title: Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
abstract: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease characterized by intense and debilitating fatigue not due to physical activity that has persisted for at least 6 months, post-exertional malaise, unrefreshing sleep, and accompanied by a number of secondary symptoms, including sore throat, memory and concentration impairment, headache, and muscle/joint pain. In patients with post-exertional malaise, significant worsening of symptoms occurs following physical exertion and exercise challenge serves as a useful method for identifying biomarkers for exertion intolerance. Evidence suggests that intestinal dysbiosis and systemic responses to gut microorganisms may play a role in the symptomology of ME/CFS. As such, we hypothesized that post-exertion worsening of ME/CFS symptoms could be due to increased bacterial translocation from the intestine into the systemic circulation. To test this hypothesis, we collected symptom reports and blood and stool samples from ten clinically characterized ME/CFS patients and ten matched healthy controls before and 15 minutes, 48 hours, and 72 hours after a maximal exercise challenge. Microbiomes of blood and stool samples were examined. Stool sample microbiomes differed between ME/CFS patients and healthy controls in the abundance of several major bacterial phyla. Following maximal exercise challenge, there was an increase in relative abundance of 6 of the 9 major bacterial phyla/genera in ME/CFS patients from baseline to 72 hours post-exercise compared to only 2 of the 9 phyla/genera in controls (p = 0.005). There was also a significant difference in clearance of specific bacterial phyla from blood following exercise with high levels of bacterial sequences maintained at 72 hours post-exercise in ME/CFS patients versus clearance in the controls. These results provide evidence for a systemic effect of an altered gut microbiome in ME/CFS patients compared to controls. Upon exercise challenge, there were significant changes in the abundance of major bacterial phyla in the gut in ME/CFS patients not observed in healthy controls. In addition, compared to controls clearance of bacteria from the blood was delayed in ME/CFS patients following exercise. These findings suggest a role for an altered gut microbiome and increased bacterial translocation following exercise in ME/CFS patients that may account for the profound post-exertional malaise experienced by ME/CFS patients.
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, WI, United States of America.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Shukla
authors.affiliation: William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America.|University of Wisconsin, Madison, WI, United States of America.
authors.forename: Dane
authors.initials: D
authors.lastname: Cook
authors.affiliation: William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America.
authors.forename: Jacob
authors.initials: J
authors.lastname: Meyer
authors.affiliation: Bateman Horne Center of Excellence, Salt Lake City, UT, United States of America.
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Vernon
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, WI, United States of America.
authors.forename: Thao
authors.initials: T
authors.lastname: Le
authors.affiliation: University of Wisconsin, Madison, WI, United States of America.
authors.forename: Derek
authors.initials: D
authors.lastname: Clevidence
authors.affiliation: University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Robertson
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, WI, United States of America.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Schrodi
authors.affiliation: Marshfield Clinic, Marshfield, WI, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Yale
authors.affiliation: University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Frank
mesh_terms: D000328:Adult; D001407:Bacillus / Q000235:genetics; D016470:Bacteremia / Q000097:blood / Q000382:microbiology* / Q000503:physiopathology; D016022:Case-Control Studies; D015673:Fatigue Syndrome, Chronic / Q000097:blood / Q000382:microbiology* / Q000503:physiopathology; D005243:Feces / Q000382:microbiology; D005260:Female; D000068536:Bacillota / Q000235:genetics; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion