 01:47:25,710 GENES UPREGULATED IN ME/CFS. 2080 01:47:25,710 --> 01:47:30,882 AND THE MONONUCLEAR CELL 2081 01:47:30,882 --> 01:47:32,450 MIGRATION AND LEUKOCYTE 2082 01:47:32,450 --> 01:47:34,586 MIGRATION AND ACTIVATION ARE THE 2083 01:47:34,586 --> 01:47:37,655 PATHWAYS REQUIRED FOR MONOOCYTE 2084 01:47:37,655 --> 01:47:41,426 TO RESPOND, GO TO TISSUE AND 2085 01:47:41,426 --> 01:47:46,031 BECOME MACROPHAGES. 2086 01:47:46,031 --> 01:47:53,972 BUT THE GENES ARE UP REGULATED 2087 01:47:53,972 --> 01:47:55,040 IN ME/CFS. 2088 01:47:55,040 --> 01:47:56,608 THE FIRST TWO HERE ARE 2089 01:47:56,608 --> 01:48:01,980 SELF-SERVICE PROTEINS CRITICAL 2090 01:48:01,980 --> 01:48:02,280 F 2091 01:48:02,280 --> 01:48:10,121 FOR MONOSITES TO -- MONOCYTE TO 2092 01:48:10,121 --> 01:48:12,023 GET INTO TISSUE AND LOWER LEVELS 2093 01:48:12,023 --> 01:48:16,027 ARE REQUIRED FOR IT TO BECOME A 2094 01:48:16,027 --> 01:48:21,399 MACROPHAGE AND THE CCL4 IS A 2095 01:48:21,399 --> 01:48:28,673 CHEMO ATTRACT ANT THAT BRINGS 2096 01:48:28,673 --> 01:48:30,108 MONOCYTES TO TISSUE. 2097 01:48:30,108 --> 01:48:33,311 THE FIRST FOUR ARE A SERIES OF 2098 01:48:33,311 --> 01:48:35,146 PRO AND INFLAMMATORY RECEPTORS. 2099 01:48:35,146 --> 01:48:36,448 THOSE ARE DIFFERENTLY REGULATED 2100 01:48:36,448 --> 01:48:38,450 AND THE FINAL ONE WHICH IS 2101 01:48:38,450 --> 01:48:43,955 IMPORTANT IS CCL4 PROBABLY MORE 2102 01:48:43,955 --> 01:48:45,323 UPREGULATED POST-CPET. 2103 01:48:45,323 --> 01:48:50,995 WHEN WE PUT IT TOGETHER THE 2104 01:48:50,995 --> 01:48:57,335 HYPOTHESIS WE HAVE NOW IS SOME 2105 01:48:57,335 --> 01:49:08,012 PART HAS WILL ELEVATE D TISSUES 2106 01:49:09,380 --> 01:49:15,487 AND WE'LL LOOK IN TISSUE BIOPSY 2107 01:49:15,487 --> 01:49:17,589 AN LOOK AT GENOMICS AND ANALYSES 2108 01:49:17,589 --> 01:49:19,557 THAT GIVE MORE SUPPORT TO THIS 2109 01:49:19,557 --> 01:49:20,058 HYPOTHESIS. 2110 01:49:20,058 --> 01:49:26,965 FIRST THING WE DID WAS DECIDED 2111 01:49:26,965 --> 01:49:32,337 TO MOVE FROM SINGLE CELL RNA SEQ 2112 01:49:32,337 --> 01:49:35,940 AND USED MONOCYTES AND THE THIS 2113 01:49:35,940 --> 01:49:37,408 IS A PRINCIPLE COMPONENT AND THE 2114 01:49:37,408 --> 01:49:40,445 YELLOW DOTS ARE CONTROLS. 2115 01:49:40,445 --> 01:49:44,549 THEY'RE TIGHTLY CLUSTERED AND 2116 01:49:44,549 --> 01:49:46,451 DISTINCT AND FROM THE ME/CFS 2117 01:49:46,451 --> 01:49:48,653 INDIVIDUALS AND THEY'RE MORE 2118 01:49:48,653 --> 01:49:49,387 DISPERSED. 2119 01:49:49,387 --> 01:49:51,723 SUGGESTING HETEROGENEITY AND 2120 01:49:51,723 --> 01:49:55,393 THAT WILL BE A FEATURE LATER IN 2121 01:49:55,393 --> 01:49:55,660 THE TALK. 2122 01:49:55,660 --> 01:50:01,399 WE CAN LOOK AT THE CONTROL AND 2123 01:50:01,399 --> 01:50:05,270 ME/CFS COHORTS YOU SEE 2124 01:50:05,270 --> 01:50:09,440 SIGNALLING MOLECULES THAT PUSH 2125 01:50:09,440 --> 01:50:11,776 MONOCYTE TO GO TO TISSUE AND THE 2126 01:50:11,776 --> 01:50:19,851 TOP IS CFS2 A KEY PLAYER IN 2127 01:50:19,851 --> 01:50:20,618 ACTIVATING IMMUNE CELLS 2128 01:50:20,618 --> 01:50:23,588 INCLUDING IN THE MONOCYTE 2129 01:50:23,588 --> 01:50:26,958 MACROPHAGE AND WE DON'T PICK IT 2130 01:50:26,958 --> 01:50:28,726 UP FOR TECHNICAL REASONS BUT 2131 01:50:28,726 --> 01:50:30,628 ANOTHER WAY TO VALIDATE THIS 2132 01:50:30,628 --> 01:50:33,398 USING THE ORTHOGONAL APPROACH 2133 01:50:33,398 --> 01:50:35,733 AND THE SAMPLES USED ARE 2134 01:50:35,733 --> 01:50:40,638 DISTINCT FROM THOSE USED IN THE 2135 01:50:40,638 --> 01:50:40,939 SINGLE CELL. 2136 01:50:40,939 --> 01:50:43,775 IT'S INDEPENDENT VALIDATION. 2137 01:50:43,775 --> 01:50:50,148 WE MOVED BEYOND VALIDATING THE 2138 01:50:50,148 --> 01:50:50,582 DYSREGULATION USING 2139 01:50:50,582 --> 01:50:53,418 TRANSCRIPTOME AND THIS IS 2140 01:50:53,418 --> 01:50:59,123 PROTEOMICS FROM CONTROL AND 2141 01:50:59,123 --> 01:51:02,227 CLASSICAL MONOCYTES AND WHEN 2142 01:51:02,227 --> 01:51:03,695 ENRICHMENT ANALYSIS ON THE 2143 01:51:03,695 --> 01:51:05,396 CHANGES IN THE PROTEOME YOU SEE 2144 01:51:05,396 --> 01:51:07,432 TERMS SUGGESTIVE OF 2145 01:51:07,432 --> 01:51:16,741 INAPPROPRIATE ACTIVATION OF M 2146 01:51:16,741 --> 01:51:17,275 MONOC 2147 01:51:17,275 --> 01:51:17,809 MONOC 2148 01:51:17,809 --> 01:51:18,409 MONOCY 2149 01:51:18,409 --> 01:51:18,676 MONOCYTES. 2150 01:51:18,676 --> 01:51:20,011 SO, I MENTIONED WE SEE MORE 2151 01:51:20,011 --> 01:51:21,112 TRANSCRIPTOME FROM CONTROLS AND 2152 01:51:21,112 --> 01:51:22,213 I'LL SPEND TIME TALK ABOUT THAT 2153 01:51:22,213 --> 01:51:25,416 BECAUSE I THINK WE FOUND 2154 01:51:25,416 --> 01:51:25,984 INTERESTING WAYS TO LOOK AT 2155 01:51:25,984 --> 01:51:29,921 THAT. 2156 01:51:29,921 --> 01:51:32,156 THE IDEA WE EXPLORED IS MAYBE IN 2157 01:51:32,156 --> 01:51:34,158 CONTROLS THERE'S A UNIFORM 2158 01:51:34,158 --> 01:51:36,661 POPULATION OF MONOCYTES THE 2159 01:51:36,661 --> 01:51:38,429 YELLOW CELLS AND IN PATIENT AS A 2160 01:51:38,429 --> 01:51:41,399 VARIABLE NUMBER OF RELATIVELY 2161 01:51:41,399 --> 01:51:49,407 NORMAL YELLOW MONOCYTES AND THE 2162 01:51:49,407 --> 01:51:54,979 DYSREGULATEDMONEYCYTESS -- 2163 01:51:54,979 --> 01:51:58,216 MONOCYTES AND THE IDEA FOR THE 2164 01:51:58,216 --> 01:52:02,587 HYPOTHESIS AND EXECUTING GOES TO 2165 01:52:02,587 --> 01:52:04,989 HANYA IN MY LAB. 2166 01:52:04,989 --> 01:52:08,059 SHE USED POSITIVE UNLABELLED 2167 01:52:08,059 --> 01:52:09,260 LEARNING THAT IMPLEMENT THE 2168 01:52:09,260 --> 01:52:11,195 CARTOON ON THE LEFT AND YOU CAN 2169 01:52:11,195 --> 01:52:14,299 SEE THE REAL DATA FOR CLASSICAL 2170 01:52:14,299 --> 01:52:15,833 MONOCYTES AND IN THE CONTROLS 2171 01:52:15,833 --> 01:52:25,376 YOU HAVE THE SEA OF YELLOW DOTS, 2172 01:52:25,376 --> 01:52:25,810 NOR 2173 01:52:25,810 --> 01:52:36,321 NORMAL MONOCYTES AND SEVERELY 2174 01:52:38,556 --> 01:52:40,291 PERTURBED MONOCYTES AND NOW 2175 01:52:40,291 --> 01:52:41,726 SPLIT IT IN INDIVIDUAL ME/CFS 2176 01:52:41,726 --> 01:52:42,560 INDIVIDUALS AND WHAT YOU CAN SEE 2177 01:52:42,560 --> 01:52:46,998 I THINK IS SOME INDIVIDUALS 2178 01:52:46,998 --> 01:52:49,400 MOSTLY HAVE BLUE CELLS THE 2179 01:52:49,400 --> 01:52:51,035 DYSREGULATED PREDICTIVE DISEASE 2180 01:52:51,035 --> 01:52:53,071 CELLS AND SOME STILL HAVE THE 2181 01:52:53,071 --> 01:52:54,505 CELLS BUT AT LOWER FREQUENCIES. 2182 01:52:54,505 --> 01:52:56,341 THIS IS THE OTHER SIDE OF THE 2183 01:52:56,341 --> 01:52:56,541 COIN. 2184 01:52:56,541 --> 01:52:58,710 THIS IS THE CONTROL COHORT. 2185 01:52:58,710 --> 01:53:01,045 YOU SEE NO BLUE CELLS THEY'RE 2186 01:53:01,045 --> 01:53:03,047 ALL PREDICTED NORMAL. 2187 01:53:03,047 --> 01:53:04,048 THIS IS SUMMARIZING THE SAME 2188 01:53:04,048 --> 01:53:05,416 DATA AND AN EASIER WAY TO LOOK 2189 01:53:05,416 --> 01:53:09,153 AT IT. 2190 01:53:09,153 --> 01:53:12,323 WE BUILT THE CLASSIFIER 2191 01:53:12,323 --> 01:53:16,994 INDEPENDENTLY FROM THE DETE 2192 01:53:16,994 --> 01:53:19,464 DATA AND CORRELATION OF THE 2193 01:53:19,464 --> 01:53:21,399 PERCENTAGE OF DISEASE AND 2194 01:53:21,399 --> 01:53:23,034 PREDICTED MONOCYTES. 2195 01:53:23,034 --> 01:53:26,771 YOU SEE'S CONGRUENT. 2196 01:53:26,771 --> 01:53:29,407 IT'S STABLE AT BASELINE AND AT 2197 01:53:29,407 --> 01:53:31,442 THE EARLY STAGES OF 2198 01:53:31,442 --> 01:53:41,853 POST-EXERTIONAL MALAISE. 2199 01:53:52,463 --> 01:53:53,531 THERE'S A STRONG CORRELATION. 2200 01:53:53,531 --> 01:53:57,435 THIS CLASSIFIER IS ABLE TO PICK 2201 01:53:57,435 --> 01:54:02,573 OUT INDIVIDUALS WITH MORE SEVERE 2202 01:54:02,573 --> 01:54:04,308 SYMPTOMS BASED ON THE PERCENTAGE 2203 01:54:04,308 --> 01:54:08,780 OF THEIR MONOCYTES PREDICTED AS 2204 01:54:08,780 --> 01:54:09,013 DISEASE. 2205 01:54:09,013 --> 01:54:11,849 THIS IS ALSO AN IMPORTANT WAY OF 2206 01:54:11,849 --> 01:54:12,617 LOOKING AT THIS. 2207 01:54:12,617 --> 01:54:16,254 THIS INDEX I WON'T TRY TO 2208 01:54:16,254 --> 01:54:16,854 PRONOU 2209 01:54:16,854 --> 01:54:18,423 PRONOUNCE, IF YOU SPLIT DATA 2210 01:54:18,423 --> 01:54:19,791 ACCORDING TO DIFFERENT CRITERIA 2211 01:54:19,791 --> 01:54:21,926 AND THE Y AXIS YOU ASK HOW MUCH 2212 01:54:21,926 --> 01:54:23,895 INFORMATION ARE YOU GETTING BY 2213 01:54:23,895 --> 01:54:24,662 SPLITTING THE DATA. 2214 01:54:24,662 --> 01:54:26,197 HOW WELL ARE YOU DISTINGUISHING 2215 01:54:26,197 --> 01:54:26,631 TWO SETS. 2216 01:54:26,631 --> 01:54:32,103 FROM THE BOTTOM UP, IF YOU SPLIT 2217 01:54:32,103 --> 01:54:34,472 ALL THE SINGLE CELL 2218 01:54:34,472 --> 01:54:35,506 TRANSCRIPTOMES YOU GET A CERTAIN 2219 01:54:35,506 --> 01:54:36,441 AMOUNT OF INFORMATION. 2220 01:54:36,441 --> 01:54:37,708 IF YOU SPLIT THE SAME DATA BY 2221 01:54:37,708 --> 01:54:41,813 INDIVIDUAL OF ORE ORIGIN YOU GET 2222 01:54:41,813 --> 01:54:42,814 MORE INFORMATION AND THIS IS THE 2223 01:54:42,814 --> 01:54:45,416 HUGE CONFOUNDING EFFECT WE GET 2224 01:54:45,416 --> 01:54:47,251 IN THE HUMAN POPULATION. 2225 01:54:47,251 --> 01:54:48,586 THERE'S HUMAN INTERINDIVIDUAL 2226 01:54:48,586 --> 01:54:49,387 VARIATION NOT RELATED TO DISEASE 2227 01:54:49,387 --> 01:54:52,523 STATE. 2228 01:54:52,523 --> 01:54:54,826 THE NEXT UP IS SEX. 2229 01:54:54,826 --> 01:54:59,297 IF YOU SPLIT BY FEMALE AND MALE 2230 01:54:59,297 --> 01:55:01,632 MORE PARTITIONING. 2231 01:55:01,632 --> 01:55:04,602 MALE AND FEMALE MONOCYTES ARE 2232 01:55:04,602 --> 01:55:06,103 DIFFERENT AND IF WE PARTITION BY 2233 01:55:06,103 --> 01:55:08,005 THE PREDICTIVE DISEASE CELLS AND 2234 01:55:08,005 --> 01:55:11,175 NORMAL CELLS YOU GET THE MOST 2235 01:55:11,175 --> 01:55:11,742 INFORMATION. 2236 01:55:11,742 --> 01:55:13,077 THERE'S INFORMATION THERE WE CAN 2237 01:55:13,077 --> 01:55:14,479 EXTRACT THAT WILL HOPEFULLY TELL 2238 01:55:14,479 --> 01:55:16,214 US SOMETHING ABOUT THE DISEASE. 2239 01:55:16,214 --> 01:55:17,415 THAT'S WHAT I'LL SHOW YOU ON THE 2240 01:55:17,415 --> 01:55:25,890 NEXT SLIDE. 2241 01:55:25,890 --> 01:55:31,362 WE TOOK THEM INTO SIX GROUP, 2242 01:55:31,362 --> 01:55:39,103 MALE AND FEMALE AND THEN WHETHER 2243 01:55:39,103 --> 01:55:40,071 THERE'S PREDICTIVE DISEASE CELLS 2244 01:55:40,071 --> 01:55:41,405 AND LOOKED AT THAT IN PRINCIPLE 2245 01:55:41,405 --> 01:55:51,682 COMPONENT SPACE. 2246 01:55:54,719 --> 01:55:56,120 YOU SEE DISEASE DISPARITY FROM 2247 01:55:56,120 --> 01:55:59,524 THE MALES ALL THE WAY TO THE 2248 01:55:59,524 --> 01:56:01,859 CONTROL AND YOU GET THE SAME 2249 01:56:01,859 --> 01:56:03,761 IDEA BUT FOR THE FEMALE. 2250 01:56:03,761 --> 01:56:08,266 WE CAN ASK WHAT ARE THE GENES 2251 01:56:08,266 --> 01:56:11,836 DRIVING THOSE PRINCIPLE 2252 01:56:11,836 --> 01:56:12,570 COMPONENT AXES AND 2253 01:56:12,570 --> 01:56:14,105 DISTINGUISHING THE CELL 2254 01:56:14,105 --> 01:56:14,505 IDENTITIES. 2255 01:56:14,505 --> 01:56:16,474 THAT'S WHAT'S PLOTTED HERE AND 2256 01:56:16,474 --> 01:56:18,609 I'LL POINT OUT CCL4 I MENTIONED 2257 01:56:18,609 --> 01:56:25,016 EARLIER AND CCL4L2 ARE AMONG THE 2258 01:56:25,016 --> 01:56:29,387 TOP GENES DRIVING THE DIFFERENCE 2259 01:56:29,387 --> 01:56:39,530 FOR MALES AND FEMALES. 2260 01:56:39,530 --> 01:56:44,168 WE TOOK EACH INDIVIDUAL ME/CFS 2261 01:56:44,168 --> 01:56:46,170 AND COMPARED GENE EXPRESSION 2262 01:56:46,170 --> 01:56:47,271 PROGRAMS BETWEEN THEM AND 2263 01:56:47,271 --> 01:56:48,573 AGGREGATED THAT ACROSS ALL THE 2264 01:56:48,573 --> 01:56:48,873 INDIVIDUALS. 2265 01:56:48,873 --> 01:56:51,042 THE REASON WE DID THIS IS 2266 01:56:51,042 --> 01:56:52,710 BECAUSE BY DOING THE 2267 01:56:52,710 --> 01:56:55,346 DIFFERENTIAL EXPRESSION ANALYSIS 2268 01:56:55,346 --> 01:56:58,883 AT THE INDIVIDUAL LEVEL YOU 2269 01:56:58,883 --> 01:57:01,385 NORMALIZE A WAY NORMAL HUMAN 2270 01:57:01,385 --> 01:57:02,920 INDIVIDUAL DIFFERENCE THE 2271 01:57:02,920 --> 01:57:03,387 CONFOUNDING VARIABLE. 2272 01:57:03,387 --> 01:57:05,656 THIS DISTILLS DOWN TO THE PUREST 2273 01:57:05,656 --> 01:57:07,425 SIGNAL DRIVING WHAT WE'RE 2274 01:57:07,425 --> 01:57:09,594 LOOKING AT HERE. 2275 01:57:09,594 --> 01:57:12,163 THE TOP PLAYERS ARE FAMILIAR. 2276 01:57:12,163 --> 01:57:16,934 CCL4 AND L2. 2277 01:57:16,934 --> 01:57:19,270 THEY'RE UP IN THE PREDICTIVE 2278 01:57:19,270 --> 01:57:20,771 DISEASE CELL AND ONE 2279 01:57:20,771 --> 01:57:23,374 INTERESTING, ATF3 TOWARDS THE 2280 01:57:23,374 --> 01:57:25,943 BOTTOM IT'S DOWN REGULATED IN 2281 01:57:25,943 --> 01:57:28,112 THE PREDICTED DISEASE CELL. 2282 01:57:28,112 --> 01:57:29,814 IT'S A TRANSCRIPTIONAL REGULATOR 2283 01:57:29,814 --> 01:57:34,518 AND REPRESSOR THAT DAMPENS A 2284 01:57:34,518 --> 01:57:35,486 PROINFLAMMATORY RESPONSE. 2285 01:57:35,486 --> 01:57:38,956 THET PREDICTIVE DISEASE CELLS 2286 01:57:38,956 --> 01:57:40,992 YOU LOST THE DAMPENING OF THE 2287 01:57:40,992 --> 01:57:42,426 PROINFLAMMATORY RESPONSE. 2288 01:57:42,426 --> 01:57:44,161 IT'S EASY TO IMAGINE PUSHING 2289 01:57:44,161 --> 01:57:49,033 THAT UP WOULD BIAS THE MONOCYTES 2290 01:57:49,033 --> 01:57:52,937 TO BECOMING MORE INFLAMMATORY 2291 01:57:52,937 --> 01:57:55,873 FAC -- MACROPHAGES AS THEY GET 2292 01:57:55,873 --> 01:57:56,774 IN THE TISSUE. 2293 01:57:56,774 --> 01:57:57,608 I TOLD YOU ABOUT THE RESEARCH ON 2294 01:57:57,608 --> 01:57:59,944 THE IMMUNE CELL AND WE HAVE 2295 01:57:59,944 --> 01:58:05,249 HIGH-QUALITY TRANSCRIPTOME IC 2296 01:58:05,249 --> 01:58:05,983 DATA ACROSS IMMUNE CELLS. 2297 01:58:05,983 --> 01:58:08,185 THIS IS A DATA SET FOR LONG 2298 01:58:08,185 --> 01:58:10,554 COVID BECAUSE WE HAVE SUCH NICE 2299 01:58:10,554 --> 01:58:11,389 QUANTITATIVE INFORMATION ACROSS 2300 01:58:11,389 --> 01:58:13,691 SO MANY CELLS IT SHOULD BE EASY 2301 01:58:13,691 --> 01:58:16,627 TO COMPARE HIS EQUIVALENT DATA 2302 01:58:16,627 --> 01:58:18,295 SETS ONE AVAILABLE FOR LONG 2303 01:58:18,295 --> 01:58:18,896 COVID. 2304 01:58:18,896 --> 01:58:20,998 I'VE SHOWN YOU DATA THAT 2305 01:58:20,998 --> 01:58:23,267 SUGGESTS THE CLASSICAL MONOCYTE 2306 01:58:23,267 --> 01:58:25,136 DYSREGULATION IS AN IMPORTANT 2307 01:58:25,136 --> 01:58:26,771 ASPECT OF ME/CFS BIOLOGY AND THE 2308 01:58:26,771 --> 01:58:29,040 INCREASED MIGRATION TO TISSUES 2309 01:58:29,040 --> 01:58:31,442 WHERE THEY DIFFERENTIATE TO 2310 01:58:31,442 --> 01:58:40,418 MACRO FATHPHAGES AND A SUBSET O 2311 01:58:40,418 --> 01:58:41,652 CELLS. 2312 01:58:41,652 --> 01:58:50,461 THIS IS WE STARTED TAPPING THE 2313 01:58:50,461 --> 01:58:50,661 FIRST. 2314 01:58:50,661 --> 01:58:54,498 WE REPEATED THE ANALYSIS AND 2315 01:58:54,498 --> 01:58:56,067 ASKED A DIFFERENT QUESTION. 2316 01:58:56,067 --> 01:58:57,134 INSTEAD OF GENE EXPRESSION 2317 01:58:57,134 --> 01:58:59,270 BETWEEN PATIENTS AND CONTROLS, 2318 01:58:59,270 --> 01:59:03,574 WE FIRST CALCULATED THE CHANGE 2319 01:59:03,574 --> 01:59:05,443 IN GENE EXPRESSION THE CPAT 2320 01:59:05,443 --> 01:59:07,278 ELICIT AND COMPARED THE CHANGES 2321 01:59:07,278 --> 01:59:10,448 IN GENE EXPRESSION BETWEEN THE 2322 01:59:10,448 --> 01:59:12,817 HEALTHY COHORT AND ME/CFS 2323 01:59:12,817 --> 01:59:17,388 INDIVIDUAL AND THE IDEA IS TO 2324 01:59:17,388 --> 01:59:19,490 HONE ON GENE EXPRESSION WITH 2325 01:59:19,490 --> 01:59:20,624 POST-EXERTIONAL MALAISE. 2326 01:59:20,624 --> 01:59:23,894 THE BIGGEST SIGNATURE BY FAR IS 2327 01:59:23,894 --> 01:59:24,662 IN PLATELETS. 2328 01:59:24,662 --> 01:59:26,063 IT'S ALMOST THE ONLY SIGNATURE 2329 01:59:26,063 --> 01:59:29,567 WE SEE WHEN WE DO THE ANALYSIS 2330 01:59:29,567 --> 01:59:31,502 IN THIS WAY. 2331 01:59:31,502 --> 01:59:37,208 THE MAJOR FUNCTION IS TO FORM 2332 01:59:37,208 --> 01:59:37,475 CLOTS. 2333 01:59:37,475 --> 01:59:41,612 THEY'RE NUCLEUS FREE AND THE 2334 01:59:41,612 --> 01:59:42,313 TRANSCRIPTOME WE'RE TALKING 2335 01:59:42,313 --> 01:59:48,652 ABOUT IS DERIVED FROM THE PARENT 2336 01:59:48,652 --> 01:59:59,330 CELLS MEGAKARE YYOCYTES AND 2337 02:00:07,171 --> 02:00:09,206 PLATELET DERIVED CLOTS ARE IN 2338 02:00:09,206 --> 02:00:10,841 LONG COVID AND TO SOME EXTENT IN 2339 02:00:10,841 --> 02:00:11,242 ME/CFS. 2340 02:00:11,242 --> 02:00:14,979 WHAT DO WE SEE? 2341 02:00:14,979 --> 02:00:17,681 WE SEE TWO THINGS. 2342 02:00:17,681 --> 02:00:19,950 AT BASELINE THE CORE GENES 2343 02:00:19,950 --> 02:00:21,418 TRANSCRIPTS REQUIRED FOR 2344 02:00:21,418 --> 02:00:23,988 PLATELET ACTIVATION, COAGULATION 2345 02:00:23,988 --> 02:00:26,891 AND IMMIGRATION, THOSE GENES ARE 2346 02:00:26,891 --> 02:00:27,424 DEPRESSED. 2347 02:00:27,424 --> 02:00:29,326 THEY'RE AT LOWER LEVELS. 2348 02:00:29,326 --> 02:00:35,166 THEN AFTER CPET THE SIGNAL WHICH 2349 02:00:35,166 --> 02:00:45,242 IS STRONG DISAPPEARS I THINK THE 2350 02:00:45,242 --> 02:00:47,211 POPULATION BECAUSE THEY CAN'T 2351 02:00:47,211 --> 02:00:50,714 GENERATE A NEW TRANSCRIPTOME. 2352 02:00:50,714 --> 02:00:53,017 THEY'RE CELL DERIVED PARTICLES. 2353 02:00:53,017 --> 02:00:55,252 THE WAY WE THINK OF THIS IS A 2354 02:00:55,252 --> 02:00:56,787 POPULATION OF DEFECTIVE 2355 02:00:56,787 --> 02:00:58,355 PLATELETS AT BASELINE. 2356 02:00:58,355 --> 02:01:00,291 YOU TRIGGER POST-EXERTIONAL 2357 02:01:00,291 --> 02:01:01,091 MALAISE AND SOMETHING CHANGES 2358 02:01:01,091 --> 02:01:04,094 AND THE PLATELET NO LONGER 2359 02:01:04,094 --> 02:01:05,229 VISIBLE TO THE ASSAY AND YOU NOW 2360 02:01:05,229 --> 02:01:07,498 HAVE A RELATIVELY NORMAL 2361 02:01:07,498 --> 02:01:10,668 POPULATION OF PLATELETS. 2362 02:01:10,668 --> 02:01:14,839 PERHAPS, POST-EXERTIONAL MALAISE 2363 02:01:14,839 --> 02:01:17,374 IS TRIGGERS MORE CLOT FORMATION. 2364 02:01:17,374 --> 02:01:21,712 WE USED CONVENTIONAL RNA SEQ AND 2365 02:01:21,712 --> 02:01:23,380 IN THE PROCESS OF USING 2366 02:01:23,380 --> 02:01:24,415 PROTEOMICS WHICH IS A BETTER WAY 2367 02:01:24,415 --> 02:01:25,716 TO DO THIS. 2368 02:01:25,716 --> 02:01:27,685 QUICKLY THEN THE LAST 30 2369 02:01:27,685 --> 02:01:31,188 SECONDS, WE NOW VERY INTERESTED 2370 02:01:31,188 --> 02:01:33,958 IN T CELL DYSREGULATION IN 2371 02:01:33,958 --> 02:01:36,393 ME/CFS. 2372 02:01:36,393 --> 02:01:37,595 WE'VE TAKEN OUR ATLAS AND THAT 2373 02:01:37,595 --> 02:01:41,432 GIVES HIGHER RESOLUTION TO LOOK 2374 02:01:41,432 --> 02:01:51,876 AT THE T CELLS AND HERE'S 2375 02:02:01,218 --> 02:02:07,458 THERE'S A CLUSTER WHERE TCF7 IS 2376 02:02:07,458 --> 02:02:09,326 UPREGULATION AND THE LATE STAGE 2377 02:02:09,326 --> 02:02:14,431 CD8s IS A HALLMARK OF PROGENITOR 2378 02:02:14,431 --> 02:02:16,400 CELLS TO AN EXHAUSTED STATE. 2379 02:02:16,400 --> 02:02:17,401 THIS IS SUGGESTING EXHAUSTION 2380 02:02:17,401 --> 02:02:19,536 AND THIS RESULT AND OTHERS 2381 02:02:19,536 --> 02:02:25,910 MOTIVATED MY LAB TO LOOKING AT 2382 02:02:25,910 --> 02:02:28,279 CD8 T CELL EXHAUSTION AND A PLUG 2383 02:02:28,279 --> 02:02:34,051 FOR JESSICA'S TALK YESTERDAY SHE 2384 02:02:34,051 --> 02:02:36,020 USED AND DAVID IN MY LAB WAS A 2385 02:02:36,020 --> 02:02:37,721 POSTER HERE IS TAKING THE SINGLE 2386 02:02:37,721 --> 02:02:40,391 CELL DATA AND LAYERING ON 2387 02:02:40,391 --> 02:02:42,526 ADDITIONAL GENOMIC DATA SETS TO 2388 02:02:42,526 --> 02:02:47,031 LOOK FOR SIGNATURES OF 2389 02:02:47,031 --> 02:02:51,168 EXHAUSTION AND THE CYTOMETRY 2390 02:02:51,168 --> 02:02:54,772 GIVE EVIDENCE OF EXHAUSTION LIKE 2391 02:02:54,772 --> 02:02:57,007 STATE IN ME/CFS OR CD8s. 2392 02:02:57,007 --> 02:03:05,349 SWEE THIS PROMINENT FEE 2393 02:03:08,485 --> 02:03:10,154 THE GENES SUGGESTED THE TISSUE 2394 02:03:10,154 --> 02:03:13,390 HOMING AND WHERE THE MONOCYTES 2395 02:03:13,390 --> 02:03:15,059 ARE BECOMING PROINFLAMMATORY 2396 02:03:15,059 --> 02:03:15,759 MACROPHAGES IN TISSUE. 2397 02:03:15,759 --> 02:03:21,432 I DIDN'T SHOW YOU THIS DATA BUT 2398 02:03:21,432 --> 02:03:31,675 YOU CAN ALSO MINE THE SINGLE 2399 02:03:31,675 --> 02:03:33,410 CELL DATA AND THERE'S 2400 02:03:33,410 --> 02:03:39,583 INTERESTING OBSERVATION THE 2401 02:03:39,583 --> 02:03:42,820 PLATELETS ARE CHANGING AND 2402 02:03:42,820 --> 02:03:48,959 LEADING TO MICROPLOT FORMATION 2403 02:03:48,959 --> 02:03:50,794 AND THIS IS OUR FUNDERS AND THIS 2404 02:03:50,794 --> 02:03:52,830 IS DONE IN COLLABORATION WITH 2405 02:03:52,830 --> 02:03:56,500 TWO OTHER LABS IN CORNELL AND A 2406 02:03:56,500 --> 02:03:57,368 GROUP FOR THE SINGLE CELL RNA 2407 02:03:57,368 --> 02:03:57,868 SEQ AND AIL STOP THERE. 2408 02:03:57,868 --> 02:04:01,438 THANKS. 2409 02:04:01,438 --> 02:04:01,872 -- I'LL STOP THERE. 2410 02:04:01,872 --> 02:04:07,544 THANKS.I'LL STOP THERE. 2411 02:04:07,544 --> 02:04:09,513 THANKS. 2412 02:04:09,513 --> 02:04:15,085 >> WE HAVE TIME FOR A FEW 2413 02:04:15,085 --> 02:04:18,288 QUESTI 2414 02:04:18,288 --> 02:04:20,024 QUESTIONS IF YOU WANT TO COME UP 2415 02:04:20,024 --> 02:04:21,091 TO THE MIC. 2416 02:04:21,091 --> 02:04:21,959 DON'T BE SHY. 2417 02:04:21,959 --> 02:04:23,660 WE DID A GREAT JOB THIS MORNING. 2418 02:04:23,660 --> 02:04:24,962 >> QUICK QUESTION. 2419 02:04:24,962 --> 02:04:27,197 RATHER THEN PLATELETS BEING 2420 02:04:27,197 --> 02:04:29,433 CONSUMED CAN THEY BE DILUTED OUT 2421 02:04:29,433 --> 02:04:31,835 FROM BEING RELEASED FROM 2422 02:04:31,835 --> 02:04:33,037 SEQUESTERED AREAS. 2423 02:04:33,037 --> 02:04:37,441 >> WOW, IT REALLY IS HARD TO 2424 02:04:37,441 --> 02:04:41,712 HEAR UP HERE. 2425 02:04:41,712 --> 02:04:43,914 >> NANCY'S QUESTION IS WHAT'S 2426 02:04:43,914 --> 02:04:47,151 GOING ON WITH THE PLATELETS 2427 02:04:47,151 --> 02:04:48,352 RATHER THAN BEING CONSUMED THEY 2428 02:04:48,352 --> 02:04:54,024 COULD BE SEQUESTERED. 2429 02:04:54,024 --> 02:04:58,295 THAT'S POSSIBLE. 2430 02:04:58,295 --> 02:05:02,132 IT'S POSSIBLE THERE'S AN INFLUX 2431 02:05:02,132 --> 02:05:05,769 OF PLATELETS. 2432 02:05:05,769 --> 02:05:16,313 THE SAMPLES ARE PLASMA AND CDMC. 2433 02:05:23,921 --> 02:05:26,423 AND THERE'S PROTEOMICS. 2434 02:05:26,423 --> 02:05:29,193 WE'LL REPEAT THESE APPROACH 2435 02:05:29,193 --> 02:05:30,294 USING PLATELETS THAT HAVE NEVER 2436 02:05:30,294 --> 02:05:32,262 BEEN FROZEN AND THAT ALLOWS YOU 2437 02:05:32,262 --> 02:05:33,497 TO BE CONFIDENT THERE'S 2438 02:05:33,497 --> 02:05:35,099 PLATELETS IN CIRCULATION BUT 2439 02:05:35,099 --> 02:05:36,433 DOES NOT SPEAK TO YOUR QUESTION 2440 02:05:36,433 --> 02:05:37,201 ABOUT SEQUESTRATION. 2441 02:05:37,201 --> 02:05:42,639 WE'RE THINKING ABOUT THESE 2442 02:05:42,639 --> 02:05:52,950 THINGS. 2443 02:05:52,950 --> 02:05:54,418 >> SINCE YOU WERE DOING SINGLE 2444 02:05:54,418 --> 02:05:56,286 CELL ANALYSIS IT'S PROBABLY NOT 2445 02:05:56,286 --> 02:05:57,454 REALISTIC TO LOOK AT OTHER 2446 02:05:57,454 --> 02:06:02,993 COMPARATORS SINCE YOU SWITCHED 2447 02:06:02,993 --> 02:06:04,595 TO MORE CONVENTIONAL DID YOU 2448 02:06:04,595 --> 02:06:06,096 LOOK HOW UNIQUE IS THIS 2449 02:06:06,096 --> 02:06:09,366 MECHANISM DO YOU THINK OR IS IT 2450 02:06:09,366 --> 02:06:12,269 GOING CROSS TO OTHER COMPLEX 2451 02:06:12,269 --> 02:06:12,536 DISEASES? 2452 02:06:12,536 --> 02:06:13,537 >> GREAT QUESTION. 2453 02:06:13,537 --> 02:06:15,139 THE QUESTION IS USING EITHER THE 2454 02:06:15,139 --> 02:06:18,041 SINGLE CELL DATA OR OTHER DATA 2455 02:06:18,041 --> 02:06:20,177 SETS, THIS SIGNATURE OF 2456 02:06:20,177 --> 02:06:22,279 DISRESOLUTION IN MONOCYTES IS IT 2457 02:06:22,279 --> 02:06:24,882 SPECIFIC TO ME/CFS OR DO YOU SEE 2458 02:06:24,882 --> 02:06:26,316 SIMILAR SIGNATURES ELSEWHERE? 2459 02:06:26,316 --> 02:06:31,989 WE STARTED DOING THAT AND LOOKED 2460 02:06:31,989 --> 02:06:42,332 AT SOME CONDITIONS. 2461 02:06:49,506 --> 02:06:59,683 >> THANK YOU. 2462 02:07:00,350 --> 02:07:03,353 >> IT GIVES ME PLEASURE TO 2463 02:07:03,353 --> 02:07:07,191 INTRODUCE DR. ALAIN MOREAU 2464 02:07:07,191 --> 02:07:09,193 TALKING ABOUT CONTRIBUTIONS OF 2465 02:07:09,193 --> 02:07:13,430 EPIGENETICS IN ME/CFS AND LONG 2466 02:07:13,430 --> 02:07:23,774 COVID PATHOGENESIS. 2467 02:07:25,442 --> 02:07:29,346 >> HERE ARE MY DISCLOSURES 2468 02:07:29,346 --> 02:07:30,914 FUNDING MY RESEARCH ON ME/CFS 2469 02:07:30,914 --> 02:07:35,219 AND LONG COVID AS WELL. 2470 02:07:35,219 --> 02:07:39,223 I SPOKE ABOUT THE EPIGENETICS 2471 02:07:39,223 --> 02:07:41,792 AND EPIGENOMICS SO YOU CAN 2472 02:07:41,792 --> 02:07:43,660 LISTEN TO THE WEBINAR AND HAVE 2473 02:07:43,660 --> 02:07:45,963 MORE DETAILS BUT IT'S CLEAR THAT 2474 02:07:45,963 --> 02:07:50,801 WE ARE WELL AWARE THERE ARE SOME 2475 02:07:50,801 --> 02:07:52,703 COMPONENTS IN ME/CFS AS 2476 02:07:52,703 --> 02:07:54,705 IDENTIFIED IN THE PEDIGREE. 2477 02:07:54,705 --> 02:08:01,144 IT'S A U.K. FAMILY YOU CAN SEE 2478 02:08:01,144 --> 02:08:11,555 OVER THREE GENERATIONS. 2479 02:08:14,658 --> 02:08:17,394 YOU SEE THE KIDS ARE SUFFERING 2480 02:08:17,394 --> 02:08:17,995 FROM ME/CFS. 2481 02:08:17,995 --> 02:08:19,763 IT'S A UNIQUE OUTSTANDING FAMILY 2482 02:08:19,763 --> 02:08:22,065 AND I THINK WE CAN LEARN A LOT 2483 02:08:22,065 --> 02:08:23,734 BY COLLECTING AND TESTING THOSE 2484 02:08:23,734 --> 02:08:24,201 FAMILIES. 2485 02:08:24,201 --> 02:08:26,436 IF YOU'RE AWARE OF SUCH 2486 02:08:26,436 --> 02:08:32,609 FAMILIES, PLEASE LET ME KNOW. 2487 02:08:32,609 --> 02:08:37,414 BUT ON THE OTHER A LOT OF 2488 02:08:37,414 --> 02:08:38,682 UNRELATED CASES WHEN WE QUESTION 2489 02:08:38,682 --> 02:08:41,218 THEM WE ALWAYS GET AN ANSWER, 2490 02:08:41,218 --> 02:08:45,255 YES, I HAVE A COUSIN OR UNCLE 2491 02:08:45,255 --> 02:08:50,327 HAVING ME/CFS OR SOMETHING 2492 02:08:50,327 --> 02:08:59,703 SIMILAR CONDITION WE SUSPECT 2493 02:08:59,703 --> 02:09:01,305 EPIGENETICS IS A STRONGER 2494 02:09:01,305 --> 02:09:02,773 CONTRIBUTOR IN RESPONSE TO A 2495 02:09:02,773 --> 02:09:07,210 VIRAL INFECTION, DRAMATIC 2496 02:09:07,210 --> 02:09:10,213 CONDITION, BACTERIA LIKE CHRONIC 2497 02:09:10,213 --> 02:09:11,214 LYME DISEASE. 2498 02:09:11,214 --> 02:09:15,452 THOSE EXPOSURES WHICH INCLUDE 2499 02:09:15,452 --> 02:09:18,855 NOT ONLY VIRUS BUT HEAVY METALS, 2500 02:09:18,855 --> 02:09:22,259 ARSENIC CAN BE EXCELLENT 2501 02:09:22,259 --> 02:09:24,995 TRIGGERS THAT RESULT IN ME/CFS 2502 02:09:24,995 --> 02:09:25,462 OVER TIME. 2503 02:09:25,462 --> 02:09:31,134 IT DOESN'T MEAN EPIGENETICS IS 2504 02:09:31,134 --> 02:09:33,070 NOT BLACK AND WHITE SITUATION. 2505 02:09:33,070 --> 02:09:37,641 THEY MAY HAVE EPIGENETICS AND 2506 02:09:37,641 --> 02:09:40,510 CROSS TALK WITH SOME 2507 02:09:40,510 --> 02:09:42,446 DISPOSITION. 2508 02:09:42,446 --> 02:09:43,847 GENETICALLY WE THINK AND HAVE 2509 02:09:43,847 --> 02:09:46,616 EVIDENCE EPIGENETICS MIGHT HAVE 2510 02:09:46,616 --> 02:09:48,752 A STRONGER CONTRIBUTION THAN 2511 02:09:48,752 --> 02:09:49,419 GENETIC ESPECIALLY ON THE 2512 02:09:49,419 --> 02:09:59,763 POPULATION AT LARGE. 2513 02:10:02,666 --> 02:10:07,637 WHAT DO WE KNOW AND IN TERMS OF 2514 02:10:07,637 --> 02:10:09,439 DNA THIS IS A DATABASE. 2515 02:10:09,439 --> 02:10:11,575 EVERY SINGLE CELL IN YOUR BODY 2516 02:10:11,575 --> 02:10:13,176 HAS THE SAME INFORMATION. 2517 02:10:13,176 --> 02:10:17,881 WE HAVE ABOUT 22,000 GENES. 2518 02:10:17,881 --> 02:10:21,318 THE DNA CELL TYPE IS THE MUSCLE 2519 02:10:21,318 --> 02:10:23,754 CELLS OR BRAIN CELLS OR BLOOD 2520 02:10:23,754 --> 02:10:26,156 CELLS WOULD BE AN ACTIVATION OF 2521 02:10:26,156 --> 02:10:29,926 SOME TRANSCRIPT THAT LEADS TO 2522 02:10:29,926 --> 02:10:32,462 MESSENGER RNA AND HAVE OVER 2523 02:10:32,462 --> 02:10:35,699 140,000 TRANSCRIPT NOT IN SINGLE 2524 02:10:35,699 --> 02:10:35,899 CELLS. 2525 02:10:35,899 --> 02:10:37,234 THIS IS OVER ALL POSSIBLE 2526 02:10:37,234 --> 02:10:37,667 TRANSCRIPT. 2527 02:10:37,667 --> 02:10:40,404 IT'S MORE COMMON TO HAVE AROUND 2528 02:10:40,404 --> 02:10:43,340 12,000 DIFFERENT TRANSCRIPT IN A 2529 02:10:43,340 --> 02:10:46,476 CELL SPECIFIC TYPE AS ANDREW 2530 02:10:46,476 --> 02:10:50,580 PRESENTS SO SUPPORTING THAT. 2531 02:10:50,580 --> 02:10:55,118 AND THESE MESSENGER RNA WILL 2532 02:10:55,118 --> 02:10:57,421 RELATE A CODE THAT WILL PRODUCE 2533 02:10:57,421 --> 02:11:01,358 AT THE END OF THE DECODING IN 2534 02:11:01,358 --> 02:11:03,860 THE MACHINERY INSIDE THE CELLS 2535 02:11:03,860 --> 02:11:05,395 IN THE FUNCTIONAL PRODUCT WE 2536 02:11:05,395 --> 02:11:05,996 CALL PROTEIN. 2537 02:11:05,996 --> 02:11:11,635 IN THE PROTEIN WE HAVE 100,000 2538 02:11:11,635 --> 02:11:11,902 PROTEINS. 2539 02:11:11,902 --> 02:11:13,670 THERE COULD BE MORE. 2540 02:11:13,670 --> 02:11:17,941 IF YOU CONSIDER THE CLEAVAGE AND 2541 02:11:17,941 --> 02:11:21,278 IT WILL CHANGE THE PROPERTIES OF 2542 02:11:21,278 --> 02:11:24,247 THE PROTEIN ALSO LOCALIZATION SO 2543 02:11:24,247 --> 02:11:29,619 THAT CAN BE IMPORTANT AND 2544 02:11:29,619 --> 02:11:33,657 PROTEIN THAT'S AT THE WRONG 2545 02:11:33,657 --> 02:11:38,962 PLACE, WRONG QUANTITY WILL LEAD 2546 02:11:38,962 --> 02:11:39,863 TO SOME DISORDER. 2547 02:11:39,863 --> 02:11:42,098 WE HAVE THE NON-CODING RNA. 2548 02:11:42,098 --> 02:11:42,999 THERE'S DIFFERENT TYPES. 2549 02:11:42,999 --> 02:11:48,738 I DON'T HAVE TIME TO REVIEW ALL 2550 02:11:48,738 --> 02:11:55,145 OF THEM BUT WE HAVE MICRORNA AND 2551 02:11:55,145 --> 02:11:58,215 YOU SEE THE NUMBER IS VERY LOW 2552 02:11:58,215 --> 02:11:59,616 OR REDUCED COMPARED TO THE OTHER 2553 02:11:59,616 --> 02:12:02,886 NUMBERS I GAVE YOU. 2554 02:12:02,886 --> 02:12:07,290 AND THOSE MICRORNA NORMALLY 2555 02:12:07,290 --> 02:12:10,393 OFTEN ATTACH IN THE REGION OF 2556 02:12:10,393 --> 02:12:14,498 MESSENGER RNA AND BY DOING THIS 2557 02:12:14,498 --> 02:12:16,032 WILL ATTRACT THE COMPLEX THIS IS 2558 02:12:16,032 --> 02:12:20,804 WHAT YOU CAN SEE ON THE CARTOON 2559 02:12:20,804 --> 02:12:23,440 WILL PREVENT ACCESS TO THE 2560 02:12:23,440 --> 02:12:25,976 MACHINERY AND WILL REDUCE THE 2561 02:12:25,976 --> 02:12:31,081 PRODUCTION OF PROTEIN. 2562 02:12:31,081 --> 02:12:34,484 SO WHICH IS ALSO INTERESTING SO 2563 02:12:34,484 --> 02:12:36,786 FURTHER ADD A LAIR OF COMPLEXITY 2564 02:12:36,786 --> 02:12:38,622 AND ONE SINGLE mRNA CAN TARGET 2565 02:12:38,622 --> 02:12:40,790 UP TO 200 GENES AND ONE GENE CAN 2566 02:12:40,790 --> 02:12:44,394 BE TARGETED BY MORE THAN ONE 2567 02:12:44,394 --> 02:12:45,428 SINGLE MICRORNA. 2568 02:12:45,428 --> 02:12:49,799 YOU MAY HAVE AMPLIFICATION OF 2569 02:12:49,799 --> 02:12:51,167 THE PHENOMENON. 2570 02:12:51,167 --> 02:12:53,436 THEY'RE MORE OFTEN USED IN 2571 02:12:53,436 --> 02:13:00,644 MOLECULAR MEDICINE AS A 2572 02:13:00,644 --> 02:13:01,611 BIOMARKER AND YOU CAN STAGE 2573 02:13:01,611 --> 02:13:09,419 CANCER TUMORS AND PREDICT 2574 02:13:09,419 --> 02:13:19,696 RESPONSE I THINK MAUREEN 2575 02:13:19,696 --> 02:13:24,100 MENTIONED THAT I'M DOING THAT TO 2576 02:13:24,100 --> 02:13:31,675 REVEAL WHAT IS GOING ON IN THE 2577 02:13:31,675 --> 02:13:39,249 PATIENT. 2578 02:13:39,249 --> 02:13:41,985 PAM IS THE HALLMARK AND INVOLVED 2579 02:13:41,985 --> 02:13:44,721 IN LONG COVID AND OTHER 2580 02:13:44,721 --> 02:13:47,490 CONDITIONS INCLUDING 2581 02:13:47,490 --> 02:13:47,824 FIBROMYALGIA. 