Abstract
The present study discusses about the effects of a combination of probiotics able to stimulate the immune system of patients affected by Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). To this purpose, patients diagnosed according to Fukuda's criteria and treated with probiotics were analyzed by means of clinical and laboratory evaluations, before and after probiotic administrations. Probiotics were selected considering the possible pathogenic mechanisms of ME/CFS syndrome, which has been associated with an impaired immune response, dysregulation of Th1/Th2 ratio, and high oxidative stress with exhaustion of antioxidant reserve due to severe mitochondrial dysfunction. Immune and oxidative dysfunction could be related with the gastrointestinal (GI) chronic low-grade inflammation in the lamina propria and intestinal mucosal surface associated with dysbiosis, leaky gut, bacterial translocation, and immune and oxidative dysfunction. Literature data demonstrate that bacterial species are able to modulate the functions of the immune and oxidative systems and that the administration of some probiotics can improve mucosal barrier function, modulating the release of proinflammatory cytokines, in CFS/ME patients. This study represents a preliminary investigation to verifying the safety and efficacy of a certain combination of probiotics in CFS/ME patients. The results suggest that probiotics can modify the well-being status as well as inflammatory and oxidative indexes in CFS/ME patients. No adverse effects were observed except for one patient, which displayed a flare-up of symptoms, although all inflammatory parameters (i.e., cytokines, fecal calprotectin, ESR, and immunoglobulins) were reduced after probiotic intake. The reactivation of fatigue symptoms in this patient, whose clinical history reported the onset of CFS/ME following mononucleosis, could be related to an abnormal stimulation of the immune system as suggested by a recent study describing an exaggerated immune activation associated with chronic fatigue.
Highlights
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a pathologic condition characterized by persistent and unexplained relapsing fatigue, physical and cognitive, that is worsened by physical and mental exertion [1]
The probiotics used to treat patients were chosen to consider the possible pathogenic mechanisms of CFS/ME syndrome which has been associated with an impaired immune response against a hypothetical infectious agent and with a dysregulation of T-helper cell 1 (Th1)/T-helper cell 2 (Th2) ratio
The results suggest that the probiotic ability to counteract the main features of CFS/ME, i.e., chronic fatigue, immune imbalance, and psychophysical discomfort, affects the wellbeing status of patients
Summary
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a pathologic condition characterized by persistent and unexplained relapsing fatigue, physical and cognitive, that is worsened by physical and mental exertion [1]. It is a multisystemic condition in which immune functions, mitochondrial function, and cardiovascular, neurological, and endocrine systems are compromised [2,3,4]. A diagnosis of mental and behavioral disorder for patients with CFS/ME is not uncommon, supported by the observation that these patients often complain difficulty of concentration or look like they have depression [8]
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