Electroacupuncture Raises Energy Levels In Chronic Fatigue Syndrome Model!

PGC-1 is a transcription coactivator that is responsible for a number of regulatory functions of cellular metabolism. It stimulates mitochondrial biogenesis and promotes muscle fiber type that is metabolically more oxidative than glycolytic which is about 15 times more efficient. It is present in high amounts where mitochondria is present like brown fat, the heart and muscle. Increased transcription of PGC-1 induces Nrf1 and Nrf2 to increase expression of mitochondrial transcription factors and other mitochondria subunits along the transport like ATP-synthase. (1)

While the cause of chronic fatigue is not known, many experts believe that symptoms of fatigue may be due to mitochondrial dysfunction where the muscles produce less energy. One study in Great Britain demonstrated that 70% of chronic fatigue syndrome (CFS) patients   have ultra structurally abnormal mitochondria.  (2)In a more recent study published just last month, researchers analyzed the benefits of electroacupuncture (EA) ST-36 on the metabolism of CFS-model in rats. They divided the mice into 4 groups; the control group, the CFS-model mice, an EA-"Zusanli" and a non-""Zusanli group. Measurements for ATP-synthase, PGC-1, AMPK and SIRT1 were taken. After forced exercise, the levels of ATP-synthase and PGC-1 were greatly reduced while levels of SIRT1 were elevated. After an application of  electroacupuncture, "the grabbing force and the expression levels of ATP synthase mRNA, SIRT 1 and PGC-1 α proteins and mRNAs, and p-AMPK/AMPK were significantly up-regulated. The results seem to show that the grabbing force of the rats after EA was due to the increased levels of ATP-synthase,  AMPK, PGC-1 and SIRT1 to reduce mitochondrial oxidative stress and to increase energy ATP. (3)

Browse the Catalog and Website!

1. PGC-1alpha: a key regulator of energy metabolism. Advances in physiology education, Vol. 30, No. 4. (1 December 2006), pp. 145-151, doi:10.1152/advan.00052.2006 by Huiyun Liang, Walter F. Ward

2. Mitochondrial Dysfunction and Chronic Fatigue Syndrome. Kent Holtorf, M.D. Holtorf Medical Group.  https://www.holtorfmed.com/mitochondrial-dysfunction-and-chronic-fatigue-syndrome/

3. [Electroacupuncture of "Zusanli" (ST 36) Raises Muscular Force by Adjusting AMPK/PGC-1 α Signaling in Rats with Chronic Fatigue Syndrome]. Zhen ci yan jiu = Acupuncture research, Vol. 43, No. 6. (25 June 2018), pp. 335-340 by Jia-Zi Z. Dong, Yun-Tao T. Wei, Huan-Yu Y. Xu, et al.

Chronic Fatigue: The Nrf2 and Mitochondrial Connection

Chronic fatigue syndrome (CFS) is a condition where symptoms last more than 6 months. One identifying feature is that the overwhelming fatigue that comes with it is not resolved with rest. CFS is now recognized as a serious health condition that is known to effect the immune and neurological systems and have other physiological impacts. In my posts, I often classify CFS as an environmental illness for the sake of simplicity. I also consider multiple chemical sensitivity (MCS) and fibromyalgia (FM) as environmental illnesses. What is common in most patients with these illnesses, is that they have higher than normal levels of oxidative stress. Oxidative stress is produced by natural cellular processes or exposure to environmental toxicants. At high levels it leads to tissue damage and disease.  Currently, the true cause of these environmental illnesses are not known. 

While the cause of CFS might not be known, several theories have been proposed. One such theory is that mitochondrial dysfunction leads to the rampant increase of oxidative stress and overall, energy depletion. (1) This in turn leads to other inflammatory processes. Of course, the opposite could be true. In general, I believe that the inhibition of the Nrf2 pathway is at the root of environmental illness. The Nrf2 is a master gene regulater that regulates the natural antioxidant system in cells and neutralizes oxidative stress. It can be inhibited by many factors including TNF-a and abnormal methylation and xenobiotics. It is upregulated by natural phenols like EGCG, sulforaphane in broccoli, resveratrol and quercetin to name a few. Recent discoveries have also lead to a number of pharmaceuticals that increase expression of Nrf2. It is only in the past few years that researchers have identified a number of ways that the Nrf2 pathway promotes cellular respiration, ATP synthesis and provides other functions in the mitochondria. 