2582 02:13:47,824 --> 02:13:50,393 WE THINK IT'S A MEASUREMENT AT 2583 02:13:50,393 --> 02:13:53,430 BASELINE AND 90 MINUTES AFTER 2584 02:13:53,430 --> 02:13:55,966 THE STRESS ACTIVATION THAT LEADS 2585 02:13:55,966 --> 02:14:03,239 TO PAM WE CAN REVEAL GOOD DAY, 2586 02:14:03,239 --> 02:14:04,341 BAD DAY BECAUSE IT'S DIFFICULT 2587 02:14:04,341 --> 02:14:05,508 TO SEND A CLINICAL NURSE AT HOME 2588 02:14:05,508 --> 02:14:08,111 WHEN WE RECEIVE A CALL. 2589 02:14:08,111 --> 02:14:11,414 I DON'T HAVE THIS YET IN FACT 2590 02:14:11,414 --> 02:14:13,416 NOBODY HAS IT AT THAT LEVEL SO 2591 02:14:13,416 --> 02:14:17,420 WE APPLIED A STANDARDIZED PROVE 2592 02:14:17,420 --> 02:14:19,956 VASION MANEUVER WHICH IS 2593 02:14:19,956 --> 02:14:21,725 RELATIVELY SAFE. 2594 02:14:21,725 --> 02:14:25,395 WE DID OVER 500 CASES SINCE 2015 2595 02:14:25,395 --> 02:14:30,600 AND NEVER HAD TO CALL 9-1-1 TO 2596 02:14:30,600 --> 02:14:32,802 HOSPITALIZE A PATIENT OUTSIDE OF 2597 02:14:32,802 --> 02:14:35,171 TREATMENT THOUGH WE INDUCED PAM 2598 02:14:35,171 --> 02:14:37,407 WHICH MEANS THE PARTICIPANTS 2599 02:14:37,407 --> 02:14:39,309 WILL BE SICKER DURING A FEW 2600 02:14:39,309 --> 02:14:41,444 HOURS UP TO A FEW DAYS BUT 2601 02:14:41,444 --> 02:14:43,680 NORMALLY FIVE DAYS LATER THEY'RE 2602 02:14:43,680 --> 02:14:45,815 GOING BACK TO THE BASELINE 2603 02:14:45,815 --> 02:14:48,385 VALUES OR CONDITION. 2604 02:14:48,385 --> 02:14:57,427 HERE YOU CAN SEE THE INFLATABLE 2605 02:14:57,427 --> 02:15:02,932 COUGH WE'RE USING AND THEY 2606 02:15:02,932 --> 02:15:04,701 RECEIVED THE MESSAGE DURING THE 2607 02:15:04,701 --> 02:15:08,672 90 MINUTES AND THE STIMULATION 2608 02:15:08,672 --> 02:15:09,506 IS THAT EVERY PARTICIPANT IS HIS 2609 02:15:09,506 --> 02:15:10,874 OWN CONTROL. 2610 02:15:10,874 --> 02:15:14,911 WE DON'T NEED TO CARE IF THEY'RE 2611 02:15:14,911 --> 02:15:16,446 TAKING NINE DIFFERENT 2612 02:15:16,446 --> 02:15:17,614 MEDICATIONS, SUPPLEMENTS, 2613 02:15:17,614 --> 02:15:22,752 WHATEVER, WE CONTROL FOR THAT 2614 02:15:22,752 --> 02:15:25,422 BECAUSE EACH PARTICIPANT IS ITS 2615 02:15:25,422 --> 02:15:35,632 OWN CONTROL. 2616 02:16:05,395 --> 02:16:11,167 WE SAW DIFFERENCE FROM THE 2617 02:16:11,167 --> 02:16:12,969 PARTICIPANTS AS WELL AS THOSE 2618 02:16:12,969 --> 02:16:15,972 SUFFERING THAT ALLOWED US TO 2619 02:16:15,972 --> 02:16:18,775 HAVE A BETTER UNDERSTANDING AND 2620 02:16:18,775 --> 02:16:22,011 COLLECTING DIFFERENT BIOLOGICAL 2621 02:16:22,011 --> 02:16:24,147 FLUIDS, MORNING URINE AND PLASMA 2622 02:16:24,147 --> 02:16:29,419 AND PBMCs AND USING THE SCEN 2623 02:16:29,419 --> 02:16:34,691 THAT ALLOWED US TO MONITOR THE 2624 02:16:34,691 --> 02:16:36,259 HEART RHYTHM AS WELL AS 2625 02:16:36,259 --> 02:16:41,297 RESPIRATORY RATE AN USING THE 2626 02:16:41,297 --> 02:16:49,205 VEST DURING THE NIGHT TO USE 2627 02:16:49,205 --> 02:16:52,509 FURTHER CHARACTERIZE ADVANCES 2628 02:16:52,509 --> 02:16:54,377 AND WE DID THAT AND NORMALLY 2629 02:16:54,377 --> 02:16:56,646 WE'RE DOING FIVE DAYS LATER AT 2630 02:16:56,646 --> 02:16:59,115 BASELINE BUT WE CAN DO TEST 2631 02:16:59,115 --> 02:17:01,584 AFTER TREATMENT TO SEE WHAT IS 2632 02:17:01,584 --> 02:17:11,761 HAPPENING. 2633 02:17:12,695 --> 02:17:17,267 I GOT A QUESTION ON THE GENTLE 2634 02:17:17,267 --> 02:17:21,437 COUGH ORE OVER THE TWO DAYS AND 2635 02:17:21,437 --> 02:17:25,809 THEY TESTED SICK PATIENT WHO 2636 02:17:25,809 --> 02:17:28,044 RARELY PARTICIPATE IN CLINICAL 2637 02:17:28,044 --> 02:17:30,580 TRIAL BECAUSE THEY CANNOT WALK 2638 02:17:30,580 --> 02:17:35,051 IN OR DO CPAC FOR A SINGLE DAY 2639 02:17:35,051 --> 02:17:38,121 SO WE TEST SICK PEOPLE AND 85% 2640 02:17:38,121 --> 02:17:40,023 ARE PEOPLE TESTING AT HOME. 2641 02:17:40,023 --> 02:17:42,458 ALL THE MACHINE ARE PORTABLE 2642 02:17:42,458 --> 02:17:47,130 MACHINE AND THE NURSES GO DOWN. 2643 02:17:47,130 --> 02:17:49,532 WHEN WE INDUCE WE SEE CHANGES AS 2644 02:17:49,532 --> 02:17:54,504 WELL AS AN EXAMPLE WHERE WE 2645 02:17:54,504 --> 02:18:01,411 MEASURE THE GOOD MARKER OF 2646 02:18:01,411 --> 02:18:06,850 FATIGUE INDUCED 90 MINUTES AFTER 2647 02:18:06,850 --> 02:18:13,423 RECEIVING THE MASSAGE. 2648 02:18:13,423 --> 02:18:15,358 THEY'RE MORE FATIGUED AND 2649 02:18:15,358 --> 02:18:18,094 IMPAIRMENT AFTER THE 90 MINUTE 2650 02:18:18,094 --> 02:18:18,461 STIMULATION. 2651 02:18:18,461 --> 02:18:22,365 WE CAN MEASURE THE WHOLE BODY 2652 02:18:22,365 --> 02:18:25,902 USING OUR STUDY DESIGN. 2653 02:18:25,902 --> 02:18:29,405 WE PUBLISHED IN 2020 THE FIRST 2654 02:18:29,405 --> 02:18:31,741 PAPER IN SCIENTIFIC REPORT WHERE 2655 02:18:31,741 --> 02:18:34,010 WE WERE ABLE TO GENERATE THE 2656 02:18:34,010 --> 02:18:37,647 PROFILE THAT LED US TO HAVE A 2657 02:18:37,647 --> 02:18:42,051 PANEL A PANEL OF 11 CIRCULATING 2658 02:18:42,051 --> 02:18:44,787 MICRORNA YOU CAN SEE IN THE 2659 02:18:44,787 --> 02:18:46,856 LIGHT BLUE HERE AND YOU SEE THIS 2660 02:18:46,856 --> 02:18:52,762 IS A PATHWAY GRAPHIC GENERATED 2661 02:18:52,762 --> 02:19:03,239 BY THE SOFTWARE AND LOOK AT 2662 02:19:05,308 --> 02:19:07,710 MENTAL FATIGUE AND FATIGUE OF 2663 02:19:07,710 --> 02:19:09,178 MUSCLE. 2664 02:19:09,178 --> 02:19:12,015 ALL BIOLOGICAL PROCESSES THAT 2665 02:19:12,015 --> 02:19:15,919 ARE QUITE RELEVANT FOR ME/CFS 2666 02:19:15,919 --> 02:19:20,123 PATIENT MOREOVER BECAUSE WE CAN 2667 02:19:20,123 --> 02:19:26,796 COMPARE THE VARIATION AFTER 90 2668 02:19:26,796 --> 02:19:28,865 MINUTES OF STIMULATION WE WERE 2669 02:19:28,865 --> 02:19:31,401 ABLE TO CLASSIFY THEM IN FOUR 2670 02:19:31,401 --> 02:19:39,642 CLUSTER IN OUR REVISED 2671 02:19:39,642 --> 02:19:43,746 CLASSIFICATION AND LEARNED SOME 2672 02:19:43,746 --> 02:19:53,690 SYMPTOMS IN CLUSTER 3 AND WE 2673 02:19:53,690 --> 02:19:57,327 FIND MORE PEOPLE SEVERELY 2674 02:19:57,327 --> 02:19:59,562 AFFECTED BY BRAIN FOG AND OTHER 2675 02:19:59,562 --> 02:20:01,965 COGNITIVE IMPAIRMENT AND THIS IS 2676 02:20:01,965 --> 02:20:03,433 IMPORTANT FOR THE PATIENT AND 2677 02:20:03,433 --> 02:20:04,033 PHYSICIANS GIVING CARE AND 2678 02:20:04,033 --> 02:20:09,439 TRYING TO FIND SOLUTIONS FOR 2679 02:20:09,439 --> 02:20:13,409 THOSE PATIENTS. 2680 02:20:13,409 --> 02:20:23,953 OF YOU CAN SEE 92 PATIENTS WITH 2681 02:20:37,700 --> 02:20:41,704 DIAGNOSIS WE APPLY OUR TEST TO 2682 02:20:41,704 --> 02:20:52,248 SEE IF IT WAS TRUE YOU REALIZE 2683 02:20:53,916 --> 02:20:55,718 THIS WAS A GAME CHANGER 2684 02:20:55,718 --> 02:20:59,655 CLINICALLY SPEAKING AND WHEN YOU 2685 02:20:59,655 --> 02:21:03,626 TRY TO ANALYZE MORE OF THE 2686 02:21:03,626 --> 02:21:04,894 POPULATION BECAUSE FM THOUGH 2687 02:21:04,894 --> 02:21:06,729 THERE'S OVERLAPPING SYMPTOMS 2688 02:21:06,729 --> 02:21:13,736 THEY'RE NOT ME AND BEING ME/FM 2689 02:21:13,736 --> 02:21:22,512 IS SICKER THAN ME AND WE SAW THE 2690 02:21:22,512 --> 02:21:24,113 CLASSIFICATION WAS THE RIGHT 2691 02:21:24,113 --> 02:21:24,280 ONE. 2692 02:21:24,280 --> 02:21:28,918 SO IF YOU'RE INTERESTED YOU CAN 2693 02:21:28,918 --> 02:21:32,789 READ THIS PAPER BUT WE HAVE A 2694 02:21:32,789 --> 02:21:33,956 DIFFERENT PROFILE BETWEEN EVENTS 2695 02:21:33,956 --> 02:21:38,294 AND THE MICRORNA ARE LOW OPPOSED 2696 02:21:38,294 --> 02:21:42,565 TO HIGH AND WHEN YOU HAVE BOTH 2697 02:21:42,565 --> 02:21:44,634 YOU HAVE A SCORE AS ILLUSTRATING 2698 02:21:44,634 --> 02:21:54,410 PANEL A AND B FOR TWO OF THE 11 2699 02:21:54,410 --> 02:21:54,677 MICRORNA. 2700 02:21:54,677 --> 02:21:59,315 CAN WE USE THE MICRO RNA TO 2701 02:21:59,315 --> 02:22:01,250 PREDICT A RESPONSE IN DIFFERENT 2702 02:22:01,250 --> 02:22:01,884 PATIENTS AND GROUPS THE ANSWER 2703 02:22:01,884 --> 02:22:12,028 IS YES. 2704 02:22:15,631 --> 02:22:17,333 THIS IS A TARGET FOR THE GENES 2705 02:22:17,333 --> 02:22:22,605 IF YOU HAVE A HIGH LEVEL OF 2706 02:22:22,605 --> 02:22:23,873 CIRCULATING MICRO RNA IT WILL 2707 02:22:23,873 --> 02:22:28,511 DISAPPEAR OR BE REDUCED WHICH 2708 02:22:28,511 --> 02:22:30,813 MEANS 75% OF THE PATIENT WON'T 2709 02:22:30,813 --> 02:22:32,615 RESPOND TO WHAT WE PREDICT AND 2710 02:22:32,615 --> 02:22:37,420 AS YOU MAY KNOW FROM PAPERS 2711 02:22:37,420 --> 02:22:42,158 SHOWING THE GENES ABOUT 25% 2712 02:22:42,158 --> 02:22:43,526 CONSIDERED GOOD RESPONDER. 2713 02:22:43,526 --> 02:22:46,162 WE ARE QUITE IN THE SAME 2714 02:22:46,162 --> 02:22:49,866 BALLPARK AS EXPECTED TO DO THAT. 2715 02:22:49,866 --> 02:22:51,634 SO I'M NOT SAYING THAT CAN 2716 02:22:51,634 --> 02:22:53,302 REPLACE A CLINICAL TRIAL BUT 2717 02:22:53,302 --> 02:22:56,005 THIS IS A GOOD START TO 2718 02:22:56,005 --> 02:22:57,573 INTRODUCE PRECISION MEDICINE FOR 2719 02:22:57,573 --> 02:23:02,578 ME. 2720 02:23:02,578 --> 02:23:04,780 WE DECIDED TO EXPLORE WHETHER 2721 02:23:04,780 --> 02:23:07,717 THEY CAN CONTRIBUTE TO THE 2722 02:23:07,717 --> 02:23:09,986 TRANSITION OF LONG COVID TO 2723 02:23:09,986 --> 02:23:12,255 ME/CFS AND AS YOU KNOW AND WELL 2724 02:23:12,255 --> 02:23:15,725 COVERED THIS MORNING BY OUR 2725 02:23:15,725 --> 02:23:16,826 LEADING CLINICIANS, THAT THERE'S 2726 02:23:16,826 --> 02:23:26,602 SOME SERIOUS OVERLAP BETWEEN THE 2727 02:23:26,602 --> 02:23:29,805 SYMPTOMS UNIQUE TO LONG COVID 2728 02:23:29,805 --> 02:23:33,209 AND THE 11 MICRO RNA ARE 2729 02:23:33,209 --> 02:23:38,347 INFECTED WITH COVID AND GENES 2730 02:23:38,347 --> 02:23:43,819 AFFECTED BY COVID ARE CLEARED BY 2731 02:23:43,819 --> 02:23:46,022 SOME OF OUR mRNA AND GAVE US THE 2732 02:23:46,022 --> 02:23:48,424 IDEA TO USE THE PANEL TO 2733 02:23:48,424 --> 02:23:49,292 STRATIFY LONG COVID AND SEE WHAT 2734 02:23:49,292 --> 02:23:54,330 IS HAPPENING. 2735 02:23:54,330 --> 02:23:55,798 CAN WE RECOGNIZE ME/CFS AND 2736 02:23:55,798 --> 02:23:56,098 CONDITIONS. 2737 02:23:56,098 --> 02:23:57,133 THIS IS WHAT WE HAVE DONE. 2738 02:23:57,133 --> 02:24:00,603 THERE'S A POSTER BY ONE OF MY 2739 02:24:00,603 --> 02:24:05,508 STUDENTS IF YOU ARE INTERESTED 2740 02:24:05,508 --> 02:24:13,716 ABOUT MORE DETAILS BUT USING 2741 02:24:13,716 --> 02:24:18,621 LONG COVID SYMPTOMS NAIVE TO 2742 02:24:18,621 --> 02:24:20,556 TREATMENT AND VACCINATION WE 2743 02:24:20,556 --> 02:24:22,158 COLLECTED LONG COVID FOLLOWING 2744 02:24:22,158 --> 02:24:25,061 THE FIRST WAVE OF THE COVID-19 2745 02:24:25,061 --> 02:24:28,297 WHICH MEANS THIS IS THE ORIGINAL 2746 02:24:28,297 --> 02:24:33,135 STRAIN NOT OMICRON OR DELTA. 2747 02:24:33,135 --> 02:24:37,740 WITH WERE ABLE TO CLASSIFY USING 2748 02:24:37,740 --> 02:24:41,344 THE MICRORNA IN SIX CLUSTERS AND 2749 02:24:41,344 --> 02:24:43,946 ONE ENDED UP AS ME AND WE 2750 02:24:43,946 --> 02:24:46,015 FURTHER STRATIFIED THEM USING 2751 02:24:46,015 --> 02:24:48,050 THE STRESS TEST IN DIFFERENT 2752 02:24:48,050 --> 02:24:52,455 CLUSTERS I JUST EXPLAINED TO 2753 02:24:52,455 --> 02:24:53,356 YOU. 2754 02:24:53,356 --> 02:24:59,695 WE WERE ABLE TO SOME ARE FM AND 2755 02:24:59,695 --> 02:25:01,397 THEY WERE FURTHER STRATIFIED AS 2756 02:25:01,397 --> 02:25:11,907 SEVERE OR MODERATE USING AN A 2757 02:25:14,477 --> 02:25:20,683 DIFFERENT GROUP OF PATIENT. 2758 02:25:20,683 --> 02:25:24,186 AND ABLE TO SPLIT INTO TWO 2759 02:25:24,186 --> 02:25:25,121 ADDITIONAL SUB GROUPS. 2760 02:25:25,121 --> 02:25:28,190 ONE WITH RESPIRATORY ILLNESSES 2761 02:25:28,190 --> 02:25:29,925 LOOKING LIKE COPD AND WE HAVE 2762 02:25:29,925 --> 02:25:33,863 MARKERS FOUND OR ASSOCIATED WITH 2763 02:25:33,863 --> 02:25:36,465 SEVERE COPD AND ANOTHER GROUP WE 2764 02:25:36,465 --> 02:25:37,733 CALL NEUROLOGICAL IMPAIRMENTS 2765 02:25:37,733 --> 02:25:42,271 AND A GROUP CALLED SEVERE 2766 02:25:42,271 --> 02:25:43,039 ALLERGY. 2767 02:25:43,039 --> 02:25:47,143 WE'LL GIVE YOU AN EXAMPLE TO 2768 02:25:47,143 --> 02:25:48,844 COMPARE PRE PANDEMIC ME VERSUS 2769 02:25:48,844 --> 02:25:54,250 LONG COVID ME AS WE QUALIFY AND 2770 02:25:54,250 --> 02:25:56,519 ALSO LONG COVID AGAINST THE 2771 02:25:56,519 --> 02:25:57,153 CONTROL WE COLLECT PRIOR TO THE 2772 02:25:57,153 --> 02:26:01,891 PANDEMIC. 2773 02:26:01,891 --> 02:26:04,360 CAN SEE IT'S HARD OR ALMOST 2774 02:26:04,360 --> 02:26:06,195 IMPOSSIBLE TO DISCRIMINATE BASED 2775 02:26:06,195 --> 02:26:10,366 ON QUESTIONNAIRE OR BASIC 2776 02:26:10,366 --> 02:26:13,069 INFORMATION THE PREPANDEMIC ME 2777 02:26:13,069 --> 02:26:17,406 OR ME/FM USING THE QUESTIONNAIRE 2778 02:26:17,406 --> 02:26:27,583 AS IT IS. 2779 02:26:41,397 --> 02:26:43,733 WE SAW ME LONG COVID AND DON'T 2780 02:26:43,733 --> 02:26:44,934 KNOW THE MEANING. 2781 02:26:44,934 --> 02:26:47,703 THE BIG DIFFERENCE IS THE RECENT 2782 02:26:47,703 --> 02:26:49,405 INFECTION SITUATION IN THE LONG 2783 02:26:49,405 --> 02:26:55,711 COVID THAT MIGHT EXPLAIN THAT WE 2784 02:26:55,711 --> 02:26:58,914 ALSO HAVE THE SUB GROUP IN LONG 2785 02:26:58,914 --> 02:27:01,717 COVID AND THIS IS THE EXAMPLE 2786 02:27:01,717 --> 02:27:03,819 WITH THE ME. 2787 02:27:03,819 --> 02:27:05,388 ADDITIONAL GENOME WIDE 2788 02:27:05,388 --> 02:27:05,888 PROFILING. 2789 02:27:05,888 --> 02:27:08,858 WE REPEAT THE SAME EXPERIMENT WE 2790 02:27:08,858 --> 02:27:11,694 HAVE DONE A LONG TIME BEFORE THE 2791 02:27:11,694 --> 02:27:13,729 PREPANDEMIC ME TO FIND OUT IF WE 2792 02:27:13,729 --> 02:27:16,632 HAVE ADDITIONAL PROFILES OR NEW 2793 02:27:16,632 --> 02:27:17,400 PATTERN SPECIFICALLY ASSOCIATED 2794 02:27:17,400 --> 02:27:22,805 WITH LONG COVID AND WHAT WE 2795 02:27:22,805 --> 02:27:24,440 GATHER HERE. 2796 02:27:24,440 --> 02:27:30,379 YOU CAN SEE THE MICROmRNA AND A 2797 02:27:30,379 --> 02:27:32,548 BUNCH OF NEW ONES IN LIGHT BLUE. 2798 02:27:32,548 --> 02:27:34,617 WHAT IS INTERESTING IS THE NEW 2799 02:27:34,617 --> 02:27:36,552 ONE MORE SPECIFICALLY ASSOCIATED 2800 02:27:36,552 --> 02:27:40,356 WITH LONG COVID ME TARGETING THE 2801 02:27:40,356 --> 02:27:41,457 VERY SAME GENES FOR THE MAJORITY 2802 02:27:41,457 --> 02:27:46,462 OF THEM. 2803 02:27:46,462 --> 02:27:47,496 THIS IS NOVEL. 2804 02:27:47,496 --> 02:27:49,265 IF YOU'RE ASKING WHY A DIFFERENT 2805 02:27:49,265 --> 02:27:52,268 VIRUS MAY END UP WITH THE SAME 2806 02:27:52,268 --> 02:27:55,638 PHENOTYPE, THIS IS ONE POSSIBLE 2807 02:27:55,638 --> 02:27:56,572 MECHANISM THAT DIFFERENT 2808 02:27:56,572 --> 02:28:01,977 ACTIVATION OR ELEVATION OF MICRO 2809 02:28:01,977 --> 02:28:03,679 mRNA LEADS TO THE SAME RESULT 2810 02:28:03,679 --> 02:28:06,315 BY TARGETING THE SAME GENES AND 2811 02:28:06,315 --> 02:28:06,615 PATHWAYS. 2812 02:28:06,615 --> 02:28:09,718 SO WE'RE STILL DIGGING. 2813 02:28:09,718 --> 02:28:11,821 THIS IS THE FIRST IN THE WORLD 2814 02:28:11,821 --> 02:28:13,422 TO PRESENT THIS RESULT AND I 2815 02:28:13,422 --> 02:28:15,491 WOULD BE VERY HAPPY TO SHARE 2816 02:28:15,491 --> 02:28:17,393 THAT DATA WITH WHOEVER IS 2817 02:28:17,393 --> 02:28:22,531 INTERESTED. 2818 02:28:22,531 --> 02:28:25,768 WE LOOKED AT DIFFERENT MARKERS. 2819 02:28:25,768 --> 02:28:28,304 NOT MUCH DIFFERENT WHEN YOU 2820 02:28:28,304 --> 02:28:31,740 COMPARE IT WITH LONG COVID ME. 2821 02:28:31,740 --> 02:28:39,348 WE LOOKED FOR FGF21 AND PA 1 2822 02:28:39,348 --> 02:28:44,487 INVOLVED IN MICRO BLOOD CLOTTING 2823 02:28:44,487 --> 02:28:48,524 SO VERY RELEVANT. 2824 02:28:48,524 --> 02:28:50,493 WE LOOKED AT THE MECHANISMS 2825 02:28:50,493 --> 02:28:53,128 WE'LL FURTHER DISCUSS AND ONE OF 2826 02:28:53,128 --> 02:29:03,672 MY STUDENTS PRESENTED A POSTER 2827 02:29:04,907 --> 02:29:07,209 AND WE JUST OBSERVED MORE 2828 02:29:07,209 --> 02:29:12,081 ELEVATION IN LONG COVID COMPARED 2829 02:29:12,081 --> 02:29:19,722 TO PREPANDEMIC AND THAT CAN 2830 02:29:19,722 --> 02:29:21,857 SIMPLY REFLECT THE LONG COVID. 2831 02:29:21,857 --> 02:29:27,096 AND INTERESTINGLY ENOUGH WHEN WE 2832 02:29:27,096 --> 02:29:33,102 DO THIS STRATIFICATION YOU CAN 2833 02:29:33,102 --> 02:29:34,637 SEE PANEL A HERE FOR INSTANCE WE 2834 02:29:34,637 --> 02:29:38,407 HAVE A STRONG ELEVATION OF ME. 2835 02:29:38,407 --> 02:29:41,410 WHICH IS ALSO THE SAME WITH THE 2836 02:29:41,410 --> 02:29:42,711 LONG COVID. 2837 02:29:42,711 --> 02:29:46,582 AGAIN, THE WAY WE CAN RECOGNIZE 2838 02:29:46,582 --> 02:29:50,886 AMONGST LONG COVID WHO IS ME CAN 2839 02:29:50,886 --> 02:29:53,422 GUIDE US TO UNDERSTAND SOME 2840 02:29:53,422 --> 02:29:57,393 DIFFERENCES OR SIMILARITIES AND 2841 02:29:57,393 --> 02:30:07,736 AS EXPLAINED YESTERDAY BY DRA 2842 02:30:07,736 --> 02:30:09,471 PRESENTER PLAYED A ROLE IN THE 2843 02:30:09,471 --> 02:30:10,706 IMMUNE RESPONSE TOWARDS THE 2844 02:30:10,706 --> 02:30:13,642 ACTIVATION OF K CELLS AND IF YOU 2845 02:30:13,642 --> 02:30:19,348 HAVE TOO MUCH SOLUBLE MICA 2846 02:30:19,348 --> 02:30:21,684 YOU'LL HAVE IMMUNE EVASION WHICH 2847 02:30:21,684 --> 02:30:28,724 CAN BE PROBLEMATIC AND BRINGS IN 2848 02:30:28,724 --> 02:30:37,032 INSTANCE OF THE IMMUNE RESPONSE 2849 02:30:37,032 --> 02:30:40,869 AND THE CELL ONE OF THESE 2850 02:30:40,869 --> 02:30:51,347 PROTEIN SP1 CAN INHIBIT THE 2851 02:31:00,289 --> 02:31:05,260 LIGANDS AND THIS IS INTRIGUING 2852 02:31:05,260 --> 02:31:06,996 AND WE SAW THE LONG COVID AND 2853 02:31:06,996 --> 02:31:09,164 YOU CAN SEE PANEL C AND D WHEN 2854 02:31:09,164 --> 02:31:10,833 WE LOOK ABOUT THE MANTLE SCORES. 2855 02:31:10,833 --> 02:31:14,737 THERE'S A NEGATIVE CORRELATION 2856 02:31:14,737 --> 02:31:16,905 WITH PRE-PANDEMIC ME AND 2857 02:31:16,905 --> 02:31:17,906 POSITIVE CORRELATION IN THE LONG 2858 02:31:17,906 --> 02:31:18,307 COVID ME. 2859 02:31:18,307 --> 02:31:24,880 WE DON'T KNOW EXACTLY WHY. 2860 02:31:24,880 --> 02:31:26,615 WE KNOW IN ME ELEVATION WITH THE 2861 02:31:26,615 --> 02:31:28,150 SEVERITY OF THE SYMPTOM AND YOU 2862 02:31:28,150 --> 02:31:31,120 CAN SEE IN PANEL E AND 2863 02:31:31,120 --> 02:31:33,389 INTERESTINGLY PANEL F WHEN WE 2864 02:31:33,389 --> 02:31:38,594 LOOK OVER TIME SO LONG COVID 2865 02:31:38,594 --> 02:31:40,663 POST-INFECTION AND OVER A YEARS 2866 02:31:40,663 --> 02:31:43,766 YOU SEE A DECLINE OF SOLUBLE 2867 02:31:43,766 --> 02:31:46,201 MICA CIRCULATING LEVELS. 2868 02:31:46,201 --> 02:31:49,738 IS IT DUE TO MICRO RNA? 2869 02:31:49,738 --> 02:31:54,009 WE DON'T KNOW. 2870 02:31:54,009 --> 02:31:56,545 IS IT SOME SARS COV2 POSSIBLY. 2871 02:31:56,545 --> 02:31:59,682 WE SUPPORT THE VIEW OF MAUREEN 2872 02:31:59,682 --> 02:32:01,750 JUST EXPLAINED AND HAVE THOSE 2873 02:32:01,750 --> 02:32:02,151 RESULTS. 2874 02:32:02,151 --> 02:32:06,055 WE'RE STILL EXPLORING THE 2875 02:32:06,055 --> 02:32:08,457 MEANING OF SUCH REDUCTION AT 2876 02:32:08,457 --> 02:32:11,160 LEAST FOR LONG COVID PATIENTS. 2877 02:32:11,160 --> 02:32:13,729 SAME WITH THE MARKERS AND 2878 02:32:13,729 --> 02:32:16,832 SIMILARITY BETWEEN LONG COVID 2879 02:32:16,832 --> 02:32:17,066 AND ME. 2880 02:32:17,066 --> 02:32:21,270 WE LOOK AT FGF21 AND IN CASE WE 2881 02:32:21,270 --> 02:32:25,407 SAW STRONG ELEVATION IN PRE 2882 02:32:25,407 --> 02:32:28,343 PANDEMIC LONG FM AND LONG COVID 2883 02:32:28,343 --> 02:32:29,478 CLASSIFIED AS ME PLUS FM. 2884 02:32:29,478 --> 02:32:31,046 I DON'T THINK IT'S JUST PURE 2885 02:32:31,046 --> 02:32:31,313 LUCK. 2886 02:32:31,313 --> 02:32:36,819 I THINK IT'S JUST THE FACT TO 2887 02:32:36,819 --> 02:32:37,786 SHOWCASE THE CAPACITY OF THE 2888 02:32:37,786 --> 02:32:40,322 TEST TO DISCRIMINATE THE 2889 02:32:40,322 --> 02:32:41,757 DIFFERENT SUB GROUP AND THE 2890 02:32:41,757 --> 02:32:45,227 PANEL B IS WORK WHERE DURING THE 2891 02:32:45,227 --> 02:32:48,964 ACUTE PHASE IT WAS THE HIGHEST 2892 02:32:48,964 --> 02:32:50,866 SEPARATING MARKER IN THE 2893 02:32:50,866 --> 02:32:52,701 AFFECTED CELL BY SARS COV2. 2894 02:32:52,701 --> 02:32:55,237 AGAIN, THERE'S A CONNECTION 2895 02:32:55,237 --> 02:32:58,607 BETWEEN THE CONTRIBUTION OF 2896 02:32:58,607 --> 02:32:58,941 FGF21. 2897 02:32:58,941 --> 02:33:04,379 PANEL C, D AND E RELATE TO 2898 02:33:04,379 --> 02:33:06,782 PREPANDEMIC ME/CFS AND WE 2899 02:33:06,782 --> 02:33:12,387 INVESTIGATE A LOT OF FGF21 AND 2900 02:33:12,387 --> 02:33:17,392 LOOK AT EXTREME LOW AND NORMAL 2901 02:33:17,392 --> 02:33:23,799 VALUES AND THE CIRCULATING FGF1 2902 02:33:23,799 --> 02:33:29,404 IS ASSOCIATED WITH SEVERITY AS 2903 02:33:29,404 --> 02:33:31,006 THE SEVERITY SEEMS TO BE 2904 02:33:31,006 --> 02:33:33,408 ASSOCIATED WITH ELEVATION OF THE 2905 02:33:33,408 --> 02:33:35,043 CIRCULATING FGF21. 2906 02:33:35,043 --> 02:33:41,416 THE GOOD NEWS IS PATIENT ON LOW 2907 02:33:41,416 --> 02:33:48,223 DOSE NALTREXONE COULD EXPLAIN 2908 02:33:48,223 --> 02:33:50,459 THE PATIENT MAY BENEFIT FROM LOW 2909 02:33:50,459 --> 02:33:54,663 DOSE NALTREXONE AND MAY 2910 02:33:54,663 --> 02:33:55,931 TRANSLATE FOR ME/CFS LONG COVID 2911 02:33:55,931 --> 02:34:06,341 AND HIGH LEVEL OF FGF21. 2912 02:34:06,675 --> 02:34:10,979 THESE ARE UNDER REVIEW AND WE 2913 02:34:10,979 --> 02:34:16,018 WERE ABLE TO STRATIFY PATIENT 2914 02:34:16,018 --> 02:34:21,223 USING OUR STRESS TEST AND TESTED 2915 02:34:21,223 --> 02:34:22,825 THEM THREE MONTHS LATER AND A 2916 02:34:22,825 --> 02:34:27,763 THIRD VISIT SIX MONTHS LATER. 2917 02:34:27,763 --> 02:34:33,402 WITH COLLECT BLOOD AND SALIVA 2918 02:34:33,402 --> 02:34:37,773 A 2919 02:34:37,773 --> 02:34:39,808 AND WE LOOKED AT THE EPITHELIAL 2920 02:34:39,808 --> 02:34:41,076 CELLS IN THE SALIVA TO 2921 02:34:41,076 --> 02:34:44,012 UNDERSTAND WHAT IS HAPPENING AND 2922 02:34:44,012 --> 02:34:49,384 IF WE CAN IDENTIFY ANOTHER LAYER 2923 02:34:49,384 --> 02:34:53,922 OF EPIGENETIC INFORMATION. 2924 02:34:53,922 --> 02:34:56,291 WE WERE ABLE TO DISCRIMINATE 2925 02:34:56,291 --> 02:34:58,527 BETWEEN LONG AND SHORT COVID. 2926 02:34:58,527 --> 02:35:02,497 THE CONTROL WE COLLECT BEFORE 2927 02:35:02,497 --> 02:35:02,931 THE PANDEMIC. 2928 02:35:02,931 --> 02:35:06,101 YOU CAN SEE IN TERMS OF THE 2929 02:35:06,101 --> 02:35:08,237 HEALTH QUESTIONNAIRE IN PANEL A, 2930 02:35:08,237 --> 02:35:12,574 B, C, D AND F THE SHORT COVID 2931 02:35:12,574 --> 02:35:13,408 BEHAVED MORE OR LESS EXACTLY 2932 02:35:13,408 --> 02:35:21,416 LIKE THE HEALTHY CONTROL WHICH 2933 02:35:21,416 --> 02:35:21,984 USING PRINCIPLE COMPONENT 2934 02:35:21,984 --> 02:35:22,251 ANALYSIS. 2935 02:35:22,251 --> 02:35:26,488 PANEL G WE WERE ABLE TO SPLIT 2936 02:35:26,488 --> 02:35:27,856 THE LONG AND SHORT COVID. 2937 02:35:27,856 --> 02:35:30,959 LONG COVID IS PINK AND THE SHORT 2938 02:35:30,959 --> 02:35:32,828 COVID IN GREEN AND THAT GIVES US 2939 02:35:32,828 --> 02:35:35,597 ALSO A HEAT MAP YOU CAN SEE WITH 2940 02:35:35,597 --> 02:35:39,434 DIFFERENCE CPG MARKERS AT VERY 2941 02:35:39,434 --> 02:35:40,802 DIFFERENT SIGNATURE BETWEEN LONG 2942 02:35:40,802 --> 02:35:42,237 COVID AND SHORT COVID THOUGH 2943 02:35:42,237 --> 02:35:45,540 BOTH GROUP HAD BEEN EXPOSED TO 2944 02:35:45,540 --> 02:35:48,110 THE SAME SARS COV2 VIRUS AT THAT 2945 02:35:48,110 --> 02:35:48,310 TIME. 2946 02:35:48,310 --> 02:35:53,148 AND WE PUSHED IT FURTHER BY 2947 02:35:53,148 --> 02:35:55,117 STRATIFYING LONG COVID AS SEVERE 2948 02:35:55,117 --> 02:35:59,187 LC1 AND MODERATE PATIENT WE WERE 2949 02:35:59,187 --> 02:36:00,555 ABLE TO SPLIT THEM USING THE Q 2950 02:36:00,555 --> 02:36:01,523 SCORE. 2951 02:36:01,523 --> 02:36:04,960 WE APPLIED THE STRESS TEST AND 2952 02:36:04,960 --> 02:36:06,428 MEASURED THE SEVERITY OF THE 2953 02:36:06,428 --> 02:36:07,429 PEN. 2954 02:36:07,429 --> 02:36:16,405 THE LC1 WAS OVER 20 AND THE LC2 2955 02:36:16,405 --> 02:36:18,540 HAS BELOW 20 AND WE HAD A 2956 02:36:18,540 --> 02:36:21,410 COMPLETELY DIFFERENT PROFILE. 2957 02:36:21,410 --> 02:36:27,950 YOU CAN SEE THE IN THE HEAT MAP 2958 02:36:27,950 --> 02:36:29,785 AND WERE ABLE TO DISCRIMINATE 2959 02:36:29,785 --> 02:36:31,920 AND HAVE A DISTINCT SIGNATURE 2960 02:36:31,920 --> 02:36:34,456 USING THE PBMCs AS WELL AS THE 2961 02:36:34,456 --> 02:36:36,625 SALIVA AND WHAT IS INTERESTING 2962 02:36:36,625 --> 02:36:41,964 IS WHEN YOU LOOK AT THE TIME 2963 02:36:41,964 --> 02:36:52,507 FRAME AND A 18 TO 20 MONTHS POST 2964 02:36:56,311 --> 02:36:58,280 INFECTION THEY'RE NOT 2965 02:36:58,280 --> 02:36:58,580 PROGRESSING. 2966 02:36:58,580 --> 02:37:00,983 HAVE YOU A BAD CLINICAL OUTCOME 2967 02:37:00,983 --> 02:37:02,784 OPPOSED TO THE GROUP 2 WHERE 2968 02:37:02,784 --> 02:37:04,419 HAVE YOU A SIGNIFICANT 2969 02:37:04,419 --> 02:37:06,521 IMPROVEMENT IN TERMS OF THE 2970 02:37:06,521 --> 02:37:09,224 TOTAL SEVERITY. 2971 02:37:09,224 --> 02:37:11,259 THIS IS VERY IMPORTANT IF WE CAN 2972 02:37:11,259 --> 02:37:17,399 USE THE PROFILE AT THE EARLY 2973 02:37:17,399 --> 02:37:19,735 STAGE OF LONG COVID WE MAY 2974 02:37:19,735 --> 02:37:24,940 PREDICT WHO HAS BETTER CHAINS TO 2975 02:37:24,940 --> 02:37:31,713 RESPOND AND THE BIOMARKER ARE 2976 02:37:31,713 --> 02:37:36,318 TARGETS WE CAN PREVENT THE 2977 02:37:36,318 --> 02:37:39,488 LONG-TERM SEQUELAE BY CAPTURING 2978 02:37:39,488 --> 02:37:41,056 THE TARGET AND MAKE' DIFFERENCE 2979 02:37:41,056 --> 02:37:42,557 BETWEEN WHO IS WHO IN TERM OF 2980 02:37:42,557 --> 02:37:43,892 LONG COVID AND TO ASSESS THE 2981 02:37:43,892 --> 02:37:53,935 CLINICAL TRAJECTORIES. 2982 02:37:53,935 --> 02:37:55,871 YOU CAN SEE ONE OF THE CPG 2983 02:37:55,871 --> 02:37:59,141 MARKER IS ASSOCIATED WITH DDR1 2984 02:37:59,141 --> 02:38:01,009 GENES AND THAT GENE WE CAN 2985 02:38:01,009 --> 02:38:04,379 MEASURE IN THE PLASMA AND YOU 2986 02:38:04,379 --> 02:38:06,515 CAN SEE THE ELEVATE IS 2987 02:38:06,515 --> 02:38:08,417 SIGNIFICANT FOR THE SEVERE LONG 2988 02:38:08,417 --> 02:38:11,420 COVID COMPARED TO LC2 OR SHORT 2989 02:38:11,420 --> 02:38:15,524 COVID AND SOLUBLE DDR1 IS ALSO 2990 02:38:15,524 --> 02:38:19,394 IMPORTANT BECAUSE IT CAN BE 2991 02:38:19,394 --> 02:38:19,628 CLEAVED. 2992 02:38:19,628 --> 02:38:25,400 I TOLD YOU WE HAVE A HIGHER 2993 02:38:25,400 --> 02:38:29,871 ELEVATION IN THIS IN COVID AND 2994 02:38:29,871 --> 02:38:33,408 PLASMA DDR1 IS CORRELATED 2995 02:38:33,408 --> 02:38:36,111 NEGATIVELY IN AGING POPULATION. 2996 02:38:36,111 --> 02:38:40,082 THERE'S A GOOD PAPER AND WE 2997 02:38:40,082 --> 02:38:41,416 MEASURED AND THE DIFFERENT 2998 02:38:41,416 --> 02:38:42,818 DEMAND IN THE LONG COVID AND YOU 2999 02:38:42,818 --> 02:38:49,791 CAN SEE ON PANEL C OR TABLE C, 3000 02:38:49,791 --> 02:38:54,996 WE SEE BOTH GROUPS ARE DIFFERENT 3001 02:38:54,996 --> 02:38:55,764 THAN THE SHORT COVID WHICH IS 3002 02:38:55,764 --> 02:39:05,907 NORMAL. 3003 02:39:11,079 --> 02:39:16,651 SOME CAN IMPROVE THE LONG COVID. 3004 02:39:16,651 --> 02:39:27,162 THIS IS THIS IS AN EXAMPLE OF 3005 02:39:28,797 --> 02:39:30,432 WHAT WE CAN DO TOGETHER AND USE 3006 02:39:30,432 --> 02:39:32,300 PRECISION MEDICINE TO CHANGE THE 3007 02:39:32,300 --> 02:39:34,369 COURSE OF ME/CFS AND LONG COVID 3008 02:39:34,369 --> 02:39:39,908 AND THIS IS AN EXAMPLE THAT LONG 3009 02:39:39,908 --> 02:39:43,445 COVID MAY INFLUENCE THE RESEARCH 3010 02:39:43,445 --> 02:39:44,379 ON ME/CFS AS WELL. 3011 02:39:44,379 --> 02:39:53,421 I'M FINISHING WITH THE LAST TWO 3012 02:39:53,421 --> 02:39:56,525 SLIDES BY QUOTING YOGA BERRA. 3013 02:39:56,525 --> 02:40:00,929 KEEP TRYING, STAY HUMBLE AND 3014 02:40:00,929 --> 02:40:04,432 TRUST YOUR INSTINCT AND ACT. 3015 02:40:04,432 --> 02:40:06,968 WE'RE ACTING TOGETHER AND WHEN 3016 02:40:06,968 --> 02:40:09,604 YOU COME TO A FORK IN THE ROAD, 3017 02:40:09,604 --> 02:40:11,506 TAKE IT. 3018 02:40:11,506 --> 02:40:14,843 IT'S TIME TO BUILD A ROAD MAP TO 3019 02:40:14,843 --> 02:40:16,978 SHIFT TO CLARITY AND MORE 3020 02:40:16,978 --> 02:40:19,781 IMPORTANTLY AND I WANT TO 3021 02:40:19,781 --> 02:40:25,420 SUPPORT THE PHASE THAT WE NEED 3022 02:40:25,420 --> 02:40:35,830 PATIENT AND I'D LIKE TO 3023 02:40:41,503 --> 02:40:44,639 ACKNOWLEDGE THE CONTRIBUTORS AND 3024 02:40:44,639 --> 02:40:55,183 THE I HAVE A TEAM WORKING WITH 3025 02:41:04,759 --> 02:41:05,427 COLLABORATORS AND THANK YOU VERY 3026 02:41:05,427 --> 02:41:15,837 MUCH FOR YOUR ATTENTION. 3027 02:41:34,789 --> 02:41:44,966 >> WE ARE COVERING THE OMICS AND 3028 02:41:44,966 --> 02:41:48,069 AS PART OF T ZERO AND THE STRESS 3029 02:41:48,069 --> 02:41:53,441 TEST WE IDENTIFY THIS BIOMARKER 3030 02:41:53,441 --> 02:42:00,649 NUMBER ONE IN RESPONSE TO THE 3031 02:42:00,649 --> 02:42:05,120 DRASTIC REDUCTION IN HAVE MORE 3032 02:42:05,120 --> 02:42:11,426 IN THE STRESS TEST AND YOU TRY 3033 02:42:11,426 --> 02:42:21,970 TO NEUTRALIZE AND AND WE LOOK AT 3034 02:42:26,941 --> 02:42:32,113 THE RED BLOOD CELL DEFORMITY AND 3035 02:42:32,113 --> 02:42:38,019 THEY'RE MORE RIGID AND THE MORE 3036 02:42:38,019 --> 02:42:48,563 RIGID IT WILL BREAK AND WE SEE 3037 02:42:52,100 --> 02:42:57,739 THE RIDGE IS DECREASED AFTER THE 3038 02:42:57,739 --> 02:42:58,273 STRESS TEST. 3039 02:42:58,273 --> 02:43:00,342 ALL IN ALL WE'RE GOING IN THE 3040 02:43:00,342 --> 02:43:02,277 RIGHT DIRECTION IT SEEMS AS PART 3041 02:43:02,277 --> 02:43:06,614 OF THE DIFFERENT MECHANISM 3042 02:43:06,614 --> 02:43:13,788 TRIGGERED WE HAVE THIS CHANGE 3043 02:43:13,788 --> 02:43:18,827 ALTERATION 3044 02:43:18,827 --> 02:43:23,865 >> YOU SEE WHAT IS HIGHLY 3045 02:43:23,865 --> 02:43:31,139 OPERATIVE IN YOUR RESEARCH AND 3046 02:43:31,139 --> 02:43:34,676 IT DIGESTED THE PROTEIN AND 3047 02:43:34,676 --> 02:43:41,216 REDUCES THE AMYLOID BETA 3048 02:43:41,216 --> 02:43:42,684 PATHOLOGY. 3049 02:43:42,684 --> 02:43:47,655 HAVE YOU CHECKED THAT AVENUE. 3050 02:43:47,655 --> 02:43:53,428 >> THE CHANGE BETWEEN ADAPTEN 3051 02:43:53,428 --> 02:43:55,230 AND IT'S INVOLVED IN THE 3052 02:43:55,230 --> 02:44:00,068 CLEAVAGE AND FILL AMOAMFILAMENT. 3053 02:44:00,068 --> 02:44:02,504 WE DID NOT LOOK AT THEM PER SE 3054 02:44:02,504 --> 02:44:05,440 BUT HAVE A GROUP OR SUBSET OF 3055 02:44:05,440 --> 02:44:07,909 PATIENT HIGH LEVEL OF SOLUBLE 3056 02:44:07,909 --> 02:44:09,344 ADAPTENS AND THAT CONDITION IS 3057 02:44:09,344 --> 02:44:09,878 NOT GOOD. 3058 02:44:09,878 --> 02:44:14,649 WE TRIED TO BRING THEY WILL DOWN 3059 02:44:14,649 --> 02:44:17,852 AND THE ONE THAT IS SULE USUAL 3060 02:44:17,852 --> 02:44:20,688 ARE HIGH IN SOLUBLE AMIC 3061 02:44:20,688 --> 02:44:22,424 IMPAIRING THE IMMUNE SYSTEM AS 3062 02:44:22,424 --> 02:44:22,991 WELL. 3063 02:44:22,991 --> 02:44:28,830 AND WE HAVE PATIENT WITH VERY 3064 02:44:28,830 --> 02:44:31,065 LOW SOLUBLE ADAPT GENS AND WE 3065 02:44:31,065 --> 02:44:36,371 TRIED TO BRING THEM AT THE 3066 02:44:36,371 --> 02:44:46,915 NORMAL LEVEL AND HAD SUCCESS AND 3067 02:44:49,017 --> 02:44:51,286 WE'RE LOOKING AT THE SIDE AND 3068 02:44:51,286 --> 02:44:53,188 DID NOT CHECK THE FACTORS 3069 02:44:53,188 --> 02:44:53,788 SPECIFICALLY AS YOU MENTIONED. 3070 02:44:53,788 --> 02:45:03,598 >> THANK YOU. 3071 02:45:03,598 --> 02:45:05,533 >> THANK YOU. 3072 02:45:05,533 --> 02:45:07,936 SO WE'VE REACHED OUR LUNCH 3073 02:45:07,936 --> 02:45:08,136 BREAK. 3074 02:45:08,136 --> 02:45:10,505 I WANTED TO ASK IF THE SPEAKERS 3075 02:45:10,505 --> 02:45:15,910 FOR THE AFTERNOON HAVE NOT YET 3076 02:45:15,910 --> 02:45:19,280 DELIVERED THEIR PRESENTATIONS TO 3077 02:45:19,280 --> 02:45:21,416 GIVE THEM TO THE A/V BOOTH 3078 02:45:21,416 --> 02:45:23,117 DURING LUNCH TO MAKE THE 3079 02:45:23,117 --> 02:45:24,886 AFTERNOON MORE SEAMLESS. 3080 02:45:24,886 --> 02:45:27,188 THE LUNCHES SOME ARE BEEN 3081 02:45:27,188 --> 02:45:29,424 PROVIDED FOR NETWORKING BY OPEN 3082 02:45:29,424 --> 02:45:30,925 MEDICINE FOUNDATION IN THE FAS 3083 02:45:30,925 --> 02:45:32,026 TERRACE. 3084 02:45:32,026 --> 02:45:34,295 IF YOU GO OUT THE DOORS GO DOWN 3085 02:45:34,295 --> 02:45:37,365 TO THE COFFEE SHOP ESSENTIALLY 3086 02:45:37,365 --> 02:45:40,201 AND TURN RIGHT AND WE WILL 3087 02:45:40,201 --> 02:45:40,635 RECONVENE AT 1:00. 3088 02:45:40,635 --> 02:45:40,902 THANK YOU. 3089 02:45:40,902 --> 02:45:40,969 3090 02:45:46,011 --> 02:45:46,511 >> GOOD AFTERNOON. 3091 02:45:46,511 --> 02:45:48,113 WE'RE GOING TO CONTINUE WITH OUR 3092 02:45:48,113 --> 02:45:49,648 PROGRAM. 3093 02:45:49,648 --> 02:45:52,150 THIS AFTERNOON AS WE DID 3094 02:45:52,150 --> 02:45:53,652 YESTERDAY WE'RE GOING TO HAVE 3095 02:45:53,652 --> 02:45:56,087 SOME PRESENTATIONS FROM THE 3096 02:45:56,087 --> 02:45:57,622 EARLY CAREER INVESTIGATOR 3097 02:45:57,622 --> 02:45:58,290 CONFERENCE WHICH HAPPENED MONDAY 3098 02:45:58,290 --> 02:46:01,126 SO WE'RE EXCITED TO HAVE THREE 3099 02:46:01,126 --> 02:46:04,296 SPEAKERS AND WE'RE GOING TO 3100 02:46:04,296 --> 02:46:09,901 START WITH HANNAH BUES FROM MGH 3101 02:46:09,901 --> 02:46:10,135 HARVARD. 3102 02:46:10,135 --> 02:46:14,339 I APOLOGIZE IF I BUTCHERED YOUR 3103 02:46:14,339 --> 02:46:17,442 NAME USING PET TO ASSESS 3104 02:46:17,442 --> 02:46:22,681 NEUROINFLAMMATION IN PASC AND 3105 02:46:22,681 --> 02:46:22,914 ME/CFS. 3106 02:46:22,914 --> 02:46:30,055 6: 3107 02:46:30,055 --> 02:46:36,494 >> I'M HANNAH BUES A CLINICAL 3108 02:46:36,494 --> 02:46:37,662 RESEARCHER AT MASSACHUSETTS 3109 02:46:37,662 --> 02:46:42,601 GENERAL HOSPITAL AND TALK ABOUT 3110 02:46:42,601 --> 02:46:47,672 AN ONGOING STUDY TO ASSESS 3111 02:46:47,672 --> 02:46:48,740 NEUROINFLAMMATION IN PASC AND 3112 02:46:48,740 --> 02:46:48,974 ME/CFS. 3113 02:46:48,974 --> 02:46:50,342 AS A BRIEF INTRODUCTION TO THE 3114 02:46:50,342 --> 02:46:52,544 STUDY WE HAVE TWO STUDY COHORT. 3115 02:46:52,544 --> 02:46:58,350 WE'RE LOOKING AT BOTH PASC AND 3116 02:46:58,350 --> 02:47:04,022 ME/CFS AND USE THE INTERNATIONAL 3117 02:47:04,022 --> 02:47:05,223 CONSENSUS IN OUR SCREENING AND 3118 02:47:05,223 --> 02:47:06,992 FOR PASC WE'RE TRYING TO CAST A 3119 02:47:06,992 --> 02:47:11,863 WIDER NET BUT STILL CAPTURE THE 3120 02:47:11,863 --> 02:47:12,364 ME LIKE DIVERSE SYMPTOM 3121 02:47:12,364 --> 02:47:12,697 PRESENTATION. 3122 02:47:12,697 --> 02:47:15,166 WE USE THE ICC BUT REQUIRE OME 3123 02:47:15,166 --> 02:47:18,336 THEY ENDORSE ONE SYMPTOM FROM 3124 02:47:18,336 --> 02:47:22,574 EACH SYMPTOM CLUSTER. 3125 02:47:22,574 --> 02:47:33,118 S IS THE SYMPTOMSLIKE FLU LIKE 3126 02:47:37,889 --> 02:47:40,025 SYMPTOMS AND ACCOUNTING SYMPTOMS 3127 02:47:40,025 --> 02:47:43,361 OVERLAP WITH THE GENERAL 3128 02:47:43,361 --> 02:47:43,795 SICKNESS RESPONSE. 3129 02:47:43,795 --> 02:47:45,430 HOW YOUR BRAIN REACTS TO YOUR 3130 02:47:45,430 --> 02:47:45,964 BODY BEING SICK. 3131 02:47:45,964 --> 02:47:51,236 WE'RE INTERESTED IN LOOKING AT 3132 02:47:51,236 --> 02:47:51,636 NEUROINFLAMMATION. 3133 02:47:51,636 --> 02:47:55,607 WE ASSESS USING PET CANNING WITH 3134 02:47:55,607 --> 02:47:57,108 THE LIGAND AND INVESTIGATE 3135 02:47:57,108 --> 02:47:57,809 POTENTIAL ROOT CAUSES BY 3136 02:47:57,809 --> 02:48:08,186 INTEGRATING OTHER MEASURES. 3137 02:48:08,186 --> 02:48:10,722 JUST TO INTRODUCE YOU TO WHAT 3138 02:48:10,722 --> 02:48:12,891 OUR PET SCAN LOOKS LIKE. 3139 02:48:12,891 --> 02:48:17,395 WE USE A DUEL SCANNER ACQUIRING 3140 02:48:17,395 --> 02:48:19,531 POSITRON EMISSION TOMOGRAPHY AND 3141 02:48:19,531 --> 02:48:22,334 MRI DATA AT THE SAME TIME 3142 02:48:22,334 --> 02:48:30,141 SIMULTANEOUSLY. 3143 02:48:30,141 --> 02:48:34,379 PBR28 BINDS TO THE TRANS LOCAT 3144 02:48:34,379 --> 02:48:42,354 ER PROTEIN ACTIVATED BY IMMUNE 3145 02:48:42,354 --> 02:48:46,891 CELLS AND ACTIVATED BY PATHOGENS 3146 02:48:46,891 --> 02:48:50,895 OR DAMAGE AND IT'S USED TO STUDY 3147 02:48:50,895 --> 02:48:53,331 INFLAMMATION AND AFFECT GLIAL 3148 02:48:53,331 --> 02:49:02,307 CELL DENSITY OR INFILTRATION OF 3149 02:49:02,307 --> 02:49:02,640 IMMUNE CELLS. 3150 02:49:02,640 --> 02:49:06,444 CAN AND WE HAVE PRE PRINTS IN 3151 02:49:06,444 --> 02:49:07,312 PASC CELLS. 3152 02:49:07,312 --> 02:49:08,713 METHODS FOR THIS PARTICULAR 3153 02:49:08,713 --> 02:49:11,015 STUDY WE TOOK THE FIRST 12 3154 02:49:11,015 --> 02:49:12,183 PATIENTS WE SCANNED WITH PASC 3155 02:49:12,183 --> 02:49:14,319 AND AGAIN ALL THESE PATIENTS 3156 02:49:14,319 --> 02:49:15,820 ENDORSED AFTER LEAST ONE SYMPTOM 3157 02:49:15,820 --> 02:49:18,022 FROM EACH CLUSTER OF THE ICC. 3158 02:49:18,022 --> 02:49:21,626 THESE PATIENTS GOT SICK EARLY IN 3159 02:49:21,626 --> 02:49:23,561 THE PANDEMIC SO PREOMICRON 3160 02:49:23,561 --> 02:49:25,430 VARIANT AND MOST WERE PREVACCINE 3161 02:49:25,430 --> 02:49:31,669 WHEN THEY ORIGINAL BY GOT SICK. 3162 02:49:31,669 --> 02:49:33,138 THEY WERE UNVACCINATED NOT 3163 02:49:33,138 --> 02:49:34,806 BECAUSE THEY CHOSE NOT TO BE BUT 3164 02:49:34,806 --> 02:49:37,942 BECAUSE IT WAS IT WAS AVAILABLE. 3165 02:49:37,942 --> 02:49:41,613 WE HAD 10 FEMALE AND 12 MALE 3166 02:49:41,613 --> 02:49:45,316 FEMALES WITH PASC. 3167 02:49:45,316 --> 02:49:47,852 WE COMPARED THEM TO A SET OF 43 3168 02:49:47,852 --> 02:49:49,354 CONTROLS WITH NO HISTORY OF 3169 02:49:49,354 --> 02:49:52,190 COVID-19 AND SOME REQUIRED 3170 02:49:52,190 --> 02:49:54,359 PREPANDEMIC AND OTHERS RECEIVED 3171 02:49:54,359 --> 02:49:57,295 A NEGATIVE ANTIBODY TEST. 3172 02:49:57,295 --> 02:49:59,764 AND WE USED SEX AS COVARIANT AND 3173 02:49:59,764 --> 02:50:05,136 A GENOTYPE AND THE CEREBELLUM 3174 02:50:05,136 --> 02:50:07,138 WAS USED TO NORMALIZE THE PET 3175 02:50:07,138 --> 02:50:07,705 SIGNAL. 3176 02:50:07,705 --> 02:50:09,407 GETTING TO THE RESULTS I'M GOING 3177 02:50:09,407 --> 02:50:10,842 TO BREAK THESE UP. 3178 02:50:10,842 --> 02:50:14,179 SO HERE WE SEE A HEAT MAP OF THE 3179 02:50:14,179 --> 02:50:16,448 AREAS IN THE BRAIN IN WHICH PASC 3180 02:50:16,448 --> 02:50:21,052 SHOWED MORE PET SIGNAL, MORE 3181 02:50:21,052 --> 02:50:21,920 TSVO AND MORE NEURAL 3182 02:50:21,920 --> 02:50:23,655 INFLAMMATION VERSUS CONTROLS. 3183 02:50:23,655 --> 02:50:25,523 IN PARTICULAR WE FOUND IT AT THE 3184 02:50:25,523 --> 02:50:28,326 LINING OF THE VENTRICLES AS WELL 3185 02:50:28,326 --> 02:50:34,332 AS REGIONS OF THE BRAIN DENSELY 3186 02:50:34,332 --> 02:50:40,905 VASCULARIZED SUCH AS THE 3187 02:50:40,905 --> 02:50:41,306 CINGULATE CORTEX. 3188 02:50:41,306 --> 02:50:45,109 HERE'S A BOX PLOT 3189 02:50:45,109 --> 02:50:45,577 REPRESENTATION. 3190 02:50:45,577 --> 02:50:50,081 YOU SEE WHOLE BRAIN ON THE LEFT 3191 02:50:50,081 --> 02:51:00,625 AND THE CORPUS COL OS UM AND WE 3192 02:51:10,068 --> 02:51:11,803 LOOKED ACROSS REGIONS. 3193 02:51:11,803 --> 02:51:14,706 SO CONSIDERING A FEW THINGS. 3194 02:51:14,706 --> 02:51:17,008 CONSIDERING THE FACT THAT 3195 02:51:17,008 --> 02:51:20,211 COVID-19 SEEMS TO BE AN 3196 02:51:20,211 --> 02:51:22,213 INFECTION THAT DRIVES PROBLEMS 3197 02:51:22,213 --> 02:51:29,487 FROM THE VASCULATURE AND WE SAW 3198 02:51:29,487 --> 02:51:31,523 VASCULARIZED REGIONS DID OUR PET 3199 02:51:31,523 --> 02:51:34,325 SIGNAL CORRELATE WITH THE 3200 02:51:34,325 --> 02:51:37,462 VASCULAR DISEASE MEASURE AND WE 3201 02:51:37,462 --> 02:51:40,231 TOOK PERIPHERAL BLOOD BEFORE THE 3202 02:51:40,231 --> 02:51:44,168 SCAN AND MEASURED ALL PART OF 3203 02:51:44,168 --> 02:51:45,336 THE VASCULAR DISEASE PANEL TO 3204 02:51:45,336 --> 02:51:48,606 SEE IF THEY CORRELATED WITH PET 3205 02:51:48,606 --> 02:51:48,840 SIGNAL. 3206 02:51:48,840 --> 02:51:51,509 IN THE PAST PATIENTS THEY DID. 3207 02:51:51,509 --> 02:51:55,146 WHERE WE SAW GREATER LEVELS WE 3208 02:51:55,146 --> 02:52:05,690 ALSO SAW INCREASED PBR28 SIGNAL. 3209 02:52:09,727 --> 02:52:12,263 THE REST OF THE PANEL HAD PRETTY 3210 02:52:12,263 --> 02:52:14,299 HIGH SIGNIFICANT CORRELATIONS. 3211 02:52:14,299 --> 02:52:15,300 SOME ONGOING WORK WE HAVE GOING 3212 02:52:15,300 --> 02:52:18,336 ON IN OUR STUDY IS CONTINUED 3213 02:52:18,336 --> 02:52:23,207 SCANNING OF PATIENTS WITH 3214 02:52:23,207 --> 02:52:27,145 PRE-COVID ME/CFS AND HEALTHY 3215 02:52:27,145 --> 02:52:27,378 CONTROL. 3216 02:52:27,378 --> 02:52:29,847 WE'RE DOING ANALYSIS OF FMRI 3217 02:52:29,847 --> 02:52:32,116 DATA WITH THE PET DATA AND ALSO 3218 02:52:32,116 --> 02:52:33,918 DOING FURTHER INVESTIGATION INTO 3219 02:52:33,918 --> 02:52:35,720 ROOT CAUSES USING PERIL RAL 3220 02:52:35,720 --> 02:52:37,188 BLOOD AND SALIVA. 3221 02:52:37,188 --> 02:52:39,557 ONE OF THE THINGS WE'RE LOOKING 3222 02:52:39,557 --> 02:52:41,893 AT IS ANALYSES OF LIVE 3223 02:52:41,893 --> 02:52:46,331 PERIPHERAL BLOOD COLLECTED 3224 02:52:46,331 --> 02:52:47,665 BEFORE THE CAN. 3225 02:52:47,665 --> 02:52:56,808 MY COLLEAGUE COLLECTS A TUBE OF 3226 02:52:56,808 --> 02:52:59,277 BLOOD AND ANALYZES IT IN REAL 3227 02:52:59,277 --> 02:53:00,478 TIME AND LOOKING AT THE BEHAVIOR 3228 02:53:00,478 --> 02:53:06,584 OF NEUTROPHILS THE WHITE CELLS 3229 02:53:06,584 --> 02:53:08,519 WHICH ARE THE FIRST IMMUNE 3230 02:53:08,519 --> 02:53:11,356 RESPONDERS OF THE SYSTEM. 3231 02:53:11,356 --> 02:53:17,328 AND USES MICROFLUIDICS. 3232 02:53:17,328 --> 02:53:21,866 THERE'S A SLIDE WHERE IN THE 3233 02:53:21,866 --> 02:53:23,434 ANALYSIS YOU CAN SEE THE 3234 02:53:23,434 --> 02:53:25,703 NEUTROPHILS THROUGH THE MAZE. 3235 02:53:25,703 --> 02:53:28,306 THAT'S WHAT SPONTANEOUS 3236 02:53:28,306 --> 02:53:28,940 MIGRATION IS. 3237 02:53:28,940 --> 02:53:30,341 HOW FAR AND LAST FROM THE 3238 02:53:30,341 --> 02:53:35,546 NEUTROPHILS SWIMMING. 3239 02:53:35,546 --> 02:53:37,148 IN LONG COVID THEY SWIM A LOT 3240 02:53:37,148 --> 02:53:38,349 COMPARED TO HEALTHY CONTROLS. 3241 02:53:38,349 --> 02:53:48,826 ANOTHER THING WE LOOK AT IS 3242 02:53:50,762 --> 02:53:52,330 PHAGOC 3243 02:53:52,330 --> 02:53:55,667 PHAGOCYTOSIS AND THERE'S A 3244 02:53:55,667 --> 02:54:00,405 PATTERN EMERGING THERE SEEMS TO 3245 02:54:00,405 --> 02:54:06,344 BE A SPLIT PARTICULARLY AMONG 3246 02:54:06,344 --> 02:54:13,017 COVID AND IT SEEMS PHAGOCYTOSIS 3247 02:54:13,017 --> 02:54:14,419 LOWER IN SOME CONTROLS AND A 3248 02:54:14,419 --> 02:54:15,953 QUESTION WHY WE'RE SEEING THAT. 3249 02:54:15,953 --> 02:54:26,431 ANOTHER THING WE LOOK AT IS 3250 02:54:28,399 --> 02:54:30,034 NETOSIS AND RELEASE THEIR OWN 3251 02:54:30,034 --> 02:54:34,639 DNA TO TRAP PATHOGENS. 3252 02:54:34,639 --> 02:54:36,774 SO IT'S A LEVEL OF EXTRA 3253 02:54:36,774 --> 02:54:38,676 CELLULAR DNA WHICH IS HOW WE 3254 02:54:38,676 --> 02:54:40,378 QUANTIFY NETS AND YOU CAN SEE 3255 02:54:40,378 --> 02:54:43,815 THAT IS INCREASED IN ME/CFS AND 3256 02:54:43,815 --> 02:54:44,982 LONG COVID. 3257 02:54:44,982 --> 02:54:49,787 WE ALSO LOOK AT PMA STIMULATED 3258 02:54:49,787 --> 02:54:50,021 NETOSIS. 3259 02:54:50,021 --> 02:54:53,091 IT'S SOMETHING USED TO MIMIC THE 3260 02:54:53,091 --> 02:54:54,459 BEHAVIORS OF BACTERIA. 3261 02:54:54,459 --> 02:54:57,695 SO FAR NO SIGNIFICANT DIFFERENCE 3262 02:54:57,695 --> 02:55:00,031 BUT SOMETHING IS POPPING UP IN 3263 02:55:00,031 --> 02:55:01,733 LONG COVID AND IT'S TOO SOON TO 3264 02:55:01,733 --> 02:55:03,568 BUT A PATTERN MAY BE EMERGING IN 3265 02:55:03,568 --> 02:55:07,271 ME/CFS AS WELL. 3266 02:55:07,271 --> 02:55:10,174 I WANTED TO FINISH OFF WITH SOME 3267 02:55:10,174 --> 02:55:11,242 OPEN QUESTIONS. 3268 02:55:11,242 --> 02:55:12,977 CONSIDERING THAT THE TOPIC OF 3269 02:55:12,977 --> 02:55:15,680 THE CONVERSATION IS LEARNING 3270 02:55:15,680 --> 02:55:16,681 FROM LONG COVID. 3271 02:55:16,681 --> 02:55:21,652 THOSE QUESTIONS ARE WHAT CAN WE 3272 02:55:21,652 --> 02:55:28,092 LEARN ABOUT ME/CFS FROM LONG 3273 02:55:28,092 --> 02:55:32,029 COVID AND THIS IS PRESENT 3274 02:55:32,029 --> 02:55:34,866 LOOKING AT THE DATA I JUST SAW 3275 02:55:34,866 --> 02:55:36,467 HOWEVER, THE CORRELATION WITH 3276 02:55:36,467 --> 02:55:39,203 THE VASCULAR DISEASE MEASURES 3277 02:55:39,203 --> 02:55:40,972 CONSIDERING COVID-19 IS A 3278 02:55:40,972 --> 02:55:42,340 PATHOGEN THAT PARTICULARLY 3279 02:55:42,340 --> 02:55:44,375 DRIVES PROBLEMS WITH THE 3280 02:55:44,375 --> 02:55:44,675 VASCULATURE. 3281 02:55:44,675 --> 02:55:46,344 WE'RE NOT TOTALLY SURE WE'RE 3282 02:55:46,344 --> 02:55:48,346 GOING TO SEE THAT IN ME/CFS IN 3283 02:55:48,346 --> 02:55:50,348 GENERAL BUT WE'LL CERTAINLY 3284 02:55:50,348 --> 02:55:50,748 LOOK. 3285 02:55:50,748 --> 02:55:53,351 AND I WANTED TO FINISH OFF WITH 3286 02:55:53,351 --> 02:56:01,492 SOME ACKNOWLEDGEMENTS TO MY 3287 02:56:01,492 --> 02:56:03,327 COLLEAGUES AND OUR STUDY 3288 02:56:03,327 --> 02:56:03,661 PARTICIPANTS. 3289 02:56:03,661 --> 02:56:04,796 WE COULDN'T DO THIS WITHOUT THEM 3290 02:56:04,796 --> 02:56:05,797 AND APPRECIATE THEM COMING IN 3291 02:56:05,797 --> 02:56:10,334 AND PARTICIPATING. 3292 02:56:10,334 --> 02:56:20,678 THANK YOU VERY MUCH. 3293 02:56:28,786 --> 02:56:32,156 >> OUR NEXT SPEAKER IS NICHOLAS 3294 02:56:32,156 --> 02:56:38,196 HAMPILOS FROM WEILL CORNELL 3295 02:56:38,196 --> 02:56:43,267 TALKING ABOUT THE EFFECT OF 3296 02:56:43,267 --> 02:56:47,939 PHYSICAL EXERTION ON CNS AND 3297 02:56:47,939 --> 02:56:50,107 OXIDATIVE STRESS ON METABOLISM 3298 02:56:50,107 --> 02:56:50,608 IN ME/CFS. 3299 02:56:50,608 --> 02:56:54,278 >> THANK YOU, DR. GREEN. 3300 02:56:54,278 --> 02:56:55,713 I'D LIKE TO FIRST THANK YOU FOR 3301 02:56:55,713 --> 02:56:57,481 THE OPPORTUNITY TO PRESENT HERE 3302 02:56:57,481 --> 02:56:59,150 TODAY AND THE NIH FOR HOSTING. 3303 02:56:59,150 --> 02:57:03,554 MY NAME'S NICHOLAS HAMPILOS A 3304 02:57:03,554 --> 02:57:04,822 FELLOW IN THE LABORATORY FOR 3305 02:57:04,822 --> 02:57:12,396 ADVANCED RESEARCH HEADED BY MY 3306 02:57:12,396 --> 02:57:14,465 VI AND I'M GOING TO PRESENT 3307 02:57:14,465 --> 02:57:20,104 ENTITLED EFFECT OF PHYSICAL 3308 02:57:20,104 --> 02:57:28,079 EXERTION ON CNS OXIDATIVE STRESS 3309 02:57:28,079 --> 02:57:31,382 AND METABOLISM IN ME/CFS. 3310 02:57:31,382 --> 02:57:34,652 ONE OF THE KEY AND HALLMARK 3311 02:57:34,652 --> 02:57:36,354 FEATURES OF ME/CFS IS CALLED 3312 02:57:36,354 --> 02:57:37,088 POST-EXERTIONAL MALAISE AND IT'S 3313 02:57:37,088 --> 02:57:41,025 A STATE IN WHICH PHYSICAL OR 3314 02:57:41,025 --> 02:57:51,569 MENTAL EXERTION KANSASER -- CAN 3315 02:58:02,280 --> 02:58:04,982 MAKE ME/CFS WORSE AND OFFER 3316 02:58:04,982 --> 02:58:05,816 COUNSELLING AND DEVELOPING MORE 3317 02:58:05,816 --> 02:58:11,489 EVIDENCE-BASED TREATMENTS. 3318 02:58:11,489 --> 02:58:19,397 WE USED PROTON MAGNETIC SPECK 3319 02:58:19,397 --> 02:58:19,597 TROSY 3320 02:58:19,597 --> 02:58:23,367 AND HAVE SHOWN PEOPLE HAVE A 3321 02:58:23,367 --> 02:58:25,403 SIGNIFICANT DEFINITION COMPARED 3322 02:58:25,403 --> 02:58:29,307 TO HEALTHY CONTROLS AND WE 3323 02:58:29,307 --> 02:58:34,645 REPLICATED THIS IN SEVERAL 3324 02:58:34,645 --> 02:58:38,082 STUDIES. 3325 02:58:38,082 --> 02:58:42,586 AND OXIDATIVE STRESS WITH FREE 3326 02:58:42,586 --> 02:58:47,425 OXYGEN AND NITROGEN FREE RAD 3327 02:58:47,425 --> 02:58:48,893 KALDZ AND THIS IS THE MOST 3328 02:58:48,893 --> 02:58:50,428 ABUNDANT AND THE DEFICIT IS 3329 02:58:50,428 --> 02:58:52,363 SUPPORTIVE OF OXIDATIVE STRESS. 3330 02:58:52,363 --> 02:58:54,332 WE'VE ALSO SHOWN IN THE BRAIN 3331 02:58:54,332 --> 02:58:57,034 AND VENTRICLES PEOPLE WITH 3332 02:58:57,034 --> 02:58:58,369 ME/CFS HAVE AN ELEVATION OF 3333 02:58:58,369 --> 02:58:59,337 LACTATE. 3334 02:58:59,337 --> 02:59:07,378 THIS IS SUGGESTIVE OF ABNORMAL 3335 02:59:07,378 --> 02:59:10,181 GLYCOLYTIC METABOLISM AND THIS 3336 02:59:10,181 --> 02:59:12,850 STUDY HAD THE POSSIBILITY OF 3337 02:59:12,850 --> 02:59:17,188 SHEDDING LIGHT ON THE 3338 02:59:17,188 --> 02:59:18,356 PATHOPHYSIOLOGY AND HOW THE 3339 02:59:18,356 --> 02:59:20,191 EXERTION AFFECTS THE METABOLITE 3340 02:59:20,191 --> 02:59:21,792 LEVELS AND SERVED AS THE 3341 02:59:21,792 --> 02:59:23,894 RATIONALE FOR THE STUDY. 3342 02:59:23,894 --> 02:59:25,730 THE OBJECTIVE WAS TO INVESTIGATE 3343 02:59:25,730 --> 02:59:29,433 A CARDIO PULMONARY EXERCISE TEST 3344 02:59:29,433 --> 02:59:34,372 IN PEOPLE WITH ME/CFS AND 3345 02:59:34,372 --> 02:59:40,378 HEALTHY PROPERTIES USING THIS 3346 02:59:40,378 --> 02:59:44,215 SPECTROSCOPY AND COMPARED TO 3347 02:59:44,215 --> 02:59:45,816 HEALTHY PARTICIPANTS BEFORE AND 3348 02:59:45,816 --> 02:59:48,386 24 HOURS AFTER CPET. 3349 02:59:48,386 --> 02:59:58,362 AND WE ALSO HYPOTHESIZED THAT 3350 02:59:58,362 --> 03:00:08,339 BRAIN METABOLITES WOULD 3351 03:00:08,339 --> 03:00:10,374 INCREASE AND WE USED THE 3352 03:00:10,374 --> 03:00:12,710 CANADIAN CONSENSUS CRITERIA AND 3353 03:00:12,710 --> 03:00:21,485 OUR CPET WAS DONE WITH EXERCISE 3354 03:00:21,485 --> 03:00:22,153 TESTING. 3355 03:00:22,153 --> 03:00:25,923 THERE'S TWO CPETs PERFORMED. 3356 03:00:25,923 --> 03:00:28,392 THIS IS PART OF THE CORNELL 3357 03:00:28,392 --> 03:00:29,360 COLLABORATIVE CENTER AND WE WERE 3358 03:00:29,360 --> 03:00:30,528 INTERESTED IN THE EFFECT OF A 3359 03:00:30,528 --> 03:00:32,129 SINGLE CPET. 3360 03:00:32,129 --> 03:00:34,832 YOU CAN SEE THE IMAGE DEPICTING 3361 03:00:34,832 --> 03:00:37,034 AN MRI PERFORMED THE CPET ON THE 3362 03:00:37,034 --> 03:00:43,607 SAME DAY AND 24 HOURS LATER WE 3363 03:00:43,607 --> 03:00:45,409 PERFORMED A SECOND SPECTROSCOPY 3364 03:00:45,409 --> 03:00:49,313 AND LOOKED FOR CHANGES IN 3365 03:00:49,313 --> 03:00:49,747 METABOLITES. 3366 03:00:49,747 --> 03:00:55,586 WE RECORDED GLUTEITHION IN THE 3367 03:00:55,586 --> 03:01:00,257 OCC IN THE TOP LEFT OF THE 3368 03:01:00,257 --> 03:01:02,827 FIGURE AND LOOKED AT THE IRON 3369 03:01:02,827 --> 03:01:04,361 ENRICHED PART OF THE GRAIN AND 3370 03:01:04,361 --> 03:01:05,129 WANTED TO SEE IF THERE WAS A 3371 03:01:05,129 --> 03:01:15,272 DEFICIT. 3372 03:01:25,516 --> 03:01:28,419 WE FOUND A DEFICIT BEFORE AND 24 3373 03:01:28,419 --> 03:01:38,362 HOURS AFTER CPET COMPARED TO 3374 03:01:38,362 --> 03:01:48,806 HEALTHY CONTROLS AND AND 3375 03:01:52,009 --> 03:01:54,378 EXERCISE HAD NO EFFECT ON 3376 03:01:54,378 --> 03:01:56,714 METABOLITE IN GLUTATHIONE AND 3377 03:01:56,714 --> 03:02:01,685 METABOLITE AFTER THE CPET. 3378 03:02:01,685 --> 03:02:03,988 WE DIDN'T SEE DIFFERENCE IN 3379 03:02:03,988 --> 03:02:05,122 GLUTATHIONE BETWEEN THE TWO 3380 03:02:05,122 --> 03:02:09,126 GROUPS BEFORE AND 24 HOURS AFTER 3381 03:02:09,126 --> 03:02:17,735 THE CPET. 3382 03:02:17,735 --> 03:02:21,772 WITH DIDN'T SEE AFFECT ON CPET 3383 03:02:21,772 --> 03:02:22,907 GLUTATHIONE LEVELS IN THIS AREA 3384 03:02:22,907 --> 03:02:25,109 AS WELL AND WITH THE LACTATE 3385 03:02:25,109 --> 03:02:29,213 LEVELS OF THE VENTRICLE WE 3386 03:02:29,213 --> 03:02:32,616 COLLABORATED OUR PRIOR FINDINGS 3387 03:02:32,616 --> 03:02:35,519 IN PEOPLE BEFORE AND 24 HOURS 3388 03:02:35,519 --> 03:02:43,994 WITH P VALUES OF .003 AND .005 3389 03:02:43,994 --> 03:02:47,531 AND DIDN'T SEE IT 24 HOURS POST 3390 03:02:47,531 --> 03:02:47,731 CPET. 3391 03:02:47,731 --> 03:02:49,200 WE WERE INTERESTED IN EXAMINING 3392 03:02:49,200 --> 03:02:52,236 FOR POTENTIAL RELATIONSHIPS 3393 03:02:52,236 --> 03:02:55,639 BETWEEN THE CPET PARAMETERS IN 3394 03:02:55,639 --> 03:03:01,512 PARTICULAR VO2 MAX AND THE 3395 03:03:01,512 --> 03:03:02,079 THRESHOLD AS WELL AS WITH 3396 03:03:02,079 --> 03:03:05,015 PRECPET NEURO METABOLITE LEVELS 3397 03:03:05,015 --> 03:03:07,952 AND SEE STATISTICALLY 3398 03:03:07,952 --> 03:03:08,519 SIGNIFICANT DIFFERENCE IN 3399 03:03:08,519 --> 03:03:08,752 LEVELS. 3400 03:03:08,752 --> 03:03:11,722 WHAT CAN WE DRAW PERFECT THE 3401 03:03:11,722 --> 03:03:12,489 STUDY? 3402 03:03:12,489 --> 03:03:17,027 WE CORROBORATED OUR FINDING OF 3403 03:03:17,027 --> 03:03:19,697 GLUTATHIONE AND LOOKING AT OX 3404 03:03:19,697 --> 03:03:23,534 DATIVE STRESS AND ABNORMAL 3405 03:03:23,534 --> 03:03:25,002 METABOLISM IN THIS CONDITION. 3406 03:03:25,002 --> 03:03:29,406 WE DID NOT SEE A DIFFERENCE IN 3407 03:03:29,406 --> 03:03:31,642 THE LEVELS AND THERE'S POTENTIAL 3408 03:03:31,642 --> 03:03:32,943 EXPLANATIONS INCLUDING THE 3409 03:03:32,943 --> 03:03:35,045 REGION MAY HAVE SIMILAR LEVELS 3410 03:03:35,045 --> 03:03:36,513 OF OXIDATIVE STRESS IN BOTH 3411 03:03:36,513 --> 03:03:38,349 GROUPS AND IT'S IRON ENRICHED 3412 03:03:38,349 --> 03:03:41,986 AND IRON IS A SUBSTRATE IN THE 3413 03:03:41,986 --> 03:03:43,754 REACTION WHICH IS AN IMPORTANT 3414 03:03:43,754 --> 03:03:46,190 SOURCE OF ERADICATING FREE 3415 03:03:46,190 --> 03:03:48,692 RADICALS AND WE DIDN'T SEE 3416 03:03:48,692 --> 03:03:52,997 EFFECT OF CPET ON GLUTATHIONE 3417 03:03:52,997 --> 03:03:58,369 AND LACTATE WITH THE KNOWING 3418 03:03:58,369 --> 03:04:07,411 EFFECT OF EXERTION IN PATIENTS 3419 03:04:07,411 --> 03:04:09,947 AND WHY DIDN'T WE SEE AN EFFECT 3420 03:04:09,947 --> 03:04:11,682 IT MAY WELL BE THAT EXERCISE 3421 03:04:11,682 --> 03:04:13,484 DOES NOT ALTER THE METABOLITES 3422 03:04:13,484 --> 03:04:15,853 OPPOSED TO A DIRECT CHALLENGE TO 3423 03:04:15,853 --> 03:04:21,525 THE BRAIN WITH THE ACTIVATION 3424 03:04:21,525 --> 03:04:27,598 PARADIGM AND MORE LIKELY LEVELS 3425 03:04:27,598 --> 03:04:30,401 COULD HAVE BEEN NORMALIZED 3426 03:04:30,401 --> 03:04:34,138 DURING THE FIRST AND SECOND 3427 03:04:34,138 --> 03:04:35,839 SPECTROSCOPY AND CHANGES COULD 3428 03:04:35,839 --> 03:04:36,774 HAVE OCCURRED AFTER THE EXERCISE 3429 03:04:36,774 --> 03:04:41,912 TEST AND NORMALIZED BEFORE THE 3430 03:04:41,912 --> 03:04:43,147 SECOND SPECTROSCOPY WAS 3431 03:04:43,147 --> 03:04:45,683 PERFORMED AND THE LITERATURE 3432 03:04:45,683 --> 03:04:48,319 SUPPORTS THIS IN EXERCISE AND 3433 03:04:48,319 --> 03:04:54,425 MEASURIING GLUTATHIONE AND 3434 03:04:54,425 --> 03:04:56,393 LACTATE AND AN INCREASE IN 3435 03:04:56,393 --> 03:04:58,329 LACTATE SHOWN IN THE BOTTLE 3436 03:04:58,329 --> 03:04:58,562 FIGURES. 3437 03:04:58,562 --> 03:05:04,301 THE STUDIES WERE PERFORMED 3438 03:05:04,301 --> 03:05:14,778 BETWEEN THE FIRST MASS SP 3439 03:05:21,285 --> 03:05:22,353 SPECTROSCOPY AND I'D LIKE TO 3440 03:05:22,353 --> 03:05:27,324 THANK THOSE WHO CONTRIBUTED. 3441 03:05:27,324 --> 03:05:28,592 AND THE DIVISION OF BIO 3442 03:05:28,592 --> 03:05:30,794 STATISTIC AND THE WEILL CORNELL 3443 03:05:30,794 --> 03:05:32,329 MEDICINE CLINICAL AND 3444 03:05:32,329 --> 03:05:33,697 TRANSLATIONAL SCIENCE CENTER AND 3445 03:05:33,697 --> 03:05:36,967 BIG THANKS TO THE NIH FOR THEIR 3446 03:05:36,967 --> 03:05:38,635 SUPPORT IN FUNDING THE 3447 03:05:38,635 --> 03:05:39,536 MULTICENTER GRANT. 3448 03:05:39,536 --> 03:05:40,537 THESE ARE MY REFERENCES AND 3449 03:05:40,537 --> 03:05:51,048 THANK YOU FOR YOUR ATTENTION. 3450 03:05:55,719 --> 03:05:56,353 >> THANK YOU. 3451 03:05:56,353 --> 03:05:59,757 YOU CAN SEE WE HAVE AN 3452 03:05:59,757 --> 03:06:03,360 OUTSTANDING CONFERENCE ON MONDAY 3453 03:06:03,360 --> 03:06:04,428 REPRESENTED BY SIX SPEAKERS OVER 3454 03:06:04,428 --> 03:06:06,830 THE TWO DAYS AND THE FINAL 3455 03:06:06,830 --> 03:06:11,568 SPEAKER FROM THE EARLY CAREER 3456 03:06:11,568 --> 03:06:16,206 INVESTIGATOR IS DR. XIANG XU 3457 03:06:16,206 --> 03:06:18,375 FROM MOUNT SINAI TELLING US 3458 03:06:18,375 --> 03:06:21,211 ABOUT STRUCTURAL AND OX GEN 3459 03:06:21,211 --> 03:06:23,614 METABOLIC MAG KNELTIC RESONANCE 3460 03:06:23,614 --> 03:06:26,383 IMAGING OF LONG-COVID AND 3461 03:06:26,383 --> 03:06:36,527 ME/CFS. 3462 03:06:36,760 --> 03:06:37,261 >> THANK YOU. 3463 03:06:37,261 --> 03:06:41,231 WE KNOW UP TO HALF THE PEOPLE 3464 03:06:41,231 --> 03:06:44,234 AFFECTED BY LONG COVID MEET 3465 03:06:44,234 --> 03:06:47,404 CRITERIA AND WE LEARNED UP TO 3466 03:06:47,404 --> 03:06:52,042 9.5% OF PEOPLE AFFECTED WITH 3467 03:06:52,042 --> 03:06:54,778 COVID FITS THE CRITERIA. 3468 03:06:54,778 --> 03:06:57,881 SO THAT'S THE OVERLAP AN WE'RE 3469 03:06:57,881 --> 03:07:01,952 GOING TO CALL THIS GROUP PASS 3470 03:07:01,952 --> 03:07:02,719 ME/CFS GROUP. 3471 03:07:02,719 --> 03:07:05,689 THEY ARE SIMILAR TO THE CLASSIC 3472 03:07:05,689 --> 03:07:08,492 ME/CFS GROUP BECAUSE THEY BOTH 3473 03:07:08,492 --> 03:07:09,993 FULFILL THE DIAGNOSTIC CRITERIA 3474 03:07:09,993 --> 03:07:11,295 BUT THEY'RE DIFFERENT IN THAT 3475 03:07:11,295 --> 03:07:13,697 THEY SHARE THE SAME INFECTIOUS 3476 03:07:13,697 --> 03:07:16,033 TRIGGER WHICH IS COVID AND THEY 3477 03:07:16,033 --> 03:07:18,268 GENERALLY HAVE SHORTER DISEASE 3478 03:07:18,268 --> 03:07:18,535 DURATION. 3479 03:07:18,535 --> 03:07:21,905 SO THE AIM OF OUR STUDY IS TO 3480 03:07:21,905 --> 03:07:23,941 COMPARE THE SIMILARITIES AND 3481 03:07:23,941 --> 03:07:27,177 DIFFERENCES IN BRAIN ANATOMY AND 3482 03:07:27,177 --> 03:07:30,380 METABOLISM BETWEEN THE PASC AND 3483 03:07:30,380 --> 03:07:33,050 THE NON-PASC AND ME/CFS PATIENTS 3484 03:07:33,050 --> 03:07:36,153 TOGETHER WITH HEALTHY CONTROLS 3485 03:07:36,153 --> 03:07:37,321 USING MAGNETIC RESONANCE 3486 03:07:37,321 --> 03:07:37,621 IMAGING. 3487 03:07:37,621 --> 03:07:40,958 THIS IS OUR STUDY DESIGN. 3488 03:07:40,958 --> 03:07:43,627 WE SCREENED OR PATIENTS THE PASC 3489 03:07:43,627 --> 03:07:46,597 AND NON-PASC ME/CFS S HAVE TO 3490 03:07:46,597 --> 03:07:49,900 FULFILL THE 1994 CASE DEFINITION 3491 03:07:49,900 --> 03:07:51,768 AND FOR THE PASC PATIENT GROUP 3492 03:07:51,768 --> 03:07:55,539 THEY HAVE TO HAVE A CONFIRMED 3493 03:07:55,539 --> 03:07:58,242 POSITIVE COVID TEST AND THEIR 3494 03:07:58,242 --> 03:07:59,176 SYMPTOM HAPPENED AFTER THE COVID 3495 03:07:59,176 --> 03:08:01,778 INFECTION AND LASTED FOR AT 3496 03:08:01,778 --> 03:08:02,813 LEAST SIX MONTHS. 3497 03:08:02,813 --> 03:08:04,815 DURING THEIR COVID INFECTION 3498 03:08:04,815 --> 03:08:07,284 THEY SHOULDN'T HAVE NEUROLOGICAL 3499 03:08:07,284 --> 03:08:15,492 SYMPTOMS OR REQUIRE OXYGEN OR 3500 03:08:15,492 --> 03:08:15,726 CPAP. 3501 03:08:15,726 --> 03:08:17,060 AND AFTER THE SCREENING WE 3502 03:08:17,060 --> 03:08:19,997 INVITE THEM TO OUR FACILITY TO 3503 03:08:19,997 --> 03:08:21,698 DO AN MRI SCAN AND THEN WE 3504 03:08:21,698 --> 03:08:22,332 EVALUATE THEIR SYMPTOM BURDEN BY 3505 03:08:22,332 --> 03:08:24,535 QUESTIONNAIRES. 3506 03:08:24,535 --> 03:08:32,609 MORE DETAILS ABOUT THE MRI SO 3507 03:08:32,609 --> 03:08:37,748 LABELLED IN BLUE ARE THE 3508 03:08:37,748 --> 03:08:38,415 STRUCTURAL ANATOMICAL SCANS AND 3509 03:08:38,415 --> 03:08:44,288 IN PINK THE MORE ADVANCED MRI 3510 03:08:44,288 --> 03:08:45,656 AIMED AT MEASURING THE BLOOD 3511 03:08:45,656 --> 03:08:49,026 FLOW AND THE SYMPTOM BURDEN WAS 3512 03:08:49,026 --> 03:08:54,231 ASSESSED BY SF36 AND 3513 03:08:54,231 --> 03:08:55,032 MULTIDIMENSIONAL INVENTORY AND 3514 03:08:55,032 --> 03:08:57,100 CORRELATE THE SYMPTOM BURDEN TO 3515 03:08:57,100 --> 03:09:00,037 THE MRI DERIVED METRICS. 3516 03:09:00,037 --> 03:09:02,172 HERE'S OUR STUDY DEMOGRAPHIC AND 3517 03:09:02,172 --> 03:09:04,274 THIS IS AN ONGOING STUDY. 3518 03:09:04,274 --> 03:09:07,678 WE STILL HAVE A RELATIVELY SMALL 3519 03:09:07,678 --> 03:09:08,345 SAMPLE SIZE. 3520 03:09:08,345 --> 03:09:11,748 FIRST LET'S LOOK AT THE 3521 03:09:11,748 --> 03:09:12,149 STRUCTURAL MRI. 3522 03:09:12,149 --> 03:09:14,217 OUR NEURAL RADIOLOGIST 3523 03:09:14,217 --> 03:09:16,353 CATEGORIZED THE FINDING TOO THE 3524 03:09:16,353 --> 03:09:24,962 FOLLOWING DOMAINS. 3525 03:09:24,962 --> 03:09:29,433 SO SOME OF THOSE WERE CHOSEN TO 3526 03:09:29,433 --> 03:09:32,069 BE RELATED TO ACUTE COVID 3527 03:09:32,069 --> 03:09:36,974 INFECTION AND THE ABNORMALITIES 3528 03:09:36,974 --> 03:09:39,743 AND AS WE CAN SEE ACROSS THE 3529 03:09:39,743 --> 03:09:41,478 COHORT WE DIDN'T OBSERVE AN 3530 03:09:41,478 --> 03:09:46,984 INCREASE IN THE NUMBER OF 3531 03:09:46,984 --> 03:09:57,461 INCIDENTS ACROSS THE GROUPS. 3532 03:09:59,863 --> 03:10:01,365 THERE'S SEVERAL FACTORS. 3533 03:10:01,365 --> 03:10:04,167 IT'S NOT SPECIFIC. 3534 03:10:04,167 --> 03:10:08,538 SO THEN WE TENDED TO THINK THE 3535 03:10:08,538 --> 03:10:10,107 STANDARD STRUCTURAL QUALITATIVE 3536 03:10:10,107 --> 03:10:15,712 MRI ARE NOT VERY INFORMATIVE FOR 3537 03:10:15,712 --> 03:10:17,948 NON-PASC VERSUS PASC ME/CFS. 3538 03:10:17,948 --> 03:10:19,883 NEXT LET'S LOOK AT THE 3539 03:10:19,883 --> 03:10:22,753 PHYSIOLOGICAL MRI. 3540 03:10:22,753 --> 03:10:28,358 FOR THIS WE APPLIED A NOVEL 3541 03:10:28,358 --> 03:10:34,031 SEQUENCE CALLED T2 TAGGING AND 3542 03:10:34,031 --> 03:10:37,267 PERFORMED THE TRUST MRI IN THE 3543 03:10:37,267 --> 03:10:40,504 MAJOR DRAINING VESSEL OF THE 3544 03:10:40,504 --> 03:10:41,304 BRAIN. 3545 03:10:41,304 --> 03:10:42,806 THIS GIVES US THE VENOUS 3546 03:10:42,806 --> 03:10:44,775 OXYGENATION OF THE ENTIRE BRAIN 3547 03:10:44,775 --> 03:10:49,813 AND ALSO MEASURE THE ARTERIAL 3548 03:10:49,813 --> 03:11:00,323 OXYGENATION THE YA USING THE 3549 03:11:01,158 --> 03:11:04,361 PULSE OXIMETER DURING COVID AND 3550 03:11:04,361 --> 03:11:07,731 THE DIFFERENCE IS HOW MUCH 3551 03:11:07,731 --> 03:11:09,666 OXYGEN IS EXTRACTED BY THE BRAIN 3552 03:11:09,666 --> 03:11:11,168 AND OES. 3553 03:11:11,168 --> 03:11:14,371 THIS IS AN EXAMPLE OF TRUST MRI 3554 03:11:14,371 --> 03:11:17,574 BEING USED IN A POST-ACUTE 3555 03:11:17,574 --> 03:11:18,341 SEQUELAE OF COVID. 3556 03:11:18,341 --> 03:11:22,713 BACK THEN THEY CALLED IT PCS, 3557 03:11:22,713 --> 03:11:24,614 POST-ACUTE COVID SYNDROME. 3558 03:11:24,614 --> 03:11:27,050 IN THIS PRELIMINARY STUDY THEY 3559 03:11:27,050 --> 03:11:31,021 FIND THE PCS PATIENT HAS 3560 03:11:31,021 --> 03:11:32,556 SIGNIFICANTLY LOWER VENOUS 3561 03:11:32,556 --> 03:11:37,461 OXYGENATION COMPARED TO CONTROLS 3562 03:11:37,461 --> 03:11:39,362 AND THEY'RE CORRELATED WITH THE 3563 03:11:39,362 --> 03:11:43,500 SCORE WHICH IS A MEASURE OF 3564 03:11:43,500 --> 03:11:43,967 FUNCTIONAL MOBILITY. 3565 03:11:43,967 --> 03:11:45,235 HERE ARE OUR RESULTS. 3566 03:11:45,235 --> 03:11:47,137 HERE FIRST I WANT TO BRING OUR 3567 03:11:47,137 --> 03:11:49,039 ATTENTION TO THE HEALTHY CONTROL 3568 03:11:49,039 --> 03:11:51,074 GROUP LABELLED IN HC. 3569 03:11:51,074 --> 03:11:53,610 YOU CAN CAN SEE ALL THE DATA 3570 03:11:53,610 --> 03:11:55,345 POINTS ARE QUITE CLUSTERED. 3571 03:11:55,345 --> 03:11:59,449 OUR MEASUREMENT IS ROBUST. 3572 03:11:59,449 --> 03:12:01,651 THE PATIENT GROUPS THE DATA 3573 03:12:01,651 --> 03:12:04,855 LOOKS A LOT MORE HETEROGENOUS. 3574 03:12:04,855 --> 03:12:07,958 WHEN WE USE THE PAIR WISE 3575 03:12:07,958 --> 03:12:11,661 COMPARISON THE PASC GROUP HAS 3576 03:12:11,661 --> 03:12:14,364 SIGNIFICANTLY LOWER OXYGENATION 3577 03:12:14,364 --> 03:12:16,366 VENOUS OXYGENATION COMPARED TO 3578 03:12:16,366 --> 03:12:19,936 THE HEALTHY CONTROL AS WELL AS 3579 03:12:19,936 --> 03:12:30,280 THE NON-PASC GROUP. 3580 03:13:00,143 --> 03:13:02,345 THERE'S THE AMOUNT OF MOLECULES 3581 03:13:02,345 --> 03:13:04,247 CONSUMED AND THE ABSOLUTE 3582 03:13:04,247 --> 03:13:04,648 MEASURE. 3583 03:13:04,648 --> 03:13:06,983 IT'S AN IMPORTANT MARKER FOR 3584 03:13:06,983 --> 03:13:09,986 BRAIN FUNCTION AND IT'S 3585 03:13:09,986 --> 03:13:11,655 REMARKABLY WELL CONSERVED IN 3586 03:13:11,655 --> 03:13:12,589 NORMAL CONDITIONS. 3587 03:13:12,589 --> 03:13:14,424 WE TALKED ABOUT THIS YESTERDAY 3588 03:13:14,424 --> 03:13:18,295 IF THE EXTRACTION FRACTION IS 3589 03:13:18,295 --> 03:13:20,964 ELEVATED IT'S TYPICALLY 3590 03:13:20,964 --> 03:13:23,500 ACCOMPANIED BY A REDUCED FLOW TO 3591 03:13:23,500 --> 03:13:33,577 HAVE A CONSERVED CMRO2 AND IT'S 3592 03:13:33,577 --> 03:13:35,612 CALCULATED WITH TIME FLOW AND 3593 03:13:35,612 --> 03:13:36,246 EXTRACTION FRACTION AND WANTED 3594 03:13:36,246 --> 03:13:39,883 TO SEE IF THERE WAS REDUCTION IN 3595 03:13:39,883 --> 03:13:47,757 CEREBRAL BLOOD FLOW AND USED 3596 03:13:47,757 --> 03:13:49,059 MEASURING THE MRI AND THE FOUR 3597 03:13:49,059 --> 03:13:51,461 MAJOR FEEDING ARTERIES TO THE 3598 03:13:51,461 --> 03:13:51,895 BRAIN. 