In Science verscheen deze week de kritiek van Wessely, van der Meer en kollega's
op de XMRV-Lombardi-Mikovits-studie en de response van dr. Mikovits op die kritiek.
Comment on "Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome"
Science. 14 May 2010; 328(5980):825. doi: 10.1126/science.1183906
Jos W. M. van der Meer, Mihai G. Netea, Jochem M. D. Galama, Frank J. M. van Kuppeveld.
http://www.sciencemag.org/cgi/content/full/328/5980/825-c
Comment on "Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome"
Science. 14 May 2010; 328(5980):825. doi: 10.1126/science.1183706.
Andrew Lloyd, Peter White, Simon Wessely, Michael Sharpe, Dedra Buchwald.
http://www.sciencemag.org/cgi/content/full/328/5980/825-b
Comment on "Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome"
Science. 14 May 2010; 328(5980):825. doi: 10.1126/science.1183545.
Cathie Sudlow, Malcolm Macleod, Rustam Al-Shahi Salman, Jon Stone.
http://www.sciencemag.org/cgi/content/full/328/5980/825-a
De grotendeels onterechte kritiek
(alleen de suggestie in de tekst van de studie dat er naast de
Fukuda- en Canadese kriteria
immunologische eisen gesteld werden zou men als terechte kritiek kunnen/moeten zien)
wordt op systematische en heldere wijze door Mikovits weerlegd:
- Slechts 25 van de 101 bloedmonsters waren afkomstig van de Lake Tahoe-uitbraak,
dus het argument dat de XMRV-Lombardi-studie niet representatief zou zijn voor "geïsoleerde gevallen" van ME/CVS (de meeste ME/CVS-patiënten) is volstrekt onjuist.
- Er was geen sprake van beïnvloeding: de bloedmonsters waren
blind (genummerd).
- De studies van
Wessely c.s.,
van der Meer c.s. en
Kerr/Gow
zijn géén replikatiestudies, omdat ze gebaseerd zijn op slechts één van de door het WPI/NCI gebruikte technieken:
de minst gevoelige, en zelfs niet op de
PCR-techniek van Lombardi, Mikovits c.s.
- De kritiek dat de populatie niet representatief zou zijn (geslacht, leeftijd..) is onterecht.
omdat de Lombardi-studie niet het doel had epidemiologisch onderzoek te doen:
de exacte percentages geïnfekteerde ME/CVS-patiënten zullen later bepaald worden.
- Oók de kritiek dat de Lombardi-studie zou beweren dat XMRV-de oorzaak is, is onjuist:
De auteurs geven in de studie juist aan dat de "causaliteitsvraag" (oorzaak of gevolg?) onderwerp van toekomstig onderzoek is,
maar dat het logisch lijkt dat XMRV de immunologische afwijkingen veroorzaakt
en dus geen opportunistische infectie is (het nieuwste argument van het NKCV:
klik hier).
Tot slot nog twee opvallende zaken:
- Van der Meer en kollega's komen niet meer met het "contaminatie-argument"!
- Er is een "zwart gat" tussen het moment van ontvangst en van acceptatie van de kritiek.
Response to Comments on "Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome"
Science. 14 May 2010; 328(5980):825. doi: 10.1126/science.1184548.
Judy A. Mikovits, Francis W. Ruscetti.
....
Samples included in our study were from CFS patients who fulfilled both the Fukuda criteria and the Canadian Consensus Criteria (CCC), regardless of severity.
We regret that a sentence in the original supporting online material ... implied that immunological abnormalities were part of the CFS diagnosis;
indeed, while many such patients do exhibit such abnormalities, they were not required for diagnosis.
All patients that met Centers for Disease Control and Prevention and CCC criteria were accepted;
none were excluded.
Patient samples were obtained from 2006 to 2009 and stored in the Whittemore Peterson Institute (WPI) repository.
....
We did not state in Lisbon or elsewhere that the samples analyzed in were only from patients from documented outbreaks of CFS,
nor did we state that the 101 patients described in exhibited all the immunological abnormalities described in our Lisbon conference presentation.
In fact, only 25 samples in came from patients identified during the 1984 to 1988 CFS outbreak in Incline Village, Nevada.
The remaining 76 samplesincluded patients with sporadic cases
from 12 U.S. states and Canada, including California, New York, North Carolina, Wisconsin, Michigan, Oregon, New Mexico, New Jersey, North Dakota, Texas, and Florida.
....
We did not state that our study proves the cause of CFS.
....
We further note that no cytokine profiles were presented in ...,
nor did we state that abnormal cytokine levels, altered natural killer cell activity, or particular RNase L profiles were a requirement for inclusion in the study.
....
All samples were blinded, as mandated by the NCI and WPI institutional review board approvals.
All experimental procedures were done by the same personnel, in the same physical laboratory space, under identical protocols.
....
We contend that the three recently published negative PCR studies do not qualify as being studies that fail to replicate our study,
as neither the same PCR methodologies were used
nor did these studies draw on the additional cell culture and immunological methods that we employed to observe XMRV nucleic acids and proteins.
....
http://www.sciencemag.org/cgi/content/full/328/5980/825-d
http://www.sciencemag.org/cgi/content/full/328/5980/825-d/DC1
Received for publication 10 November 2009.
Accepted for publication 19 April 2010.
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