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Post-exertional malaise
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=== Gene expression === <embedvideo service="youtube" dimensions="400" alignment="right" container="frame" description="''72. Gene-expression and exercise / Gen-expressie en inspanning – Dr. Lucinda Bateman'' (2015) By Dr. Lucinda Bateman/Wetenschap voor Patienten - ME/cvs Vereniging">https://www.youtube.com/watch?v=F1PP21TmUPs</embedvideo> One example is gene expression. In a 2009 study Light et al. showed that after a moderate exercise test, the [[leukocyte]]s of ME/CFS patients showed an increase in expression of [[Adrenergic receptor|adrenergic]], metabolite detecting and immune-related genes that was not seen in healthy controls. Before the exercise test there were no abnormalities in the expression of these genes of ME/CFS patients. The authors speculated this to be evidence for sensitization of fatigue pathways in ME/CFS.<ref name="Light2009" /> The research team was able to confirm their results in a subsequent study using a larger sample of 48 patients.<ref name="Light2011" /> In a 2012 comparison MS patients also displayed an increase in post-exercise gene expression, but only ME/CFS patients showed increases in metabolite-detecting sensory receptors. According to the authors:<blockquote>"Because only the CFS patients showed increases in these metabolite-detecting receptors, the sensory receptor elements of this gene profile seem particularly specific to CFS and may reflect dysregulated pathways that directly contribute to increased effort sense during exercise and postexertional malaise."<ref name="White2011" /></blockquote>Attempts at replication by other research teams have produced contradictory results. Meyer et al. were unable to confirm most of the post-exertional increases in gene expression, except for some in the adrenergic and glucocorticoid pathway.<ref name="Meyer2013" /> An [[Australia|Australian]] team under the guidance of [[Andrew Lloyd]] failed to find any significant exercise-induced changes in leucocyte gene expression, though the patient sample used (n = 10) was rather small and did not include any patients with severe disability.<ref name="Keech2016">{{Cite journal | last = Keech | first = Andrew | last2 = Vollmer-Conna | first2 = Ute | last3 = Barry | first3 = Benjamin K. | last4 = Lloyd | first4 = Andrew R. | date = 2016 | title=Gene Expression in Response to Exercise in Patients with Chronic Fatigue Syndrome: A Pilot Study|url=https://www.ncbi.nlm.nih.gov/pubmed/27713703|journal=Frontiers in Physiology|volume=7 | pages = 421|doi=10.3389/fphys.2016.00421|issn=1664-042X|pmc=5031769|pmid=27713703}}</ref>
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