So how exactly does Nrf2 function in the mitochondria? It seems it does it in a number of ways including reducing oxidative stress by promoting the action of complex 1, regulating the expression of ATP synthase subunit α, allows for more efficient oxidative phosphorylation, increases the levels of ATP, there is better integration of fatty acid oxidation with the TCA cycle (a process that occurs through the action for example, of glucoraphanin which is the precursor of the classical Nrf2 activator sulforaphane ), it promotes biogenesis, increases PGC-1 and maintains mitochondrial integrity. (2)

While it is not known if mitochondrial dysfunction occurs in all environmental illnesses, it makes sense that it might be a possibility. In any case, there is a reason to believe that energy depletion from oxidative stress may be a factor in causing some symptoms. 

Related:
*Dysfunction of Methylation and Nrf2 in Environmental Illness - Is This A Better Explanation than NO/ONOO- ?

*Sexual Dimorphism in Mitochondrial Biogenesis! 
*Impairments in Muscle Function After Cigarette Exposure and Environmental Illness 
*Green Tea Catechins May Protect Cells From Particulate Matter!

1. Chronic fatigue syndrome and mitochondrial dysfunction International Journal of Clinical and Experimental Medicine, Vol. 2, No. 1. (2009), pp. 1-16 by Norman E. Sarah Myhill

2. The emerging role of Nrf2 in mitochondrial function. Free radical biology & medicine, Vol. 88, No. Pt B. (11 November 2015), pp. 179-188 by Albena T. Dinkova-Kostova, Andrey Y. Abramov.

Synergistic Activity Not Individual Dose of Antioxidants Combine for Overall Health Impact!

"Not only do antioxidant pills not seem to help, they seem to increase overall mortality—that’s like paying to live a shorter life. Just giving high doses of isolated vitamins may cause disturbances in our body’s own natural antioxidant network. There are hundreds of different antioxidants in plant foods. They don’t act in isolation; they work synergistically. Mother Nature cannot be trapped in a bottle."

Does Antioxidant Intake Matter for Cancer? NutritionFacts.org. Michael Greger, M.D. April 7, 2015. http://nutritionfacts.org/2015/04/07/food-antioxidants-and-cancer/

Sexual Dimorphism in Mitochondrial Biogenesis!

Zawada et al has demonstrated that growth hormone is a key regulator of mitochondrial biogenesis. In experiments with  growth hormone knockouts, he found that there are "significant sexual dimorphic differences in mitochondrial biogenesis markers including a decrease of PGC-1a, AMPk, SIRT1 and Nrf2 in brains of females compared to males. In kidneys, AMPk and SIRT1 were lower in females." You may recognize that I have written about all of these proteins in the past in relation to environmental illnesses. Now, I wonder if this sexual dimorphism in mitochodrial biogenesis can account for any of the gender differences that are seen in the prevalence of conditions such as CFS? (Bell) 

Gene expression of key regulators of mitochondrial biogenesis is sex dependent in mice with growth hormone receptor deletion in liver. Aging, Vol. 7, No. 3. (March 2015), pp. 195-204 by Ilona Zawada, Michal M. Masternak, Edward O. List, et al. http://www.citeulike.org/user/kimberlykramer2015/article/13579428

ME/CFS as a Mitochondrial Disease Prohealth (26 April 2006) by David S. Bell, MD. http://www.prohealth.com/library/showarticle.cfm?libid=13611

Tregs and Immunosuppression in Environmental Illness!

 

      In the past several blogs, I have proposed that multiple chemical sensitivity may be due to the loss of Fox3p regulatory T cells  or Tregs which are negative regulators of inflammation. On one hand, several  studies over the past several years have demonstrated that the loss of immunosuppression from Tregs results in diseases like asthma or inflammatory bowel disease (Wang) But what about less common conditions like multiple chemical sensitivity (MCS) that seems to result in a "loss of tolerance"? Over the last six years, I have made a case for the aberrant signalling from the Nrf2 or AhR may also contribute to symptoms and Nrf2 activators which many are AhR ligands may be of benefit in relieving symptoms at least temporarily.  On the other hand, one author argued that patients exposed to less air pollution exhibited lower Tregs and that the increase or decrease of them could be useful in monitoring environmental disease. (Micovic)

     I found a few recent studies that are interesting as far as Treg suppression in relation to environmental disease. In one of these studies, Kohli found that a mixture of second hand smoke and ambient air pollution resulted in hypermethylation and decreased transcription of IFN-y and Fox3p Tregs. Passed studies show an association with a decrease of both of these proteins in asthma and allergic disease. Ambient air pollution, according to the author, is generally considered as "compounds that include polycyclic aromatic hydrocarbons (PAH), particulate matter that is less than 2.5 um (PM 2.5) , particulate matter less than 10um (PM10), carbon and ozone."

    Vallares has found that growth hormone (GH) stimulates T and B cell proliferation. In his study in autoimmune diabetes, he observed that consistent production of GH prevented the progression of pancreatic symptoms to overt autoimmune diabetes. This involved GH changing the cytokine environment and maintained a suppressor T cell (Treg) population.

    I have written several times about resveratrol, a phytochemical in wine, is an Nrf2 activator and might be a treatment for autoimmune disease like inflammatory bowel disease.  Recently Wang et al reported that resveratrol can inhibit inflammatory cytokines and relieve oxidative stress from a high-fat diet. Interestingly, resveratrol prevented the suppression of Tregs via the the aryl hydrocarbon receptor that is inhibited by high-fat diet. It seems that resveratrol not only stimulates Nrf2 but also acts through the AhR, and both of which I suspect could play a role in MCS. In addition, Busbee and Haniah write how AhR signalling may impact autoimmune disease by activating Fox3p Tregs and inhibiting or downregulating Th17. Haniah makes the comment that further study is needed but the AhR may prove to be a therapeutic strategy against autoimmune diseases.  Busbee notes that the AhR signals impact a number of genes, many of which I have discussed before and is present in a variety of tissue.  

       

For further reading:
Chemical Sensitivity and Th2 Autoimmune Disease: The Loss of Treg Cells As Referee!

T regulatory cells and B cells cooperate to form a regulatory loop that maintains gut homeostasis and suppresses dextran sulfate sodium-induced colitis. Mucosal immunology (25 March 2015) by L. Wang, A. Ray, X. Jiang, et al. http://www.citeulike.org/user/kimberlykramer2015/article/13578157

Regulatory T cells (Tregs) monitoring in environmental diseases. Collegium antropologicum, Vol. 33, No. 3. (September 2009), pp. 743-746 by Vladimir Mićović, Bozo Vojniković, Aleksandar Bulog, et al. http://www.citeulike.org/user/kimberlykramer2015/article/6090770

Secondhand smoke in combination with ambient air pollution exposure is associated with increasedx CpG methylation and decreased expression of IFN-γ in T effector cells and Foxp3 in T regulatory cells in children. Clinical epigenetics, Vol. 4, No. 1. (2012), doi:10.1186/1868-7083-4-17 by Arunima Kohli, Marco A. Garcia, Rachel L. Miller, et al. http://www.citeulike.org/user/kimberlykramer2015/article/13578755

ME/CFS as a Mitochondrial Disease Prohealth (26 April 2006) by David S. Bell, MD. http://www.prohealth.com/library/showarticle.cfm?libid=13611

 Use of natural AhR ligands as potential therapeutic modalities against inflammatory disorders. Nutrition reviews, Vol. 71, No. 6. (June 2013), pp. 353-369, doi:10.1111/nure.12024 by Philip B. Busbee, Michael Rouse, Mitzi Nagarkatti, Prakash S. Nagarkatti. http://www.citeulike.org/user/kimberlykramer2015/article/13407541

Toward understanding the role of aryl hydrocarbon receptor in the immune system: current progress and future trends. BioMed research international, Vol. 2014 (2014) by Hamza Hanieh. http://www.citeulike.org/user/kimberlykramer2015/article/13579639

Dysfunction of Methylation and Nrf2 in Environmental Illness - Is This A Better Explanation than NO/ONOO- ?