3599 03:13:51,895 --> 03:14:02,439 AND HERE'S OUR CBF MEASUREMENT. 3600 03:14:12,382 --> 03:14:16,052 AND THE PASC PATIENT HAS 3601 03:14:16,052 --> 03:14:22,292 ELEVATED CMR2 WITH THE GROUP 3602 03:14:22,292 --> 03:14:23,293 TRENDING SIGNIFICANCE AND OUR 3603 03:14:23,293 --> 03:14:27,864 SYMPTOM MEASUREMENT AND BOTH 3604 03:14:27,864 --> 03:14:29,432 PATIENT GROUPS HAVE SEVERE 3605 03:14:29,432 --> 03:14:31,635 IMPAIRMENT IN TERMS OF PHYSICAL 3606 03:14:31,635 --> 03:14:32,936 FUNCTION AND ARE BASICALLY OUT 3607 03:14:32,936 --> 03:14:35,171 OF CHART USING THE FATIGUE 3608 03:14:35,171 --> 03:14:35,438 MEASURES. 3609 03:14:35,438 --> 03:14:38,742 HERE SHOWS GENERAL FATIGUE AS AN 3610 03:14:38,742 --> 03:14:42,345 EXAMPLE THAT THEY ARE HEEDING 3611 03:14:42,345 --> 03:14:43,246 THE TEST. 3612 03:14:43,246 --> 03:14:46,082 LASTLY WE CORRELATED THE 3613 03:14:46,082 --> 03:14:47,550 OXYGENATION TO THE PARTICULAR 3614 03:14:47,550 --> 03:14:50,153 MEASURES AND SEE THE PHYSICAL 3615 03:14:50,153 --> 03:14:59,129 FUNCTION SCORE IS POSITIVELY 3616 03:14:59,129 --> 03:14:59,696 CORAL 3617 03:14:59,696 --> 03:15:01,298 CORRELATED WITH THE LEVEL. 3618 03:15:01,298 --> 03:15:05,135 THAT'S OUR FINDING TO SUMMARIZE 3619 03:15:05,135 --> 03:15:05,435 EVERYTHING. 3620 03:15:05,435 --> 03:15:08,471 FIRST QUALITATIVE ANATOMICAL MRI 3621 03:15:08,471 --> 03:15:11,341 DOES NOT SHOW STRUCTURAL 3622 03:15:11,341 --> 03:15:13,376 DIFFERENCES BETWEEN PASC AND 3623 03:15:13,376 --> 03:15:14,344 HEALTHY CONTROLS AND COMPARED TO 3624 03:15:14,344 --> 03:15:16,346 THE HEALTHY CONTROLS PASC 3625 03:15:16,346 --> 03:15:21,251 PATIENT ARE CHARACTERIZED BY 3626 03:15:21,251 --> 03:15:24,421 LOWER VENOUS OX OXYGENATION AND 3627 03:15:24,421 --> 03:15:27,057 HIGHER EXTRACTION TO THEIR BRAIN 3628 03:15:27,057 --> 03:15:30,460 AND THIS PHYSICAL ABNORMALITY IS 3629 03:15:30,460 --> 03:15:34,864 DUE TO BRAIN OXYGEN CONSUMPTION 3630 03:15:34,864 --> 03:15:36,533 RATHER THAN LOWER BLOOD SUPPLY. 3631 03:15:36,533 --> 03:15:38,868 THE FUNCTION IS POSITIVELY 3632 03:15:38,868 --> 03:15:40,870 CORRELATED WITH VENOUS 3633 03:15:40,870 --> 03:15:42,372 OXYGENATION AND GENERAL FATIGUE 3634 03:15:42,372 --> 03:15:44,641 IS NEGATIVELY CORRELATED WITH 3635 03:15:44,641 --> 03:15:45,075 VENOUS OXYGENATION. 3636 03:15:45,075 --> 03:15:47,978 THE POINT I WANT TO MAKE IS THAT 3637 03:15:47,978 --> 03:15:51,715 COMPARED TO THE STRUCTURAL 3638 03:15:51,715 --> 03:15:54,184 CHANGES WE MOSTLY FREQUENTLY 3639 03:15:54,184 --> 03:15:56,419 LOOK AT ALTERNATIONS IN 3640 03:15:56,419 --> 03:15:57,821 METABOLIC PARAMETERS MAY BE MORE 3641 03:15:57,821 --> 03:15:59,656 SENSITIVE IMAGING BIOMARKERS. 3642 03:15:59,656 --> 03:16:03,660 WITH THAT HERE'S MY 3643 03:16:03,660 --> 03:16:04,060 ACKNOWLEDGEMENTS. 3644 03:16:04,060 --> 03:16:06,129 THE STUDY WAS SUPPORTED BY THE 3645 03:16:06,129 --> 03:16:07,864 NIH AND WE'RE GRATEFUL FOR OUR 3646 03:16:07,864 --> 03:16:10,367 RESEARCH PARTICIPANT WHO JOINED 3647 03:16:10,367 --> 03:16:13,370 OUR STUDY AND OUR MRI 3648 03:16:13,370 --> 03:16:15,438 TECHNOLOGIST AND COLLEAGUES AT 3649 03:16:15,438 --> 03:16:16,106 THE BIOMEDICAL ENGINEERING 3650 03:16:16,106 --> 03:16:16,740 INSTITUTE AND THANK YOU ALL FOR 3651 03:16:16,740 --> 03:16:27,017 YOUR ATTENTION. 3652 03:16:41,364 --> 03:16:42,365 >> THANK YOU. 3653 03:16:42,365 --> 03:16:44,667 OUR NEXT SESSION IS TITLED 3654 03:16:44,667 --> 03:16:46,436 NEUROLOGY OF LONG COVID AND 3655 03:16:46,436 --> 03:16:49,639 ME/CFS AND ACTUALLY TRANSITIONS 3656 03:16:49,639 --> 03:16:51,908 NICELY FROM OUR PREVIOUS 3657 03:16:51,908 --> 03:16:52,175 SPEAKERS. 3658 03:16:52,175 --> 03:16:57,680 THE FIRST TALK WILL BE FROM 3659 03:16:57,680 --> 03:16:59,682 DR. JARED YOUNGER WHO'S WORK HAS 3660 03:16:59,682 --> 03:17:00,850 BEEN MENTIONED IN THE CONFERENCE 3661 03:17:00,850 --> 03:17:03,486 FROM UNIVERSITY OF ALABAMA 3662 03:17:03,486 --> 03:17:04,821 BIRMINGHAM AND BY ZOOM. 3663 03:17:04,821 --> 03:17:06,256 HIS TITLE IS BRAIN INFLAMMATION 3664 03:17:06,256 --> 03:17:07,891 AND ME/CFS HOW WE MEASURE IT AND 3665 03:17:07,891 --> 03:17:14,864 HOW WE MIGHT TREAT IT. 3666 03:17:14,864 --> 03:17:17,867 >> THANKS. 3667 03:17:17,867 --> 03:17:19,702 I WANT TO MAKE SURE EVERYONE CAN 3668 03:17:19,702 --> 03:17:22,372 HEAR ME. 3669 03:17:22,372 --> 03:17:23,106 SOUND GOOD? 3670 03:17:23,106 --> 03:17:24,107 ALL RIGHT. 3671 03:17:24,107 --> 03:17:26,209 I'M GOING ASSUME THAT'S GOOD 3672 03:17:26,209 --> 03:17:27,877 UNLESS SOMETHING FLAGS ME AND 3673 03:17:27,877 --> 03:17:32,816 SAYS WE NEED TO FIX SOMETHING. 3674 03:17:32,816 --> 03:17:36,052 I AM AN EXPERIMENTAL PSYCHO 3675 03:17:36,052 --> 03:17:37,087 PHYSIOLOGIST BY TRAINING AND DO 3676 03:17:37,087 --> 03:17:40,590 HUMAN STUDIES ONLY AND BASICALLY 3677 03:17:40,590 --> 03:17:42,258 WATCH THE BASIC SCIENCE WORK AND 3678 03:17:42,258 --> 03:17:43,860 ANIMAL MODEL WORK AND WHEN I SEE 3679 03:17:43,860 --> 03:17:45,261 SOMETHING EXCITING I TRY TO 3680 03:17:45,261 --> 03:17:46,362 FIGURE OUT THE BEST WAY TO TEST 3681 03:17:46,362 --> 03:17:51,434 THAT IN HUMANS. 3682 03:17:51,434 --> 03:17:57,207 I DO HIGH RISK STUDIES AND MY 3683 03:17:57,207 --> 03:18:04,380 TOPIC OF INTEREST IS BRAIN 3684 03:18:04,380 --> 03:18:11,888 INFLAMMATION. 3685 03:18:11,888 --> 03:18:14,557 I'LL TALK ABOUT PHARMACEUTICALS 3686 03:18:14,557 --> 03:18:19,596 THAT DON'T USE AND MY GRANT 3687 03:18:19,596 --> 03:18:22,432 FUNDING IS FROM DOD, NIH AND 3688 03:18:22,432 --> 03:18:23,733 FIBROMYALGIA SYNDROME FOUNDATION 3689 03:18:23,733 --> 03:18:27,137 AND U.K. AND ALL MY PROJECTS ARE 3690 03:18:27,137 --> 03:18:32,308 ME/CFS, FIBROMYALGIA AND SOME IS 3691 03:18:32,308 --> 03:18:36,880 APPLICABLE TO LONG COVID BUT 3692 03:18:36,880 --> 03:18:37,881 DON'T HAVE A LOT OF LONG COVID 3693 03:18:37,881 --> 03:18:38,882 DATA BECAUSE WHEN THE GRANTS 3694 03:18:38,882 --> 03:18:41,017 CAME OUT I WAS SO BUSY TRYING TO 3695 03:18:41,017 --> 03:18:42,952 GET MY STUDIES BACK ON TRACK 3696 03:18:42,952 --> 03:18:44,988 AFTER THE LONG SHUT DOWN THAT IT 3697 03:18:44,988 --> 03:18:48,658 JUST TOOK UP ALL MY TIME AND I 3698 03:18:48,658 --> 03:18:50,326 COULDN'T DEVELOP MYSELF TO ANY 3699 03:18:50,326 --> 03:18:51,161 OTHER PROJECT. 3700 03:18:51,161 --> 03:18:52,762 I HAVE A LITTLE BIT BUT NOT A 3701 03:18:52,762 --> 03:18:53,429 LOT OF LONG COVID STUFF. 3702 03:18:53,429 --> 03:18:57,133 AS I SAID, EVERYTHING IS GOING 3703 03:18:57,133 --> 03:18:58,134 TO BE CENTERED ON BRAIN 3704 03:18:58,134 --> 03:18:59,068 INFLAMMATION AND I'M GOING TO 3705 03:18:59,068 --> 03:19:02,138 START WITH A QUICK OVERVIEW OF 3706 03:19:02,138 --> 03:19:03,239 WHAT BRAIN INFLAMMATION MEANS 3707 03:19:03,239 --> 03:19:05,742 AND GET US ALL ON THE SAME PAGE 3708 03:19:05,742 --> 03:19:07,277 AND THEN TALK ABOUT NEUROIMAGING 3709 03:19:07,277 --> 03:19:09,279 WORK AND THEN TALK ABOUT 3710 03:19:09,279 --> 03:19:09,579 TREATMENTS. 3711 03:19:09,579 --> 03:19:20,123 THINGS THAT CAN TARGET THE BRAIN 3712 03:19:23,893 --> 03:19:24,894 INFLAMMATION AND WE'LL HEAR 3713 03:19:24,894 --> 03:19:26,462 TALKS ON IMAGING AND THERE'S 3714 03:19:26,462 --> 03:19:29,065 GOING TO BE AREAS OF EVERY LAP. 3715 03:19:29,065 --> 03:19:32,335 I WANT TO DE-EMPHASIZE THAT AND 3716 03:19:32,335 --> 03:19:33,903 NEXT YEAR ADD MORE FINISHED 3717 03:19:33,903 --> 03:19:34,170 PROJECTS. 3718 03:19:34,170 --> 03:19:36,005 WE'LL HAVE A LOT OF RESULT TO 3719 03:19:36,005 --> 03:19:38,107 LOOK AT IN 2024. 3720 03:19:38,107 --> 03:19:40,376 I WANT TO SPEND MOST MY TIME 3721 03:19:40,376 --> 03:19:41,711 TALKING ABOUT TREATMENTS RATHER 3722 03:19:41,711 --> 03:19:42,812 THAN IMAGING THIS TIME. 3723 03:19:42,812 --> 03:19:44,881 SO THIS IS WHAT WE'RE TARGETING. 3724 03:19:44,881 --> 03:19:47,517 THESE ARE THE MICROGLIA YOU 3725 03:19:47,517 --> 03:19:49,619 HEARD MENTIONED MULTIPLE TIMES 3726 03:19:49,619 --> 03:19:52,589 AND THE GREEN ARE THE MICROGLIA 3727 03:19:52,589 --> 03:19:55,592 AND THE BLUE ARE DOPAMINERGIC 3728 03:19:55,592 --> 03:20:01,531 NEURONS AND THE MICROGLIA ARE 3729 03:20:01,531 --> 03:20:01,931 EVE 3730 03:20:01,931 --> 03:20:02,665 EVERYWHERE THERE'S NEURONS ON A 3731 03:20:02,665 --> 03:20:09,439 ONE TO ONE RATIO AND THERE'S 3732 03:20:09,439 --> 03:20:11,407 LITTLE MAGENTA SPOTS WHERE 3733 03:20:11,407 --> 03:20:12,175 MICROGLIA REACHED OUT AND 3734 03:20:12,175 --> 03:20:13,276 TOUCHING THE NEURONS AND CAN 3735 03:20:13,276 --> 03:20:16,379 SENSE THE STATE OF THE NEURONS 3736 03:20:16,379 --> 03:20:17,680 AND AFFECT NEURONAL FUNCTION AS 3737 03:20:17,680 --> 03:20:18,014 WELL. 3738 03:20:18,014 --> 03:20:19,649 THEY'RE VERY INVOLVED IN ALL 3739 03:20:19,649 --> 03:20:27,257 PROCESSES IN THE BRAIN. 3740 03:20:27,257 --> 03:20:28,491 AND INTERFERING AND PLAYING A 3741 03:20:28,491 --> 03:20:30,360 ROLE IN THE PROCESSES OF THE 3742 03:20:30,360 --> 03:20:40,470 BRAIN. 3743 03:20:44,040 --> 03:20:46,776 AND IT SHOWS THE MICROGLIA STATE 3744 03:20:46,776 --> 03:20:49,078 AND WHAT THEY PRODUCE. 3745 03:20:49,078 --> 03:20:52,382 THE MICROGLIA ARE TYPICALLY IN 3746 03:20:52,382 --> 03:20:54,350 AN ARRESTING STATE AND MOVING 3747 03:20:54,350 --> 03:20:57,253 AROUND LOOKING FOR ISSUES. 3748 03:20:57,253 --> 03:20:59,055 THEY CAN ALSO ADOPT AN 3749 03:20:59,055 --> 03:20:59,789 INFLAMMATORY STATE USUALLY 3750 03:20:59,789 --> 03:21:01,090 CALLED AN ACTIVATED STATE AND 3751 03:21:01,090 --> 03:21:03,259 THIS IS WHEN THEY'RE IN THEIR 3752 03:21:03,259 --> 03:21:05,995 FIGHTING STANCE AND PRODUCING 3753 03:21:05,995 --> 03:21:09,732 ALL THESE PRO-INFLAMMATORY 3754 03:21:09,732 --> 03:21:11,367 CYTOKINES THAT MAKE US FEEL 3755 03:21:11,367 --> 03:21:13,036 HORRIBLE AND PROBABLY PRODUCING 3756 03:21:13,036 --> 03:21:15,338 SYMPTOMS OF ME/CFS AND CAN ADOPT 3757 03:21:15,338 --> 03:21:18,341 AN ANTI-INFLAMMATORY STATE IN 3758 03:21:18,341 --> 03:21:21,678 GREEN AND THEN PRODUCE 3759 03:21:21,678 --> 03:21:24,080 ANTI-INFLAMMATORY CYTOKINES TO 3760 03:21:24,080 --> 03:21:25,081 REDUCE INFLAMMATION IN THE BRAIN 3761 03:21:25,081 --> 03:21:28,818 AND GET THINGS BACK NORMAL AND 3762 03:21:28,818 --> 03:21:31,220 MICROGLIA CAN MORE QUICKLY 3763 03:21:31,220 --> 03:21:41,597 SOMETIMES IN SECONDS. 3764 03:21:45,268 --> 03:21:54,243 IN THE PRIME STATE IT LOOKS LIKE 3765 03:21:54,243 --> 03:21:59,182 A NORMAL SITE AND PROTEINS THAT 3766 03:21:59,182 --> 03:22:00,683 ALLOW THE PRESENTATION OF 3767 03:22:00,683 --> 03:22:04,387 ANTIGENS TO OTHER CELLS AND 3768 03:22:04,387 --> 03:22:06,656 BASICALLY MEANS THEY'RE PRIMING 3769 03:22:06,656 --> 03:22:09,592 UP EVERYTHING THE ASTROCYTES AND 3770 03:22:09,592 --> 03:22:10,993 T CELLS IN THE BODY AND PRIME 3771 03:22:10,993 --> 03:22:16,165 EVERYTHING FOR AN INFLAMMATORY 3772 03:22:16,165 --> 03:22:16,432 RESPONSE. 3773 03:22:16,432 --> 03:22:26,976 THEY LOOK BASICALLY NORMAL AND 3774 03:22:29,112 --> 03:22:31,781 IN THAT PRIME STATE THEY CAN 3775 03:22:31,781 --> 03:22:33,816 INVITE T CELL TO GET THROUGH THE 3776 03:22:33,816 --> 03:22:35,985 BLOOD BRAIN BARRIER AND CAUSE 3777 03:22:35,985 --> 03:22:36,419 MORE INFLAMMATION. 3778 03:22:36,419 --> 03:22:40,423 THAT'S A STATE YOU DO NOT WANT 3779 03:22:40,423 --> 03:22:41,858 YOUR MICROGLIA IN LONG TERM AND 3780 03:22:41,858 --> 03:22:43,192 IT CAN CAUSE PROBLEMS. 3781 03:22:43,192 --> 03:22:46,396 OUR GOAL FOR ME/CFS IS TO GET 3782 03:22:46,396 --> 03:22:50,366 THE MICROGLIA BACK TO THE 3783 03:22:50,366 --> 03:22:51,634 RESTING STATE. 3784 03:22:51,634 --> 03:22:54,837 WHY ARE YOUR MICROGLIA 3785 03:22:54,837 --> 03:22:55,605 SENSITIZED. 3786 03:22:55,605 --> 03:22:58,641 THERE'S LOTS OF REASONS. 3787 03:22:58,641 --> 03:23:02,011 THIS IS ONE EXAMPLE. 3788 03:23:02,011 --> 03:23:05,381 ADIPOSE TISSUE IS GENERALLY NOT 3789 03:23:05,381 --> 03:23:07,116 INFLAMMATORY BUT WHEN AS THE TOO 3790 03:23:07,116 --> 03:23:11,521 MUCH WHITE ADIPOSE TISSUE IT 3791 03:23:11,521 --> 03:23:12,155 BECOMES VERY INFLAMMATORY AND 3792 03:23:12,155 --> 03:23:14,357 THAT INFLAMMATION IN THE BODY 3793 03:23:14,357 --> 03:23:16,826 AND READY ENTERS THE CENTRAL 3794 03:23:16,826 --> 03:23:18,361 NERVOUS SYSTEM AND CAUSES 3795 03:23:18,361 --> 03:23:19,495 INFLAMMATION IN THE BRAIN. 3796 03:23:19,495 --> 03:23:21,197 WHAT HAPPENS WHEN YOU HAVE A LOT 3797 03:23:21,197 --> 03:23:25,601 OF WHITE ADIPOSE TISSUE YOUR 3798 03:23:25,601 --> 03:23:30,239 LEPTIN LEVELS GO UP AND YOU GET 3799 03:23:30,239 --> 03:23:31,507 RESISTANCE AND TO THE 3800 03:23:31,507 --> 03:23:32,842 HYPOTHALAMUS STOPS RESPONDING 3801 03:23:32,842 --> 03:23:36,412 AND YOU FEEL HUNGRY THOUGH YOU 3802 03:23:36,412 --> 03:23:38,047 SHOULD HAVE HAD ENOUGH FOOD BUT 3803 03:23:38,047 --> 03:23:39,682 DON'T GET THAT SIGNAL TO TURN 3804 03:23:39,682 --> 03:23:43,553 OFF YOUR HUNGER. 3805 03:23:43,553 --> 03:23:47,156 THE PROBLEM IS YOUR HYPOTHALAMUS 3806 03:23:47,156 --> 03:23:50,193 BECOMES RESISTANT TO THE LEPTIN 3807 03:23:50,193 --> 03:23:52,128 AND THE MICROGLIA DON'T BECOME 3808 03:23:52,128 --> 03:23:56,766 SENSITIZED AND AS THE LEPTIN 3809 03:23:56,766 --> 03:23:58,901 RISES THEY START TO ADOPT AN 3810 03:23:58,901 --> 03:23:59,402 INFLAMMATORY STATE. 3811 03:23:59,402 --> 03:24:02,071 THAT'S ONE WAY WHAT'S GOING ON 3812 03:24:02,071 --> 03:24:05,741 IN THE BODY CAN AFFECT WHAT THE 3813 03:24:05,741 --> 03:24:07,043 MICROGLIA ARE DOING AND 3814 03:24:07,043 --> 03:24:12,615 SOMETHING AS SIMPLE AS WHITE 3815 03:24:12,615 --> 03:24:13,883 ADIPOSE TISSUE CAN TO 3816 03:24:13,883 --> 03:24:16,452 INFLAMMATION IN THE BRAIN. 3817 03:24:16,452 --> 03:24:18,354 ANY PERIPHERAL INFLAMMATION 3818 03:24:18,354 --> 03:24:19,889 STATE CAN CAUSE MICROGLIA 3819 03:24:19,889 --> 03:24:24,126 PRIMING AND ALTERED GUT 3820 03:24:24,126 --> 03:24:27,797 MICROGLIA AND NORMAL AGING 3821 03:24:27,797 --> 03:24:32,134 CAUSES MICROGLIA TO BE 3822 03:24:32,134 --> 03:24:34,570 SENSITIZED AND SLEEP APNEA CAN 3823 03:24:34,570 --> 03:24:36,706 DO THAT AND TOXIC EXPOSURES, 3824 03:24:36,706 --> 03:24:39,175 CERTAIN MEDICATIONS CAN DO THAT 3825 03:24:39,175 --> 03:24:41,944 AND OPIOID ANALGESICS ARE THE 3826 03:24:41,944 --> 03:24:42,545 BEST EXAMPLE. 3827 03:24:42,545 --> 03:24:45,781 CHRONIC STRESS AND OF COURSE THE 3828 03:24:45,781 --> 03:24:47,984 IMMUNE HITS VIRAL OR BACTERIAL 3829 03:24:47,984 --> 03:24:49,852 ESPECIALLY IF YOU HAVE A 3830 03:24:49,852 --> 03:24:51,554 SEQUENCE OF IMMUNE HITS TOO 3831 03:24:51,554 --> 03:24:53,189 CLOSE TOGETHER OR A STRONG 3832 03:24:53,189 --> 03:25:01,030 IMMUNE HIT THAT ESPECIALLY 3833 03:25:01,030 --> 03:25:01,797 SOMETHING INFILTRATED THE BRAIN 3834 03:25:01,797 --> 03:25:04,100 CAN MAKE THEM INTO THE PRIME 3835 03:25:04,100 --> 03:25:07,270 STATE AND READY TO GO TO 3836 03:25:07,270 --> 03:25:08,504 ACTIVATED STATE WITH MINIMAL 3837 03:25:08,504 --> 03:25:10,773 PROVOCATION AND SOMETHING YOUR 3838 03:25:10,773 --> 03:25:13,209 BODY'S DOING LIKE JUST EXERTING 3839 03:25:13,209 --> 03:25:15,478 YOURSELF A LITTLE BIT AND THE 3840 03:25:15,478 --> 03:25:16,345 MICROGLIA SENSITIZED INTERPRET 3841 03:25:16,345 --> 03:25:21,584 THAT AS A NEW PATHOGEN EXPOSURE. 3842 03:25:21,584 --> 03:25:25,555 I BELIEVE THAT'S WHAT'S GOING ON 3843 03:25:25,555 --> 03:25:28,457 WITH THE CNS. 3844 03:25:28,457 --> 03:25:32,028 WE DO COMPLEX IMAGING PROTOCOLS 3845 03:25:32,028 --> 03:25:33,663 SIMILAR TO OTHERS WE ADJUST 3846 03:25:33,663 --> 03:25:34,664 HEARD. 3847 03:25:34,664 --> 03:25:38,367 WE INJECT PEOPLE WITH ENDOTOXIN 3848 03:25:38,367 --> 03:25:43,539 AND SCAN THEM BEFORE AND AFTER 3849 03:25:43,539 --> 03:25:46,709 TO SEE IN THE ABNORMALITIES ARE 3850 03:25:46,709 --> 03:25:49,512 RESPONDING TO IMMUNE TRIGGERS. 3851 03:25:49,512 --> 03:25:51,180 I WON'T TALK ABOUT THAT THIS 3852 03:25:51,180 --> 03:25:51,447 TIME. 3853 03:25:51,447 --> 03:25:55,351 YOU PROBABLY SAW THE WORK ON THE 3854 03:25:55,351 --> 03:25:57,453 LEUKOCYTE INFILTRATION OF THE 3855 03:25:57,453 --> 03:26:00,156 BRAIN AND THAT'S GOING TO BE 3856 03:26:00,156 --> 03:26:00,790 VERY INTERESTING BECAUSE AGAIN 3857 03:26:00,790 --> 03:26:02,692 THESE MICROGLIA HAVE THE ABILITY 3858 03:26:02,692 --> 03:26:07,597 TO PULL THESE T CELLS IN AND 3859 03:26:07,597 --> 03:26:10,099 WE'D LOVE TO SEE THAT IF IT'S 3860 03:26:10,099 --> 03:26:11,300 HAPPENING AND WE'LL PERFORM 3861 03:26:11,300 --> 03:26:12,602 RESULTS NEXT YEAR ON THIS AND 3862 03:26:12,602 --> 03:26:13,769 GET HEADS UP ON THE TYPES OF 3863 03:26:13,769 --> 03:26:15,037 THINGS WE'RE WORKING ON BUT 3864 03:26:15,037 --> 03:26:16,939 THERE'S ONLY TWO I WANT TO 3865 03:26:16,939 --> 03:26:17,807 MENTION IN PARTICULAR TODAY 3866 03:26:17,807 --> 03:26:19,675 BECAUSE I WANT TO MOVE TO THE 3867 03:26:19,675 --> 03:26:19,976 TREATMENTS. 3868 03:26:19,976 --> 03:26:22,678 AND ACTUALLY BOTH OF THESE 3869 03:26:22,678 --> 03:26:23,746 YOU'VE ALREADY BEEN NOTIFIED ARE 3870 03:26:23,746 --> 03:26:24,246 BIG DEALS. 3871 03:26:24,246 --> 03:26:26,282 WE JUST HEARD ABOUT THESE. 3872 03:26:26,282 --> 03:26:28,484 IT'S NICE WE'RE GETTING 3873 03:26:28,484 --> 03:26:29,285 CONVERGING EVIDENCE. 3874 03:26:29,285 --> 03:26:32,355 THE FIRST IS USING PET TO LOOK 3875 03:26:32,355 --> 03:26:33,389 AT ACTIVATED MICROGLIA. 3876 03:26:33,389 --> 03:26:36,425 YOU HEARD HOW THAT HAP JNZ WE 3877 03:26:36,425 --> 03:26:39,695 HAVE TSPO LIGANDS WHEN MICROGLIA 3878 03:26:39,695 --> 03:26:43,399 ARE ACTIVATED THEY THE PET 3879 03:26:43,399 --> 03:26:45,301 LIGAND GOES THERE AND IF WE SEE 3880 03:26:45,301 --> 03:26:47,269 A LOT OF SIGNAL WE KNOW THE 3881 03:26:47,269 --> 03:26:51,007 MICROGLIA ARE ACTIVATED. 3882 03:26:51,007 --> 03:26:53,009 THIS IS A STUDY IN FIBROMYALGIA 3883 03:26:53,009 --> 03:26:58,347 AND I WANTED TO SHOW YOU HALF 3884 03:26:58,347 --> 03:27:08,824 THE BRAIN SHOWED ACTIVATED 3885 03:27:11,927 --> 03:27:13,062 MICROGLIA I HAVEN'T TRIED TO DO 3886 03:27:13,062 --> 03:27:15,831 MORE ADVANCED CASE DEFINITION 3887 03:27:15,831 --> 03:27:18,734 AND THE SAMPLE IS SMALL LIKE 3888 03:27:18,734 --> 03:27:19,301 15-15. 3889 03:27:19,301 --> 03:27:20,369 I DON'T KNOW HOW MANY WOULD MEET 3890 03:27:20,369 --> 03:27:24,674 THE CRITERIA BUT ENOUGH TO TELL 3891 03:27:24,674 --> 03:27:26,909 US WHEN WE FIND IN MICROGLIA 3892 03:27:26,909 --> 03:27:29,645 THERE'S A GOOD CHANCE WE'LL SEE 3893 03:27:29,645 --> 03:27:31,147 THAT IN A PURE ME/CFS SAMPLE AND 3894 03:27:31,147 --> 03:27:32,848 THAT'S LIKELY THE CASE. 3895 03:27:32,848 --> 03:27:34,450 MICHELLE JAMES SPEAKING NEXT 3896 03:27:34,450 --> 03:27:38,821 WILL PROBABLY PRESENT MORE DATA 3897 03:27:38,821 --> 03:27:39,422 THAT'S THE CASE. 3898 03:27:39,422 --> 03:27:46,095 WE HAVE A STUDY FUNDED BY NINDS 3899 03:27:46,095 --> 03:27:50,332 IT'S 20 HEALTHY CONTROLS AND 9 3900 03:27:50,332 --> 03:27:52,501 ME/CFS RUN AND THREE ALL 3901 03:27:52,501 --> 03:27:58,607 SCREENED AND READY TO GO AND 3902 03:27:58,607 --> 03:28:01,310 THAT IS THREE HEALTHY CONTROLS 3903 03:28:01,310 --> 03:28:02,478 AND ONE READY TO GO. 3904 03:28:02,478 --> 03:28:04,346 WE'RE NOT TOO FAR FROM FINISHING 3905 03:28:04,346 --> 03:28:07,149 THE ME/CFS BUT WE NEED MORE THIL 3906 03:28:07,149 --> 03:28:07,683 CONTROLS BEFORE WE FINISH. 3907 03:28:07,683 --> 03:28:09,351 I BELIEVE WE'LL HAVE THAT 3908 03:28:09,351 --> 03:28:11,520 FINISHED IN 2024 AND IF OUR 3909 03:28:11,520 --> 03:28:14,557 RESULTS AGREE WITH WHAT YOU JUST 3910 03:28:14,557 --> 03:28:16,592 TALKED ABOUT, AND MICHELLE 3911 03:28:16,592 --> 03:28:18,928 JAMES' STUFF WHICH WE'LL ALL 3912 03:28:18,928 --> 03:28:21,330 AGREE WE'LL HAVE POWERFUL 3913 03:28:21,330 --> 03:28:24,533 EVIDENCE THE MICROGLIA IS IN AN 3914 03:28:24,533 --> 03:28:25,334 AGITATED INFLAMED STATE AND IT'S 3915 03:28:25,334 --> 03:28:26,602 IMPORTANT TO KNOW. 3916 03:28:26,602 --> 03:28:28,404 THE SECOND PART IS THE LACTATE 3917 03:28:28,404 --> 03:28:29,872 IN THE BRAIN WHICH ALSO YOU JUST 3918 03:28:29,872 --> 03:28:32,041 HEARD ABOUT AND THAT'S BECAUSE 3919 03:28:32,041 --> 03:28:34,510 THE LACTATE IS REALLY SUPER 3920 03:28:34,510 --> 03:28:36,245 IMPORTANT AND SO MANY STUDIES 3921 03:28:36,245 --> 03:28:38,080 INCLUDING OUR STUDIES HAVE FOUND 3922 03:28:38,080 --> 03:28:40,149 LACTATE ALL THROUGHOUT THE BRAIN 3923 03:28:40,149 --> 03:28:41,050 IN ME/CFS. 3924 03:28:41,050 --> 03:28:44,153 THIS IS A CRITICAL PART OF THE 3925 03:28:44,153 --> 03:28:45,154 PATHOPHYSIOLOGY AND OF THE 3926 03:28:45,154 --> 03:28:45,521 DISEASE. 3927 03:28:45,521 --> 03:28:47,656 SO WHAT WE DO YOU'VE HEARD ABOUT 3928 03:28:47,656 --> 03:28:52,495 THIS AS WELL, WE DO MAGNETIC 3929 03:28:52,495 --> 03:28:54,029 RESONANCE SPECTROSCOPY AND A 3930 03:28:54,029 --> 03:28:55,598 SEQUENCE THAT ALLOWS US TO LOOK 3931 03:28:55,598 --> 03:28:56,999 THROUGHOUT THE BRIN AND GET LOTS 3932 03:28:56,999 --> 03:28:59,201 OF MEASUREMENTS AND WE'RE 3933 03:28:59,201 --> 03:29:00,870 LOOKING FOR PEAKS OF LACTATE 3934 03:29:00,870 --> 03:29:04,440 AMONG OTHER THINGS BUT I ONLY 3935 03:29:04,440 --> 03:29:05,908 WANT TO MENTION THE LACTATE 3936 03:29:05,908 --> 03:29:06,275 RIGHT NOW. 3937 03:29:06,275 --> 03:29:08,544 WE'RE FINDING IN OUR SAMPLE. 3938 03:29:08,544 --> 03:29:10,846 I PUBLISHED LACTATE BEFORE AND 3939 03:29:10,846 --> 03:29:15,584 WE FIND MORE LACTATE THROUGHOUT 3940 03:29:15,584 --> 03:29:16,719 THE BRAIN AND ME/CFS THAN 3941 03:29:16,719 --> 03:29:18,721 HEALTHY CONTROLS AND RUNNING A 3942 03:29:18,721 --> 03:29:20,556 LARGER VERSION OF THAT STUDY. 3943 03:29:20,556 --> 03:29:30,332 THE LACTATE AS DISCUSSED BEFORE 3944 03:29:30,332 --> 03:29:33,169 IT'S AN ALTERNATIVE METABOLIC 3945 03:29:33,169 --> 03:29:34,370 PATHWAY AND YOU MAY SWITCH TO 3946 03:29:34,370 --> 03:29:35,538 LACTATE FOR ENERGY. 3947 03:29:35,538 --> 03:29:38,541 WHY WOULD THAT HAPPEN? 3948 03:29:38,541 --> 03:29:41,610 IT'S LIKELY NEURAL OR BRAIN 3949 03:29:41,610 --> 03:29:41,944 INFLAMMATION. 3950 03:29:41,944 --> 03:29:44,213 THERE'S SO MUCH DEMAND TO FEED 3951 03:29:44,213 --> 03:29:46,315 THOSE PROCESSES THAT THERE NEEDS 3952 03:29:46,315 --> 03:29:48,484 TO BE AN ALTERNATIVE ENERGY 3953 03:29:48,484 --> 03:29:48,717 PROCESS. 3954 03:29:48,717 --> 03:29:49,218 THAT'S WHAT WE THINK IS 3955 03:29:49,218 --> 03:29:51,887 HAPPENING. 3956 03:29:51,887 --> 03:29:53,622 I WANT TO SHOW THIS BRIEFLY. 3957 03:29:53,622 --> 03:29:56,158 I SHOWED THIS THREE MONTHS AGO 3958 03:29:56,158 --> 03:29:59,862 AT THE NIH WEBINAR AND WE'RE 3959 03:29:59,862 --> 03:30:02,765 FINDING THERE ARE NOT EVERY 3960 03:30:02,765 --> 03:30:03,632 PATIENT SHOWS STRANGE ELEVATIONS 3961 03:30:03,632 --> 03:30:06,202 OF LACTATE BUT THERE'S A 3962 03:30:06,202 --> 03:30:08,938 SUBGROUP OF THE ME/CFS 3963 03:30:08,938 --> 03:30:12,074 PARTICIPANTS THAT DO SHOW CLEAR 3964 03:30:12,074 --> 03:30:13,209 ABNORMAL ELEVATIONS IN LACTATE. 3965 03:30:13,209 --> 03:30:15,344 I NEED TO DO A LOT OF WORK ON 3966 03:30:15,344 --> 03:30:17,112 THESE DATA AND NEED TO RUN MORE 3967 03:30:17,112 --> 03:30:19,081 SUBJECTS AS WELL BUT IT'S 3968 03:30:19,081 --> 03:30:21,116 LOOKING VERY INTERESTING. 3969 03:30:21,116 --> 03:30:23,452 SO AGAIN, THE LACTATE IS SUPER 3970 03:30:23,452 --> 03:30:25,721 IMPORTANT SO WHEN YOU COMBINE 3971 03:30:25,721 --> 03:30:29,825 THE PET LOOKING AT THE MICROGLIA 3972 03:30:29,825 --> 03:30:31,594 AND THEY'RE BOTH SHOWING THE 3973 03:30:31,594 --> 03:30:34,096 SAME THING WE HAVE CLEAR 3974 03:30:34,096 --> 03:30:35,331 EVIDENCE THAT THERE'S BRAIN 3975 03:30:35,331 --> 03:30:36,265 INFLAMMATION AND I THINK THERE'S 3976 03:30:36,265 --> 03:30:37,666 ALMOST NO DOUBT ABOUT THAT NOW. 3977 03:30:37,666 --> 03:30:40,102 I DON'T KNOW IF OTHERS WOULD 3978 03:30:40,102 --> 03:30:42,271 DISAGREE BUT THE EVIDENCE IS SO 3979 03:30:42,271 --> 03:30:44,373 STRONG AND WITH AN A LITTLE BIT 3980 03:30:44,373 --> 03:30:46,141 MORE DATA I THINK WE'LL HAVE IT 3981 03:30:46,141 --> 03:30:50,946 LOCKED DOWN AND WELL DECIDED. 3982 03:30:50,946 --> 03:30:55,117 AND THERE'S ONE MAJOR 3983 03:30:55,117 --> 03:30:55,651 ALTERNATIVE AND THAT IS 3984 03:30:55,651 --> 03:30:58,354 INADEQUATE BLOOD FLOW TO THE 3985 03:30:58,354 --> 03:30:59,521 BRAIN DUE TO VASCULAR PROBLEM. 3986 03:30:59,521 --> 03:31:03,926 WE HAVE TO CONTROL FOR THAT. 3987 03:31:03,926 --> 03:31:08,364 THAT'S A VERY PLAUSIBLE 3988 03:31:08,364 --> 03:31:10,633 HYPOTHESIS OF ME/CFS THERE'S NOT 3989 03:31:10,633 --> 03:31:12,601 ENOUGH OXYGEN TO THE BRAIN AND 3990 03:31:12,601 --> 03:31:16,872 WE EXCITE THE HYDROGEN ATOMS AND 3991 03:31:16,872 --> 03:31:18,841 MEASURE THEM AT THE BRAIN AND 3992 03:31:18,841 --> 03:31:21,510 READ HOW FAST THE BLOOD'S 3993 03:31:21,510 --> 03:31:23,379 FLOWING THROUGH THE BRAIN AND IF 3994 03:31:23,379 --> 03:31:24,747 THERE'S NOT ENOUGH BLOOD OR 3995 03:31:24,747 --> 03:31:26,415 OXYGEN GETTING TO THE BRAIN OR 3996 03:31:26,415 --> 03:31:30,786 SOME PIECE OF THE BRAIN AND IN 3997 03:31:30,786 --> 03:31:33,255 ME/CFS IF THERE WAS A PATHOLOGY 3998 03:31:33,255 --> 03:31:38,160 WE WOULD EXPECT NOT ENOUGH BLOOD 3999 03:31:38,160 --> 03:31:38,360 FLOW. 4000 03:31:38,360 --> 03:31:40,829 THIS IS NOT MY IMAGE. 4001 03:31:40,829 --> 03:31:43,599 THIS IS A HYPOFOCAL PROFUSION 4002 03:31:43,599 --> 03:31:45,434 AND THE BLUE MEANS NOT ENOUGH 4003 03:31:45,434 --> 03:31:47,636 BLOOD OR OX GEN REACHING THE 4004 03:31:47,636 --> 03:31:47,870 AREA. 4005 03:31:47,870 --> 03:31:51,040 WHAT WE ARE DOING I DON'T EXPECT 4006 03:31:51,040 --> 03:31:53,242 TO SEE OR RARELY SEE THIS IT 4007 03:31:53,242 --> 03:31:56,278 WILL BE DISTRIBUTED THROUGHOUT 4008 03:31:56,278 --> 03:31:57,179 MOST OF THE BRAIN WE'LL FIND OUT 4009 03:31:57,179 --> 03:31:58,147 SOON. 4010 03:31:58,147 --> 03:32:02,351 I WAS HOPING TO HAVE NEW ASL 4011 03:32:02,351 --> 03:32:04,987 DATA PHOR YOU. 4012 03:32:04,987 --> 03:32:06,956 WE HAVE 50 CONTROLS AND WE'RE 4013 03:32:06,956 --> 03:32:08,490 NOT ABLE TO GET THAT THROUGH THE 4014 03:32:08,490 --> 03:32:09,858 PIPELINE AND PROCESS IN TIME. 4015 03:32:09,858 --> 03:32:12,161 IT WILL PROBABLY BE A FEW MORE 4016 03:32:12,161 --> 03:32:15,698 WEEKS AND HAVE AN ANSWER WHETHER 4017 03:32:15,698 --> 03:32:17,366 ME/CFS SHOWS HYPERPROFUSION 4018 03:32:17,366 --> 03:32:18,767 USING OUR SPIN LABELLING. 4019 03:32:18,767 --> 03:32:20,536 IF WE FIND A DIFFERENCE AND YOU 4020 03:32:20,536 --> 03:32:24,106 HEARD REASONS WHY WE MIGHT, IF 4021 03:32:24,106 --> 03:32:26,909 WE SHOWED OUR GROUPS IN THE 4022 03:32:26,909 --> 03:32:29,011 SCANNER SHOW HYPERPROFUSION IT 4023 03:32:29,011 --> 03:32:31,046 WILL BE HUGE SUPPORT NOR 4024 03:32:31,046 --> 03:32:34,049 HYPOTHESIS THERE'S AN OX GEN OR 4025 03:32:34,049 --> 03:32:35,884 BLOOD FLOW PROBLEM. 4026 03:32:35,884 --> 03:32:38,020 IF WE DON'T FIND AN ABNORMALITY 4027 03:32:38,020 --> 03:32:40,222 IT WILL MAKE IT INCONCLUSIVE. 4028 03:32:40,222 --> 03:32:42,057 THERE'S REASON TO BELIEVE THE 4029 03:32:42,057 --> 03:32:43,192 PARTICIPANTS WOULD HAVE TO BE 4030 03:32:43,192 --> 03:32:45,694 SITTING OR STANDING IN ORDER FOR 4031 03:32:45,694 --> 03:32:47,763 THAT PROFUSION PROBLEM TO 4032 03:32:47,763 --> 03:32:48,130 MANIFEST. 4033 03:32:48,130 --> 03:32:51,567 SO IF I DON'T SEE ANYTHING 4034 03:32:51,567 --> 03:32:54,336 ABNORMAL, I WILL PROBABLY GOING 4035 03:32:54,336 --> 03:32:56,138 FORWARD ADD A TASK TO OUR 4036 03:32:56,138 --> 03:32:57,673 SCANNER SIMILAR TO THINGS YOU 4037 03:32:57,673 --> 03:32:59,208 HEARD BEFORE THE LAST COUPLE 4038 03:32:59,208 --> 03:33:03,379 DAYS WHERE WE'LL DO THE ASL, IT 4039 03:33:03,379 --> 03:33:04,146 ONLY TAKES ABOUT SIX MINUTES AND 4040 03:33:04,146 --> 03:33:09,952 PULL THEM FROM THE SCANNER AND 4041 03:33:09,952 --> 03:33:11,854 USE AN ORTHOSTATIC TOLERANCE 4042 03:33:11,854 --> 03:33:13,255 TEST MAYBE LASTS ABOUT FIVE 4043 03:33:13,255 --> 03:33:14,556 MINUTES AND PUT THEM BACK IN THE 4044 03:33:14,556 --> 03:33:18,193 SCANNER AND SEE IF WE'VE 4045 03:33:18,193 --> 03:33:19,762 PROVOKED HYPERPROFUSION AND IF 4046 03:33:19,762 --> 03:33:21,130 WE FIND THAT IT WILL BE 4047 03:33:21,130 --> 03:33:22,464 INCREDIBLE ESPECIALLY IF IT'S 4048 03:33:22,464 --> 03:33:26,335 SOMETHING THAT DOESN'T AFFECT 4049 03:33:26,335 --> 03:33:28,604 HEALTHY CONTROLS BUT DOES AFFECT 4050 03:33:28,604 --> 03:33:28,837 ME/CFS. 4051 03:33:28,837 --> 03:33:31,740 WE'LL SEE WHAT WE CAN DO QUICKLY 4052 03:33:31,740 --> 03:33:34,576 BY THE SCANNER TO DO IT AND PUT 4053 03:33:34,576 --> 03:33:38,347 IT BACK IN AND SEE IF THAT'S 4054 03:33:38,347 --> 03:33:41,583 PART OF THE ME/CFS. 4055 03:33:41,583 --> 03:33:44,319 AS MOST OF YOU KNOW, LABS, HUMAN 4056 03:33:44,319 --> 03:33:45,854 CLINICAL LABS HAVE CYCLES. 4057 03:33:45,854 --> 03:33:47,456 SOME YEARS WE'RE WRITING GRANTS 4058 03:33:47,456 --> 03:33:49,425 AND PAPERS THE WHOLE YEAR. 4059 03:33:49,425 --> 03:33:52,027 SOME YEARS WE'RE JUST COLLECTING 4060 03:33:52,027 --> 03:33:54,630 DATA LIKE CRAZY GOING AS FAST AS 4061 03:33:54,630 --> 03:33:56,799 WE CAN AND SOME YEARS ANSWERING 4062 03:33:56,799 --> 03:33:59,168 QUESTIONS AND NEXT YEAR IS 4063 03:33:59,168 --> 03:34:01,770 FORTUNATELY ONE OF THOSE 4064 03:34:01,770 --> 03:34:03,605 ANALYZING AND GETTING RESULTS 4065 03:34:03,605 --> 03:34:05,174 AND THOSE ARE MY FAVORITE YEARS 4066 03:34:05,174 --> 03:34:06,742 SO I'M EXCITE ABOUT 204. 4067 03:34:06,742 --> 03:34:08,110 FINALLY SOME OF THE PROJECT 4068 03:34:08,110 --> 03:34:09,878 THREE AND FIVE YEARS LONG AND 4069 03:34:09,878 --> 03:34:11,280 YOU WAIT UNTIL THE END AND 4070 03:34:11,280 --> 03:34:12,314 FINALLY GET TO FIND OUT WHAT 4071 03:34:12,314 --> 03:34:14,716 HAPPENS AND THERE'S GOING TO BE 4072 03:34:14,716 --> 03:34:15,350 A LOT OF THAT NEXT YEAR. 4073 03:34:15,350 --> 03:34:24,259 I GUESS STAY TUNED. 4074 03:34:24,259 --> 03:34:25,394 SOME TREATMENTS. 4075 03:34:25,394 --> 03:34:29,131 I HOPE THERE'S A HUGE PUSH ON 4076 03:34:29,131 --> 03:34:31,100 GETTING CLINICAL TRIALS GOING. 4077 03:34:31,100 --> 03:34:34,236 THERE'S A SEF SIT AND WE NEED TO 4078 03:34:34,236 --> 03:34:35,237 REMEDY THAT. 4079 03:34:35,237 --> 03:34:36,305 IF YOU'VE WATCHED MY TALKS 4080 03:34:36,305 --> 03:34:38,207 PREVIOUSLY I HAVE A LONG AND 4081 03:34:38,207 --> 03:34:40,509 GROWING LIST OF POTENTIAL 4082 03:34:40,509 --> 03:34:42,344 TREATMENTS THAT WOULD LOVE TO 4083 03:34:42,344 --> 03:34:43,645 SEE TESTED IN ME/CFS. 4084 03:34:43,645 --> 03:34:46,515 EIGHT YEARS AGO IT WAS 20 AND 4085 03:34:46,515 --> 03:34:49,718 THEN NOW IT'S PROBABLY AT 100. 4086 03:34:49,718 --> 03:34:55,624 I'M NOT EVEN GOING TO SHOW THE 4087 03:34:55,624 --> 03:35:01,330 SLIDE BECAUSE IT'S TWO SLIDES. 4088 03:35:01,330 --> 03:35:03,132 AND DRILL DOWN ON THE THINGS 4089 03:35:03,132 --> 03:35:06,135 THAT GET PRIORITIZED. 4090 03:35:06,135 --> 03:35:10,339 SOME OF THE DRUGS OR TREATMENT 4091 03:35:10,339 --> 03:35:11,507 OPTIONS ARE GOING TO DEPEND ON 4092 03:35:11,507 --> 03:35:12,908 WHAT I SEE WITH THE RESULTS OVER 4093 03:35:12,908 --> 03:35:15,244 THE NEXT YEAR. 4094 03:35:15,244 --> 03:35:18,180 WE SEE LEUKOCYTE PENETRATION OF 4095 03:35:18,180 --> 03:35:23,118 THE BRAIN WE MAY LOOK AT MORE 4096 03:35:23,118 --> 03:35:25,687 POPULATION DEPLETERS OR 4097 03:35:25,687 --> 03:35:27,222 ALTERNATIVES OR SOMETHING THAT 4098 03:35:27,222 --> 03:35:29,691 REPAIRS BLOOD BRAIN BARRIER. 