Understanding Brain Immune Interactions in Fibromyalgia May Lead to Better Treatments

Understanding Brain Immune Interactions in Fibromyalgia May Lead to Better Treatments

While fibromyalgia is increasingly viewed as a serious medical problem, patients are still regularly dismissed with demeaning comments like the disease is just in their heads. But new brain research might prove that this notion is right – just not in the way of condescending criticism.

Jarred Younger at the University of Alabama at Birmingham was convinced that there was more to fibromyalgia than the research and clinical communities were willing to admit. “I made it my mission to figure out what is wrong with these patients and how to treat them,” he recently told the UAB Magazine in an article focusing on his research, Prisoners of Pain – Solving the mysteries of fibromyalgia could help patients break free.

When studying pain as a young postdoctoral researcher at Stanford, his conviction that fibromyalgia was a poorly understood medical condition led him to survey immune molecules in the blood of fibromyalgia patients. He discovered that leptin, a factor released by fat tissue, was much higher in fibromyalgia patients than in healthy people. And not only were the levels higher, but Younger also discovered that the concentrations could predict patients’ severity of symptoms from day to day.

Research in past decades has revealed how intertwined the immune system and brain really are. Realizing that the brain was a likely source of the symptoms patients experienced, Younger’s initial findings led him to steer his attention in the direction of the central nervous system.

Leptin is a molecule that, unlike many others, can pass into the brain, and Younger believes that by doing so, it causes pain and fatigue. While he doesn’t know exactly how that happens, he suspects that microglia – brain immune cells – are somehow involved in the process.

“Microglia defend our brain against everything,” Younger said. “When we get the flu, for instance, microglia are activated. These cells make us want to crawl into bed and do nothing – so our body can devote its resources to fighting off the flu.”

Younger believes that microglia are wrongfully activated in patients with fibromyalgia, causing the cascade of symptoms including depression and cognitive dysfunction, atop the pain and fatigue.

“It’s only very recently that people are starting to explore what sensitizes microglia,” Younger said. “The cells can be in a quiet, helpful state, or an active, warlike state.” His findings, he hopes, will help reveal the difference.

As part of this research, he needs to develop and optimize technological solutions to assess microglial activation. Today, there are no methods that can directly measure activation and inflammatory activity of microglia while a person is still alive. He hopes to overcome this by the advancement of specialized brain scan techniques measuring the temperature of the brain or the presence of specific factors in the brain.

In another line of research, Younger started to explore alternative ways to treat fibromyalgia patients. He found an option in an unlikely candidate: naltrexone – used to treat opioid and alcohol addiction. He has shown that low doses of the drug decreased the amount of pain without severe side effects. Interestingly, naltrexone is also known to prevent microglia from producing inflammatory factors.

Younger’s research is changing the way we view fibromyalgia, and he is determined to continue his research to expand his understanding. Leading the work of the Neuroinflammation, Pain and Fatigue Lab at UAB, he pursues the leptin lead, trying to figure out why the factor is elevated in patients, and what consequences it has. Ultimately, he wishes to understand how all these factors are linked.

“There’s a chain of events, and we don’t know where leptin falls in that chain,” he said. “So we begin with one piece of the puzzle and start looking in both directions.”

An important part of the work by the research team is the empowerment of patients. Offering the opportunity to show physicians and family members that there is plenty of science explaining their condition gives patients hope.

And their hope is likely not unfounded. The understanding of fibromyalgia brought on by the research of Younger and his peers may lead to improved future treatments.

“Twenty years ago, rheumatoid arthritis absolutely wrecked people’s bodies, and there wasn’t a lot that could be done about it. Over time, researchers discovered the parts of the immune system that were involved, and that helped them develop better treatments,” Younger said.

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