One of the most important themes of my research is that accumulation of ammonia may play a causal role in including in conditions such MCS and autism through alterations in the methionine and glutamine synthetase pathway and elevations of ammonia in general which may change the expression of a variety of genes that regulate cell function. Of course, this has been suggested by a number of experts. Further, I also have proposed that the dysfunction in Nrf2 and related genes contribute to the severity and elicits autoimmune-type responses and chemicals such as PFOS may influence it or "trigger" it in addition to other chemicals that are more commonly considered as more toxic. In support, in support it has been suggested that hyperammonemia may alter that nitric-oxide-cGMP pathway (Hermenegildo) and as a result this could alter NO funtioning and contribute to conditions such as fibrosis in some tissues and endothelial dysfunction. Alterations in the ornithine pathway may contribute to this but it is worth mentioning that NO may alter this pathway on it own. (Bauer) Interestingly, recently it has been reported that one of the benefits of fish oil may be mediated through the eNOS-cGMP pathway. (Lopez)  Nrf2 also has an important role in regulating NO and CO through its interaction with the antioxidant HO-1 and plays a substantial neuroprotective role against diseases such as Parkinson's disease. The deficiency or lack of Nrf2 expression offers one explanation of why individuals with MCS are so sensitive to carbon monoxide, nitrous oxide and other greenhouse gases. Mainly, because of the dysregulation of their regulator HO-1 by Nrf2. Tinnitus is common with MCS and can be associated with over-exposure to nitrous oxide which may also indicate problems associated with vitamin B and methylation. (Wipedia) Genetic polymorphisms in HO-1 and metal toxicity may also contribute to this problem. (You can see how lead, mercury and aluminum alter function in different steps in the cycle....here but you have to look closely.) Other Nrf2 interactions include modulation of Il-6 which is elevated in neuroinflammatory responses in the brain and Il-10 which is an anti-inflammatory that modulates sickness syndrome. According to a new report, sickness syndrome may be implicated in causing some of the symptoms of Gulf War Syndrome.


In addition, conditions such as elevations of ammonia activate the CRF pathway in animals that display hyperanxious behavior and recently this pathway has been shown to regulate both anxiety and depression as a consequence of stress. (Biomedicine) Interestingly, the glutamine pathway is also altered during depression and as a result, one may suggest this pathway may be dysregulated from exposure to chemicals such as PFOS and cause mood changes such as depression and anxiety and endogenous elevations of ammonia may induce mood changes even more. In addition, dysfunction of Nrf2 may lead to neurotoxicity and other consequences including augmenting ammonia accumulation. Chemical sensitivity has been implied as important in autism and ammonia may contribute to this which is produced endogenously and exogenously and many therapies used for MCS have also been used to reduce ammonia levels in autism. An interesting suggestion is that in some form through the dysfunction of Nrf2, deficits in the ornithine pathway contribute to the cellular toxicity experienced in MCS and autism. Of course, there are a number of other genetic defects that may alter the urea-cycle, including minor ones that may not appear until adulthood or later because of compensation from other pathways lost with ageing. Ammonia production is higher correlated with inflammatory markers in liver injury and has a profound effect on the permeability of the blood-brain-barrier, providing access of more toxic agents to brain tissue. (Jalan)