4099 03:35:29,691 --> 03:35:31,827 IF WE SEE PROBLEMS WITH CEREBRAL 4100 03:35:31,827 --> 03:35:36,398 PROFUSION WE MAY LOOK AT 4101 03:35:36,398 --> 03:35:38,800 METHYLINE BLUE SHOWING TO CALM 4102 03:35:38,800 --> 03:35:40,435 MICROGLIA AND BLOOD FLOW. 4103 03:35:40,435 --> 03:35:42,004 WE'LL SEE WHAT THE DATA LOOKS 4104 03:35:42,004 --> 03:35:43,472 LIKE AND IF THAT LEADS TO 4105 03:35:43,472 --> 03:35:44,406 PARTICULAR TREATMENT OPTION. 4106 03:35:44,406 --> 03:35:47,809 HOWEVER, THERE ARE TWO TREAT 4107 03:35:47,809 --> 03:35:49,611 TREATMENTS I BELIEVE WE SHOULD 4108 03:35:49,611 --> 03:35:52,915 TEST NOW REGARDLESS OF HOW THE 4109 03:35:52,915 --> 03:35:54,283 TESTS TURN OUT. 4110 03:35:54,283 --> 03:35:56,685 AS THE TWO DRUGS HAVE SUCH A 4111 03:35:56,685 --> 03:35:59,354 GOOD CHANCE OF REDUCING 4112 03:35:59,354 --> 03:36:00,355 MICROGLIA EXCITABILITY IN A 4113 03:36:00,355 --> 03:36:01,490 BENEFICIAL WAY I THINK WE NEED 4114 03:36:01,490 --> 03:36:06,128 TO TEST THEM RIGHT NOW. 4115 03:36:06,128 --> 03:36:07,829 SOME OF YOU PROBABLY KNOW WHAT 4116 03:36:07,829 --> 03:36:10,465 I'M GOING SUGGEST OR REQUEST BUT 4117 03:36:10,465 --> 03:36:12,801 I'LL GO OVER IT ANY WAY. 4118 03:36:12,801 --> 03:36:16,605 I'LL ONLY TALK ABOUT TWO. 4119 03:36:16,605 --> 03:36:21,243 THE FIRST IS NALTREXONE. 4120 03:36:21,243 --> 03:36:26,348 IT'S AN OPIOID ANTAGONIST 4121 03:36:26,348 --> 03:36:28,517 CLASSICALLY AND THERE'S 4122 03:36:28,517 --> 03:36:33,655 ENDOGENOUS OPIOID RECEPTORS AND 4123 03:36:33,655 --> 03:36:36,625 HAVE NATURAL PAIN KILLING 4124 03:36:36,625 --> 03:36:38,327 CHEMICALS AND THEY'RE LEGAL 4125 03:36:38,327 --> 03:36:44,967 OPIOIDS LIKE OXYCODONE AND 4126 03:36:44,967 --> 03:36:55,510 ILLEGAL OPIOIDS LIKE HEROIN AND 4127 03:36:55,844 --> 03:37:01,950 THEY'LL TAKE NALTREXONE BLOCKS 4128 03:37:01,950 --> 03:37:03,418 ENDOGENOUS AND YOUR OWN 4129 03:37:03,418 --> 03:37:04,886 ENDOGENOUS PAIN CONTROL SYSTEMS. 4130 03:37:04,886 --> 03:37:09,091 THERE'S DOWN SIDE BUT SUPER 4131 03:37:09,091 --> 03:37:10,058 EFFECTIVE AND IT'S INCREDIBLY 4132 03:37:10,058 --> 03:37:11,860 IMPORTANT OF A DRUG. 4133 03:37:11,860 --> 03:37:13,362 RECENTLY THERE'S LOTUS 4134 03:37:13,362 --> 03:37:13,895 NALTREXONE. 4135 03:37:13,895 --> 03:37:17,699 INSTEAD OF 50 OR 100 MILLIGRAMS 4136 03:37:17,699 --> 03:37:19,668 A DAY IT'S BETWEEN 1 AND 5 4137 03:37:19,668 --> 03:37:20,202 MILLIGRAMS A DAY. 4138 03:37:20,202 --> 03:37:22,437 MOST OF YOU KNOW THIS. 4139 03:37:22,437 --> 03:37:25,674 THE REASON WHY IT WORKS IS 4140 03:37:25,674 --> 03:37:27,909 BECAUSE NALTREXONE ANTAGONIZES 4141 03:37:27,909 --> 03:37:30,612 TWO TARGETS. 4142 03:37:30,612 --> 03:37:33,282 ONE THE OPIOID I JUST MENTIONED 4143 03:37:33,282 --> 03:37:36,952 AND THE OTHER IS THE RECEPTOR 4 4144 03:37:36,952 --> 03:37:39,955 ON MICROGLIA AND WHEN YOU 4145 03:37:39,955 --> 03:37:42,157 ANTAGONIZE IT ON MICROGLIA YOU 4146 03:37:42,157 --> 03:37:44,226 SHUT OFF THE FLOW OF 4147 03:37:44,226 --> 03:37:47,729 PRO-INFLAMMATORY AGENTS FROM THE 4148 03:37:47,729 --> 03:37:52,100 MICROGLIA AND THIS WILL EASE 4149 03:37:52,100 --> 03:37:53,635 FATIGUE AND PAIN AND COGNITIVE 4150 03:37:53,635 --> 03:37:56,405 ISSUES AMONG OTHERS. 4151 03:37:56,405 --> 03:38:00,275 I'VE BEEN SHOWING -- I HAD TO 4152 03:38:00,275 --> 03:38:05,047 LOOK UP THE DATE YESTERDAY AND 4153 03:38:05,047 --> 03:38:08,083 IT'S BEEN SINCE 2009 SINCE I'VE 4154 03:38:08,083 --> 03:38:14,456 BEEN PUBLISHING WITH LOTUS 4155 03:38:14,456 --> 03:38:17,592 NALTREXONE AND EFFECTIVE IN FIBE 4156 03:38:17,592 --> 03:38:18,960 REMYALGIA BUT NOT USED IN 4157 03:38:18,960 --> 03:38:19,194 ME/CFS. 4158 03:38:19,194 --> 03:38:23,332 THERE'S BEEN NOT BEEN A 4159 03:38:23,332 --> 03:38:24,032 PUBLISHED CLINICAL TRIAL FOR 4160 03:38:24,032 --> 03:38:25,400 ME/CFS AND WHAT I DID LAST NIGHT 4161 03:38:25,400 --> 03:38:29,471 IS I TOOK THE LAST STUDY I DID 4162 03:38:29,471 --> 03:38:36,611 WHICH WAS 2014 IN 30 4163 03:38:36,611 --> 03:38:39,281 FIBROMYALGIA PATIENTS AND A 4.5 4164 03:38:39,281 --> 03:38:44,586 MILLIGRAMS A DAY AND 50% OF THE 4165 03:38:44,586 --> 03:38:46,488 FM PATIENTS HAD A CLINICALLY 4166 03:38:46,488 --> 03:38:47,889 SIGNIFICANT REACTION TO THE 4167 03:38:47,889 --> 03:38:50,359 NALTREXONE AND HAD A REDUCTION 4168 03:38:50,359 --> 03:38:52,594 OF THEIR SYMPTOMS. 4169 03:38:52,594 --> 03:38:54,029 50% IS GREAT. 4170 03:38:54,029 --> 03:38:57,032 THEY HAD A MUCH OR VERY MUCH 4171 03:38:57,032 --> 03:39:00,135 IMPROVED STATE AND THE LDN OVER 4172 03:39:00,135 --> 03:39:02,504 PLACEBO AND I TOOK THE DATA SET 4173 03:39:02,504 --> 03:39:04,806 AND FOUND AND DUG IT UP THROUGH 4174 03:39:04,806 --> 03:39:05,841 MY HARD DRIVE AND WENT THROUGH 4175 03:39:05,841 --> 03:39:09,144 THE RECORDS AND WAS ABLE TOFIDE 4176 03:39:09,144 --> 03:39:14,750 THE PARTICIPANTS WHO ALSO MEET 4177 03:39:14,750 --> 03:39:25,193 THE CRITERIA FOR AND LAST 4178 03:39:30,098 --> 03:39:34,403 ENTITLE I LOOKED AT THEIR 4179 03:39:34,403 --> 03:39:39,708 FATIGUE. 4180 03:39:39,708 --> 03:39:42,177 THERE WAS A REDUCTION IN THEIR 4181 03:39:42,177 --> 03:39:44,713 FATIGUE FROM 0 TO 100 FROM 4182 03:39:44,713 --> 03:39:50,051 BASELINE TO LOTUS NALTREXONE AND 4183 03:39:50,051 --> 03:39:51,353 SIGNIFICANT COMPARED TO PLACEBO. 4184 03:39:51,353 --> 03:39:54,189 THE REASON THE P VALUES ARE SO 4185 03:39:54,189 --> 03:39:56,758 HIGH IS BECAUSE I DID DAILY 4186 03:39:56,758 --> 03:39:57,826 SYMPTOM REPORTS. 4187 03:39:57,826 --> 03:40:04,566 IT'S AN ACROSS-SECTIONAL TRIAL 4188 03:40:04,566 --> 03:40:15,110 WHERE HALF HAD BETTER THAN 25% 4189 03:40:23,285 --> 03:40:24,853 REDUCTION OF THEIR FATIGUE. 4190 03:40:24,853 --> 03:40:31,793 THIS IS A LOW ESTIMATE AND I 4191 03:40:31,793 --> 03:40:33,728 TOOK ALL THE DATA AND THIS ALSO 4192 03:40:33,728 --> 03:40:35,864 INCLUDES THE FIRST FEW DAYS WHEN 4193 03:40:35,864 --> 03:40:37,365 THE REDUCTION OF SYMPTOMS IS NOT 4194 03:40:37,365 --> 03:40:40,569 THAT IMPRESSIVE AND ALL THE 4195 03:40:40,569 --> 03:40:44,072 STUFF IN THE MIDDLE. 4196 03:40:44,072 --> 03:40:51,480 HAD I THE FATIGUE WOULD HAVE 4197 03:40:51,480 --> 03:40:54,983 BEEN 32% OR 35% ON AVERAGE AND 4198 03:40:54,983 --> 03:40:56,485 THAT DOES MEET CLINICAL 4199 03:40:56,485 --> 03:40:58,053 SIGNIFICANCE. 4200 03:40:58,053 --> 03:41:03,925 I THINK OF 30% REDUCTION AS 4201 03:41:03,925 --> 03:41:06,094 CLINICALLY SIGNIFICANT AND THE 4202 03:41:06,094 --> 03:41:07,496 SCORE OF VERY MUCH IMPROVED OR 4203 03:41:07,496 --> 03:41:09,464 MUCH IMPROVED AND WHAT WE'RE 4204 03:41:09,464 --> 03:41:10,031 TARGETING FOR. 4205 03:41:10,031 --> 03:41:17,839 IT WASN'T A STUDY DESIGNED FOR 4206 03:41:17,839 --> 03:41:19,975 ME/CFS AND ENOUGH TO SAY WE HAVE 4207 03:41:19,975 --> 03:41:24,379 TO DO A PROPER CLINICAL TRIAL OF 4208 03:41:24,379 --> 03:41:29,718 LOTUS NALTREXONE. 4209 03:41:29,718 --> 03:41:32,153 NOW, WHENEVER I GIVE A TALK 4210 03:41:32,153 --> 03:41:35,023 USUALLY THE DAY BEFORE I DO A 4211 03:41:35,023 --> 03:41:36,958 LITERATURE SEARCH AND MAKE SURE 4212 03:41:36,958 --> 03:41:39,094 THERE ISN'T SOME GROUNDBREAKING 4213 03:41:39,094 --> 03:41:41,663 NEW DATA THAT CONFLICTS WITH 4214 03:41:41,663 --> 03:41:43,198 WHAT I'M TALKING ABOUT. 4215 03:41:43,198 --> 03:41:45,534 LAST NIGHT I DID THE LIT REVIEW 4216 03:41:45,534 --> 03:41:47,335 AND FOUND A GROUNDBREAKING NEW 4217 03:41:47,335 --> 03:41:48,603 STUDIED THAT CONFLICTS WITH WHAT 4218 03:41:48,603 --> 03:41:51,673 I'M SAYING SO I NEED TO TALK IT 4219 03:41:51,673 --> 03:41:52,807 ABOUT BRIEFLY. 4220 03:41:52,807 --> 03:41:55,143 I DON'T KNOW IF IT'S BEEN 4221 03:41:55,143 --> 03:41:55,410 DISCUSSED. 4222 03:41:55,410 --> 03:41:57,779 I DIDN'T HEAR IT MENTIONED AND 4223 03:41:57,779 --> 03:41:58,813 APOLOGIZE IF IT WAS AND THERE 4224 03:41:58,813 --> 03:42:02,284 WAS A PAPER PUBLISHED LAST WEEK 4225 03:42:02,284 --> 03:42:05,787 ON LOTUS NALTREXONE. 4226 03:42:05,787 --> 03:42:09,658 99 PEOPLE FROM DENMARK USING 6 4227 03:42:09,658 --> 03:42:13,662 MILLIGRAMS A DAY FOR 12 WEEKS 4228 03:42:13,662 --> 03:42:14,162 FOR FIBROMYALGIA. 4229 03:42:14,162 --> 03:42:16,565 THEY DID A PARALLEL GROUP. 4230 03:42:16,565 --> 03:42:18,867 HALF WITH PLACEBO AND HALF LDN 4231 03:42:18,867 --> 03:42:22,837 AND USED A DOSAGE HIGHER THAN 4232 03:42:22,837 --> 03:42:24,406 WHAT I'VE USED 6 MILLIGRAMS IS 4233 03:42:24,406 --> 03:42:26,207 NOT THAT DIFFERENT FROM WHAT I 4234 03:42:26,207 --> 03:42:27,475 TEST. 4235 03:42:27,475 --> 03:42:30,845 ANYWAY, THEY DID NOT FIND 4236 03:42:30,845 --> 03:42:33,715 STATISTICAL DIFFERENCE BETWEEN 4237 03:42:33,715 --> 03:42:35,650 THEIR GROUP AND PLACEBO GROUP 4238 03:42:35,650 --> 03:42:38,720 AND THERE'S A HUGE DEAL MADE OUT 4239 03:42:38,720 --> 03:42:40,221 OF THIS. 4240 03:42:40,221 --> 03:42:44,759 I STILL NEED TIME TO SCRUTINIZE 4241 03:42:44,759 --> 03:42:45,794 THE PAPER AND LOOKED WELL DONE 4242 03:42:45,794 --> 03:42:48,964 AND THE DECISIONS LOOK WELL AND 4243 03:42:48,964 --> 03:42:51,032 I DON'T DOUBT THE QUALITY OF 4244 03:42:51,032 --> 03:42:52,901 THEIR DATA OR STATISTICS. 4245 03:42:52,901 --> 03:42:55,203 THERE WAS A COMPANION COMMENTARY 4246 03:42:55,203 --> 03:42:58,106 THAT WENT WITH IT I BELIEVE WENT 4247 03:42:58,106 --> 03:42:58,506 TOO FAR. 4248 03:42:58,506 --> 03:43:02,377 I'LL TELL YOU WHY. 4249 03:43:02,377 --> 03:43:08,216 YOU CAN FIND THE COMMENTARY IN 4250 03:43:08,216 --> 03:43:10,151 LANCET IT SAID IT'S A 4251 03:43:10,151 --> 03:43:12,120 RESOUNDINGLY NEGATIVE TRIAL FOR 4252 03:43:12,120 --> 03:43:14,122 LDN AND TELL YOU WHY I DON'T 4253 03:43:14,122 --> 03:43:17,459 THINK THAT'S TRUE ANDY DON'T 4254 03:43:17,459 --> 03:43:19,628 THINK THE STUDY SHOULD DISSUADE 4255 03:43:19,628 --> 03:43:22,764 US FROM RUNNING LDN AND THE 4256 03:43:22,764 --> 03:43:24,966 EDITORIAL SAID PHYSICIANS SHOULD 4257 03:43:24,966 --> 03:43:26,901 STOP PRESCRIBING LDN AND THERE'S 4258 03:43:26,901 --> 03:43:28,803 STRONG EVIDENCE WE SHOULD NOT 4259 03:43:28,803 --> 03:43:31,072 GIVE IN TO ANY PATIENTS OR 4260 03:43:31,072 --> 03:43:32,374 PATIENTS UNLESS THEY'RE ALREADY 4261 03:43:32,374 --> 03:43:33,074 ON IT. 4262 03:43:33,074 --> 03:43:34,376 YOU SHOULD NOT PRESCRIBE IT TO 4263 03:43:34,376 --> 03:43:36,144 ANY NEW PATIENTS. 4264 03:43:36,144 --> 03:43:37,979 I STRONGLY DISAGREE AND BELIEVE 4265 03:43:37,979 --> 03:43:39,748 THE PHYSICIANS AT THE CONFERENCE 4266 03:43:39,748 --> 03:43:41,883 I BELIEVE THEY WOULD STRONGLY 4267 03:43:41,883 --> 03:43:42,851 DISAGREE WITH THAT AS WELL. 4268 03:43:42,851 --> 03:43:44,419 I HAVE PLENTY OF PHYSICIANS THAT 4269 03:43:44,419 --> 03:43:46,855 WOULD THINK IT'S NOT GOOD ADVICE 4270 03:43:46,855 --> 03:43:48,056 BECAUSE THE DRUG IS SO HELPFUL 4271 03:43:48,056 --> 03:43:48,857 FOR A LOT OF PEOPLE. 4272 03:43:48,857 --> 03:43:51,159 THE REASON WHY I DON'T LIKE 4273 03:43:51,159 --> 03:43:52,594 THEIR CONCLUSIONS IN 4274 03:43:52,594 --> 03:43:57,766 INTERPRETING THE STUDY, FIRST, 4275 03:43:57,766 --> 03:44:02,370 THIS STUDY 48% OF THE 4276 03:44:02,370 --> 03:44:06,374 FIBROMYALGIA PATIENTS HAD A 4277 03:44:06,374 --> 03:44:08,109 CLINICALLY SIGNIFICANT REDUCTION 4278 03:44:08,109 --> 03:44:10,011 IN THEIR SYMPTOMS ALMOST HALF. 4279 03:44:10,011 --> 03:44:12,147 THAT'S ALMOST EXACTLY WHAT I'VE 4280 03:44:12,147 --> 03:44:13,314 ALWAYS FOUND. 4281 03:44:13,314 --> 03:44:16,651 THEY GOT 48%, IN MY STUDY I HAD 4282 03:44:16,651 --> 03:44:16,918 50%. 4283 03:44:16,918 --> 03:44:19,254 VERY SIMILAR IN TERMS OF EFFECT 4284 03:44:19,254 --> 03:44:19,521 SIZE. 4285 03:44:19,521 --> 03:44:22,157 THE DIFFERENCE IS THEY DID A 4286 03:44:22,157 --> 03:44:23,825 PARALLEL GROUP STUDY WHICH YOU 4287 03:44:23,825 --> 03:44:26,061 NEED A LOT OF PEOPLE TO HAVE THE 4288 03:44:26,061 --> 03:44:28,530 STATISTICAL SENSITIVITY TO FIND 4289 03:44:28,530 --> 03:44:28,863 AN EFFECT. 4290 03:44:28,863 --> 03:44:31,566 THAT'S WHY FDA TRIALS THAT USE 4291 03:44:31,566 --> 03:44:34,369 PARALLEL GROUPS HAVE 100, 200, 4292 03:44:34,369 --> 03:44:37,338 300, 400 PEOPLE. 4293 03:44:37,338 --> 03:44:40,575 HAD THEY RUN 40 TO 60 MORE 4294 03:44:40,575 --> 03:44:43,311 PEOPLE THEY WOULD HAVE HAD 4295 03:44:43,311 --> 03:44:44,245 STATISTICAL DIFFERENCE. 4296 03:44:44,245 --> 03:44:45,313 THAT'S MY INTERPRETATION. 4297 03:44:45,313 --> 03:44:47,582 TAKE A LOOK AND LET ME KNOW WHAT 4298 03:44:47,582 --> 03:44:48,316 YOU THINK. 4299 03:44:48,316 --> 03:44:51,486 THE DATA LOOKED FINE TO ME AND I 4300 03:44:51,486 --> 03:44:53,254 DO NOT THINK IT SHOULD STOP US 4301 03:44:53,254 --> 03:44:55,757 FROM LOOKING AT LDN. 4302 03:44:55,757 --> 03:44:57,358 I JUST SAW THIS LAST NIGHT AND 4303 03:44:57,358 --> 03:44:58,359 THOUGHT THIS IS GOING TO BE A 4304 03:44:58,359 --> 03:44:59,994 BIG DEAL BECAUSE PEOPLE ARE 4305 03:44:59,994 --> 03:45:02,363 GOING TO SEE THE TITLE AND THE 4306 03:45:02,363 --> 03:45:05,166 COMMENTARY AND GO OH, LDN'S 4307 03:45:05,166 --> 03:45:06,000 DEAD. 4308 03:45:06,000 --> 03:45:07,936 WE SHOULDN'T TRY IT. 4309 03:45:07,936 --> 03:45:10,705 I'VE TALKED TO OVER 1,000 PEOPLE 4310 03:45:10,705 --> 03:45:16,311 OVER THE LAST 10 YEARS AND IT 4311 03:45:16,311 --> 03:45:21,282 WOULD BE BAD TO GIVE UP ON LDM 4312 03:45:21,282 --> 03:45:21,649 RIGHT NOW. 4313 03:45:21,649 --> 03:45:23,418 ONE THING THE COMMENTARY SAID I 4314 03:45:23,418 --> 03:45:27,956 AGREE WITH IS WE NEED TO RUN 4315 03:45:27,956 --> 03:45:30,358 FINALLY A PROPERLY POWERED 4316 03:45:30,358 --> 03:45:32,727 ADEQUATE SAMPLE SIZE, CLINICAL 4317 03:45:32,727 --> 03:45:33,895 TRIAL OF LDN. 4318 03:45:33,895 --> 03:45:35,730 WE NEED THAT TO ANSWER THE 4319 03:45:35,730 --> 03:45:37,031 QUESTIONS TIMELY. 4320 03:45:37,031 --> 03:45:38,967 I'VE GONE ON ABOUT THAT LONG 4321 03:45:38,967 --> 03:45:41,269 ENOUGH AND ALMOST OUT OF TIME SO 4322 03:45:41,269 --> 03:45:43,438 WE HAVE TO KEEP GOING. 4323 03:45:43,438 --> 03:45:45,373 NOW, REAL QUICK THERE'S ANOTHER 4324 03:45:45,373 --> 03:45:47,642 DRUG I'D LOVE TO SEE USED IN 4325 03:45:47,642 --> 03:45:48,109 HUMANS. 4326 03:45:48,109 --> 03:45:50,211 THAT'S BECAUSE AS EFFECTIVE AS I 4327 03:45:50,211 --> 03:45:53,782 BELIEVE LDN IS THERE'S A 4328 03:45:53,782 --> 03:45:55,116 HINDRANCE AND THAT'S THE OPIOID 4329 03:45:55,116 --> 03:45:55,483 BLOCKADE. 4330 03:45:55,483 --> 03:45:59,254 IF YOU START TO GET ABOVE 6 4331 03:45:59,254 --> 03:46:02,824 MILLIGRAMS YOU BLOCK THE OPIOID 4332 03:46:02,824 --> 03:46:05,960 UP SO MUCH YOU CAN START TO 4333 03:46:05,960 --> 03:46:07,061 CAUSE SYMPTOMS FOR AN 4334 03:46:07,061 --> 03:46:07,829 INDIVIDUAL. 4335 03:46:07,829 --> 03:46:10,598 YOU DON'T WANT TO BLOCK THE 4336 03:46:10,598 --> 03:46:15,537 OPIOID SYSTEM OUR BLOCKED THE 4337 03:46:15,537 --> 03:46:16,604 EUPHORIA, PAIN CONTROL SYSTEMS. 4338 03:46:16,604 --> 03:46:18,606 I DON'T THINK IT'S HELPFUL AND 4339 03:46:18,606 --> 03:46:20,208 KEEPING US RESTRICTED IN THIS 4340 03:46:20,208 --> 03:46:27,816 REALLY TIGHT RANGE. 4341 03:46:27,816 --> 03:46:29,651 WE NEED A WAY TO REMOVE THE 4342 03:46:29,651 --> 03:46:30,385 CEILING AND THERE'S A WAY TO DO 4343 03:46:30,385 --> 03:46:34,522 THAT. 4344 03:46:34,522 --> 03:46:40,762 THIS IS CALL DEXTRONE NALTREXONE 4345 03:46:40,762 --> 03:46:43,898 IDENTICAL TO THE NALTREXONE WE 4346 03:46:43,898 --> 03:46:48,203 TAKE EXCEPT A FLIPPED IMAGE AND 4347 03:46:48,203 --> 03:46:53,041 SAME MOLECULAR FORMULA AND ATOMS 4348 03:46:53,041 --> 03:46:54,375 IT AFFECT THE RECEPTORS 4349 03:46:54,375 --> 03:46:58,313 DIFFERENT AND WHEN YOU TAKE IT 4350 03:46:58,313 --> 03:47:01,482 COMMERCIALLY YOU'RE TAKING LEGAL 4351 03:47:01,482 --> 03:47:04,552 NALTREXONE AND DEXTRONE 4352 03:47:04,552 --> 03:47:05,954 NALTREXONE HAS ONE IMPORTANT 4353 03:47:05,954 --> 03:47:09,958 EXCEPTION IT DOESN'T INTERFERE 4354 03:47:09,958 --> 03:47:14,195 WITH THE RECEPTORS. 4355 03:47:14,195 --> 03:47:17,098 WE CAN RAMP UP THE DOSE AND HAVE 4356 03:47:17,098 --> 03:47:21,870 A MORE POWERFUL EFFECT ON THE 4357 03:47:21,870 --> 03:47:24,372 MICROGLIA AND THIS IS ONLY 4358 03:47:24,372 --> 03:47:26,374 SHOWING LEGAL NALTREXONE HAVE 4359 03:47:26,374 --> 03:47:28,743 THE SAME EFFECT BY DOSAGE ON THE 4360 03:47:28,743 --> 03:47:30,245 PRODUCTION OF INFLAMMATORY 4361 03:47:30,245 --> 03:47:34,983 CHEMICALS FROM MICROGLIA AND 4362 03:47:34,983 --> 03:47:36,551 THEY BOTH SUPPRESS MICROGLIA AND 4363 03:47:36,551 --> 03:47:38,686 DOESN'T BLOCK THE OPIOID 4364 03:47:38,686 --> 03:47:38,953 RECEPTORS. 4365 03:47:38,953 --> 03:47:40,455 WE'LL HAVE TO SYNTHESIZE THIS 4366 03:47:40,455 --> 03:47:41,856 AND WILL HAVE TO DO FDA TRIALS 4367 03:47:41,856 --> 03:47:44,325 TO GET THIS IN HUMANS. 4368 03:47:44,325 --> 03:47:47,562 IT WOULD PROBABLY COST $1.5 4369 03:47:47,562 --> 03:47:50,365 BILLION TO DO BUT WORTH PUTTING 4370 03:47:50,365 --> 03:47:52,500 MONEY INTO. 4371 03:47:52,500 --> 03:47:56,104 THERE'S ONE HUGE CAVEAT TO ALL 4372 03:47:56,104 --> 03:47:57,372 THIS WORK. 4373 03:47:57,372 --> 03:48:01,042 WE CAN SEE BRAIN INFLAMMATION. 4374 03:48:01,042 --> 03:48:03,344 WE HAVE TO BE CAREFUL TO KNOW IS 4375 03:48:03,344 --> 03:48:05,380 THE BRAIN INFLAMMATION THE 4376 03:48:05,380 --> 03:48:06,214 PROBLEM OR IS THE BRAIN 4377 03:48:06,214 --> 03:48:11,386 INFLAMMATION TRYING TO SOLVE THE 4378 03:48:11,386 --> 03:48:11,986 PROBLEM? 4379 03:48:11,986 --> 03:48:14,756 WE HAVE TO CONSIDER WHERE IS 4380 03:48:14,756 --> 03:48:16,524 BRAIN INFLAMMATION IN THE ENTIRE 4381 03:48:16,524 --> 03:48:17,358 PATHOLOGICAL PROCESS. 4382 03:48:17,358 --> 03:48:20,495 I'M PUSHING FOR CLINICAL TRIALS. 4383 03:48:20,495 --> 03:48:28,102 WE NEED TO HAVE AN AGREED SET 4384 03:48:28,102 --> 03:48:30,371 OF CRITERIA AND DEFINE SAM SIZE 4385 03:48:30,371 --> 03:48:32,674 AND COMMON OUTCOMES AND CASE 4386 03:48:32,674 --> 03:48:34,042 CRITERIA AND HAVE EVERYONE USE 4387 03:48:34,042 --> 03:48:35,610 THE BASIC SAME PLAN TO COMPARE 4388 03:48:35,610 --> 03:48:36,611 AND CONTRAST THE DIFFERENT 4389 03:48:36,611 --> 03:48:36,844 TRIALS. 4390 03:48:36,844 --> 03:48:41,015 I WOULD LOVE TO SEE THAT HAPPEN. 4391 03:48:41,015 --> 03:48:44,452 THAT'S IT MY NEW YEAR'S 4392 03:48:44,452 --> 03:48:47,388 RESOLUTION IS TO DO A LOT OF 4393 03:48:47,388 --> 03:48:49,624 VIDEOS SO MY YOUTUBE PAGE IS 4394 03:48:49,624 --> 03:48:52,060 YOUNGER LAB YOU CAN LOOK AT ANY 4395 03:48:52,060 --> 03:48:52,827 TIME AND PROMISE MY NEW YEAR'S 4396 03:48:52,827 --> 03:48:55,663 RESOLUTION IS TO TRY TO DO A 4397 03:48:55,663 --> 03:48:56,998 VIDEO EVERY TWO WEEKS. 4398 03:48:56,998 --> 03:48:59,400 I TRIED BEFORE AND FAILED 4399 03:48:59,400 --> 03:49:00,735 MISERABLY AND HOPE THIS TIME I 4400 03:49:00,735 --> 03:49:02,103 CAN STICK IT TO AND GET THE 4401 03:49:02,103 --> 03:49:02,904 INFORMATION OUT AND I'LL STOP 4402 03:49:02,904 --> 03:49:03,571 THERE AND THANK YOU FOR YOUR 4403 03:49:03,571 --> 03:49:13,915 TIME AND LISTENING. 4404 03:50:03,731 --> 03:50:05,299 >> IT GIVES A PERSON AN 4405 03:50:05,299 --> 03:50:09,804 INFECTION BUT YOU DON'T WANT TO 4406 03:50:09,804 --> 03:50:12,273 SPREAD OF INFECTION OR SEPSIS OR 4407 03:50:12,273 --> 03:50:13,674 SOMETHING AND WE'VE ONLY DONE 4408 03:50:13,674 --> 03:50:17,645 THIS IN HALF THE MEAN CRITERIA 4409 03:50:17,645 --> 03:50:18,513 FOR CHRONIC FATIGUE SYNDROME. 4410 03:50:18,513 --> 03:50:20,681 WHEN YOU GIVE A LOW LEVEL 4411 03:50:20,681 --> 03:50:25,586 ANTIGEN TO A HEALTHY CONTROL AND 4412 03:50:25,586 --> 03:50:30,691 THE BRAIN DOESN'T REACT AND THEY 4413 03:50:30,691 --> 03:50:33,761 DON'T FEEL ANYTHING AND THEY 4414 03:50:33,761 --> 03:50:34,662 REACT ABNORMALLY. 4415 03:50:34,662 --> 03:50:38,199 THERE'S A HUGE INCREASE OF 4416 03:50:38,199 --> 03:50:40,368 LEPTIN AND SUPPRESSION OF OTHER 4417 03:50:40,368 --> 03:50:42,370 CHEMICALS AND THE MICROGLIA ARE 4418 03:50:42,370 --> 03:50:45,807 BE ACTIVATED AND THE SUPPRESSION 4419 03:50:45,807 --> 03:50:47,708 SUGGESTIONS THE BREAKS ON 4420 03:50:47,708 --> 03:50:49,577 MICROGLIA AREN'T THERE. 4421 03:50:49,577 --> 03:50:51,312 IN FIBROMYALGIA WE SCAN THE 4422 03:50:51,312 --> 03:50:53,147 BRAIN AND FINDING THERE'S NOT AN 4423 03:50:53,147 --> 03:50:54,348 INFLAMMATORY RESPONSE IN THE 4424 03:50:54,348 --> 03:50:58,219 HEALTHY CONTROLLED BRAIN BUT IN 4425 03:50:58,219 --> 03:50:58,820 FIBROMYALGIA THERE'S A LARGE 4426 03:50:58,820 --> 03:51:01,756 INFLAMMATORY RESPONSE TO A SUPER 4427 03:51:01,756 --> 03:51:02,590 LOW TRIGGER. 4428 03:51:02,590 --> 03:51:04,459 THAT'S THE BEST WE HAVE IN TERMS 4429 03:51:04,459 --> 03:51:06,861 OF LOOKING AT THIS. 4430 03:51:06,861 --> 03:51:12,600 >> LPS WOULD MIMIC A BACTERIAL 4431 03:51:12,600 --> 03:51:13,267 NOT VIRAL INFECTION. 4432 03:51:13,267 --> 03:51:15,236 LET'S DO A VIRAL INFECTION. 4433 03:51:15,236 --> 03:51:17,605 >> YOU CAN DO THAT WITH THE 4434 03:51:17,605 --> 03:51:17,939 VACCINE MAYBE. 4435 03:51:17,939 --> 03:51:28,049 >> NO. 4436 03:51:35,456 --> 03:51:36,657 PEOPLE COME TO THE HOSPITAL ALL 4437 03:51:36,657 --> 03:51:38,092 THE TIME WITH VIRAL INFECTION. 4438 03:51:38,092 --> 03:51:39,494 >> IT'S AN INTERESTING APPROACH. 4439 03:51:39,494 --> 03:51:42,563 WE HAVE THE SCANNER SCHEDULE. 4440 03:51:42,563 --> 03:51:45,333 IF SOMEONE'S SICK WE CAN SAY THE 4441 03:51:45,333 --> 03:51:46,267 SCANNER'S AVAILABLE AND BRING IT 4442 03:51:46,267 --> 03:51:49,837 OVER. 4443 03:51:49,837 --> 03:51:52,807 THAT CAN BE DONE. 4444 03:51:52,807 --> 03:52:00,281 A COLLEAGUE THAT BRINGS IN SKITS 4445 03:52:00,281 --> 03:52:04,619 FR 4446 03:52:04,619 --> 03:52:09,290 FREN -- SCHIZOPHRENIC REACTION 4447 03:52:09,290 --> 03:52:10,291 WE CAN SCREEN. 4448 03:52:10,291 --> 03:52:14,128 >> THE NEXT SPEAKER BEFORE WE 4449 03:52:14,128 --> 03:52:16,597 MOVE TO THE PANEL DISCUSSION IS 4450 03:52:16,597 --> 03:52:19,200 DR. MICHELLE JAMES FROM STANFORD 4451 03:52:19,200 --> 03:52:21,469 TALKING ABOUT ILLUMINATING WHOLE 4452 03:52:21,469 --> 03:52:22,303 BODY RESPONSES USING PET KEEPING 4453 03:52:22,303 --> 03:52:31,879 ON OUR THEME. 4454 03:52:31,879 --> 03:52:33,314 >> HELLO, EVERYONE. 4455 03:52:33,314 --> 03:52:36,784 THANK YOU FOR THE OPPORTUNITY TO 4456 03:52:36,784 --> 03:52:39,387 BE HERE AND SHARE DATA WITH YOU 4457 03:52:39,387 --> 03:52:39,587 ALL. 4458 03:52:39,587 --> 03:52:41,856 A LITTLE OVERVIEW WHAT I'LL BE 4459 03:52:41,856 --> 03:52:42,523 SPEAKING ABOUT. 4460 03:52:42,523 --> 03:52:46,160 I'LL GIVE BACKGROUND OF THE PET 4461 03:52:46,160 --> 03:52:48,196 IMAGING BIOMARKERS US AND OTHER 4462 03:52:48,196 --> 03:52:51,332 GROUPS ARE EXPLORING OR LOOKING 4463 03:52:51,332 --> 03:52:55,336 OR INFLAMMATION EXPANDING ON PET 4464 03:52:55,336 --> 03:52:59,340 IMAGING OF INFLAMMATION AND SHOW 4465 03:52:59,340 --> 03:53:01,976 OUR PRELIMINARY DATA AND INSIGHT 4466 03:53:01,976 --> 03:53:06,314 FROM PET MRI STUDY IN ME/CFS AND 4467 03:53:06,314 --> 03:53:08,950 THEN I'LL LOOKING FORWARD TO 4468 03:53:08,950 --> 03:53:10,351 HIGHLIGHTING SOME OF THE NEWER 4469 03:53:10,351 --> 03:53:12,220 PET TRACES BEING DEVELOPED IN MY 4470 03:53:12,220 --> 03:53:14,188 LAB FOR IMAGING DIFFERENT KINDS 4471 03:53:14,188 --> 03:53:16,657 OF IMMUNE CELLS AND I'LL WRAP UP 4472 03:53:16,657 --> 03:53:21,262 WITH CONCLUSIONS AS WELL. 4473 03:53:21,262 --> 03:53:24,298 LIKE WHAT YOU'VE SEEN FROM 4474 03:53:24,298 --> 03:53:26,367 HANNAH'S PRESENTATION AND 4475 03:53:26,367 --> 03:53:28,002 DR. YOUNGER'S PRESENTATION WE'RE 4476 03:53:28,002 --> 03:53:31,272 MOTIVATED TO TRY TO SHED LIGHT 4477 03:53:31,272 --> 03:53:33,908 ON NEURAL INFLAMMATION IN THE 4478 03:53:33,908 --> 03:53:35,776 MOLECULAR LEVEL AT ME/CFS TO 4479 03:53:35,776 --> 03:53:36,611 INFORMATION MORE ABOUT THE 4480 03:53:36,611 --> 03:53:39,213 SPATIAL TEMPORAL DYNAMICS AND 4481 03:53:39,213 --> 03:53:40,114 ULTIMATELY WE'D LOVE TO BE ABLE 4482 03:53:40,114 --> 03:53:42,350 TO USE ONE OF THOSE APPROACHES 4483 03:53:42,350 --> 03:53:43,784 IN CLINICAL TRIALS OF NEW DRUGS 4484 03:53:43,784 --> 03:53:45,786 LIKE WHAT DR. YOUNGER WAS 4485 03:53:45,786 --> 03:53:47,722 TALKING ABOUT TO DETECT IF 4486 03:53:47,722 --> 03:53:50,358 SOMEBODY'S RESPONDING OR NOT 4487 03:53:50,358 --> 03:53:52,293 MORE RAPIDLY. 4488 03:53:52,293 --> 03:53:54,362 SO AS YOU'VE SEEN AND HEARD 4489 03:53:54,362 --> 03:54:00,868 THERE'S LOTS OF TECHNIQUES FOR 4490 03:54:00,868 --> 03:54:01,369 MEASURING INFLAMMATORY 4491 03:54:01,369 --> 03:54:01,669 BIOMARKERS. 4492 03:54:01,669 --> 03:54:03,404 SOME ARE IN BLOOD AND YOU'VE 4493 03:54:03,404 --> 03:54:05,606 SEEN GREAT TALKS LOOKING AT 4494 03:54:05,606 --> 03:54:07,108 VARIOUS MARKERS OF IMMUNE CELLS 4495 03:54:07,108 --> 03:54:10,111 AND THE FUNCTIONAL PHENOTYPES 4496 03:54:10,111 --> 03:54:12,847 AND BLOOD AND CSF IS ANOTHER 4497 03:54:12,847 --> 03:54:15,750 OPTION AND USE STRUCTURAL 4498 03:54:15,750 --> 03:54:20,354 IMAGING FOR BRAIN TUMORS AND 4499 03:54:20,354 --> 03:54:23,291 STROKES AND THINGS LIKE THAT AND 4500 03:54:23,291 --> 03:54:27,361 THE BASIC STATE OF THE ART 4501 03:54:27,361 --> 03:54:30,364 CHANGES IS YOU LOOK AT 4502 03:54:30,364 --> 03:54:31,732 STRUCTURAL CHANGES ALONE THAN 4503 03:54:31,732 --> 03:54:36,003 MORE FUNCTIONAL CHANGES. 4504 03:54:36,003 --> 03:54:39,307 AND POST MORTEM ANALYSES ARE 4505 03:54:39,307 --> 03:54:41,208 HELPFUL AND CAN PROVIDE SPECIFIC 4506 03:54:41,208 --> 03:54:43,611 INFORMATION ABOUT BIOMARKERS OR 4507 03:54:43,611 --> 03:54:45,313 IMMUNE CELLS AND THEN IN A 4508 03:54:45,313 --> 03:54:46,147 SPATIAL MANNER. 4509 03:54:46,147 --> 03:54:48,349 THAT'S GREAT BUT IT'S OBVIOUSLY 4510 03:54:48,349 --> 03:54:50,284 TOO LATE. 4511 03:54:50,284 --> 03:54:52,253 WE'D LIKE TO BE ABLE TO LOOK AT 4512 03:54:52,253 --> 03:54:54,855 THIS KIND OF INFORMATION IN A 4513 03:54:54,855 --> 03:54:56,457 LIVING SUBJECT. 4514 03:54:56,457 --> 03:55:01,495 THAT'S WHY MOLECULAR IMAGING 4515 03:55:01,495 --> 03:55:05,433 COMES IN AND USING TOMOGRAPHY 4516 03:55:05,433 --> 03:55:06,801 AND WHAT A LOVE ABOUT PET IS 4517 03:55:06,801 --> 03:55:08,669 IT'S SENSITIVE. 4518 03:55:08,669 --> 03:55:10,404 YOU CAN LOOK AT DIFFERENT 4519 03:55:10,404 --> 03:55:14,375 MOLECULAR CHANGES OF THE NANO 4520 03:55:14,375 --> 03:55:19,113 MOLAR AM AND LOOKING AT SMALL 4521 03:55:19,113 --> 03:55:20,881 CHANGES WHICH GIVES ME HOPE 4522 03:55:20,881 --> 03:55:22,483 WE'LL BE ABLE TO DETECT CHANGES 4523 03:55:22,483 --> 03:55:24,385 AT EARLY STAGE FOR INSTANCE. 4524 03:55:24,385 --> 03:55:26,354 WHAT ARE SOME OF THE BIOMARKERS 4525 03:55:26,354 --> 03:55:33,694 PEOPLE ARE LOOKING AT? 4526 03:55:33,694 --> 03:55:36,630 THE RED LABEL THE RADIO CHEMISTS 4527 03:55:36,630 --> 03:55:39,633 AROUND THE WORLD TRY TO MAKE PET 4528 03:55:39,633 --> 03:55:41,335 TRACERS FOR. 4529 03:55:41,335 --> 03:55:49,677 HAVE YOU YOUR MICROGLIA AND 4530 03:55:49,677 --> 03:55:51,445 ASTROCYTES AND A COLLEGIATE THE 4531 03:55:51,445 --> 03:55:53,848 UNIVERSITY OF MICHIGAN JUST MADE 4532 03:55:53,848 --> 03:55:56,717 A NICE PET TRACER LOOKING AT THE 4533 03:55:56,717 --> 03:55:59,019 ACTIVITY OF MAOB THAT COULD BE 4534 03:55:59,019 --> 03:55:59,920 OF INTEREST TO PEOPLE TRANSLATED 4535 03:55:59,920 --> 03:56:01,222 TO THE CLINIC. 4536 03:56:01,222 --> 03:56:05,159 WE HAVE PERIPHERAL IMMUNE CELLS 4537 03:56:05,159 --> 03:56:10,297 SO YOUR MYELOID CELLS THAT MAY 4538 03:56:10,297 --> 03:56:11,766 INFILTRATE THE CNS AND YOU ARE 4539 03:56:11,766 --> 03:56:14,268 HAVE A RANGE OF MARKERS. 4540 03:56:14,268 --> 03:56:16,537 YOUR ADAPTIVE IMMUNE CELLS, T 4541 03:56:16,537 --> 03:56:17,171 CELLS AND B CELLS. 4542 03:56:17,171 --> 03:56:19,006 I'LL TALK ABOUT SOME OF THOSE 4543 03:56:19,006 --> 03:56:19,607 MARKERS AND PET TRACERS IN A 4544 03:56:19,607 --> 03:56:26,347 BIT. 4545 03:56:26,347 --> 03:56:30,351 AND LOOK AT CYTOKINE SIGNALLING 4546 03:56:30,351 --> 03:56:33,320 OR OXIDATIVE STRESS AND THERE'S 4547 03:56:33,320 --> 03:56:38,292 BEEN PET TRACERS. 4548 03:56:38,292 --> 03:56:40,494 AND WE HAVE A NICE TOOLBOX OF 4549 03:56:40,494 --> 03:56:44,098 PET IMAGING AGENTS TO LOOK AT 4550 03:56:44,098 --> 03:56:46,200 DIFFERENT IMMUNE CELLS AND 4551 03:56:46,200 --> 03:56:49,336 LOOKING AT SOME OF THESE IN THE 4552 03:56:49,336 --> 03:56:51,038 CONTEXT OF CANCER OR OTHER 4553 03:56:51,038 --> 03:56:51,305 DISEASES. 4554 03:56:51,305 --> 03:57:00,214 I THINK WE CAN APPLY THEM TO 4555 03:57:00,214 --> 03:57:01,715 DISEASES LIKE ME/CFS AND TSPO 4556 03:57:01,715 --> 03:57:03,050 AND I'LL TALK WITH THE RESULTS 4557 03:57:03,050 --> 03:57:08,989 OF OUR PET IMAGING IN A MINUTE. 4558 03:57:08,989 --> 03:57:12,259 YOU CAN SEE THERE'S A NUMBER OF 4559 03:57:12,259 --> 03:57:13,394 CELL TYPES. 4560 03:57:13,394 --> 03:57:15,596 IT'S PREDOMINANTLY ON YOUR 4561 03:57:15,596 --> 03:57:16,430 ACTIVATED MYELOID CELLS. 4562 03:57:16,430 --> 03:57:17,898 DEPENDING ON THE CONTEXT IT 4563 03:57:17,898 --> 03:57:20,768 COULD BE MORE EXPRESSED ON 4564 03:57:20,768 --> 03:57:22,436 ASTROCYTES AND CERTAINLY 4565 03:57:22,436 --> 03:57:26,373 EXPRESSED AT HIGH LEVEL ON 4566 03:57:26,373 --> 03:57:29,243 ENDOTHELIAL CELLS AND ALSO 4567 03:57:29,243 --> 03:57:32,313 CANCER. 4568 03:57:32,313 --> 03:57:34,381 WITH NEED TO BE CAREFUL THOUGH 4569 03:57:34,381 --> 03:57:40,120 IT'S A USEFUL MARKER AND HAVE 4570 03:57:40,120 --> 03:57:42,857 MARKERS MORE SPECIFIC FOR 4571 03:57:42,857 --> 03:57:44,892 MACROPHAGES AND I WANT TO FLAG I 4572 03:57:44,892 --> 03:57:46,627 WON'T HAVE TIME IT TALK ABOUT 4573 03:57:46,627 --> 03:57:49,096 THE T CELL IMAGING AGENTS BUT IF 4574 03:57:49,096 --> 03:57:52,633 YOU LOOK AT THE TABLE IT'S A 4575 03:57:52,633 --> 03:57:54,802 NICE COUPLE OF TRACERS DOWN THE 4576 03:57:54,802 --> 03:57:55,035 LINE. 4577 03:57:55,035 --> 03:57:58,339 ONE THAT'S GREAT FOR LOOKING AT 4578 03:57:58,339 --> 03:58:02,676 CD 8 T CELLS AND A LINEAGE 4579 03:58:02,676 --> 03:58:04,345 MARKER ADAM WU DEVELOPED FROM 4580 03:58:04,345 --> 03:58:10,684 UCLA AND THE TOP TRACER THERE IS 4581 03:58:10,684 --> 03:58:11,919 AVAILABLE FOR CLINICAL USING. 4582 03:58:11,919 --> 03:58:14,355 IF PEOPLE ARE INTERESTED IN 4583 03:58:14,355 --> 03:58:16,624 IMAGING T CELLS IT COULD BE A 4584 03:58:16,624 --> 03:58:18,292 GOOD ONE. 4585 03:58:18,292 --> 03:58:21,228 AND THERE'S IMAGING AGENTS 4586 03:58:21,228 --> 03:58:31,739 LOOKING AT T CELL ACTIVATION. 4587 03:58:43,984 --> 03:58:45,953 AND THERE'S INTERESTING PROTEIN 4588 03:58:45,953 --> 03:58:51,458 ON THE MITOCHONDRIAL MEMBRANE. 4589 03:58:51,458 --> 03:58:56,063 IT REACTS WITH REACTIVE OXYGEN 4590 03:58:56,063 --> 03:59:02,870 SPECIES AND HAS REGULATION OF 4591 03:59:02,870 --> 03:59:03,203 MITOCHONDRIA. 4592 03:59:03,203 --> 03:59:09,910 IT'S SUPPRESSED ON DIFFERENT 4593 03:59:09,910 --> 03:59:11,679 TISSUES SO KEEP THAT IN MIND. 4594 03:59:11,679 --> 03:59:13,814 IT BECOMES ELEVATED IN THE KWON 4595 03:59:13,814 --> 03:59:15,649 TEXT OF INFLAMMATION. 4596 03:59:15,649 --> 03:59:19,587 PEOPLE THOUGHT IT COULD SERVE AS 4597 03:59:19,587 --> 03:59:21,155 THIS DIAGNOSTIC SENSOR OF 4598 03:59:21,155 --> 03:59:22,623 INFLAMMATION AND WHY IT STARTED 4599 03:59:22,623 --> 03:59:23,524 TO BE INVESTIGATED. 4600 03:59:23,524 --> 03:59:26,360 THERE'S A NUMBER OF PET TRACERS 4601 03:59:26,360 --> 03:59:29,163 FOR THAT AND I'M GOING TO SHARE 4602 03:59:29,163 --> 03:59:31,198 ABOUT WHAT WE'RE DOING OUR 4603 03:59:31,198 --> 03:59:33,467 ULTIMATE GOAL I HAD MENTIONED 4604 03:59:33,467 --> 03:59:38,973 BEFORE IS TO SPECIFICALLY TRACK 4605 03:59:38,973 --> 03:59:40,040 AND MONITOR INFLAMMATION IN VIVO 4606 03:59:40,040 --> 03:59:42,810 WITH THE ULTIMATE GOAL OF USING 4607 03:59:42,810 --> 03:59:45,646 IT FOR THERAPEUTIC DRUG TRIALS. 4608 03:59:45,646 --> 03:59:47,481 WE'RE COMPARING ME/CFS FOR 4609 03:59:47,481 --> 03:59:50,084 CONTROLS WITH AGE, SEX AND 4610 03:59:50,084 --> 03:59:51,318 GENOTYPING EVERYONE AND 4611 03:59:51,318 --> 03:59:52,853 COLLECTING BLOOD AND SALIVA AND 4612 03:59:52,853 --> 03:59:55,656 WOULD LIKE TO BE ABLE TO 4613 03:59:55,656 --> 03:59:57,524 CORRELATE OUR FINDINGS WITH 4614 03:59:57,524 --> 03:59:58,626 FLUID BASED BIOMARKERS OF 4615 03:59:58,626 --> 04:00:00,227 INFECTION ULTIMATELY. 4616 04:00:00,227 --> 04:00:06,367 WE'RE LOOKING AT MODERATE TO 4617 04:00:06,367 --> 04:00:16,910 SEVERE ME/CFS AND THIS IS NICE 4618 04:00:20,447 --> 04:00:26,253 TO HAVE BOTH HANNAH AND OTHERS 4619 04:00:26,253 --> 04:00:30,357 WORKING ON THE SAME THING TO 4620 04:00:30,357 --> 04:00:32,026 MOVE THE FIELD FORWARD AND 4621 04:00:32,026 --> 04:00:33,727 HERE'S IMAGES WE'VE BEEN 4622 04:00:33,727 --> 04:00:34,061 ACQUIRING. 4623 04:00:34,061 --> 04:00:37,364 THESE ARE SOME OF THE FEMALE 4624 04:00:37,364 --> 04:00:38,032 IMAGES. 4625 04:00:38,032 --> 04:00:39,867 YOU CAN SEE VISUALLY WE'RE 4626 04:00:39,867 --> 04:00:44,438 GETTING THIS INCREASED UPTAKE OR 4627 04:00:44,438 --> 04:00:47,107 SIGNAL IN THE THALAMUS AND PONDS 4628 04:00:47,107 --> 04:00:49,109 AND CORTICAL REGIONS COMPARED TO 4629 04:00:49,109 --> 04:00:51,712 THE HEALTHY AND SOME MALE IMAGES 4630 04:00:51,712 --> 04:00:52,713 LOOKED A LITTLE BIT DIFFERENT TO 4631 04:00:52,713 --> 04:00:55,315 ME IN THE AMOUNT OF UPTAKE AND 4632 04:00:55,315 --> 04:00:58,218 THEY'RE ALL SEX DIFFERENCES IN 4633 04:00:58,218 --> 04:00:59,353 TSPO SO THEY'RE IMPORTANT TO 4634 04:00:59,353 --> 04:00:59,620 CONSIDER. 4635 04:00:59,620 --> 04:01:00,754 WHAT IS INTERESTING TO ME WHEN I 4636 04:01:00,754 --> 04:01:03,290 LOOKED AT ALL THE IMAGES WE'VE 4637 04:01:03,290 --> 04:01:05,059 ACQUIRED SO FAR IS WE KEPT 4638 04:01:05,059 --> 04:01:06,360 SEEING THE SIGNAL OUTSIDE THE 4639 04:01:06,360 --> 04:01:09,797 BRAIN. 4640 04:01:09,797 --> 04:01:12,433 IT'S THE CAROTID GLANDS. 4641 04:01:12,433 --> 04:01:14,635 THE SALIVARY GLANDS AND FOUND 4642 04:01:14,635 --> 04:01:20,441 THERE'S AN INCREASED NUMBER OF 4643 04:01:20,441 --> 04:01:26,246 CELLS THAT ARE IN THE SALIVARY 4644 04:01:26,246 --> 04:01:26,613 GLANDS. 4645 04:01:26,613 --> 04:01:28,649 AND WE'RE PROBABLY SEEING THEM 4646 04:01:28,649 --> 04:01:30,017 HERE WHICH IS VERY INTERESTING 4647 04:01:30,017 --> 04:01:33,554 AND I THOUGHT WHAT ELSE ARE WE 4648 04:01:33,554 --> 04:01:33,854 MISSING? 4649 04:01:33,854 --> 04:01:36,190 SO I WANTED TO AT THAT POINT SEE 4650 04:01:36,190 --> 04:01:38,859 IF WE COULD DO A WHOLE BODY SCAN 4651 04:01:38,859 --> 04:01:44,665 AND BECAUSE IT'S A CARBON 11 4652 04:01:44,665 --> 04:01:46,233 TRACER PEOPLE LAUGHED AT ME 4653 04:01:46,233 --> 04:01:48,769 THEY'RE LIKE YOU'RE GOING TO DO 4654 04:01:48,769 --> 04:01:50,404 A WHOLE BODY SCAN? 4655 04:01:50,404 --> 04:01:53,807 WE DON'T HAVE A WHOLE BODY 4656 04:01:53,807 --> 04:01:55,309 SCANNER AT STANFORD THEY'RE JUST 4657 04:01:55,309 --> 04:01:56,910 COMING ONLINE AND I THOUGHT WE 4658 04:01:56,910 --> 04:01:58,779 CAN TRY AND SEE WHAT WE CAN SEE. 4659 04:01:58,779 --> 04:02:04,918 SOMEONE HAS BEEN INJECTED WITH A 4660 04:02:04,918 --> 04:02:06,153 RADIO TRACER IT'S THROUGHOUT THE 4661 04:02:06,153 --> 04:02:08,756 BODY SO WHY NOT TRY TO CAPTURE 4662 04:02:08,756 --> 04:02:09,223 THE INFORMATION. 4663 04:02:09,223 --> 04:02:10,424 I JUMPED IN THE SCANNER. 4664 04:02:10,424 --> 04:02:12,459 THIS IS ME. 4665 04:02:12,459 --> 04:02:14,528 I THOUGHT I SHOULD TRY IT FIRST 4666 04:02:14,528 --> 04:02:16,663 AND MAKE SURE IT'S WORTH DOING 4667 04:02:16,663 --> 04:02:18,265 BEFORE PUTTING A PATIENT THROUGH 4668 04:02:18,265 --> 04:02:19,967 IT AND IT WAS GOOD TO UNDERSTAND 4669 04:02:19,967 --> 04:02:22,402 WHAT WE'RE ASKING PATIENTS TO DO 4670 04:02:22,402 --> 04:02:24,772 PEOPLE WITH ME/CFS HAVE LIGHT 4671 04:02:24,772 --> 04:02:26,140 AND SOUND SENSITIVITY SO WE'VE 4672 04:02:26,140 --> 04:02:27,174 TRIED TO DECREASE ALL THOSE 4673 04:02:27,174 --> 04:02:32,579 THINGS TO MAKE IT MORE 4674 04:02:32,579 --> 04:02:32,980 COMFORTABLE. 4675 04:02:32,980 --> 04:02:39,219 SO THESE ARE THE WHOLE BODY PET 4676 04:02:39,219 --> 04:02:40,621 MRI SCANS AND WE'RE SEEING 4677 04:02:40,621 --> 04:02:45,459 SIGNAL IN THE HEART AND LIVER 4678 04:02:45,459 --> 04:02:51,932 AND GUT. 4679 04:02:51,932 --> 04:02:54,234 AND WE STARTED WITH GREAT 4680 04:02:54,234 --> 04:02:58,372 FUNDING FROM NINDS TO DO WHOLE 4681 04:02:58,372 --> 04:03:03,877 BODY SCANS AND SEE VISUALLY FROM 4682 04:03:03,877 --> 04:03:10,617 THE SCANS YOU CAN SEE THE BONE 4683 04:03:10,617 --> 04:03:12,820 MARROW LIGHTING UP AND THE 4684 04:03:12,820 --> 04:03:13,253 MUSCLES. 4685 04:03:13,253 --> 04:03:14,721 THAT SURPRISED ME HOW MUCH THE 4686 04:03:14,721 --> 04:03:16,290 MUSCLES LIGHT UP COMPARED TO THE 4687 04:03:16,290 --> 04:03:26,033 QUIET MUSCLES IN THE CONTROL 4688 04:03:26,033 --> 04:03:28,101 THESE ARE ALL SEX AND GENOTYPED 4689 04:03:28,101 --> 04:03:28,402 MATCHED. 4690 04:03:28,402 --> 04:03:31,071 THE SCANNER IS PROBABLY NOT AS 4691 04:03:31,071 --> 04:03:32,406 GOOD BE BECAUSE OF THE CARBON 11 4692 04:03:32,406 --> 04:03:34,341 BUT WE'RE GETTING A MORE 4693 04:03:34,341 --> 04:03:36,210 SENSITIVE SCANNER SOON AND WE'LL 4694 04:03:36,210 --> 04:03:38,345 BE COLLECTING MORE IMAGES AND 4695 04:03:38,345 --> 04:03:41,515 SEEING MORE INSIGHT BUT THE SAME 4696 04:03:41,515 --> 04:03:43,083 PATTERN OF MUSCLE UPTAKE AND 4697 04:03:43,083 --> 04:03:51,358 BONE MARROW UPTAKE. 4698 04:03:51,358 --> 04:03:54,862 THE UPPER THIGH AND TRICEP IT 4699 04:03:54,862 --> 04:03:57,497 SEEMS THERE'S TWO SUBSETS HERE 4700 04:03:57,497 --> 04:03:59,399 AND IN THE SMALL COHORT WE HAVE 4701 04:03:59,399 --> 04:03:59,867 SO FAR. 4702 04:03:59,867 --> 04:04:03,503 TAKE IT WITH A GRAIN OF SALT. 4703 04:04:03,503 --> 04:04:09,109 WE'RE TRYING TO SHOW THE DATA. 4704 04:04:09,109 --> 04:04:19,820 WE'RE EXCITE D WE'RE NOT SEEING 4705 04:04:19,820 --> 04:04:21,288 IT IN THE THIGH SO FAR BUT 4706 04:04:21,288 --> 04:04:24,625 SEEING IT MORE IN THE TRICEP. 4707 04:04:24,625 --> 04:04:26,093 BONE MARROW. 4708 04:04:26,093 --> 04:04:28,629 THAT'S SOMETHING WE'RE SEEING IN 4709 04:04:28,629 --> 04:04:38,906 FEMALES SO FAR. 4710 04:04:39,840 --> 04:04:41,074 WE'LL BE ANALYZING EVERYTHING IN 4711 04:04:41,074 --> 04:04:42,542 MORE REGIONS SOON. 4712 04:04:42,542 --> 04:04:44,611 WE WANT TO LOOK AT SPLEEN AND 4713 04:04:44,611 --> 04:04:46,346 THE GUT AND LUNGS. 4714 04:04:46,346 --> 04:04:48,282 OTHER AREAS IF PEOPLE HAVE OTHER 4715 04:04:48,282 --> 04:04:51,018 THOUGHTS PLEASE LET ME KNOW AND 4716 04:04:51,018 --> 04:04:56,156 WE HAVE COLLABORATORS THAT WANT 4717 04:04:56,156 --> 04:04:56,924 TO USE MACHINE LEARNING AND A.I. 4718 04:04:56,924 --> 04:04:58,325 BECAUSE THERE'S THINGS WE COULD 4719 04:04:58,325 --> 04:04:59,026 BE MISSING. 4720 04:04:59,026 --> 04:05:01,395 WE WANT TO INCREASE OUR PATIENT 4721 04:05:01,395 --> 04:05:03,130 POPULATION BY A BUILT. 4722 04:05:03,130 --> 04:05:05,832 WE'RE UP TO SIX MATCHED PAYERS 4723 04:05:05,832 --> 04:05:11,672 AND HAVE THE SEVENTH ABOUT TO 4724 04:05:11,672 --> 04:05:19,146 HAPPEN IN JANUARY. 4725 04:05:19,146 --> 04:05:23,650 AND WE WANT TO EXTRACT 4726 04:05:23,650 --> 04:05:24,151 MEANINGFUL INFORMATION. 4727 04:05:24,151 --> 04:05:26,954 IN PARALLEL WE'RE LOOKING AT 4728 04:05:26,954 --> 04:05:29,022 MORE SPECIFIC BIOMARKERS OF 4729 04:05:29,022 --> 04:05:29,356 INFLAMMATION. 4730 04:05:29,356 --> 04:05:31,558 IT'S EXPRESSED IN OTHER CELL 4731 04:05:31,558 --> 04:05:34,061 TYPES AND WHAT HAS BEEN USEFUL 4732 04:05:34,061 --> 04:05:36,496 AND CONTINUES TO BE TREATFUL IN 4733 04:05:36,496 --> 04:05:37,331 SHEDDING LIGHT IN INFLAMMATION 4734 04:05:37,331 --> 04:05:39,366 THE SIGNAL MAY BE MURKY AT 4735 04:05:39,366 --> 04:05:39,700 TIMES. 4736 04:05:39,700 --> 04:05:41,501 IF WE WANT SOMETHING SENSITIVE 4737 04:05:41,501 --> 04:05:44,004 TO GIVE THE EARLIEST INDICATOR 4738 04:05:44,004 --> 04:05:45,505 IF SOMEBODY'S RESPONDING TO A 4739 04:05:45,505 --> 04:05:51,011 THERAPY OR NOT WE WANT SOMETHING 4740 04:05:51,011 --> 04:05:57,818 CLEAN. 4741 04:05:57,818 --> 04:06:00,454 AND WE'RE LOOKING AT THIS RIGHT 4742 04:06:00,454 --> 04:06:01,922 NOW AND GETTING INTERESTING 4743 04:06:01,922 --> 04:06:02,723 RESULTS. 4744 04:06:02,723 --> 04:06:05,158 THIS IS FROM THE LAB RNA SEQ 4745 04:06:05,158 --> 04:06:06,827 DATA SET IN HUMAN BRAIN AND YOU 4746 04:06:06,827 --> 04:06:08,929 CAN SEE BY LOOKING AT THE 4747 04:06:08,929 --> 04:06:10,664 DIFFERENT CELL TYPES AND THE 4748 04:06:10,664 --> 04:06:15,369 EXPRESSION OF TSPO IT DOES SEEM 4749 04:06:15,369 --> 04:06:17,170 TO BE MORE SPECIFIC FOR YOUR 4750 04:06:17,170 --> 04:06:22,542 MICROGLIA AND MACROPHAGES. 4751 04:06:22,542 --> 04:06:25,612 GPR84 IS UPREGULATED IN THE 4752 04:06:25,612 --> 04:06:29,583 CONTEXT OF MALADAPTIVE 4753 04:06:29,583 --> 04:06:33,186 INFLAMMATION AND WE TOOK 4754 04:06:33,186 --> 04:06:35,956 MACROPHAGES AND LOOKED AT THE 4755 04:06:35,956 --> 04:06:40,293 EXPRESSION OF GPR84 AFTER 4756 04:06:40,293 --> 04:06:44,598 STIMULATING THE CELLS WITH LPS 4757 04:06:44,598 --> 04:06:48,802 AND WE SAW THE TSPO DOESN'T GET 4758 04:06:48,802 --> 04:06:50,303 UPREGULATED AND THAT'S WHAT 4759 04:06:50,303 --> 04:06:53,407 PEOPLE HAVE SEEN WITH THE PET 4760 04:06:53,407 --> 04:06:56,543 SCANS AND OTHER TESTS DOING ON 4761 04:06:56,543 --> 04:07:01,281 TSPO IS THE NUMBER OF RECEPTORS 4762 04:07:01,281 --> 04:07:03,984 DON'T GO UPPER CELLS. 4763 04:07:03,984 --> 04:07:07,054 THERE'S MORE CELLS EXPRESSING 4764 04:07:07,054 --> 04:07:09,423 TSPO AND HERE THE NUMBER OF GPR 4765 04:07:09,423 --> 04:07:12,192 RECEPTORS GO UPPER CELL AND 4766 04:07:12,192 --> 04:07:14,194 WOULD BE MORE CELLS EXPRESSING 4767 04:07:14,194 --> 04:07:14,828 GPR84. 4768 04:07:14,828 --> 04:07:16,363 THAT'S EXCITING BECAUSE WE MAY 4769 04:07:16,363 --> 04:07:16,863 GET A BETTER SIGNAL TO 4770 04:07:16,863 --> 04:07:27,074 BACKGROUND. 4771 04:07:33,914 --> 04:07:36,216 WE'VE MADE TWO TRACERS COMPARING 4772 04:07:36,216 --> 04:07:37,317 THEM. 4773 04:07:37,317 --> 04:07:38,752 SO WE'VE DONE A LOT OF CELL 4774 04:07:38,752 --> 04:07:42,422 BINDING STUDIES USING CELLS THAT 4775 04:07:42,422 --> 04:07:51,731 EXPRESS HUMAN GPR84 AND GET GOOD 4776 04:07:51,731 --> 04:08:01,875 BINDING. 4777 04:08:06,580 --> 04:08:08,515 THIS GETS WASHED OUT AND 24 4778 04:08:08,515 --> 04:08:11,118 HOURS LATER WE DO IMAGING AND 4779 04:08:11,118 --> 04:08:15,922 SCORE THE MICE IN TERMS OF THEIR 4780 04:08:15,922 --> 04:08:18,859 SEVERITY AND SEPSIS SYMPTOMS AND 4781 04:08:18,859 --> 04:08:20,760 SEE HIGHER UPTAKE COMPARED TO 4782 04:08:20,760 --> 04:08:22,362 THE CONTROLS AND SEVERE SEPTIC 4783 04:08:22,362 --> 04:08:25,532 MICE WE SEE MORE UPTAKE. 4784 04:08:25,532 --> 04:08:27,901 IT SEEMS TO CORRELATE AND 4785 04:08:27,901 --> 04:08:29,536 CORRESPOND TO DISEASE SEVERITY 4786 04:08:29,536 --> 04:08:31,338 OR INFLAMMATION SEVERITY. 4787 04:08:31,338 --> 04:08:34,674 THEN WE CONFIRM SPECIFICITY BY 4788 04:08:34,674 --> 04:08:42,849 DOING ORDER RADRADIOGRAPHY AND S 4789 04:08:42,849 --> 04:08:45,919 CORRESPONDS WITH THE LITERATURE 4790 04:08:45,919 --> 04:08:52,225 WITH RNA LOOKING AT GPR84 IN THE 4791 04:08:52,225 --> 04:09:02,435 MOUSE MODEL. 4792 04:09:02,836 --> 04:09:04,271 AND LOOKING TO DETECT 4793 04:09:04,271 --> 04:09:06,373 UPREGULATION AND I'M SHOWING 4794 04:09:06,373 --> 04:09:14,080 WITH THE TRAITORS WE'RE DETECT 4795 04:09:14,080 --> 04:09:16,449 ING A NINE-FOLD INCREASE IN THE 4796 04:09:16,449 --> 04:09:17,817 HUMAN DERIVED MACROPHAGES AND 4797 04:09:17,817 --> 04:09:20,053 WE'RE ABLE TO BLOCK THE SNAM 4798 04:09:20,053 --> 04:09:30,463 OVER 50% WHICH IS GREAT. 4799 04:09:41,141 --> 04:09:44,945 IT CAN BEING QUICKER THAN A 4800 04:09:44,945 --> 04:09:46,680 THERAPEUTIC BECAUSE THE BARRIER 4801 04:09:46,680 --> 04:09:48,348 TO GET THE APPROVAL IS LOWER 4802 04:09:48,348 --> 04:09:50,217 BECAUSE YOU'RE ONLY INJECTING A 4803 04:09:50,217 --> 04:09:54,354 VERY LOW AMOUNT THAT SHOULD NOT 4804 04:09:54,354 --> 04:09:58,625 BE PHARMACO LOGICALLY ACTIVE. 4805 04:09:58,625 --> 04:10:01,328 AND WE'LL COMPARE TRACES IN 4806 04:10:01,328 --> 04:10:04,931 NON-HUMAN PRIMATES AND CELLS AN 4807 04:10:04,931 --> 04:10:05,365 TISSUE. 4808 04:10:05,365 --> 04:10:07,901 IF ANYONE HAS ANY TISSUE SAMPLES 4809 04:10:07,901 --> 04:10:09,936 FROM ME/CFS WHETHER MUSCLE OR 4810 04:10:09,936 --> 04:10:12,005 BRIN OR ANYTHING, WOULD LOVE TO 4811 04:10:12,005 --> 04:10:14,407 COLLABORATE AND SEE IF WE COULD 4812 04:10:14,407 --> 04:10:16,409 TEST OUR NEW PET TRACERS TO SEE 4813 04:10:16,409 --> 04:10:17,911 IF THEY'LL BE ABLE TO 4814 04:10:17,911 --> 04:10:18,578 DIFFERENTIATE BETWEEN ME/CFS AND 4815 04:10:18,578 --> 04:10:28,722 CONTROL. 4816 04:10:35,362 --> 04:10:42,335 I WANTED TO HIGHLIGHT TWO OTHER 4817 04:10:42,335 --> 04:10:48,742 MARKERS AND PET TRACE ERS AND W 4818 04:10:48,742 --> 04:10:53,513 MADE AN ANTIBODY BASED PET 4819 04:10:53,513 --> 04:10:53,813 TRACER. 4820 04:10:53,813 --> 04:10:56,283 AND THE ANTIBODY HAS BEEN 4821 04:10:56,283 --> 04:10:56,516 AMAZING. 4822 04:10:56,516 --> 04:10:59,185 IT'S CHANGED MY MIND ABOUT 4823 04:10:59,185 --> 04:11:00,287 ANTIBODY IMAGING ACTUALLY. 4824 04:11:00,287 --> 04:11:10,830 YOU'LL SEE FROM THE IMAGES THAT 4825 04:11:15,368 --> 04:11:17,270 YOU CAN SEE THE LOW SIGNAL. 4826 04:11:17,270 --> 04:11:18,872 JUST THE RED SIGNAL IN THE HEART 4827 04:11:18,872 --> 04:11:24,110 AND DESCENDING AORTA IS 4828 04:11:24,110 --> 04:11:25,845 INDICATIVE OF WHERE AN ANTIBODY 4829 04:11:25,845 --> 04:11:28,415 WOULD GO AND HANGING OUT IN THE 4830 04:11:28,415 --> 04:11:32,886 BLOOD POOL AND YOU MOVE TO THE 4831 04:11:32,886 --> 04:11:33,219 PRE-E.A. 4832 04:11:33,219 --> 04:11:36,323 THE MICE LOOK NORMAL AND WALKING 4833 04:11:36,323 --> 04:11:38,358 AROUND THE CAGE AND COATS ARE 4834 04:11:38,358 --> 04:11:40,560 SHINY BUT THEY'RE ABOUT TO GET 4835 04:11:40,560 --> 04:11:40,760 SICK. 4836 04:11:40,760 --> 04:11:42,329 THEIR PET SCAN WOULD KNOW THAT 4837 04:11:42,329 --> 04:11:44,831 BECAUSE YOU CAN SEE THE SPLEEN 4838 04:11:44,831 --> 04:11:47,500 IS LIGHTING UP AND BONE MARROW 4839 04:11:47,500 --> 04:11:49,369 AND LUMBAR SPINAL CORD LIGHTING. 4840 04:11:49,369 --> 04:11:49,502 . 4841 04:11:49,502 --> 04:11:52,706 VERY CLEAR AND THE REGION WHERE 4842 04:11:52,706 --> 04:11:56,076 WE INDUCE INFLAMMATION IN THE 4843 04:11:56,076 --> 04:11:56,276 CHEST. 4844 04:11:56,276 --> 04:11:59,579 THAT IS CLEAR AND AS THE MICE 4845 04:11:59,579 --> 04:12:02,182 BECOME PARALYZED THEY GET 4846 04:12:02,182 --> 04:12:03,583 PARALYSIS IT'S AWFUL. 4847 04:12:03,583 --> 04:12:06,419 WE DO SEE THAT SIGNAL CREEPING 4848 04:12:06,419 --> 04:12:08,955 UP THE SPINAL CORD AND REALLY 4849 04:12:08,955 --> 04:12:11,691 PLOGE OUT IN THE BONE MARROW AND 4850 04:12:11,691 --> 04:12:15,195 SPLEEN AND SEE THE PERIPHERAL 4851 04:12:15,195 --> 04:12:17,664 CELLS THE MACROPHAGES AND SEE 4852 04:12:17,664 --> 04:12:18,898 THEM TRAFFICKING IN THE SPINAL 4853 04:12:18,898 --> 04:12:21,201 CORD AND UP TOWARDS THE BRAIN. 4854 04:12:21,201 --> 04:12:23,636 IF YOU COMPARE THAT WITH A PET 4855 04:12:23,636 --> 04:12:25,372 OF THE SAME MICE BELOW YOU CAN'T 4856 04:12:25,372 --> 04:12:27,841 REALLY TELL WHAT'S GOING ON WITH 4857 04:12:27,841 --> 04:12:32,612 THE TSPO BECAUSE THERE'S TSPO 4858 04:12:32,612 --> 04:12:34,948 EXPRESSED THROUGHOUT THE BODY 4859 04:12:34,948 --> 04:12:37,717 AND OBSCURES OUR ABILITY TO GET 4860 04:12:37,717 --> 04:12:40,553 THE SPINAL CORD AND LOOK AT 4861 04:12:40,553 --> 04:12:42,655 REMITTING EAA AND YOU'RE LOOKING 4862 04:12:42,655 --> 04:12:46,359 AT THE SPINAL CORD AND NAIVE 4863 04:12:46,359 --> 04:12:47,660 SIGNAL IN THE SPINAL CORD AND 4864 04:12:47,660 --> 04:12:49,596 FIRST WAVE OF DISEASE YOU SEE 4865 04:12:49,596 --> 04:12:50,363 THE SIGNAL LIGHT UP IN THE 4866 04:12:50,363 --> 04:12:52,565 SPINAL CORD. 4867 04:12:52,565 --> 04:12:53,833 REMISSION, THAT SIGNAL GOES WAY. 4868 04:12:53,833 --> 04:12:55,935 THE RELAPSE, THE SIGNAL COMES 4869 04:12:55,935 --> 04:13:01,074 BACK AND BELOW YOU SEE WE'VE 4870 04:13:01,074 --> 04:13:02,642 TAKEN NO SIGNAL IN THE SPINAL 4871 04:13:02,642 --> 04:13:04,711 CORD OR REMISSION AND TRACKS 4872 04:13:04,711 --> 04:13:15,088 WITH DISEASE SEVERITY. 4873 04:13:17,157 --> 04:13:19,025 THIS IS THE SITUATION WHERE WE 4874 04:13:19,025 --> 04:13:22,128 ARE LOOKING AT ALL EAE MICE 4875 04:13:22,128 --> 04:13:22,695 BEFORE THERAPY. 4876 04:13:22,695 --> 04:13:25,532 THE ONE IN THE MIDDLE AND SEE 4877 04:13:25,532 --> 04:13:26,800 THE SIGNAL IN THE SPINAL CORD 4878 04:13:26,800 --> 04:13:34,340 AND KNEE WITH THE BONE MARROW 4879 04:13:34,340 --> 04:13:37,444 AND THEN WE TREAT THEM WHICH 4880 04:13:37,444 --> 04:13:40,680 STOPS THE IMMUNE CELLS FROM 4881 04:13:40,680 --> 04:13:42,348 LEAVING THE SPLEEN AND LYMPH 4882 04:13:42,348 --> 04:13:43,650 NODES AND SEE THE SIGNAL 4883 04:13:43,650 --> 04:13:47,754 DISAPPEAR. 4884 04:13:47,754 --> 04:13:50,957 THIS IS REALLY CLEAR RESPONSE AT 4885 04:13:50,957 --> 04:13:54,861 THE MOLECULAR LEVEL A WEEK AFTER 4886 04:13:54,861 --> 04:13:57,197 GIVING THE DRUG HOPE WE CAN DO 4887 04:13:57,197 --> 04:13:57,997 SOMETHING LIKE THIS IN A 4888 04:13:57,997 --> 04:13:58,465 CLINICAL TRIAL. 4889 04:13:58,465 --> 04:14:01,835 WE ALSO LOOK AT HUMAN TISSUE. 4890 04:14:01,835 --> 04:14:07,540 WE WORK WITH THE PATHOLOGY 4891 04:14:07,540 --> 04:14:15,582 DEPARTMENT CLOSELY AT STANFORD. 4892 04:14:15,582 --> 04:14:17,617 THESE WERE LESIONS FRESH LESIONS 4893 04:14:17,617 --> 04:14:19,786 AND TREATMENT NAIVE, HARD TO 4894 04:14:19,786 --> 04:14:24,157 COME BY THAT KIND OF TISSUE AND 4895 04:14:24,157 --> 04:14:25,892 WE SHOWED TERM ONE IN THE BOTTOM 4896 04:14:25,892 --> 04:14:27,994 RIGHT IN THE BROWN STRAINING IS 4897 04:14:27,994 --> 04:14:28,795 HIGHLY EXPRESSED. 4898 04:14:28,795 --> 04:14:30,363 THERE'S TERM 1 POSITIVE CELLS IN 4899 04:14:30,363 --> 04:14:32,031 THE LESIONS COMPARED TO THE 4900 04:14:32,031 --> 04:14:37,937 IMAGE ABOVE WHICH IS A NON-MS 4901 04:14:37,937 --> 04:14:38,605 REGION OF THE BRAIN. 4902 04:14:38,605 --> 04:14:40,306 IT'S NOT JUST A GOOD BIOMARKER 4903 04:14:40,306 --> 04:14:41,374 FOR MICE BUT SEEMS TO BE 4904 04:14:41,374 --> 04:14:41,908 RELEVANT IN THE CLINICAL 4905 04:14:41,908 --> 04:14:46,713 SETTING. 4906 04:14:46,713 --> 04:14:48,882 LASTLY I WANTED TO HIGHLIGHT THE 4907 04:14:48,882 --> 04:14:50,483 B CELL IMAGING WORK WE'VE BEEN 4908 04:14:50,483 --> 04:14:51,150 DOING. 4909 04:14:51,150 --> 04:14:54,754 THIS IS SIMILAR WHERE WE'RE 4910 04:14:54,754 --> 04:14:58,324 DOING IT IN AN MS AND EA MODEL 4911 04:14:58,324 --> 04:15:00,126 AND WOULD LOVE TO TRY THIS IF WE 4912 04:15:00,126 --> 04:15:01,895 HAVE MOUSE MODEL FOR ME/CFS. 4913 04:15:01,895 --> 04:15:03,830 I KNOW THAT'S A QUESTION BEING 4914 04:15:03,830 --> 04:15:04,464 RAISED A LOT. 4915 04:15:04,464 --> 04:15:07,367 ULTIMATELY YOU CAN MOVE TO THE 4916 04:15:07,367 --> 04:15:08,101 CLINIC QUICKLY. 4917 04:15:08,101 --> 04:15:09,969 HOPEFULLY WE CAN DO THAT. 4918 04:15:09,969 --> 04:15:13,806 HERE WE'RE USING AN ANTI-B CELL 4919 04:15:13,806 --> 04:15:14,173 THERAPY. 4920 04:15:14,173 --> 04:15:22,215 I KNOW JARRED MENTIONED 4921 04:15:22,215 --> 04:15:24,017 RETOXIMAB AND THIS IS A 4922 04:15:24,017 --> 04:15:27,554 TREATMENT AND UNTREATED MOUSE 4923 04:15:27,554 --> 04:15:31,291 AND YOU CAN SEE HERE THE CLASSIC 4924 04:15:31,291 --> 04:15:36,029 B CELL RESERVOIRS AND THE SPLEEN 4925 04:15:36,029 --> 04:15:37,363 IS HIGH SIGNAL. 4926 04:15:37,363 --> 04:15:39,732 HAVE YOU LYMPH NODES AND BONE 4927 04:15:39,732 --> 04:15:40,533 MARROW. 4928 04:15:40,533 --> 04:15:41,968 ALL LIGHTING UP WHERE YOU WOULD 4929 04:15:41,968 --> 04:15:43,169 THINK THERE'S B CELLS. 4930 04:15:43,169 --> 04:15:53,680 WE TREATED A SET OF MICE YOU 4931 04:15:54,414 --> 04:16:00,086 THINK BRAIN SIGNAL IS GONE AND 4932 04:16:00,086 --> 04:16:01,955 LYMPH NODES THIS MOUSE MUST BE 4933 04:16:01,955 --> 04:16:02,855 BETTER. 4934 04:16:02,855 --> 04:16:03,890 UNFORTUNATELY THEY'RE ALL STILL 4935 04:16:03,890 --> 04:16:04,157 PARALYZED. 4936 04:16:04,157 --> 04:16:06,659 THEY WERE NOT BETTER AND WE 4937 04:16:06,659 --> 04:16:08,161 COULD NOT REPRODUCE THE 4938 04:16:08,161 --> 04:16:08,461 LITERATURE. 4939 04:16:08,461 --> 04:16:14,334 PEOPLE SAID THE TREATMENTS HAVE 4940 04:16:14,334 --> 04:16:16,736 WORKED I TOLD MY GRAD STUDENT 4941 04:16:16,736 --> 04:16:18,771 LET'S NOT GET PERTURBED BUT HAVE 4942 04:16:18,771 --> 04:16:22,342 A LOOK CLOSER AT WHAT MIGHT BE 4943 04:16:22,342 --> 04:16:32,518 GOING ON. 4944 04:16:35,722 --> 04:16:38,057 I SAID LET'S HAVE A LOOK AT THE 4945 04:16:38,057 --> 04:16:38,458 FLOOR. 4946 04:16:38,458 --> 04:16:40,760 SO SPLEEN WERE DEPLETED THE B 4947 04:16:40,760 --> 04:16:42,128 CELLS COMPLETELY. 4948 04:16:42,128 --> 04:16:43,329 THEY'RE GONE. 4949 04:16:43,329 --> 04:16:46,099 BUT IF WE LOOK AT THE BRAIN AND 4950 04:16:46,099 --> 04:16:51,938 SPINAL CORD WE SEE INDEED THERE 4951 04:16:51,938 --> 04:16:54,807 ARE CD POSITIVE B CELLS AND HAVE 4952 04:16:54,807 --> 04:16:58,811 BEEN AS EFFECTIVE IN AT LEE 4953 04:16:58,811 --> 04:17:00,647 ELIMINATING THOSE IN THE AREAS 4954 04:17:00,647 --> 04:17:02,281 WHICH WE HAVEN'T BEEN ABLE TO 4955 04:17:02,281 --> 04:17:03,383 SEE IN THE LIVING SUBJECT. 4956 04:17:03,383 --> 04:17:07,720 THE STANDARD OF CARE IS TAKING 4957 04:17:07,720 --> 04:17:08,721 BLOOD MEASUREMENTS BUT WHAT 4958 04:17:08,721 --> 04:17:09,555 ABOUT IN THE BRAIN AND SPINAL 4959 04:17:09,555 --> 04:17:09,756 CORD? 4960 04:17:09,756 --> 04:17:11,491 WE DON'T HAVE A WAY TO LOOK AT 4961 04:17:11,491 --> 04:17:12,959 THAT AND HOPING THE PET 4962 04:17:12,959 --> 04:17:13,926 STRATEGIES COULD PROVIDE A 4963 04:17:13,926 --> 04:17:14,327 MEANS. 4964 04:17:14,327 --> 04:17:16,796 THIS IS STAINING SHOWING WE'RE 4965 04:17:16,796 --> 04:17:20,800 PRETTY GOOD AT DEPLETING B CELLS 4966 04:17:20,800 --> 04:17:24,671 IN THE MENINGES. 4967 04:17:24,671 --> 04:17:30,376 AND THERE'S STILL SOME IN THE 4968 04:17:30,376 --> 04:17:32,879 PARENCHYMAL AND IT CAN PERMIT 4969 04:17:32,879 --> 04:17:34,781 INNATE ACTIVATION IN THE WHOLE 4970 04:17:34,781 --> 04:17:36,983 BODY OF ME/CFS. 4971 04:17:36,983 --> 04:17:38,251 WE'RE IN THE EARLY STAGES AND 4972 04:17:38,251 --> 04:17:41,154 WHAT WE'RE SEEING IS QUITE 4973 04:17:41,154 --> 04:17:42,355 ENCOURAGING BECAUSE WHERE IT'S 4974 04:17:42,355 --> 04:17:44,824 SEEING AREAS WE DIDN'T KNOW 4975 04:17:44,824 --> 04:17:46,359 BEFORE WE ARE LIGHTING UP WITH 4976 04:17:46,359 --> 04:17:49,495 THE ACTIVATED MACROPHAGES. 4977 04:17:49,495 --> 04:17:53,800 SO THAT IS STAGING FOR THAT AND 4978 04:17:53,800 --> 04:17:55,468 HOPEFULLY WE'LL HAVE MORE TO 4979 04:17:55,468 --> 04:17:56,569 REPORT NEXT YEAR AND IF YOU WANT 4980 04:17:56,569 --> 04:17:58,805 TO ENROLL IN THE STUDY CONTACT 4981 04:17:58,805 --> 04:17:58,971 ME. 4982 04:17:58,971 --> 04:18:01,674 WE'RE ALSO INTERESTED AND 4983 04:18:01,674 --> 04:18:03,576 MOTIVATED BY OUR NEW PET TRACERS 4984 04:18:03,576 --> 04:18:05,311 AND THE SPECIFICITY AND 4985 04:18:05,311 --> 04:18:07,013 SELECTIVITY WE MAY BE ABLE TO 4986 04:18:07,013 --> 04:18:08,648 GET THE SIGNAL TO NOISE THAT MAY 4987 04:18:08,648 --> 04:18:09,882 BE BETTER THAN WHAT WE CURRENTLY 4988 04:18:09,882 --> 04:18:10,383 DO. 4989 04:18:10,383 --> 04:18:15,822 WE'RE ABOUT TO TRANSLATE THOSE 4990 04:18:15,822 --> 04:18:20,893 NEXT YEAR. 4991 04:18:20,893 --> 04:18:22,862 AND THESE ALL COULD BE EXPLORED 4992 04:18:22,862 --> 04:18:27,033 IN THE CONTEXT OF ME/CFS 4993 04:18:27,033 --> 04:18:27,333 ULTIMATELY. 4994 04:18:27,333 --> 04:18:28,167 WE'RE CONTINUING OUR WORK. 4995 04:18:28,167 --> 04:18:29,769 ONE QUESTION I WOULD LOVE TO ASK 4996 04:18:29,769 --> 04:18:34,807 THE COMMUNITY AND LOVE TO SPEAK 4997 04:18:34,807 --> 04:18:37,276 TO PEOPLE ON NEW SPECIFIC 4998 04:18:37,276 --> 04:18:40,980 TARGETS WE COULD MAKE PET 4999 04:18:40,980 --> 04:18:44,283 TRACERS FOR IMMUNE TARGETS 5000 04:18:44,283 --> 04:18:45,785 COMING OUT IN THE PROTEOMIC DATA 5001 04:18:45,785 --> 04:18:47,153 SETS AND I'M HERE AND WILLING. 5002 04:18:47,153 --> 04:18:48,755 WOULD LOVE TO TALK WITH YOU ALL 5003 04:18:48,755 --> 04:18:51,357 ABOUT OTHER TARGETS THAT MAY BE 5004 04:18:51,357 --> 04:18:52,258 MORE SPECIFIC FOR ME/CFS. 5005 04:18:52,258 --> 04:18:54,360 I WANT TO END WITH MY 5006 04:18:54,360 --> 04:18:58,431 ACKNOWLEDG 5007 04:18:58,431 --> 04:18:58,831 ACKNOWLEDGEMENTS. 5008 04:18:58,831 --> 04:19:04,804 HUGE SHOUT OUT TO MEGAN BELL WHO 5009 04:19:04,804 --> 04:19:08,074 TIRELESSLY WORKS ON RECRUITMENT 5010 04:19:08,074 --> 04:19:10,376 AND OTHERS WHO WORKED HARD ON 5011 04:19:10,376 --> 04:19:20,586 THE PROJECT. 5012 04:19:40,306 --> 04:19:42,375 MANY HAVE HELPED ADVICE AND 5013 04:19:42,375 --> 04:19:52,785 THANK YOU FOR LISTENING. 5014 04:20:05,031 --> 04:20:07,533 >> IF I CAN HAVE THE PANEL 5015 04:20:07,533 --> 04:20:09,569 MEMBERS COME UP WHILE MICHELLE 5016 04:20:09,569 --> 04:20:11,337 ANSWERS QUESTIONS, WE'LL DOUBLE 5017 04:20:11,337 --> 04:20:11,871 DIP HERE. 5018 04:20:11,871 --> 04:20:16,709 >> I WAS INTRIGUED BY THE FACT 5019 04:20:16,709 --> 04:20:20,913 HAVE YOU A HARDER TIME CLEARING 5020 04:20:20,913 --> 04:20:21,714 THE T CELLS IN THE TISSUES THAN 5021 04:20:21,714 --> 04:20:25,318 SPLEEN AND FITS WELL WITH THE 5022 04:20:25,318 --> 04:20:32,558 WORK" CD19 CAR OF ITs AND LUPUS 5023 04:20:32,558 --> 04:20:36,529 WHERE IT'S HAD AN INCREDIBLE 5024 04:20:36,529 --> 04:20:40,833 THAN THE ANTIBODY ITSELF 5025 04:20:40,833 --> 04:20:41,200 THERAPEUTICALLY. 5026 04:20:41,200 --> 04:20:42,935 IT MAY BE INTERESTING TO USE IN 5027 04:20:42,935 --> 04:20:50,309 THE CAR T WHICH I THINK WILL BE 5028 04:20:50,309 --> 04:20:52,311 WILDLY AVAILABLE ESPECIALLY FOR 5029 04:20:52,311 --> 04:20:52,511 MICE. 5030 04:20:52,511 --> 04:20:54,881 >> I AGREE AND WHAT WE'RE 5031 04:20:54,881 --> 04:21:02,288 LOOKING AT NEUROLOGICAL DISEASES 5032 04:21:02,288 --> 04:21:07,927 AND WE'RE MONITORING. 5033 04:21:07,927 --> 04:21:18,104 THANK YOU. 5034 04:21:27,146 --> 04:21:28,848 >> THANK YOU MICHELLE FOR 5035 04:21:28,848 --> 04:21:35,288 MULTITASKING TOO. 5036 04:21:35,288 --> 04:21:39,292 FOR THE LAST TWO SESSIONS OF THE 5037 04:21:39,292 --> 04:21:41,093 MEETING THE FINAL SESSION WILL 5038 04:21:41,093 --> 04:21:46,365 BE CLOSING THOUGHTS AND SUMMARY 5039 04:21:46,365 --> 04:21:48,134 FROM DR. KOMAROFF WHO OFFERED TO 5040 04:21:48,134 --> 04:21:49,702 DO THAT FOR US AN HAS DONE IT IN 5041 04:21:49,702 --> 04:21:50,937 THE PAST AND WE ALL LOOK FORWARD 5042 04:21:50,937 --> 04:21:51,604 TO THAT. 5043 04:21:51,604 --> 04:21:56,142 BEFORE WE GET TO TONY'S THOUGHTS 5044 04:21:56,142 --> 04:21:58,544 ABOUT CRYSTALLIZING WHAT HE SEES 5045 04:21:58,544 --> 04:22:00,780 AND SUMMARIZES I THOUGHT IT 5046 04:22:00,780 --> 04:22:02,381 WOULD BE GOOD TO GIVE OUR 5047 04:22:02,381 --> 04:22:04,250 SPEAKERS AT LEAST SOME OF OUR 5048 04:22:04,250 --> 04:22:07,586 SPEAKERS FROM TODAY A CHANCE TO 5049 04:22:07,586 --> 04:22:09,689 TALK ABOUT WHAT THEY'VE THOUGHT 5050 04:22:09,689 --> 04:22:11,457 ABOUT SINCE THE MEETING STARTED 5051 04:22:11,457 --> 04:22:16,796 AND WHAT HITS HOME KEEPING IN 5052 04:22:16,796 --> 04:22:20,399 MIND THAT AND PRESENT THE STATE 5053 04:22:20,399 --> 04:22:22,835 OF THE ART RESEARCH AND TRYING 5054 04:22:22,835 --> 04:22:24,637 TO HIGHLIGHT WHERE THAT'S 5055 04:22:24,637 --> 04:22:26,939 MATCHING TO PANEL WAYS THAT WE 5056 04:22:26,939 --> 04:22:29,375 BETTER UNDERSTAND AND CAN 5057 04:22:29,375 --> 04:22:31,277 POTENTIALLY BE MEASURED AS 5058 04:22:31,277 --> 04:22:35,514 BIOMARKERS AND EVEN MORE SO AS 5059 04:22:35,514 --> 04:22:37,616 TREATMENTS KNOWING IT'S A 5060 04:22:37,616 --> 04:22:38,351 SLIDING SCALE BUT WE'D BE 5061 04:22:38,351 --> 04:22:39,652 INTERESTED IN YOUR OPINIONS. 5062 04:22:39,652 --> 04:22:44,590 WE HEARD ABOUT ONGOING TRIALS 5063 04:22:44,590 --> 04:22:46,359 THAT AREN'T BE CURRENTLY 5064 04:22:46,359 --> 04:22:49,662 SUPPORTED BY NIH BUT BY OTHER 5065 04:22:49,662 --> 04:22:51,897 PARTNERS SOME HAVE COLLABORATED 5066 04:22:51,897 --> 04:22:53,566 WITH. 5067 04:22:53,566 --> 04:22:58,371 IT'D BE GREAT TO GET YOUR 5068 04:22:58,371 --> 04:22:58,637 THOUGHTS. 5069 04:22:58,637 --> 04:23:09,015 WE CAN START WITH YOU. 5070 04:23:21,794 --> 04:23:23,162 WE'RE LOOKING ACROSS DIFFERENT 5071 04:23:23,162 --> 04:23:24,797 SYMPTOMS AND SEEM TO BE 5072 04:23:24,797 --> 04:23:29,902 CONNECTED AND ANSWERS STARTING 5073 04:23:29,902 --> 04:23:34,840 TO COME FORWARD AND I WANT TO 5074 04:23:34,840 --> 04:23:36,275 SAY MAUREEN HAS CHALLENGED US 5075 04:23:36,275 --> 04:23:38,377 AND I THINK WE HAVE TO ANSWER 5076 04:23:38,377 --> 04:23:41,347 THAT CHALLENGE. 5077 04:23:41,347 --> 04:23:44,417 I THINK SHE'S MADE GOOD POINTS 5078 04:23:44,417 --> 04:23:54,927 AND THEY'RE ANSWERABLE POINTS. 5079 04:23:58,831 --> 04:24:08,908 I HAVE THE PERSPECTIVE OF BEING 5080 04:24:08,908 --> 04:24:11,377 OLD IN THE FIELD. 5081 04:24:11,377 --> 04:24:14,413 AND A GROUP FOUNDED MUSCLE 5082 04:24:14,413 --> 04:24:17,683 BIOPSY AND RETRACTED IT BECAUSE 5083 04:24:17,683 --> 04:24:18,651 THEY HADN'T. 5084 04:24:18,651 --> 04:24:21,821 ESTABLISHED THE CONTROL AND SOUR 5085 04:24:21,821 --> 04:24:22,721 THE FIELD. 5086 04:24:22,721 --> 04:24:25,891 IT WAS A VALID PATH TO GO DOWN. 5087 04:24:25,891 --> 04:24:28,928 I THOUGHT A SINGLE GROUP'S 5088 04:24:28,928 --> 04:24:32,565 EXPERIENCE AND THAT IS ECHOED IN 5089 04:24:32,565 --> 04:24:35,134 THE FIELD FAR TOO OFTEN. 5090 04:24:35,134 --> 04:24:37,136 JARRED CONVERSATION ABOUT THE 5091 04:24:37,136 --> 04:24:40,306 LVN PAPER THAT CONTRADICTS HIS 5092 04:24:40,306 --> 04:24:42,141 OWN PREMISES IN THE EARLIER 5093 04:24:42,141 --> 04:24:43,476 PAPERS IS JUST THE POINT THAT 5094 04:24:43,476 --> 04:24:45,678 HAS TO BE MADE. 5095 04:24:45,678 --> 04:24:47,980 THERE ARE SOME VERY UNDERPOWERED 5096 04:24:47,980 --> 04:24:50,983 STUDIES THAT HAVE DRIVEN OUR 5097 04:24:50,983 --> 04:24:54,353 BELIEFS ABOUT WHAT'S GOING ON. 5098 04:24:54,353 --> 04:24:55,955 FINALLY IN THE LAST CENTERS AND 5099 04:24:55,955 --> 04:24:59,992 WITH GROUP COMING IN AND THE 5100 04:24:59,992 --> 04:25:01,627 LONG COVID FOCUS WELL POWER ED 5101 04:25:01,627 --> 04:25:05,531 STUDIES ARE COMING OUT THAT ARE 5102 04:25:05,531 --> 04:25:06,765 KNOCKING THE COBWEBS OUT OF THE 5103 04:25:06,765 --> 04:25:07,933 WAYS WE'VE BEEN THINKING AND 5104 04:25:07,933 --> 04:25:10,369 IT'S TIME TO STAND UP AND PAY 5105 04:25:10,369 --> 04:25:20,880 ATTENTION TO THESE DATA SETS. 5106 04:25:24,950 --> 04:25:28,154 >> I LOVE HOW COLLABORATIVE 5107 04:25:28,154 --> 04:25:29,421 EVERYONE IS IN THE FIELD. 