Alterations in the methionine pathway have also been suggested to play an important role in autism and we suggest here, MCS and relies on the notion of abherrant methylation "tagging" that potentiate the problems or vice versa. Q10 and vitamin B12 has been used as a therapy for MCS but is also used to assist mitochondrial function and support the methionine cycle and reduce ammonia, respectively. In methyl cycle disfunction, BH4 is drained in ammonia detoxification (Yasko ?) in addition to its role for NOS production and peroxynitrite which is part of the NO/ONOO- hypothesis. (Pall) Here we see the dichotomy between the Methyl Pathway and the NO/ONOO- hypothesis where BH4 is concerned. In one BH4-dependant process, NOS is converted to nitric oxide and on the other hand it assists in ammonia detoxification in the methylation cycle. If you put alterations in Nrf2 function, which is activated by ONOO- into the mix it can alter expression of genes important for these processes. ONOO- is not the only pro-oxidant that activates the Nrf2, it has been suggested that H2O2 is a much stronger activator and numerous other conditions normally upregulate Nrf2 in normal circumstances. Marzec recently demonstrated that SNPs that exist in the Nrf2 may make on more or less susceptible to oxidative stress and therefore cellular injury and dysfunction. The inheritability hypothesis of epigenetics also relies on methylation and helps to explain why environmental illnesses largely run in families and the relationships between gene expression help to explain why gender plays an important role too! Unfortunately, alterations in methylation and consequently, alteration of function has been demonstrated in Nrf2 and several other genes implicated in environmental illness including autism. (To get an idea of how complicated genetics in environmental illness is --click here. ) In addition, alterations in Nrf2 and PGC-1a may contribute to diabetes and insulin resistance and are associated with POP exposures. In addition, GSK-3b involvement from reduced expression of PGC-1a, elevations in dopamine and exposures to bacteria (endotoxin) are a few additional factors that may hamper Nrf2 detoxification system which can lead to more elevations of neuroinflammatory processes, mood changes and significantly increase the likelihood of more neurodegeneration; all associated with environmental illness. GSK-3b signaling also may involve alterations in dopamine-regulated behaviors such as twitching (Tourette's) and ADHD that are often co-morbid with environmental illnesses after exposure injury. Incidentally, a number of behavioral responses to drugs (ie cocaine) can be reduced by GSK-3b inhibitors.

Currently, the NO/ONOO- cycle hypothesis which implicates elevation in ONOO as an important cause for responses in the conditions and proposed by Martin Pall, PhD is one of the most commonly accepted hypothesis to explain many of the symptoms in many environmental illnesses including MCS, chronic fatigue syndrome, fibromyalgia and PTSD. While this hypothesis is an important one, I can not say that it accurately describes the multi-inflammatory processes that occur in all of these illnesses and fails to adequately describe the metabolic processes that lead to these conditions. For one, obesity and insulin resistance and diabetes are important in environmental disease and the complications of ageing augment most of these and others as well. Recent evidence is highly suggestive these conditions may influence the development of the more commonly accept EI conditions and for this reason, I have to include them under that umbrella as well. In addition, there is no mention of methylation or how dysregulation of the antioxidant system Nrf2 negatively impacts the expression of NO, CO, HO-1, Il-10 as well as, modulates inflammatory cytokine expression. HO-1 (again with interaction from Nrf2) and vitamin D are involved in the suppressive function of regulatory Tcells. Their absence has been implicated in autoimmune disease that provides an explanation for why environmental illnesses like CFS and GWS and others including diabetes have autoimmune-type behavior. A recent study has presented the hypothesis that exposure to environmental pollutants and high ammonia levels directly alters Treg behavior. In would suggest the inability of oxidants including peroxynitrite and H2O2 to activate Nrf2 is one explanation for failure of the Nrf2 antioxidant system in addition to impairments in activation and regulation of Keap1 and genetic expression of the many genes that regulate the system in different ways. Not only does Nrf2 regulate NO but so does SIRT1 through AMPK, all of which are indirectly or directly involved in activating PGC-1a upregulated by exercise which prevents activation of GSK-3b that turns off the antioxidant system which provide upregulation of nuclear factors including NRF1. In further support, pharmaceutical therapies such as those that elevate PGC-1a and reduce ammonia levels, electroacupuncture, food therapies that elevate Nrf2 through sauna or Waon therapy and nutrition and antioxidant support to reduce mitochondrial dysfunction may be a valuable "tool kit" for the treatment of MCS, autism, provide some relief in CFS and PTSD and help prevent endothelial damage that may be instrumental in causing a number of health consequences in many of them.

 

Link to citations.