5108 04:25:29,421 --> 04:25:32,191 IT'S WELCOMING AND I'VE ENJOYED 5109 04:25:32,191 --> 04:25:34,560 THE TALKED AND IT FIELD LIKE 5110 04:25:34,560 --> 04:25:39,565 WE'RE PRIMED AND IN AN ABOUT WAY 5111 04:25:39,565 --> 04:25:40,900 TO PUSH FORWARD MULTIPLE AREAS. 5112 04:25:40,900 --> 04:25:46,839 I WAS ASKED TO GIVE A WEBINAR 5113 04:25:46,839 --> 04:25:48,941 THE OTHER DAY AND WANTED TO 5114 04:25:48,941 --> 04:25:52,811 CAPTURE EVERYTHING AND SURPRISED 5115 04:25:52,811 --> 04:25:55,414 THERE WAS ONLY TWO PET IMAGING 5116 04:25:55,414 --> 04:25:56,949 STUDIES PUBLISHED FOR MECHGS AND 5117 04:25:56,949 --> 04:25:58,384 THAT STRUCK ME AS A WIDE OPEN 5118 04:25:58,384 --> 04:26:00,152 SPACE AND IT'S NICE TO SEE OTHER 5119 04:26:00,152 --> 04:26:02,221 GROUPS HERE PRESENTING. 5120 04:26:02,221 --> 04:26:03,689 JARRED IN THE MGH GROUP. 5121 04:26:03,689 --> 04:26:06,358 IT'S ONE AREA WHERE I THINK WE 5122 04:26:06,358 --> 04:26:08,327 CAN START TO SHED LIGHT. 5123 04:26:08,327 --> 04:26:10,863 OBVIOUSLY I'M BIASSED BUT IT'S 5124 04:26:10,863 --> 04:26:12,631 ASTOUNDING WE HAVEN'T DONE AS 5125 04:26:12,631 --> 04:26:14,099 MANY IMAGING STUDIES NOT JUST 5126 04:26:14,099 --> 04:26:16,168 PET BUT OTHER ONES TO REALLY 5127 04:26:16,168 --> 04:26:22,441 HELP SHED INSIGHTS ON MULTIPLE 5128 04:26:22,441 --> 04:26:32,585 LEVELS. 5129 04:26:40,092 --> 04:26:43,462 I'D LIKE TO LEARN WHAT WE CAN 5130 04:26:43,462 --> 04:26:44,697 DRAW INFORMATION COMING AT THE 5131 04:26:44,697 --> 04:26:45,998 SAME PROBLEM FROM DIFFERENT WAYS 5132 04:26:45,998 --> 04:26:56,542 I THINK THERE'S A QUESTION HERE. 5133 04:27:06,785 --> 04:27:15,060 MY LAB IS MAKE MOUSE MODEL ON 5134 04:27:15,060 --> 04:27:16,862 POST-EXERTIONAL MALAISE AND WE 5135 04:27:16,862 --> 04:27:26,372 HAVE AN OPPORTUNITY TO DO THE 5136 04:27:26,372 --> 04:27:28,474 HISTO LOGICAL ANALYSIS IN THE 5137 04:27:28,474 --> 04:27:34,213 MICE AND WE HAVE A COUPLE 5138 04:27:34,213 --> 04:27:44,690 FINDING IN THE MODEL SHOW A 5139 04:27:51,363 --> 04:27:51,730 PATHOLOGY. 5140 04:27:51,730 --> 04:27:55,634 WHEN WE DO SOME MUSCLE HISTO 5141 04:27:55,634 --> 04:28:02,374 LOGIC WE DIDN'T SEE ANY T CELL 5142 04:28:02,374 --> 04:28:05,411 INFILTRATION NEITHER CD4 NOR CD 5143 04:28:05,411 --> 04:28:09,615 8 T CELLS BUT ONLY MACRO PHAGE 5144 04:28:09,615 --> 04:28:12,751 ACTIVATION AND THEY HAVE A 5145 04:28:12,751 --> 04:28:13,419 PHENOTYPE. 5146 04:28:13,419 --> 04:28:23,896 THEY EXPRESS A LOT OF CD40. 5147 04:28:33,505 --> 04:28:40,846 MOST HAVE AN ENLARGED SPLEEN 5148 04:28:40,846 --> 04:28:46,785 ALMOST TWICE THE SIZE AS REGULAR 5149 04:28:46,785 --> 04:28:47,853 WILD TYPE MOUSE. 5150 04:28:47,853 --> 04:28:49,421 >> MAYBE YOU GUYS CAN TALK ABOUT 5151 04:28:49,421 --> 04:28:51,256 THIS OFFLINE. 5152 04:28:51,256 --> 04:28:56,795 >> WE CAN TALK MORE. 5153 04:28:56,795 --> 04:28:58,230 >> I FOUND YOUR PRESENTATION 5154 04:28:58,230 --> 04:29:01,533 VERY INTERESTING AND ALIGNS WITH 5155 04:29:01,533 --> 04:29:03,035 MY FINDINGS. 5156 04:29:03,035 --> 04:29:03,602 >> GREAT. 5157 04:29:03,602 --> 04:29:05,037 >> WE CAN DISCUSS ON THAT. 5158 04:29:05,037 --> 04:29:06,472 >> LET'S TALK MORE. 5159 04:29:06,472 --> 04:29:08,107 WOULD LOVE TO HEAR THAT. 5160 04:29:08,107 --> 04:29:08,440 THANK YOU. 5161 04:29:08,440 --> 04:29:17,149 THANK YOU FOR RAISING THAT. 5162 04:29:17,149 --> 04:29:19,551 ONE THING WE SHOULD KEEP IN MIND 5163 04:29:19,551 --> 04:29:25,290 AND MIND IS THE FACT WE'RE 5164 04:29:25,290 --> 04:29:35,834 TRYING TO REPOSITION DRUGS AND 5165 04:29:38,437 --> 04:29:40,773 THE EFFICACY ON THE PATIENT IS 5166 04:29:40,773 --> 04:29:50,382 NOT DUE TO THE DEFLATION OF THE 5167 04:29:50,382 --> 04:29:56,889 LYMPHOCYTE. 5168 04:29:56,889 --> 04:29:59,658 WE HAVE TREATMENT BEFORE AND 5169 04:29:59,658 --> 04:30:00,859 AFTER AND SAME WITH DR. YOUNG 5170 04:30:00,859 --> 04:30:02,361 THEY PRESENT THE EFFECT IS NOT 5171 04:30:02,361 --> 04:30:04,830 TRUE AND THE RECEPTOR AND I JUST 5172 04:30:04,830 --> 04:30:08,767 SHOWED YOU THIS MORNING THAT THE 5173 04:30:08,767 --> 04:30:12,971 OF NALTREXONE IS GOING POSSIBLY 5174 04:30:12,971 --> 04:30:14,139 THROUGH FGF21. 5175 04:30:14,139 --> 04:30:19,611 WE NEED TO KEEP THE OPPORTUNITY 5176 04:30:19,611 --> 04:30:28,120 TO LOOK AT THE OFF TARGET AFFECT 5177 04:30:28,120 --> 04:30:33,325 AND LOOK AT BIOMARKERS. 5178 04:30:33,325 --> 04:30:38,163 I'M OPEN FOR COLLABORATION ON 5179 04:30:38,163 --> 04:30:40,265 THE FAVORITE MOLECULE AND CAN 5180 04:30:40,265 --> 04:30:41,533 ACHIEVE THAT BECAUSE AT THE END 5181 04:30:41,533 --> 04:30:43,902 OF THE DAY IT'S COMPLEX AND 5182 04:30:43,902 --> 04:30:45,904 OFTEN WE'RE PLAYING WITH 5183 04:30:45,904 --> 04:30:50,375 MOLECULES SO KNOWN WE DON'T 5184 04:30:50,375 --> 04:30:53,512 THINK THEY EXERT THE TARGETED 5185 04:30:53,512 --> 04:30:54,313 EFFECT BUT THE TRUE NATURE OF 5186 04:30:54,313 --> 04:30:57,683 THE EFFICACY IS IN A NARROW SET 5187 04:30:57,683 --> 04:30:59,485 OF BIOMARKER WE NEGLECT TO LOOK 5188 04:30:59,485 --> 04:31:02,421 AT BECAUSE WE NEGLECT TO LOOK AT 5189 04:31:02,421 --> 04:31:07,259 SUCH POSSIBILITY. 5190 04:31:07,259 --> 04:31:14,500 WE DON'T WE LOOK AT THE 5191 04:31:14,500 --> 04:31:24,042 POSSIBILITIES. 5192 04:31:24,042 --> 04:31:25,744 >> TWO COMMENTS. 5193 04:31:25,744 --> 04:31:28,413 THE FIRST IS AT LEAST FROM WHERE 5194 04:31:28,413 --> 04:31:32,150 I SIT THE MOMENTUM AND THE 5195 04:31:32,150 --> 04:31:33,352 RESEARCH PROGRESS IS NIGHT AN 5196 04:31:33,352 --> 04:31:35,287 DAY WHERE WE ARE NOW TO WHERE WE 5197 04:31:35,287 --> 04:31:36,788 WERE WHEN WE HAD THE MEETING 5198 04:31:36,788 --> 04:31:37,456 FOUR YEARS AGO. 5199 04:31:37,456 --> 04:31:38,357 THAT'S REALLY IMPORTANT TO 5200 04:31:38,357 --> 04:31:41,493 ACKNOWLEDGE. 5201 04:31:41,493 --> 04:31:43,695 AND THE SECOND IS I FEEL THERE'S 5202 04:31:43,695 --> 04:31:45,464 BEEN SO MUCH PROGRESS AND I 5203 04:31:45,464 --> 04:31:46,565 AGREE IT'S A COLLABORATIVE GROUP 5204 04:31:46,565 --> 04:31:49,368 BUT I THINK THERE'S AN 5205 04:31:49,368 --> 04:31:52,304 OPPORTUNITY AND NEED FOR 5206 04:31:52,304 --> 04:31:55,374 RIGOROUS INTEGRATIVE ANALYSIS 5207 04:31:55,374 --> 04:31:57,509 AND CROSSING SOME VERY 5208 04:31:57,509 --> 04:31:58,877 COMPLICATED DATA SETS THAT ARE 5209 04:31:58,877 --> 04:32:00,412 NOT OFTEN MELDED TOGETHER 5210 04:32:00,412 --> 04:32:01,914 CAREFULLY AND I THINK THAT'S 5211 04:32:01,914 --> 04:32:03,715 GOING TO BE AN IMPORTANT, I 5212 04:32:03,715 --> 04:32:05,017 THINK, NEXT PHASE IN RESEARCH IN 5213 04:32:05,017 --> 04:32:05,417 THIS FIELD. 5214 04:32:05,417 --> 04:32:15,794 I'LL LEAVE IT AT THAT. 5215 04:32:36,181 --> 04:32:43,789 >> SOW I'D LICK -- LIKE TO 5216 04:32:43,789 --> 04:32:46,792 COMMENT THE NAME CHRONIC FATIGUE 5217 04:32:46,792 --> 04:32:47,926 SYNDROME DOES NOT SERVE THE 5218 04:32:47,926 --> 04:32:48,293 PATIENTS WELL. 5219 04:32:48,293 --> 04:32:50,162 IT'S A TERRIBLE NAME. 5220 04:32:50,162 --> 04:32:52,297 IN 1955 WHEN THERE WAS THE 5221 04:32:52,297 --> 04:32:54,533 OUTBREAK THERE WAS A BRILLIANT 5222 04:32:54,533 --> 04:33:00,739 DOCTOR WHO CAME UP WITH THE NAME 5223 04:33:00,739 --> 04:33:01,373 MYALGIC ENCEPHALOMYELITIS AND 5224 04:33:01,373 --> 04:33:03,375 IT'S A MOUTHFUL BUT WHAT I'M 5225 04:33:03,375 --> 04:33:05,243 HEARING FROM THE AFTERNOON NEURO 5226 04:33:05,243 --> 04:33:11,283 IMAGING TALK IS WHY CAN'T WE USE 5227 04:33:11,283 --> 04:33:12,718 ENCEPHALOMYELITIS MEANING 5228 04:33:12,718 --> 04:33:13,785 INFLAMMATION OF THE BRAIN AND 5229 04:33:13,785 --> 04:33:16,855 SPINAL CORD AND WHEN CAN WE USE 5230 04:33:16,855 --> 04:33:22,427 THE NAME ME INSTEAD OF ME/CFS. 5231 04:33:22,427 --> 04:33:31,003 THAT'S MY MAIN COMMENT. 5232 04:33:31,003 --> 04:33:33,805 >> LONG AS WE'RE BEING 5233 04:33:33,805 --> 04:33:36,408 REVOLUTIONARY THERE WAS A 5234 04:33:36,408 --> 04:33:37,609 RECOMMENDATION AND WE'VE ALL 5235 04:33:37,609 --> 04:33:38,644 WANTED TO DROP THE OTHER HALF 5236 04:33:38,644 --> 04:33:41,380 FOR A WHILE AND I THINK THERE'S 5237 04:33:41,380 --> 04:33:41,747 CONSENSUS. 5238 04:33:41,747 --> 04:33:43,515 I DON'T KNOW WHY WE JUST DON'T 5239 04:33:43,515 --> 04:33:46,351 DO IT SO WHEN YOU SUBMIT YOUR 5240 04:33:46,351 --> 04:33:48,520 PAPERS DROP THE OTHER HALF. 5241 04:33:48,520 --> 04:33:51,256 I WANT TO BE A LITTLE OUT THERE 5242 04:33:51,256 --> 04:33:54,793 AND CHALLENGE MY COLLEAGUES HERE 5243 04:33:54,793 --> 04:33:56,161 IN THE MEDIA BUSINESS TO SAY ARE 5244 04:33:56,161 --> 04:33:58,797 WE READY FOR MEDIATED SUB 5245 04:33:58,797 --> 04:34:02,367 GROUPING ENOUGH TO DO TARGETED 5246 04:34:02,367 --> 04:34:03,435 THERAPY MEDIATORS? 5247 04:34:03,435 --> 04:34:06,371 I VOTE YES AND OUR FOCUS OUR 5248 04:34:06,371 --> 04:34:08,740 DRIVE SHOULD BE TO GET THESE 5249 04:34:08,740 --> 04:34:10,375 TRANSLATIONAL RESEARCH PROJECTS 5250 04:34:10,375 --> 04:34:11,443 OUT AND DONE. 5251 04:34:11,443 --> 04:34:21,853 AND WE NEED A MECHANISM. 5252 04:34:24,823 --> 04:34:28,260 THE TOOL EXIST AND FOR 5253 04:34:28,260 --> 04:34:32,197 CLINICIANS AND USE THEM 5254 04:34:32,197 --> 04:34:37,202 PROSPECTIVELY THAN TO DO WHAT 5255 04:34:37,202 --> 04:34:38,070 I'LL CALLING. 5256 04:34:38,070 --> 04:34:48,580 AND IF YOU FAIL, FAIL, FAIL, 5257 04:35:00,625 --> 04:35:05,464 INVEST MILLIONS WOULD BE 5258 04:35:05,464 --> 04:35:07,733 DIFFICULT TO FURTHER ATTRACT BIO 5259 04:35:07,733 --> 04:35:09,468 TECH TO WORK WITH A COMPLEX 5260 04:35:09,468 --> 04:35:10,702 DISEASE AND IF WE HAVE BETTER 5261 04:35:10,702 --> 04:35:12,170 PLANNING AND I KNOW IT'S URGENT 5262 04:35:12,170 --> 04:35:12,971 BUT WE HAVE THE TOOLS. 5263 04:35:12,971 --> 04:35:23,415 NOT ONLY ME BUT THE GROUP 5264 04:35:23,415 --> 04:35:25,283 IMPLEMENT THE TOOLS IN THE 5265 04:35:25,283 --> 04:35:27,786 DESIGN OF A CLINICAL TRIAL, 5266 04:35:27,786 --> 04:35:29,621 BETTER SELECTION OF PATIENTS NOR 5267 04:35:29,621 --> 04:35:32,023 BETTER DRUG AT THE BEST 5268 04:35:32,023 --> 04:35:32,290 TREATMENT. 5269 04:35:32,290 --> 04:35:37,596 THIS IS PRECISION MEDICINE AND 5270 04:35:37,596 --> 04:35:41,199 WHAT WE NEED AND CAN MAKE A 5271 04:35:41,199 --> 04:35:42,367 DIFFERENCE WITH THE PROOF OF 5272 04:35:42,367 --> 04:35:50,108 CONCEPT WITH ME. 5273 04:35:50,108 --> 04:35:51,343 >> NOW'S YOUR CHANCE TO TALK 5274 04:35:51,343 --> 04:35:52,744 ABOUT THE DATA REPOSITORY. 5275 04:35:52,744 --> 04:35:54,846 >> I'LL TAKE THAT OPPORTUNITY. 5276 04:35:54,846 --> 04:35:56,948 NANCY MENTIONED FIVE YEARS AGO 5277 04:35:56,948 --> 04:35:59,151 WHEN WE START THE COLLABORATIVE 5278 04:35:59,151 --> 04:36:02,354 RESEARCH CENTERS WITH THE NIH 5279 04:36:02,354 --> 04:36:06,358 PROGRAM NINDS FUNDED THE DATA 5280 04:36:06,358 --> 04:36:07,025 MANAGEMENT COORDINATING CENTER 5281 04:36:07,025 --> 04:36:09,961 AND ONE OF THE PROJECTS THEY 5282 04:36:09,961 --> 04:36:15,934 WORKED ON TO HELP GET TO SOME OF 5283 04:36:15,934 --> 04:36:20,438 THE INTEGRATION WAS THE ME/CFS 5284 04:36:20,438 --> 04:36:22,007 PROJECT AND WERE ON THE TERRACE 5285 04:36:22,007 --> 04:36:24,209 TODAY IF PEOPLE WANTED TO SEE 5286 04:36:24,209 --> 04:36:25,911 IT. 5287 04:36:25,911 --> 04:36:27,979 THE IDEA IS EVENTUALLY THERE'LL 5288 04:36:27,979 --> 04:36:33,218 BE ENOUGH DATA TO TAKE OUT AND 5289 04:36:33,218 --> 04:36:36,688 ANALYZE BECAUSE UP TO THIS POINT 5290 04:36:36,688 --> 04:36:39,424 MOST THE COHORT HAVE BEEN HARD 5291 04:36:39,424 --> 04:36:42,227 TO SUMMARIZE AND THE 5292 04:36:42,227 --> 04:36:44,095 DEMOGRAPHICS AREN'T 5293 04:36:44,095 --> 04:36:46,765 REPRESENTATIVE OF THE 5294 04:36:46,765 --> 04:36:47,732 COMMUNITIES THEY NEED TO AND 5295 04:36:47,732 --> 04:36:50,368 PERHAPS OVER TIME WE CAN ENRICH 5296 04:36:50,368 --> 04:36:52,737 AS WE PULL IT IN AND LARGER 5297 04:36:52,737 --> 04:36:55,040 RECOVER EFFORTS IF THEY'RE 5298 04:36:55,040 --> 04:36:56,474 RELEVANT THOUGH THEY'RE 5299 04:36:56,474 --> 04:36:59,377 COLLECTED FOR A DIFFERENT 5300 04:36:59,377 --> 04:36:59,644 PURPOSE. 5301 04:36:59,644 --> 04:37:00,879 >> THEY'RE DEMOGRAPHICALLY 5302 04:37:00,879 --> 04:37:01,479 DIFFERENT. 5303 04:37:01,479 --> 04:37:10,222 >> IT'S A SHAMELESS PLUG FAND TE 5304 04:37:10,222 --> 04:37:16,895 SEARCH TO THE PLATFORM FOR 5305 04:37:16,895 --> 04:37:27,038 FIND 5306 04:37:34,412 --> 04:37:34,746 FINDING. 5307 04:37:34,746 --> 04:37:38,717 I THINK TONY'S REMEMBER ALSO. 5308 04:37:38,717 --> 04:37:44,389 IF THERE ARE ONLY FINAL THOUGHTS 5309 04:37:44,389 --> 04:37:47,792 FROM THE PANEL? 5310 04:37:47,792 --> 04:37:58,136 THANK YOU VERY MUCH. 5311 04:38:27,532 --> 04:38:30,869 >> FIRST, I'D LIKE TO THANK THE 5312 04:38:30,869 --> 04:38:31,903 PANEL DISCUSSION AND GIVE THEIR 5313 04:38:31,903 --> 04:38:33,171 THOUGHTS AFTER THEY PARTICIPATED 5314 04:38:33,171 --> 04:38:34,372 IN THE LAST TWO DAYS OF THE 5315 04:38:34,372 --> 04:38:36,741 CONFERENCE AND TO CLOSE OUT THE 5316 04:38:36,741 --> 04:38:39,811 CONFERENCE WE ARE FORTUNATE TO 5317 04:38:39,811 --> 04:38:42,981 HAVE DR. TONY KOMAROFF WHOSE 5318 04:38:42,981 --> 04:38:44,683 WORK WAS PRESENTED ON THE SLIDE 5319 04:38:44,683 --> 04:38:46,351 EARLIER GIVE A SUMMARY AND 5320 04:38:46,351 --> 04:38:46,851 CLOSING THOUGHTS. 5321 04:38:46,851 --> 04:38:57,362 HOW FAR WE'VE COME AND FUTURE 5322 04:38:58,430 --> 04:38:59,397 DIRECTIONS. 5323 04:38:59,397 --> 04:39:01,633 PROFESSOR AT HARVARD AND SENIOR 5324 04:39:01,633 --> 04:39:04,903 PHYSICIAN AT BRIGHAM AND WOMEN'S 5325 04:39:04,903 --> 04:39:14,879 HOSPITAL. 5326 04:39:14,879 --> 04:39:16,181 >> THANK YOU. 5327 04:39:16,181 --> 04:39:18,116 CAN EVERYONE HEAR ME? 5328 04:39:18,116 --> 04:39:18,316 GOOD. 5329 04:39:18,316 --> 04:39:23,588 I'VE HAD TROUBLE HEARING FOLKS. 5330 04:39:23,588 --> 04:39:29,594 SO THANKS FOR HAVING ME THOUGH 5331 04:39:29,594 --> 04:39:31,229 I'M DAUNTED BY THE CHALLENGE 5332 04:39:31,229 --> 04:39:33,465 BECAUSE THERE'S A LOT OF FIELDS 5333 04:39:33,465 --> 04:39:35,633 WHOSE WORK WAS REPRESENTED HERE 5334 04:39:35,633 --> 04:39:37,102 AND I'M NOT AN EXPERT ON ANY ONE 5335 04:39:37,102 --> 04:39:42,707 OF THOSE FIELDS BUT WHAT I'LL 5336 04:39:42,707 --> 04:39:53,084 TRY TO DO IS PUT THIS 5337 04:39:53,985 --> 04:39:56,221 PRESENTATION IN THE WEBINAR 5338 04:39:56,221 --> 04:39:57,956 SERIES NINDS HAS ORGANIZED AND 5339 04:39:57,956 --> 04:39:58,523 THE PRIOR LITERATURE INTO A 5340 04:39:58,523 --> 04:40:08,033 CONTEXT. 5341 04:40:08,033 --> 04:40:10,368 DISCLOSURES, I HAVE NOTHING TO 5342 04:40:10,368 --> 04:40:10,769 DISCLOSE. 5343 04:40:10,769 --> 04:40:12,804 TOPICS I WANT TO DISCUSS IS HOW 5344 04:40:12,804 --> 04:40:15,440 WHAT YOU HEARD OVER THE LAST TWO 5345 04:40:15,440 --> 04:40:17,776 DAYS FITS OR DOESN'T WITH WHAT 5346 04:40:17,776 --> 04:40:27,585 HAS BEEN PUBLISHED IN THE PAST. 5347 04:40:27,585 --> 04:40:30,355 AND WHAT IS EMERGING IN THE PATH 5348 04:40:30,355 --> 04:40:32,924 OF PHYSIOLOGY OF ME/CFS AND LONG 5349 04:40:32,924 --> 04:40:37,862 COVID AND PROPOSE A HYPOTHESIS 5350 04:40:37,862 --> 04:40:39,964 ABOUT HOW THE WIDE VARIETY OF 5351 04:40:39,964 --> 04:40:43,168 DIFFERENT ABNORMALITIES BEING 5352 04:40:43,168 --> 04:40:44,702 REPORTED IN THE CONDITIONS MIGHT 5353 04:40:44,702 --> 04:40:46,371 EFFECT EACH OTHER AND MIGHT HAVE 5354 04:40:46,371 --> 04:40:54,512 A COMMON CAUSE. 5355 04:40:54,512 --> 04:40:57,715 AND RESEARCH QUESTIONS THAT 5356 04:40:57,715 --> 04:41:07,725 SEEMED IMPORTANT TO ME. 5357 04:41:07,725 --> 04:41:12,464 WHEN THE ILLNESSES WERE YOUNG 5358 04:41:12,464 --> 04:41:13,898 THERE WERE PEOPLE WHO 5359 04:41:13,898 --> 04:41:15,100 UNDERSTANDABLY SAID THE PATIENTS 5360 04:41:15,100 --> 04:41:18,069 HAVE SYMPTOMS BUT IS THERE 5361 04:41:18,069 --> 04:41:21,506 ANYTHING REALLY WRONG BIO 5362 04:41:21,506 --> 04:41:21,773 LOGICALLY? 5363 04:41:21,773 --> 04:41:26,478 THAT WAS A FAIR QUESTION YEARS 5364 04:41:26,478 --> 04:41:28,313 AGO FOR ME/CFS AND TWO AND THREE 5365 04:41:28,313 --> 04:41:29,681 YEARS AGO FOR LONG COVID BUT NOW 5366 04:41:29,681 --> 04:41:31,116 I THINK IT'S NOT. 5367 04:41:31,116 --> 04:41:33,852 NOW IT'S CLEAR THAT AS YOU'VE 5368 04:41:33,852 --> 04:41:36,554 HEARD THERE'S MULTIPLE 5369 04:41:36,554 --> 04:41:40,191 DIFFERENCE OBJECTIVE MEASURABLE 5370 04:41:40,191 --> 04:41:41,526 BIOLOGICAL ABNORMALITIES NOT 5371 04:41:41,526 --> 04:41:45,296 JUST ONE-OFF REPORTS BUT THAT 5372 04:41:45,296 --> 04:41:46,898 HAVE BEEN REPLICATED REPEATEDLY 5373 04:41:46,898 --> 04:41:48,399 BY DIFFERENT LABS, STUDYING 5374 04:41:48,399 --> 04:41:49,267 DIFFERENT GROUPS OF PATIENTS 5375 04:41:49,267 --> 04:41:52,904 WITH THESE ILLNESSES. 5376 04:41:52,904 --> 04:41:58,276 I THINK MY OWN VIEW IS ME/CFS IS 5377 04:41:58,276 --> 04:42:01,779 UNLIKELY TO BE CAUSED BY SINGLE 5378 04:42:01,779 --> 04:42:04,215 NOVEL INFECTIOUS AGENT. 5379 04:42:04,215 --> 04:42:09,120 INSTEAD I THINK IT INVOLVES A 5380 04:42:09,120 --> 04:42:10,255 DYSFUNCTIONAL RESPONSE 5381 04:42:10,255 --> 04:42:10,788 IMMUNOLOGIC METABOLIC TO 5382 04:42:10,788 --> 04:42:17,162 INFECTION OR INJURY. 5383 04:42:17,162 --> 04:42:19,697 COULD THERE BE A NOVEL AGENT 5384 04:42:19,697 --> 04:42:21,299 THAT EX PLAINS SOME OF THE 5385 04:42:21,299 --> 04:42:21,499 CASES. 5386 04:42:21,499 --> 04:42:21,699 YES. 5387 04:42:21,699 --> 04:42:26,204 THERE COULD BE WELL KNOWN AGENTS 5388 04:42:26,204 --> 04:42:29,440 LIKE THE HERPES VIRUSES THAT 5389 04:42:29,440 --> 04:42:30,675 STAND FOR A FRACTION OF THE 5390 04:42:30,675 --> 04:42:39,651 CASES, YES, BUT A SING -- 5391 04:42:39,651 --> 04:42:40,919 SINGLE NOVEL AGENT EXPLAINING 5392 04:42:40,919 --> 04:42:45,089 ALL THE CASES, UNLIKELY. 5393 04:42:45,089 --> 04:42:50,762 THE BIOLOGICAL ABNORMALITIES 5394 04:42:50,762 --> 04:43:01,239 BEING REPORTED IN BOTH THE 5395 04:43:02,407 --> 04:43:06,344 AUTONOMIC SYSTEM AND NUCLEIC 5396 04:43:06,344 --> 04:43:10,915 ACID AND ANTIGEN AND 5397 04:43:10,915 --> 04:43:13,785 ABNORMALITIES OF THE GUT 5398 04:43:13,785 --> 04:43:16,654 MICROBIOME THAT TRIGGER 5399 04:43:16,654 --> 04:43:17,822 METABOLIC REACTION. 5400 04:43:17,822 --> 04:43:20,758 METABOLISM SPECIFICALLY DEFICITS 5401 04:43:20,758 --> 04:43:24,028 IN ENERGY PRODUCTION AND REDOX 5402 04:43:24,028 --> 04:43:27,332 IMBALANCE AND FINALLY 5403 04:43:27,332 --> 04:43:28,132 ABNORMALITIES IN THE 5404 04:43:28,132 --> 04:43:30,168 CARDIOVASCULAR AND PULMONARY 5405 04:43:30,168 --> 04:43:30,535 SYSTEM. 5406 04:43:30,535 --> 04:43:34,906 I'M GOING SUMMARIZE ALL THESE 5407 04:43:34,906 --> 04:43:35,773 ABNORMALITIES GOING RAPIDLY 5408 04:43:35,773 --> 04:43:38,343 THROUGH THEM AND MAKING A WHOLE 5409 04:43:38,343 --> 04:43:40,612 SERIES OF ASSERTIONS THAT THE 5410 04:43:40,612 --> 04:43:47,118 TIME WON'T ALLOW ME TO PRESENT 5411 04:43:47,118 --> 04:43:48,753 DATA TO SUPPORT SO TAKE WHAT I 5412 04:43:48,753 --> 04:43:54,659 SAY AND LOOK AT A SOURCE 5413 04:43:54,659 --> 04:44:05,203 DOCUMENT AND PURPORTING TO FIND 5414 04:44:11,342 --> 04:44:14,345 OR NOT FIND THE ABNORMALITIES 5415 04:44:14,345 --> 04:44:21,085 ARE CITED EXPLICITLY. 5416 04:44:21,085 --> 04:44:23,688 I'LL GIVE YOU A SENSE OF WHAT 5417 04:44:23,688 --> 04:44:24,355 ABNORMALITIES HAVE BEEN REPORTED 5418 04:44:24,355 --> 04:44:33,531 BY MANY GROUPS AND WHICH HAVE 5419 04:44:33,531 --> 04:44:35,933 HAD NEGATIVE REPORTS TO GET A 5420 04:44:35,933 --> 04:44:38,236 SENSE OF THE PREPONDERANCE OF 5421 04:44:38,236 --> 04:44:42,340 THE EVIDENCE ON THAT PARTICULAR 5422 04:44:42,340 --> 04:44:44,275 ABNORMALITY OF EITHER OF THE TWO 5423 04:44:44,275 --> 04:44:45,076 DISEASES. 5424 04:44:45,076 --> 04:44:48,146 HERE'S THE FIRST SLIDE. 5425 04:44:48,146 --> 04:44:51,149 NEUROLOGIC ABNORMALITIES AND 5426 04:44:51,149 --> 04:44:54,185 EACH I'LL SLOW A BIG X MEANS 5427 04:44:54,185 --> 04:44:54,786 THERE ARE LOTS OF REPLICATED 5428 04:44:54,786 --> 04:45:04,929 REPORTS. 5429 04:45:09,100 --> 04:45:10,835 SMALL X MEANS THE POSITIVE 5430 04:45:10,835 --> 04:45:11,969 OUTWEIGH THE NEGATIVE REPORTS 5431 04:45:11,969 --> 04:45:14,038 BUT IT'S NOT A SLAM DUNK. 5432 04:45:14,038 --> 04:45:16,908 IT'S NOT ABSOLUTELY SOLIDLY 5433 04:45:16,908 --> 04:45:23,247 ESTABLISHED. 5434 04:45:23,247 --> 04:45:26,351 THIS BIG Xs MEAN LOTS OF 5435 04:45:26,351 --> 04:45:28,720 EVIDENCE AND LITTLE Xs MEAN 5436 04:45:28,720 --> 04:45:29,620 LITTLE EVIDENCE. 5437 04:45:29,620 --> 04:45:31,756 TAKE ONE EXAMPLE. 5438 04:45:31,756 --> 04:45:35,259 COGNITIVE DEFICITS, BRAIN FOG. 5439 04:45:35,259 --> 04:45:37,795 ONE OF THE FUNDAMENTAL PROBLEMS 5440 04:45:37,795 --> 04:45:40,031 OF BOTH ILLNESSES. 5441 04:45:40,031 --> 04:45:45,370 WHAT DO WE KNOW ABOUT THEM FROM 5442 04:45:45,370 --> 04:45:47,905 THE LITERATURE AND HOW MANY 5443 04:45:47,905 --> 04:45:50,375 STUDIES BEAR ON IT? 5444 04:45:50,375 --> 04:45:55,046 THERE'S MORE THAN 24 BUT 24 GOOD 5445 04:45:55,046 --> 04:45:57,315 STUDIES DEMONSTRATING COGNITIVE 5446 04:45:57,315 --> 04:45:59,417 DEFICITS PRIMARILY IN THE 5447 04:45:59,417 --> 04:46:00,885 ATTENTION AND REACTION TIME. 5448 04:46:00,885 --> 04:46:07,658 THESE DEFICITS WORSEN AFTER BOTH 5449 04:46:07,658 --> 04:46:10,361 PHYSICAL AND COGNITIVE CHALLENGE 5450 04:46:10,361 --> 04:46:20,905 S AN THEY'RE NOT EXPLAINED BY A 5451 04:46:24,942 --> 04:46:27,812 COMBINANT MOOD DISORDERS AND TWO 5452 04:46:27,812 --> 04:46:30,882 STUDIES SHOW THERE'S NEGATIVE 5453 04:46:30,882 --> 04:46:34,352 STUDIES AND ASSERT IT'S 5454 04:46:34,352 --> 04:46:35,820 REPRESENTATIVE OF THE BALANCES 5455 04:46:35,820 --> 04:46:37,021 OF THE EVIDENCE OF ALL THE BIG 5456 04:46:37,021 --> 04:46:43,060 Xs WE'LL BE LOOKING AT. 5457 04:46:43,060 --> 04:46:47,298 BESIDES COGNITIVE AND 5458 04:46:47,298 --> 04:46:50,334 NEUROVASCULAR ABNORMALITIES AND 5459 04:46:50,334 --> 04:46:52,036 ANTIBODIES AGAINST NEURAL 5460 04:46:52,036 --> 04:46:54,038 TARGETS AND COGNITIVE 5461 04:46:54,038 --> 04:46:55,907 ABNORMALITIES AND THE NERVOUS 5462 04:46:55,907 --> 04:46:57,141 SYSTEM AND THOUGH THE LITERATURE 5463 04:46:57,141 --> 04:47:02,513 HAS ARTICLES CHALLENGING THE 5464 04:47:02,513 --> 04:47:05,783 SPECIFICITY OF THE AUTO ANTIBODY 5465 04:47:05,783 --> 04:47:06,350 ASSAYS. 5466 04:47:06,350 --> 04:47:08,920 THERE'S A HYPOMETABOLIC STATE IN 5467 04:47:08,920 --> 04:47:10,822 THE BRAIN, GRAY AND WHITE MATTER 5468 04:47:10,822 --> 04:47:16,127 ABNORMALITIYIES ON IMAGING AND 5469 04:47:16,127 --> 04:47:23,634 SMALL FIBER NEURO ON -- 5470 04:47:23,634 --> 04:47:24,869 NEUROPATHY AND YOU HEARD THAT 5471 04:47:24,869 --> 04:47:28,806 FROM DR. JAMES AND YOUNGER AND 5472 04:47:28,806 --> 04:47:33,244 BUES AND OTHERS. 5473 04:47:33,244 --> 04:47:38,349 HERE'S AN EARLY STUDY USING A 5474 04:47:38,349 --> 04:47:43,120 LIGAND AGAINST A MOLECULE IN THE 5475 04:47:43,120 --> 04:47:50,361 MICROGLIAL CELLS AND ASTROCYTES 5476 04:47:50,361 --> 04:47:54,365 WITH INFLAMMATION WITH COMPARED 5477 04:47:54,365 --> 04:47:56,100 TO HEALTHY CONTROLS AND THE 5478 04:47:56,100 --> 04:47:58,536 TRACER WOULD BE REGARDED AS 5479 04:47:58,536 --> 04:48:07,979 OUTDATED BUT STILL PROVOCATIVE. 5480 04:48:07,979 --> 04:48:11,349 AND A STUDY IN LONG COVID 5481 04:48:11,349 --> 04:48:12,617 PATIENTS SHOWING NEURAL 5482 04:48:12,617 --> 04:48:15,019 INFLAMMATORY WITH A DIFFERENT 5483 04:48:15,019 --> 04:48:15,620 LIGAND IN MULTIPLE DIFFERENT 5484 04:48:15,620 --> 04:48:25,897 AREAS OF THE BRAIN. 5485 04:48:25,897 --> 04:48:30,167 AND HERE IN FIBROMYALGIA. 5486 04:48:30,167 --> 04:48:32,136 EVIDENCE OF NEURAL INFLAMMATION 5487 04:48:32,136 --> 04:48:37,575 IN THAT CLINICALLY SIMILAR 5488 04:48:37,575 --> 04:48:40,912 CONDITION AND THE DEGREE OF 5489 04:48:40,912 --> 04:48:43,648 INFLAMMATION CORRELATED WITH THE 5490 04:48:43,648 --> 04:48:46,484 SEVERITY OF FATIGUE AND OTHER 5491 04:48:46,484 --> 04:48:48,119 SYMPTOMS. 5492 04:48:48,119 --> 04:48:49,320 A CORRELATION BETWEEN A 5493 04:48:49,320 --> 04:48:52,924 BIOMARKER AND THE SEVERITY OF 5494 04:48:52,924 --> 04:48:56,427 THE SYMPTOM. 5495 04:48:56,427 --> 04:48:57,495 IMMUNOLOGIC ABNORMALITIES 5496 04:48:57,495 --> 04:48:59,897 DECREASE NATURE KILLER CELL 5497 04:48:59,897 --> 04:49:10,441 FUNCTION AND ABNORMALCYTE -- AC 5498 04:49:10,975 --> 04:49:16,914 NORMAL CYTOKINE ANTIBODIES AND 5499 04:49:16,914 --> 04:49:22,653 RATES OF APOTOSIS AND HLA 5500 04:49:22,653 --> 04:49:23,054 ASSOCIATIONS. 5501 04:49:23,054 --> 04:49:27,425 AND WITH THE NEUROLOGIC 5502 04:49:27,425 --> 04:49:28,259 ABNORMALITIES MANY ARE BEING 5503 04:49:28,259 --> 04:49:34,398 REPORTED IN LONG COVID. 5504 04:49:34,398 --> 04:49:39,337 THE IMMUNOLOGIC MEASURES OF 5505 04:49:39,337 --> 04:49:40,271 INFLAMMATION TEND TO BE WORSE IN 5506 04:49:40,271 --> 04:49:40,538 FEMALES. 5507 04:49:40,538 --> 04:49:46,344 I'M THINKING OF THE FINDINGS 5508 04:49:46,344 --> 04:49:49,447 REPORTED BY MARK DAVIS AND 5509 04:49:49,447 --> 04:49:57,188 OTHERS THERE'S A GENDER 5510 04:49:57,188 --> 04:49:58,923 PHYSIOLOGY DIFFERENCE IN 5511 04:49:58,923 --> 04:50:00,057 MULTIPLE TYPES OF MEASURES THAT 5512 04:50:00,057 --> 04:50:02,360 IS VERY IMPORTANT TO PURSUE 5513 04:50:02,360 --> 04:50:04,895 PARTICULARLY GIVEN THE FACT THAT 5514 04:50:04,895 --> 04:50:09,333 THESE ILLNESSES ARE BEING FOUND 5515 04:50:09,333 --> 04:50:10,501 TWO OR THREE TIMES MORE OFTEN IN 5516 04:50:10,501 --> 04:50:12,637 WOMEN THAN IN MEN. 5517 04:50:12,637 --> 04:50:18,042 AND METABOLIC ABNORMALITIES 5518 04:50:18,042 --> 04:50:21,379 DIMINISHED ATP PRODUCTION FROM 5519 04:50:21,379 --> 04:50:23,814 OXYGEN, GLUCOSE, FATTY ACIDS AND 5520 04:50:23,814 --> 04:50:25,449 AMINO ACIDS. 5521 04:50:25,449 --> 04:50:28,352 AND YOU HEARD SOME DETAILED 5522 04:50:28,352 --> 04:50:32,990 INFORMATION ABOUT THAT AT THE 5523 04:50:32,990 --> 04:50:33,457 CONFERENCE. 5524 04:50:33,457 --> 04:50:36,661 REDOX IMBALANCE. 5525 04:50:36,661 --> 04:50:38,863 YOU HEARD ABOUT SOME OF THE 5526 04:50:38,863 --> 04:50:40,965 EVIDENCE OF REDOX IMBALANCE IN 5527 04:50:40,965 --> 04:50:44,368 IMMUNE CELL SUBSETS. 5528 04:50:44,368 --> 04:50:48,806 AND HYPOMETABOLIC STATE IN THE 5529 04:50:48,806 --> 04:50:50,341 BLOOD AND BRAIN AND AGAIN ALL 5530 04:50:50,341 --> 04:50:53,577 THESE ARE NOW BEING REPORTED IN 5531 04:50:53,577 --> 04:51:01,252 PEOPLE WITH LONG COVID. 5532 04:51:01,252 --> 04:51:03,521 CARDIO PULMONARY ABNORMALITIES 5533 04:51:03,521 --> 04:51:08,826 AND DIMINISHED EXERCISE CAPACITY 5534 04:51:08,826 --> 04:51:19,370 AND ENDOTHELIAL DYSFUNCTION AND 5535 04:51:22,840 --> 04:51:23,307 PLATELET NUMBERS IN THEIR 5536 04:51:23,307 --> 04:51:28,913 CHEMISTRY. 5537 04:51:28,913 --> 04:51:29,980 AND AGAIN MANY OF THESE NOW 5538 04:51:29,980 --> 04:51:37,254 BEING REPORTED IN LONG COVID. 5539 04:51:37,254 --> 04:51:43,360 ENDOTHELIAL DYSFUNCTION YOU 5540 04:51:43,360 --> 04:51:48,132 HEARD EVIDENCE OF PLATELET 5541 04:51:48,132 --> 04:51:52,536 AGGREGATION ABNORMALITIES 5542 04:51:52,536 --> 04:51:55,840 FOLLOWS FROM DYSFUNCTION AND 5543 04:51:55,840 --> 04:51:58,342 ENDOTHELIAL DYSFUNCTION AND 5544 04:51:58,342 --> 04:52:04,215 BEING FOUND AS SHOWED IN THE 5545 04:52:04,215 --> 04:52:05,149 SLIDE PRIMARILY IN THE BRAIN 5546 04:52:05,149 --> 04:52:05,783 STEM AND MORE BROADLY THROUGHOUT 5547 04:52:05,783 --> 04:52:13,324 THE BRAIN. 5548 04:52:13,324 --> 04:52:14,358 FINALLY LOW GRADE GUT 5549 04:52:14,358 --> 04:52:16,927 INFLAMMATION DUE TO DIFFERENCES 5550 04:52:16,927 --> 04:52:24,034 OR ABNORMALITIES IN THE 5551 04:52:24,034 --> 04:52:26,036 MICROBIOME AND I'D SUMMARIZE THE 5552 04:52:26,036 --> 04:52:27,872 RESULTS PRESENTED HERE AND 5553 04:52:27,872 --> 04:52:31,175 PREVIOUSLY AS THE FOLLOWING. 5554 04:52:31,175 --> 04:52:34,345 REDUCE NUMBERS OF BACTERIA 5555 04:52:34,345 --> 04:52:38,349 PRODUCING ANTI-INFLAMMATORY 5556 04:52:38,349 --> 04:52:40,951 MOLECULES PARTICULARLY BUTYRATE 5557 04:52:40,951 --> 04:52:42,720 AND ACETATE THAT CORRELATE 5558 04:52:42,720 --> 04:52:45,222 STRONG WITH THE FATIGUE. 5559 04:52:45,222 --> 04:52:46,123 ANOTHER BIOMARKER THAT 5560 04:52:46,123 --> 04:52:47,758 CORRELATES WITH THE SYMPTOM. 5561 04:52:47,758 --> 04:52:49,426 REDUCED LEVELS OF THE MOLECULES 5562 04:52:49,426 --> 04:52:52,997 IN STOOL AND PLASMA SO NOT ONLY 5563 04:52:52,997 --> 04:52:55,900 ARE THE BACTERIAL SPECIES THAT 5564 04:52:55,900 --> 04:52:57,735 MAKE A PARTICULAR MOLECULE 5565 04:52:57,735 --> 04:53:02,306 DIMINISHED IN NUMBER BUT THAT 5566 04:53:02,306 --> 04:53:04,942 MOLECULE LEVELS ARE DIMINISHED 5567 04:53:04,942 --> 04:53:07,244 IN PLASMA AND STOOL AS YOU WOULD 5568 04:53:07,244 --> 04:53:07,945 EXPECT. 5569 04:53:07,945 --> 04:53:11,148 THE DYSBIOSIS SEEMS TO WANE OVER 5570 04:53:11,148 --> 04:53:13,717 THE YEARS BUT IS FOLLOWED BY 5571 04:53:13,717 --> 04:53:15,486 LONG LASTING METABOLIC CHANGES 5572 04:53:15,486 --> 04:53:18,722 PARTICULARLY IN LIPIDS. 5573 04:53:18,722 --> 04:53:22,126 SO WITH MICROBIOME STUDIES AS 5574 04:53:22,126 --> 04:53:25,796 WITH IMMUNOLOGIC AND METABOLIC 5575 04:53:25,796 --> 04:53:28,732 STUDIES WHEN IN THE COURSE OF 5576 04:53:28,732 --> 04:53:30,801 EFCSS YOU STUDY PATIENTS REALLY 5577 04:53:30,801 --> 04:53:32,403 AFFECTS THE RESULTS. 5578 04:53:32,403 --> 04:53:34,038 THERE'S DIFFERENCES IN PEOPLE 5579 04:53:34,038 --> 04:53:35,573 WHO HAVE BEEN ILL FOR THREE TO 5580 04:53:35,573 --> 04:53:36,874 FOUR YEARS FROM THOSE WHO HAVE 5581 04:53:36,874 --> 04:53:40,311 BEEN ILL MUCH LONGER. 5582 04:53:40,311 --> 04:53:44,481 A SEMI ACUTE PROCESS BECOMES 5583 04:53:44,481 --> 04:53:46,951 VERY CHRONIC. 5584 04:53:46,951 --> 04:53:49,820 THE RESULTING GUT INFLAMMATION 5585 04:53:49,820 --> 04:53:51,255 ALLOWS BACTERIAL PRODUCTS AND 5586 04:53:51,255 --> 04:53:54,358 ORGANISMS TO ENTER THE SYSTEMIC 5587 04:53:54,358 --> 04:53:58,362 INFLAMMATION POSSIBLY CAUSING 5588 04:53:58,362 --> 04:54:00,965 SYSTEMIC INFLAMMATION AND NEURAL 5589 04:54:00,965 --> 04:54:01,298 INFLAMMATION. 5590 04:54:01,298 --> 04:54:05,636 DR. HANSON'S GROUP FIRST 5591 04:54:05,636 --> 04:54:08,239 REPORTED THIS AND THE FINDINGS 5592 04:54:08,239 --> 04:54:09,640 HAVE BEEN REPLICATED IN MULTIPLE 5593 04:54:09,640 --> 04:54:13,644 COHORT OF ME/CFS. 5594 04:54:13,644 --> 04:54:19,984 TO MY KNOWLEDGE THE GUT MICROBUY 5595 04:54:19,984 --> 04:54:25,389 HOME HAS NOT -- GUT MICROBIOME 5596 04:54:25,389 --> 04:54:28,359 HAS NOT BEEN AGGRESSIVELY 5597 04:54:28,359 --> 04:54:30,561 STUDIED IN LONG COVID AND 20, 30 5598 04:54:30,561 --> 04:54:32,463 YEARS AGO THEY WOULD HAVE SAID 5599 04:54:32,463 --> 04:54:33,364 IS ANYTHING WRONG WITH THE 5600 04:54:33,364 --> 04:54:35,499 PEOPLE AND NOW THE SKEPTICS ARE 5601 04:54:35,499 --> 04:54:37,768 SAYING HOW COULD ALL THESE 5602 04:54:37,768 --> 04:54:39,336 THINGS POSSIBLY BE WRONG WITH 5603 04:54:39,336 --> 04:54:39,937 THESE PEOPLE? 5604 04:54:39,937 --> 04:54:45,209 WELL, IT'S A FAIR QUESTION. 5605 04:54:45,209 --> 04:54:46,944 I THINK THERE'S SOME WAYS YOU 5606 04:54:46,944 --> 04:54:50,347 CAN IMAGINE THEY WOULD ALL BE 5607 04:54:50,347 --> 04:54:52,983 FOUND BECAUSE THEY MANY OF THEM 5608 04:54:52,983 --> 04:54:55,719 AS I'LL ARGUE EFFECT EACH OTHER. 5609 04:54:55,719 --> 04:55:02,693 THEY REINFORCE EACH OTHER. 5610 04:55:02,693 --> 04:55:05,596 AND IF ALL THESE ABNORMALITIES 5611 04:55:05,596 --> 04:55:07,431 ARE BY HAPPENSTANCE BUT 5612 04:55:07,431 --> 04:55:10,935 HAPPENING BECAUSE THEY ARE BEING 5613 04:55:10,935 --> 04:55:13,537 ORCHESTRATED BY A BIOLOGICAL 5614 04:55:13,537 --> 04:55:15,606 PROCESS, WHICH I WILL TRY TO 5615 04:55:15,606 --> 04:55:17,641 ARGUE MAY BE THE CASE, THEN THIS 5616 04:55:17,641 --> 04:55:20,778 IS EXACTLY WHAT WITH YOU WOULD 5617 04:55:20,778 --> 04:55:21,345 EXPECT. 5618 04:55:21,345 --> 04:55:24,448 YOU WOULD EXPECT AN ORCHESTRATED 5619 04:55:24,448 --> 04:55:27,751 RESPONSE TO PRODUCE A SERIES OF 5620 04:55:27,751 --> 04:55:31,555 BIOLOGIC CHANGES ALL OF WHICH 5621 04:55:31,555 --> 04:55:33,724 ARE DESIGN TO ACHIEVE PURPOSE 5622 04:55:33,724 --> 04:55:36,794 FOR THE ORGANISM. 5623 04:55:36,794 --> 04:55:40,397 SO, HOW DO THESE VARIOUS 5624 04:55:40,397 --> 04:55:46,937 ABNORMALITIES AFFECT EACH OTHER? 5625 04:55:46,937 --> 04:55:49,273 THE POINTER ISN'T WORKING. 5626 04:55:49,273 --> 04:55:51,608 A FEW OF THE ABNORMALITIES ARE 5627 04:55:51,608 --> 04:55:53,844 SHOWN HERE IN THE GRAPHIC. 5628 04:55:53,844 --> 04:55:58,382 MITOCHONDRIAL DYSFUNCTION, 5629 04:55:58,382 --> 04:56:01,552 OXIDATIVE STRESS, CHRONIC 5630 04:56:01,552 --> 04:56:02,386 INFLAMMATION THROUGH 5631 04:56:02,386 --> 04:56:04,989 INFLAMMASOME ACTIVATION AND THE 5632 04:56:04,989 --> 04:56:05,622 IMPORTANCE OF THE FIGURE IS 5633 04:56:05,622 --> 04:56:08,959 THESE -- YOU'LL SEE THE ARROWS 5634 04:56:08,959 --> 04:56:10,394 CONNECTING ALL THESE DIFFERENT 5635 04:56:10,394 --> 04:56:13,464 ABNORMALITIES ARE TWO-HEADED 5636 04:56:13,464 --> 04:56:13,864 ARROWS. 5637 04:56:13,864 --> 04:56:17,835 THESE ARE BI-DIRECTIONAL 5638 04:56:17,835 --> 04:56:18,135 CONNECTIONS. 5639 04:56:18,135 --> 04:56:22,406 IF MULTIPLE METABOLIC 5640 04:56:22,406 --> 04:56:24,441 IMMUNOLOGIC INFECTIOUS 5641 04:56:24,441 --> 04:56:26,310 CARDIOVASCULAR ABNORMALITIES 5642 04:56:26,310 --> 04:56:27,678 HAVE BI-DIRECTIONAL CONNECTIONS. 5643 04:56:27,678 --> 04:56:30,547 THAT, IF THEY CAN REINFORCE EACH 5644 04:56:30,547 --> 04:56:34,218 OTHER TWO THINGS ARE TRUE OR AT 5645 04:56:34,218 --> 04:56:34,918 LEAST POSSIBLE. 5646 04:56:34,918 --> 04:56:39,156 ONE, YOU HAVE THE POTENTIAL FOR 5647 04:56:39,156 --> 04:56:41,525 ONGOING VICIOUS CYCLES. 5648 04:56:41,525 --> 04:56:44,561 ONE THING IS BAD, IT MAKE 5649 04:56:44,561 --> 04:56:46,430 SOMETHING ELSE BAD WHICH IN TURN 5650 04:56:46,430 --> 04:56:48,432 MAKES SOMETHING ELSE BAD WHICH 5651 04:56:48,432 --> 04:56:50,300 MAKES THE THING WHICH MADE IT 5652 04:56:50,300 --> 04:56:51,769 BAD AND WORSE. 5653 04:56:51,769 --> 04:56:55,773 YOU WILL GET TO A STATE WHERE 5654 04:56:55,773 --> 04:56:57,674 THESE THINGS REINFORCE EACH 5655 04:56:57,674 --> 04:56:58,375 OTHER CHRONICALLY AND CAN'T TURN 5656 04:56:58,375 --> 04:57:03,914 EACH OTHER OFF. 5657 04:57:03,914 --> 04:57:05,883 SECONDLY, THE THING THAT'S 5658 04:57:05,883 --> 04:57:09,386 IMPLIED BY A SITUATION LIKE THIS 5659 04:57:09,386 --> 04:57:12,189 WHERE YOU HAVE A BUNCH OF 5660 04:57:12,189 --> 04:57:13,791 ABNORMALITIES THAT CAN EFFECT 5661 04:57:13,791 --> 04:57:14,858 EACH OTHER AND WITH ANY 5662 04:57:14,858 --> 04:57:18,362 INDIVIDUAL WITH THE ILLNESS, THE 5663 04:57:18,362 --> 04:57:19,296 INITIAL TRIGGERING EVENT THE 5664 04:57:19,296 --> 04:57:22,699 FIRST DOMINO TO FALL MAY HAVE 5665 04:57:22,699 --> 04:57:23,634 BEEN DIFFERENT FROM AN ANOTHER 5666 04:57:23,634 --> 04:57:23,867 PATIENT. 5667 04:57:23,867 --> 04:57:28,672 IT MAY HAVE BEEN SOMETHING THAT 5668 04:57:28,672 --> 04:57:33,077 UPSET REDOX BALANCE. 5669 04:57:33,077 --> 04:57:35,879 AND THAT INTERN TRIGGERED OTHER 5670 04:57:35,879 --> 04:57:38,148 ABNORMALITIES IN ONE PERSON AND 5671 04:57:38,148 --> 04:57:39,950 IN OTHER ANOTHER PERSON MAY HAVE 5672 04:57:39,950 --> 04:57:42,286 BEEN A VIRAL INFECTION THAT 5673 04:57:42,286 --> 04:57:43,787 CAUSED MITOCHONDRIAL INFECTION 5674 04:57:43,787 --> 04:57:47,858 AND SET THE CASCADE OF PATHOLOGY 5675 04:57:47,858 --> 04:57:48,225 INTO MOTION. 5676 04:57:48,225 --> 04:57:50,360 THE POINT IS IT CAN BE A 5677 04:57:50,360 --> 04:57:55,432 DIFFERENT TRIGGER IN EACH 5678 04:57:55,432 --> 04:57:58,302 INDIVIDUAL BUT THE STEW OF 5679 04:57:58,302 --> 04:57:58,936 REINFORCING ABNORMALITIES TURNS 5680 04:57:58,936 --> 04:58:06,043 OUT TO BE THE SAME. 5681 04:58:06,043 --> 04:58:09,279 SO WHAT TRIGGERS THESE 5682 04:58:09,279 --> 04:58:09,913 PATHOPHYSIOLOGIC ABNORMALITIES 5683 04:58:09,913 --> 04:58:11,115 AN WHAT TRIGGERS THE SYMPTOMS OF 5684 04:58:11,115 --> 04:58:14,318 THESE ILLNESSES? 5685 04:58:14,318 --> 04:58:20,124 I PUT FORWARD A HYPOTHESIS THE 5686 04:58:20,124 --> 04:58:22,359 SICKNESS BEHAVIOR HYPOTHESIS. 5687 04:58:22,359 --> 04:58:26,730 DR. KOROSHETZ ALLUDED TO THIS. 5688 04:58:26,730 --> 04:58:34,371 THIS HYPOTHESIS I LABEL IT THAT 5689 04:58:34,371 --> 04:58:39,042 IS VERY ATTRACTIVE TO ME BECAUSE 5690 04:58:39,042 --> 04:58:40,210 A LOT OF THE DATA WE'VE HEARD 5691 04:58:40,210 --> 04:58:41,712 AND NEW INFORMATION IN THE LAST 5692 04:58:41,712 --> 04:58:44,915 FOUR YEARS SINCE THERE WAS AN 5693 04:58:44,915 --> 04:58:50,087 NIH CONFERENCE ON ME/CFS IN 5694 04:58:50,087 --> 04:59:00,631 2019, IT MAY BE AN A TRIGGER OR 5695 04:59:14,778 --> 04:59:16,280 NON-INFECTIOUS INJURY. 5696 04:59:16,280 --> 04:59:20,117 THIS LEADS TO AN ORCHESTRATED 5697 04:59:20,117 --> 04:59:22,352 PROTECTIVE BIOLOGICAL RESPONSE 5698 04:59:22,352 --> 04:59:25,756 OR SET OF RESPONSES DESIGN TO BE 5699 04:59:25,756 --> 04:59:30,761 TEMPORARY TO HELP THE ORGANISM 5700 04:59:30,761 --> 04:59:33,664 INITIALLY HEAL THE INJURY, 5701 04:59:33,664 --> 04:59:38,368 ERADICATE THE INFECTION BUT FOR 5702 04:59:38,368 --> 04:59:40,737 WHATEVER REASON TEMPORARY 5703 04:59:40,737 --> 04:59:41,371 ORCHESTRATED RESPONSE BECOMES 5704 04:59:41,371 --> 04:59:46,510 PROLONGED. 5705 04:59:46,510 --> 04:59:48,345 WHY DOES IT BECOME PROLONGED? 5706 04:59:48,345 --> 04:59:51,715 IT COULD BECOME PROLONGED 5707 04:59:51,715 --> 04:59:53,483 BECAUSE LIKE EVERY HOMEOSTATIC 5708 04:59:53,483 --> 04:59:54,718 PROCESS IN THE BODY THERE'S ON 5709 04:59:54,718 --> 04:59:57,688 AND OFF SWITCHES AND IF AN OFF 5710 04:59:57,688 --> 04:59:59,623 SWITCH GETS STUCK YOU CAN GET 5711 04:59:59,623 --> 05:00:02,859 STUCK IN WHAT WAS MEANT TO BE A 5712 05:00:02,859 --> 05:00:05,829 TEMPORARY RESPONSE AND CAN 5713 05:00:05,829 --> 05:00:07,264 BECOME PERMANENT OR SECONDARILY 5714 05:00:07,264 --> 05:00:11,368 IF THERE IS IN FACT AN ONGOING 5715 05:00:11,368 --> 05:00:13,036 THREAT IN THE BODY LIKE AN 5716 05:00:13,036 --> 05:00:16,506 ONGOING RESERVOIR OF AN 5717 05:00:16,506 --> 05:00:17,841 INFECTIOUS AGENT EITHER LIVING 5718 05:00:17,841 --> 05:00:20,811 AGENT OR NUCLEIC ACID OR 5719 05:00:20,811 --> 05:00:25,182 ANTIGEN, THAT COULD TRIGGER AN 5720 05:00:25,182 --> 05:00:27,951 ONGOING RESPONSE BECAUSE THE 5721 05:00:27,951 --> 05:00:30,120 FIGHT HAS NOT YET BEEN WON. 5722 05:00:30,120 --> 05:00:33,924 SO WHAT ARE OTHER EXAMPLES IN 5723 05:00:33,924 --> 05:00:37,094 BIOLOGY OF SUCH ORCHESTRATED 5724 05:00:37,094 --> 05:00:38,362 PROTECTIVE RESPONSES. 5725 05:00:38,362 --> 05:00:40,897 YEAH, BESIDES SICKNESS BEHAVIOR 5726 05:00:40,897 --> 05:00:42,766 WHICH I'LL TALK ABOUT MORE IN 5727 05:00:42,766 --> 05:00:46,136 WHICH IS ITSELF A WHOLE MATURE 5728 05:00:46,136 --> 05:00:51,141 FIELD OF BIOLOGY, THERE IS THE 5729 05:00:51,141 --> 05:00:53,377 CELL DANGER RESPONSE TALKED 5730 05:00:53,377 --> 05:00:55,345 ABOUT IN THE 2019 MEETING. 5731 05:00:55,345 --> 05:00:59,983 THERE'S THE STATE OF DOWER IN 5732 05:00:59,983 --> 05:01:05,289 THE WORM C. ELEGANS AND 5733 05:01:05,289 --> 05:01:09,126 HIBERNATION AND TORPOR IN 5734 05:01:09,126 --> 05:01:17,834 ANIMALS AND THE INTEGRATED 5735 05:01:17,834 --> 05:01:20,337 STRESS RESPONSE TO A WHOLE 5736 05:01:20,337 --> 05:01:24,207 ORGANISM AND MAJOR VITAL THREAT. 5737 05:01:24,207 --> 05:01:26,209 IT'S A PLAUSIBLE HYPOTHESIS THE 5738 05:01:26,209 --> 05:01:28,645 SYMPTOMS OF THE ILLNESS MAY IN 5739 05:01:28,645 --> 05:01:31,715 FACT REFLECT SUCH A PROCESS. 5740 05:01:31,715 --> 05:01:36,453 AND HOW IN FACT DO WE GET THE 5741 05:01:36,453 --> 05:01:36,720 SYMPTOMS. 5742 05:01:36,720 --> 05:01:40,590 HOW ARE THEY PROTECTIVE AND WHAT 5743 05:01:40,590 --> 05:01:42,926 MECHANISTICALLY FINALLY CAUSES 5744 05:01:42,926 --> 05:01:44,428 THE SYMPTOMS THEMSELVES? 5745 05:01:44,428 --> 05:01:46,863 IS THERE A FIND FINAL COMMON 5746 05:01:46,863 --> 05:01:48,498 PATHWAY THAT LEADS TO THE 5747 05:01:48,498 --> 05:01:49,399 SYMPTOMS? 5748 05:01:49,399 --> 05:01:52,569 AND EVEN IF THAT FINAL COMMON 5749 05:01:52,569 --> 05:01:54,471 PATHWAY IS A SINGLE PATHWAY THAT 5750 05:01:54,471 --> 05:01:58,342 CAN BE TRIGGERED BY MANY OTHER 5751 05:01:58,342 --> 05:02:00,777 PHYSIO LOGIC ABNORMALITIES IF 5752 05:02:00,777 --> 05:02:01,611 THERE'S A FINAL COMMON PATHWAY 5753 05:02:01,611 --> 05:02:05,015 IT COULD BE THE TARGET FOR 5754 05:02:05,015 --> 05:02:07,184 THERAPIES. 5755 05:02:07,184 --> 05:02:10,654 SO LET'S DISCUSS THAT PLAUSIBLE 5756 05:02:10,654 --> 05:02:14,891 POSSIBILITY. 5757 05:02:14,891 --> 05:02:16,226 MAINLY PEOPLE WITH ME/CFS 5758 05:02:16,226 --> 05:02:19,529 DESCRIBE THE ILLNESS AS IT'S 5759 05:02:19,529 --> 05:02:24,201 LIKE A FLU OR VIRUS THAT NEVER 5760 05:02:24,201 --> 05:02:24,501 GOES AWAY. 5761 05:02:24,501 --> 05:02:27,337 WE'VE ALL HAD A FLU OR TEMPORARY 5762 05:02:27,337 --> 05:02:29,106 INFECTIOUS ILLNESS AND KNOW WHAT 5763 05:02:29,106 --> 05:02:34,177 WE FEEL LIKE. 5764 05:02:34,177 --> 05:02:38,382 WE HAVE A SET OF HARD WIRED 5765 05:02:38,382 --> 05:02:42,986 PROTECTIVE SYMPTOMS THAT LEAD TO 5766 05:02:42,986 --> 05:02:44,554 BEHAVIORAL CHANGE. 5767 05:02:44,554 --> 05:02:46,990 BECAUSE OF THE SYMPTOMS WE ARE 5768 05:02:46,990 --> 05:02:49,025 LESS PHYSICALLY ACTIVE AND LESS 5769 05:02:49,025 --> 05:02:50,026 MENTALLY ACTIVE AND SLEEPING 5770 05:02:50,026 --> 05:02:52,763 MORE AND NOT SPENDING A LOT OF 5771 05:02:52,763 --> 05:02:53,330 TIME THINKING. 5772 05:02:53,330 --> 05:02:56,700 WE DON'T EAT AND DIGEST AS MUCH. 5773 05:02:56,700 --> 05:02:58,368 WE HAVE LESS SEX, IN OTHER 5774 05:02:58,368 --> 05:03:00,871 WORDS, THERE'S A SET OF SYMPTOMS 5775 05:03:00,871 --> 05:03:02,773 GENERATED THAT CHANGES OUR 5776 05:03:02,773 --> 05:03:04,908 BEHAVIOR THAT REDUCES A WHOLE 5777 05:03:04,908 --> 05:03:06,676 GROUP OF ACTIVITIES THAT DO 5778 05:03:06,676 --> 05:03:08,979 WHAT? 5779 05:03:08,979 --> 05:03:10,213 THAT CONSUME ENERGY. 5780 05:03:10,213 --> 05:03:15,285 THAT CONSUME ATP. 5781 05:03:15,285 --> 05:03:17,921 THE PROTECTIVE RESPONSE IS DON'T 5782 05:03:17,921 --> 05:03:19,990 DO THOSE THINGS BECAUSE THEY'RE 5783 05:03:19,990 --> 05:03:22,025 GOING TO SPEND ATP ON THEM AND 5784 05:03:22,025 --> 05:03:25,395 WE NEED THE ATP TO FIGHT THE 5785 05:03:25,395 --> 05:03:33,036 INFECTION OR TO HEAL THE INJURY. 5786 05:03:33,036 --> 05:03:34,471 WHETHER THAT IS CORRECT THERE'S 5787 05:03:34,471 --> 05:03:38,508 NO DOUBT SICKNESS BEHAVIOR 5788 05:03:38,508 --> 05:03:40,510 FOLLOWING IN EXPERIMENTALLY 5789 05:03:40,510 --> 05:03:42,379 INDUCED INFECTION OR INJURY IS 5790 05:03:42,379 --> 05:03:45,215 SEEN AND DOCUMENTS ABUNDANTLY 5791 05:03:45,215 --> 05:03:46,750 ACROSS THE ANIMAL KINGDOM. 5792 05:03:46,750 --> 05:03:50,520 IT'S NOT HARD TO TELL WHEN OUR 5793 05:03:50,520 --> 05:03:52,923 PETS ARE ILL. 5794 05:03:52,923 --> 05:03:55,125 THEY ACT LIKE WE FEEL WHEN WE 5795 05:03:55,125 --> 05:03:56,026 GET ILL. 5796 05:03:56,026 --> 05:03:58,728 IT'S NOT HARD TO TELL WHEN 5797 05:03:58,728 --> 05:04:04,734 YOU'RE DOG'S UNDER THE WEATHER. 5798 05:04:04,734 --> 05:04:06,002 IT'S BEEN PRESERVED THROUGHOUT 5799 05:04:06,002 --> 05:04:07,070 THE ANIMAL KINGDOM. 5800 05:04:07,070 --> 05:04:10,574 THAT'S THE HYPOTHESIS. 5801 05:04:10,574 --> 05:04:11,842 THE SYMPTOMS HAVE A PURPOSE 5802 05:04:11,842 --> 05:04:15,011 WHICH IS IS BEHAVIOR CHANGE AND 5803 05:04:15,011 --> 05:04:17,714 THAT'S DESIGN TO PRESERVE ATP TO 5804 05:04:17,714 --> 05:04:24,054 DEAL WITH THE VITAL THREAT. 5805 05:04:24,054 --> 05:04:30,360 SO WHAT THEN MECHANISTICALLY 5806 05:04:30,360 --> 05:04:31,862 CAUSES SYMPTOMS? 5807 05:04:31,862 --> 05:04:33,597 IN THE 2019 ME/CFS CONFERENCE 5808 05:04:33,597 --> 05:04:38,034 THE FOLLOWING HYPOTHESIS WAS PUT 5809 05:04:38,034 --> 05:04:39,536 FORWARD THAT WE KNOW THE BRAIN 5810 05:04:39,536 --> 05:04:43,206 IS FILLED WITH A GROUP OF NUCLEI 5811 05:04:43,206 --> 05:04:50,447 OF NEURONS DEDICATED TO ONE 5812 05:04:50,447 --> 05:04:58,355 TASK. 5813 05:04:58,355 --> 05:05:01,825 THE THEORY WAS MAYBE THERE'S 5814 05:05:01,825 --> 05:05:04,728 NUCLEI FOR THE TASK OF 5815 05:05:04,728 --> 05:05:15,238 GENERATING SICKNESS SYMPTOMS. 5816 05:05:19,242 --> 05:05:22,979 THAT WAS PLAUSIBLE AND IN THE 5817 05:05:22,979 --> 05:05:28,084 LAST FOUR YEARS A WHOLE GROUP OF 5818 05:05:28,084 --> 05:05:31,488 NUCLEI IN THE BRAIN STEM AND 5819 05:05:31,488 --> 05:05:32,355 HYPOTHALAMUS HAVE BEEN 5820 05:05:32,355 --> 05:05:34,357 IDENTIFIED UP RODENTS IN PAPERS 5821 05:05:34,357 --> 05:05:36,626 ALL PUBLISHED IN NATURE THAT 5822 05:05:36,626 --> 05:05:39,896 MAKE MUCH MORE PLAUSIBLE THE 5823 05:05:39,896 --> 05:05:42,165 POSSIBILITY THAT INDEED THE 5824 05:05:42,165 --> 05:05:44,734 SYMPTOMS OF SICKNESS BEHAVIOR 5825 05:05:44,734 --> 05:05:48,104 THAT LOAD TO SICKNESS BEHAVIOR 5826 05:05:48,104 --> 05:05:50,640 ARE ORCHESTRATED BY A GROUP OF 5827 05:05:50,640 --> 05:05:53,009 NUCLEI IN THE BRAIN. 5828 05:05:53,009 --> 05:05:58,114 ANOTHER TARGET FOR THERAPY. 5829 05:05:58,114 --> 05:06:01,484 THE MODEL IS THAT NO 5830 05:06:01,484 --> 05:06:03,620 INFLAMMATION AUTONOMIC 5831 05:06:03,620 --> 05:06:05,355 ABNORMALITIES AND AUTO IMMUNITY 5832 05:06:05,355 --> 05:06:09,426 AND DEFECTIVE ENERGY AND IMMUNE 5833 05:06:09,426 --> 05:06:10,994 ABNORMALITIES CAN ALL CONVERGE 5834 05:06:10,994 --> 05:06:14,364 TO STIMULATE THESE FATIGUE 5835 05:06:14,364 --> 05:06:16,967 NUCLEI AND GENERATE THESE 5836 05:06:16,967 --> 05:06:18,635 SYMPTOMS THAT CHANGE BEHAVIOR TO 5837 05:06:18,635 --> 05:06:20,637 HELP THE ANIMAL, THE HUMAN IN 5838 05:06:20,637 --> 05:06:23,106 THIS CASE DEAL WITH THE VITAL 5839 05:06:23,106 --> 05:06:23,340 THREAT. 5840 05:06:23,340 --> 05:06:28,612 SO THAT'S THE HYPOTHESIS BUT 5841 05:06:28,612 --> 05:06:30,380 OBVIOUSLY FAR -- WE DON'T KNOW 5842 05:06:30,380 --> 05:06:33,617 THE NUCLEI EXIST IN HUMANS SO 5843 05:06:33,617 --> 05:06:40,290 THERE'S MORE TO BE DONE BUT TO 5844 05:06:40,290 --> 05:06:45,862 ME SCIENCE PROCEEDS BIG 5845 05:06:45,862 --> 05:06:47,831 REASONABLE HIYPOTHHYPOTHESES. 5846 05:06:47,831 --> 05:06:51,067 IN CONCLUSION, WHAT HAVE WE 5847 05:06:51,067 --> 05:06:54,371 LEARNED SO FAR IN THE NEARLY 40 5848 05:06:54,371 --> 05:06:58,408 YEARS OF RESEARCH ON ME/CFS AND 5849 05:06:58,408 --> 05:07:03,713 RECENTLY LONG COVID? 5850 05:07:03,713 --> 05:07:08,585 WHATEVER WE'VE LEARN IS BECAUSE 5851 05:07:08,585 --> 05:07:12,656 OF NIH AND CDC AND FOUNDATIONS 5852 05:07:12,656 --> 05:07:16,660 DEDICATED CURING THESE 5853 05:07:16,660 --> 05:07:16,926 ILLNESSES. 5854 05:07:16,926 --> 05:07:18,728 DESPITE THE FACT ONE HEARS 5855 05:07:18,728 --> 05:07:22,399 SOMETIMES PEOPLE REPORT THESE 5856 05:07:22,399 --> 05:07:25,101 ABNORMALITIES BUT NOTHING HOLDS 5857 05:07:25,101 --> 05:07:34,244 UP THERE'S MANY ABNORMALITIES 5858 05:07:34,244 --> 05:07:37,480 THAT HAVE HELD UP AND PLAUSIBLE 5859 05:07:37,480 --> 05:07:39,582 BUT FAR FROM PROVEN THEY 5860 05:07:39,582 --> 05:07:41,084 CO-EXIST AN REINFORCE EACH OTHER 5861 05:07:41,084 --> 05:07:47,957 AND GENERATE THE PERSISTENT 5862 05:07:47,957 --> 05:07:50,093 PATHOLOGY AND SYMPTOMS OF 5863 05:07:50,093 --> 05:07:53,296 CHRONIC DISEASE, ILLNESS. 5864 05:07:53,296 --> 05:07:56,866 AND ALSO PLAUSIBLE THEY CAUSE 5865 05:07:56,866 --> 05:08:00,170 THE SYMPTOMS BY ACTIVATING THE 5866 05:08:00,170 --> 05:08:00,937 FINAL COMMON PATHWAY THESE 5867 05:08:00,937 --> 05:08:06,443 NUCLEI IN THE BRAIN. 5868 05:08:06,443 --> 05:08:08,445 TO ME THE FACT THAT AND I WOULD 5869 05:08:08,445 --> 05:08:11,448 SAY ONLY IN THE LAST YEAR HAS IT 5870 05:08:11,448 --> 05:08:13,717 REALLY BECOME CLEAR SO MUCH OF 5871 05:08:13,717 --> 05:08:16,486 THE UNDERLYING PATHOLOGY IS 5872 05:08:16,486 --> 05:08:19,789 SHARED BETWEEN LONG COVID AND 5873 05:08:19,789 --> 05:08:22,392 ME/CFS DOESN'T MEAN THEY'RE 5874 05:08:22,392 --> 05:08:25,829 EXACTLY THE SAME ILLNESS. 5875 05:08:25,829 --> 05:08:28,598 WE KNOW THAT SARS COV2 PRODUCES 5876 05:08:28,598 --> 05:08:31,634 TWO SYMPTOMS THAT ARE REALLY NOT 5877 05:08:31,634 --> 05:08:34,838 SEEN IN ME/CFS, LOSS OF TASTE 5878 05:08:34,838 --> 05:08:38,374 AND SMELL, AND THERE ARE MANY 5879 05:08:38,374 --> 05:08:40,543 OTHER EXAMPLES TOO WHERE AN 5880 05:08:40,543 --> 05:08:44,614 ME/CFS-LIKE ILLNESS OR LONG 5881 05:08:44,614 --> 05:08:45,949 COVID-LIKE ILLNESS TRIGGERED BY 5882 05:08:45,949 --> 05:08:51,321 ONE AGENT MAY HAVE UNIQUE 5883 05:08:51,321 --> 05:08:53,823 ASPECTS AND MAY HAVE SHARED 5884 05:08:53,823 --> 05:08:56,693 SYMPTOMS AND PATHOPHYSIOLOGY. 5885 05:08:56,693 --> 05:08:59,028 MY BET IS WHAT IS LEARNED ABOUT 5886 05:08:59,028 --> 05:09:01,498 THE BIOLOGY OF LONG COVID FROM 5887 05:09:01,498 --> 05:09:03,867 THE RECOVER STUDIO AND OTHERS 5888 05:09:03,867 --> 05:09:05,268 WILL HAVE LESSONS APPLICABLE TO 5889 05:09:05,268 --> 05:09:13,910 ME/CFS. 5890 05:09:13,910 --> 05:09:16,479 WON'T KNOW FOR A COUPLE YEARS 5891 05:09:16,479 --> 05:09:20,016 BUT MY GUESS IS IT WILL APPLY TO 5892 05:09:20,016 --> 05:09:20,283 ME/CFS. 5893 05:09:20,283 --> 05:09:22,051 THE QUESTION IS WILL THERE BE AN 5894 05:09:22,051 --> 05:09:23,820 INVESTMENT TO SEE WHETHER THE 5895 05:09:23,820 --> 05:09:28,124 UNDERLYING ABNORMALITIES IN LONG 5896 05:09:28,124 --> 05:09:37,534 COVID ARE FOUND IN ME/CFS AS 5897 05:09:37,534 --> 05:09:48,077 WELL AND YOU HEARD A DETAILED 5898 05:09:54,450 --> 05:10:00,156 SET OF RESEARCH IN METABOLOMIC 5899 05:10:00,156 --> 05:10:05,628 AND IMMUNE SYSTEM AND NERVOUS 5900 05:10:05,628 --> 05:10:08,731 SYSTEM AND IMMUNE SYSTEM AND GUT 5901 05:10:08,731 --> 05:10:12,669 MICROBIOME AND GENOMICS AND THE 5902 05:10:12,669 --> 05:10:18,107 LITERATURE IS WELL SUPPORTED BY 5903 05:10:18,107 --> 05:10:27,217 PRIOR WORK THAT SAYS YES, THIS 5904 05:10:27,217 --> 05:10:29,552 IS GOING TO BE AN AREA TO LEARN 5905 05:10:29,552 --> 05:10:31,287 MORE ABOUT AND THE RESEARCH 5906 05:10:31,287 --> 05:10:33,790 AGENDA BE BROADENED WITH ENOUGH 5907 05:10:33,790 --> 05:10:39,062 FINANCIAL SUPPORT NOT JUST TO 5908 05:10:39,062 --> 05:10:44,701 FOCUS ON ME/CFS AND LONG COVID 5909 05:10:44,701 --> 05:10:49,072 AND OTHER POST-ACUTE SYNDROMES 5910 05:10:49,072 --> 05:10:50,874 LIKE LYME DISEASE AND 5911 05:10:50,874 --> 05:10:56,012 FIBROMYALGIA AND THE BEHAVIOR 5912 05:10:56,012 --> 05:11:06,489 CHANGES THAT FOLLOW CERTAIN. 5913 05:11:30,580 --> 05:11:31,915 IF YOU UNDERSTAND WHAT'S GOING 5914 05:11:31,915 --> 05:11:33,750 ON IN THE BODY HAVE YOU TARGETS 5915 05:11:33,750 --> 05:11:34,784 FOR EFFECTIVE TREATMENTS. 5916 05:11:34,784 --> 05:11:44,360 MUCH MORE LIKELY TARGETS TO GET 5917 05:11:44,360 --> 05:11:45,828 SPECIFIC WITH IF YOU DON'T HAVE 5918 05:11:45,828 --> 05:11:46,896 SPECIFICS TO MEASURE YOU ARE 5919 05:11:46,896 --> 05:11:51,401 SHOOT DARK. 5920 05:11:51,401 --> 05:11:55,238 I ASK THAT QUESTION BECAUSE I'M 5921 05:11:55,238 --> 05:11:56,572 ASKED BY PATIENTS WHY SO MUCH 5922 05:11:56,572 --> 05:11:57,674 INVESTMENT IN UNDERSTANDING THE 5923 05:11:57,674 --> 05:11:59,008 BIOLOGY OF THE ILLNESS AND IT'S 5924 05:11:59,008 --> 05:12:00,610 BECAUSE HOW WE GET TO TREATMENT 5925 05:12:00,610 --> 05:12:05,214 AND BETTER DIAGNOSTIC TESTS. 5926 05:12:05,214 --> 05:12:06,449 THE IMPORTANT RESEARCH TOPICS 5927 05:12:06,449 --> 05:12:16,993 BEYOND THOSE LISTED AND I WOULD 5928 05:12:19,228 --> 05:12:20,897 PLACE SPECIAL EMPHASIS ON SOME 5929 05:12:20,897 --> 05:12:23,032 YOU HEARD ON THE MEETING THE 5930 05:12:23,032 --> 05:12:25,468 ROLE OF THE PRO INFLAMMATORY GUT 5931 05:12:25,468 --> 05:12:28,805 AND MICROBIOME AND ENDTHELIAL 5932 05:12:28,805 --> 05:12:30,340 DYSFUNCTION AND VASCULAR 5933 05:12:30,340 --> 05:12:33,476 ABNORMALITIES THAT DIRECTLY LEAD 5934 05:12:33,476 --> 05:12:36,779 TO METABOLIC ABNORMALITIES, 5935 05:12:36,779 --> 05:12:38,915 COAGULATION ABNORMALITIES, 5936 05:12:38,915 --> 05:12:42,051 DIMINISHED BLOOD FLOW ENHANCED 5937 05:12:42,051 --> 05:12:43,019 HYPOXIA. 5938 05:12:43,019 --> 05:12:47,023 THE FORMATION OF MICRO CLOTS IS 5939 05:12:47,023 --> 05:12:49,392 A CONSEQUENCE OF ENDOTHELIAL 5940 05:12:49,392 --> 05:12:49,993 DYSFUNCTION. 5941 05:12:49,993 --> 05:12:52,128 THAT'S A FERTILE AREA WAITING 5942 05:12:52,128 --> 05:12:55,298 FOR US TO LEARN MORE ABOUT. 5943 05:12:55,298 --> 05:12:59,035 THE REACTIVATION OF HERPES 5944 05:12:59,035 --> 05:13:06,342 VIRUSES EPB AND VZV PERSISTING 5945 05:13:06,342 --> 05:13:09,212 RESERVOIRS OF SARS COV2. 5946 05:13:09,212 --> 05:13:10,913 YOU HEARD FROM OTHERS ABOUT THE 5947 05:13:10,913 --> 05:13:14,283 GROWING EVIDENCE IN LONG COVID 5948 05:13:14,283 --> 05:13:15,952 THERE'S PERSISTENT RESERVOIRS OF 5949 05:13:15,952 --> 05:13:22,992 NUCLEIC ACID AND ANTIGEN ELICIT 5950 05:13:22,992 --> 05:13:26,596 ELICITING AN IMMUNE RESPONSE 5951 05:13:26,596 --> 05:13:30,366 TIED TO THE ILLNESS. 5952 05:13:30,366 --> 05:13:37,740 PHENOTYPIC STUDIES AND YOU HEARD 5953 05:13:37,740 --> 05:13:40,109 ABOUT SPECIFIC DEFICITS IN 5954 05:13:40,109 --> 05:13:45,214 IMMUNE CELL SUBSETS THAT MAY BE 5955 05:13:45,214 --> 05:13:46,983 INVISIBLE IF YOU STUDY A GROUP 5956 05:13:46,983 --> 05:13:49,052 OF DIFFERENT IMMUNE CELLS AS A 5957 05:13:49,052 --> 05:13:50,753 GROUP AS TRADITIONAL IMMUNOLOGIC 5958 05:13:50,753 --> 05:13:56,492 STUDIES TENDED TO DO. 5959 05:13:56,492 --> 05:13:59,662 IMPAIRMENT OF SEVERAL NEURAL 5960 05:13:59,662 --> 05:14:02,365 ENDOCRINE AXIS. 5961 05:14:02,365 --> 05:14:04,200 SEROTONIN DEPLETION. 5962 05:14:04,200 --> 05:14:08,771 THERE'S MIXED EVIDENCE IN 5963 05:14:08,771 --> 05:14:09,372 ME/CFS. 5964 05:14:09,372 --> 05:14:13,643 THERE'S WORK IN LONG COVID AND 5965 05:14:13,643 --> 05:14:16,145 NEEDS TO BE PURSUED MORE 5966 05:14:16,145 --> 05:14:21,951 RIGOROUSLY AND SEROTONIN AND THE 5967 05:14:21,951 --> 05:14:24,387 PATHWAY BIOLOGY BECAUSE THAT HAS 5968 05:14:24,387 --> 05:14:27,023 IMPLICATIONS BOTH FOR NEUROLOGIC 5969 05:14:27,023 --> 05:14:30,660 FUNCTION AND ENERGY GENERATION. 5970 05:14:30,660 --> 05:14:36,099 DE FEFKT IN MOLECULAR ENERGY 5971 05:14:36,099 --> 05:14:36,399 SENSORS. 5972 05:14:36,399 --> 05:14:41,070 AND AMPK AND AND ANIMAL MODELS 5973 05:14:41,070 --> 05:14:43,706 OF SICKNESS BEHAVIOR. 5974 05:14:43,706 --> 05:14:50,079 THIS -- THE BIGGEST LIMITING 5975 05:14:50,079 --> 05:14:51,314 FACTOR IN STUDYING ME/CFS HAS 5976 05:14:51,314 --> 05:14:52,982 BEEN THE LACK OF AN ANIMAL MODEL 5977 05:14:52,982 --> 05:14:55,418 BECAUSE SO MANY OF THE 5978 05:14:55,418 --> 05:14:58,354 EXPERIMENTS WANT TO DO ONE CAN'T 5979 05:14:58,354 --> 05:14:58,688 DO IN HUMANS. 5980 05:14:58,688 --> 05:15:01,424 THERE ARE ANIMAL MODELS OF 5981 05:15:01,424 --> 05:15:01,924 SICKNESS BEHAVIOR. 5982 05:15:01,924 --> 05:15:06,062 THE QUESTION IS TO WHAT EXTENT 5983 05:15:06,062 --> 05:15:08,431 IS THE SICK APPEARING ANIMAL 5984 05:15:08,431 --> 05:15:10,366 REFLECTS WHAT'S HAPPENING IN A 5985 05:15:10,366 --> 05:15:13,035 SICK HUMAN BUT I THINK THOSE 5986 05:15:13,035 --> 05:15:15,738 SHOULD BE PURSUED. 5987 05:15:15,738 --> 05:15:18,141 SPECIFIC INVENTIONS IN 5988 05:15:18,141 --> 05:15:20,576 ESTABLISHED ANIMAL MODELS OF 5989 05:15:20,576 --> 05:15:22,778 BEHAVIOR THAT REFLECT THE 5990 05:15:22,778 --> 05:15:24,914 FINDING IN THE MEETING AND PRIOR 5991 05:15:24,914 --> 05:15:28,050 LITERATURE SHOULD BE CONDUCTED. 5992 05:15:28,050 --> 05:15:38,394 AND FINALLY TREATMENT TRIALS AND 5993 05:15:38,394 --> 05:15:43,266 I WOULD FOCUS ON 5994 05:15:43,266 --> 05:15:47,770 IMMUNOMODULATORS AND OXIDATIVE 5995 05:15:47,770 --> 05:15:48,037 STRESS. 5996 05:15:48,037 --> 05:15:51,174 THERE'S WAYS OF INTERSECTING 5997 05:15:51,174 --> 05:15:59,482 THOSE AND IMPROVING THOSE. 5998 05:15:59,482 --> 05:16:04,954 FINAL POINTS, THIS MEETING IF 5999 05:16:04,954 --> 05:16:07,089 YOU THINK OF THE QUALITY AND 6000 05:16:07,089 --> 05:16:08,858 EXTENSIVENESS OF THE WORK 6001 05:16:08,858 --> 05:16:10,026 PRESENTED AT THIS MEETING 6002 05:16:10,026 --> 05:16:12,495 COMPARED WITH THE MEETING FOUR 6003 05:16:12,495 --> 05:16:15,898 YEARS AGO IN MEETINGS IN THE 6004 05:16:15,898 --> 05:16:20,703 DECADE BEFORE THAT, SO MUCH MORE 6005 05:16:20,703 --> 05:16:26,375 WE KNOW ABOUT CERTAINLY ME/CFS 6006 05:16:26,375 --> 05:16:28,110 AND NOW LONG COVID BECAUSE OF 6007 05:16:28,110 --> 05:16:29,545 THE INVESTMENT IN RESEARCH. 6008 05:16:29,545 --> 05:16:32,448 IT'S PAID OFF MANY CORE 6009 05:16:32,448 --> 05:16:33,849 BIOLOGICAL ABNORMALITIES HAVE 6010 05:16:33,849 --> 05:16:34,617 BEEN IDENTIFIED. 6011 05:16:34,617 --> 05:16:35,785 HOW THEY'RE CAUSING THE 6012 05:16:35,785 --> 05:16:36,219 SYMPTOMS? 6013 05:16:36,219 --> 05:16:39,422 WE STILL DON'T FULLY UNDERSTAND 6014 05:16:39,422 --> 05:16:41,257 BUT THEY'RE PRETTY WELL 6015 05:16:41,257 --> 05:16:42,325 ESTABLISHED. 6016 05:16:42,325 --> 05:16:43,793 THAT'S WHERE YOU GO LOOKING AND 6017 05:16:43,793 --> 05:16:45,528 WHERE WE SHOULD GO LOOKING. 6018 05:16:45,528 --> 05:16:48,264 SO OBVIOUSLY I'D LIKE EVERYONE 6019 05:16:48,264 --> 05:16:52,835 ELSE AT THIS MEETING WOULD ARGUE 6020 05:16:52,835 --> 05:16:54,370 FOR CONTINUED AND EXPANDED 6021 05:16:54,370 --> 05:16:56,872 INVESTMENT IN STUDYING BOTH 6022 05:16:56,872 --> 05:16:57,139 ILLNESSES. 6023 05:16:57,139 --> 05:17:02,645 ALONG WITH THAT ADDED 6024 05:17:02,645 --> 05:17:05,281 INVESTMENT, I WOULD URGE THAT A 6025 05:17:05,281 --> 05:17:08,551 CONVENING BODY IN THE NIH IS THE 6026 05:17:08,551 --> 05:17:10,319 MOST OBVIOUS ONE I COULD THINK 6027 05:17:10,319 --> 05:17:14,290 OF AND IDENTIFY SCIENTISTS OUT 6028 05:17:14,290 --> 05:17:17,093 THERE WHO RECEIVE NIH SUPPORT 6029 05:17:17,093 --> 05:17:18,794 WHO HAVE EXPERTISE THAT BEARS 6030 05:17:18,794 --> 05:17:20,630 EXACTLY ON THE AREAS OF 6031 05:17:20,630 --> 05:17:22,765 ABNORMALITIES WE HEARD ABOUT AT 6032 05:17:22,765 --> 05:17:24,500 THIS MEETING BUT LABORATORIES 6033 05:17:24,500 --> 05:17:27,270 THAT DON'T KNOW THE FIRST THING 6034 05:17:27,270 --> 05:17:29,071 ABOUT ME/CFS OR LONG COVID 6035 05:17:29,071 --> 05:17:31,540 AREN'T WORKING ON IT NOW BUT 6036 05:17:31,540 --> 05:17:39,849 HAVE THE TOOLS TO LOOK AT THE 6037 05:17:39,849 --> 05:17:41,784 IMMUNOLOGIC ABNORMALITIES THAT 6038 05:17:41,784 --> 05:17:43,919 HAVE BEEN WELL ESTABLISHED IN 6039 05:17:43,919 --> 05:17:47,323 ME/CFS AND LONG COVID. 6040 05:17:47,323 --> 05:17:49,792 FIND THE FINANCIAL SUPPORT AND 6041 05:17:49,792 --> 05:17:51,894 AGGRESSIVELY GO OUT AND FIND THE 6042 05:17:51,894 --> 05:17:54,730 PEOPLE WHO HAVE THE SKILL SET WE 6043 05:17:54,730 --> 05:17:58,367 NEED TO SPEND SOME TIME STUDYING 6044 05:17:58,367 --> 05:18:01,170 THESE TWO IMPORTANT PROBLEMS. 6045 05:18:01,170 --> 05:18:02,838 I HOPE THAT'S WHAT HAPPENS AND 6046 05:18:02,838 --> 05:18:04,774 HOPE X YEARS FROM NOW WHEN WE 6047 05:18:04,774 --> 05:18:05,841 HAVE THE NEXT MEETING WE'RE 6048 05:18:05,841 --> 05:18:09,078 GOING TO SEE THE FRUITS OF THAT 6049 05:18:09,078 --> 05:18:10,713 ADDED EFFORT AND UNDERSTAND MORE 6050 05:18:10,713 --> 05:18:14,350 ABOUT BOTH OF THESE ILLNESSES. 6051 05:18:14,350 --> 05:18:24,660 THANKS VERY MUCH. 6052 05:19:00,663 --> 05:19:10,106 [INDISCERNIBLE] 6053 05:19:10,106 --> 05:19:11,173 >> I DID NOT. 6054 05:19:11,173 --> 05:19:14,143 THE QUESTION WAS IF I LOOKED AT 6055 05:19:14,143 --> 05:19:18,814 PARTICULAR EXPRESSED ENZYME 6056 05:19:18,814 --> 05:19:20,750 PATHWAY IN THESE ILLNESSES. 6057 05:19:20,750 --> 05:19:22,485 I'M NOT AWARE THERE'S BEEN MUCH 6058 05:19:22,485 --> 05:19:24,186 RESEARCH SPECIFICALLY IN 6059 05:19:24,186 --> 05:19:25,621 PATIENTS WITH THESE TWO 6060 05:19:25,621 --> 05:19:25,888 ILLNESSES. 6061 05:19:25,888 --> 05:19:31,026 I'M NOT CHALLENGING THE FACT 6062 05:19:31,026 --> 05:19:37,967 THAT THERE SHOULD BE BUT I'M NOT 6063 05:19:37,967 --> 05:19:40,369 FAMILIAR. 6064 05:19:40,369 --> 05:19:45,841 >> PAPER HAVE LOOKED AT THE 6065 05:19:45,841 --> 05:19:49,879 HEMOGENNASE LEVEL AND OTHERS 6066 05:19:49,879 --> 05:19:51,547 WERE AMONG THE PREDICTIVE 6067 05:19:51,547 --> 05:19:54,283 OUTCOMES IN COVID. 6068 05:19:54,283 --> 05:19:54,583 >> OKAY. 6069 05:19:54,583 --> 05:19:56,018 IF YOU COULD SEND ME A SUMMARY 6070 05:19:56,018 --> 05:20:03,659 OF THOSE I'D LIKE TO KNOW THAT. 6071 05:20:03,659 --> 05:20:05,060 >> THANK YOU. 6072 05:20:05,060 --> 05:20:09,198 I WANT TO THANK YOU ALL FOR 6073 05:20:09,198 --> 05:20:12,168 COMING AND EVEN MORE OR EQUALLY 6074 05:20:12,168 --> 05:20:14,036 IMPORTANTLY THE ENVIRONMENT 6075 05:20:14,036 --> 05:20:17,072 AUDIENCE FOR ATTENDING WHICH 6076 05:20:17,072 --> 05:20:18,207 INCLUDES A LOT OF FOLKS WHO 6077 05:20:18,207 --> 05:20:19,842 FRANKLY COULDN'T GET HERE TODAY. 6078 05:20:19,842 --> 05:20:21,811 WE HAD A SMALL SLICE WITH OUR 6079 05:20:21,811 --> 05:20:23,612 LIVED EXPERIENCE INDIVIDUALS AND 6080 05:20:23,612 --> 05:20:28,017 I KNOW AT TIMES IT'S BEEN HARD 6081 05:20:28,017 --> 05:20:30,953 TO WATCH FROM FRONT TO BACK AND 6082 05:20:30,953 --> 05:20:33,923 THE ENTIRE CONFERENCE WILL BE 6083 05:20:33,923 --> 05:20:43,032 ARCHIVED AND AVAILABLE ONLINE AT 6084 05:20:43,032 --> 05:20:48,070 NIH. 6085 05:20:48,070 --> 05:20:50,339 NIH.VIDEOCAST.gov AND WHILE TRY 6086 05:20:50,339 --> 05:20:52,875 TO ADDRESS QUESTIONS BY E-MAIL 6087 05:20:52,875 --> 05:20:54,477 FOLLOWING THE CONFERENCE. 6088 05:20:54,477 --> 05:20:57,012 THANK YOU FOR YOUR PATIENCE AND 6089 05:20:57,012 --> 05:20:58,681 ATTENDANCE ONLINE AND THE FOLKS 6090 05:20:58,681 --> 05:20:59,348 HERE. 6091 05:20:59,348 --> 05:21:03,352 THANK YOU TO THE SPEAKERS FOR 6092 05:21:03,352 --> 05:21:03,619 ATTENDING. 6093 05:21:03,619 --> 05:21:06,322 I WANT TO THANK NINDS AND THE 6094 05:21:06,322 --> 05:21:08,858 OTHER PARTNERS IN THE NIH 6095 05:21:08,858 --> 05:21:09,692 WORKING GROUP AS WELL AS THE 6096 05:21:09,692 --> 05:21:11,193 TREMENDOUS EFFORT I THINK WAS 6097 05:21:11,193 --> 05:21:13,229 ACKNOWLEDGED MULTIPLE TIMES AND 6098 05:21:13,229 --> 05:21:15,898 SHOULD BE FOR THE RESEARCH ROAD 6099 05:21:15,898 --> 05:21:19,568 MAP EFFORTS LED BY DOCTORS HANS 6100 05:21:19,568 --> 05:21:22,404 JON AND WHITTMORE AND BATEMAN. 6101 05:21:22,404 --> 05:21:27,610 FINALLY, I WANT TO THANK THE NIH 6102 05:21:27,610 --> 05:21:30,346 STAFF WHO HELPED WITH THIS 6103 05:21:30,346 --> 05:21:31,747 SOMETIMES CHALLENGING MEETING 6104 05:21:31,747 --> 05:21:34,316 WITH ZOOM AND VIDEO CONFERENCE 6105 05:21:34,316 --> 05:21:35,150 FOR PULLING THIS OFF AND 6106 05:21:35,150 --> 05:21:37,386 DELIVERING AND TRYING TO GET 6107 05:21:37,386 --> 05:21:38,854 INFORMATION BACK OUT TO THE 6108 05:21:38,854 --> 05:21:39,855 PUBLIC ABOUT THE GOALS OF THE 6109 05:21:39,855 --> 05:21:43,692 MEETING AND WHAT WE'RE TRYING TO 6110 05:21:43,692 --> 05:21:45,861 ACHIEVE AND OUR SUPPORT STAFF. 6111 05:21:45,861 --> 05:21:51,700 I HAVE TO CALL OUT GRACE TALINI 6112 05:21:51,700 --> 05:21:53,602 IN THE BACK WITH THOSE WHO 6113 05:21:53,602 --> 05:21:55,337 HELPED US PULL THIS OFF AND WITH 6114 05:21:55,337 --> 05:21:56,305 THAT I WILL END THE MEETING AND 6115 05:21:56,305 --> 05:21:56,672 THANK YOU AGAIN. 6116 05:21:56,672 --> 05:21:56,739