XMRV & MRV's

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Related Pages

List of positive and negative ME & CFS-related studies

Timeline of published XMRV & MLV-related retrovirus studies

Ongoing ME or CFS related XMRV studies

XMRV blood supply studies

Retrovirus testing methodologies

XMRV Blood Working Group

XMRV Testing - how to get tested

'FDA TABLE: Prevalence Studies on XMRV and MLV-related Virus Infection in Human Diseases and General Populations'

General

Xenotropic Murine Leukemia Virus-Related Virus (XMRV) is a human exogenous gammaretrovirus that was first described in 2006.[1] Currently it is not known whether this retrovirus can cause disease, but studies are underway to investigate this possibility, particularly in patients with Prostate Cancer and Chronic Fatigue Syndrome.


XMRV is polytropic/xenotropic hybrid. [2] In August 2010, a second CFS study (Lo et al) detected a more diverse group of MLV-related sequences that more closely resembled polytropic MLV's.


"In contrast to the reported findings of near-genetic identity of all XMRVs, we identified a genetically diverse group of MLV-related viruses. The gag and env sequences from CFS patients were more closely related to those of polytropic mouse endogenous retroviruses than to those of XMRVs and were even less closely related to those of ecotropic MLVs."


Lo et al, 'Detection of MLV-related virus gene sequences in blood of patients with chronic fatigue syndrome and healthy blood donors' (PNAS, 23 August 2010) [3]


"Clearly multiple sequences have been identified, in, particularly in Chronic Fatigue Syndrome patients and in some cases in normals. As yet, we can really only refer to one virus, and that's XMRV. That's the only one of these sequences that we know is in a replicating virus. I think it's very important to keep that in mind. We don't know what, if any virus, the sequences that match into PMV or MPMV clades, other than XMRV, what their biology is."


"...clearly there are a bunch of different sequences. I think before we start referring to a bunch of different viruses we really need to have viruses that go with those sequences. We can say there are sequences there that look like endogenous MLVs, maybe a little different from, but we just don't have a virus yet to go with them."

Dr John Coffin, '1st International Workshop on XMRV: Q&A Wrap-up Session' (NIH, 8 September 2010, 3mins 32secs in) [4]


On the 18th October 2010, reports of the NJCFSA Fall Conference (Oct 17, Eatontown, NJ) started to circulate the web. XMRV had been found in those patients testing positive for MLV-related viruses in Lo et al, by Frank Ruscetti of the National Cancer Institute. [5]


"While each of these viruses, xenotropic, polytropic and modified-polytropic viruses (M-PMV), has been placed in distinct categories within the larger subgroup of murine leukemia viruses, it is important to note that they share considerable similarity with each other and utilize alleles of the same receptor for viral entry. The PMV and M-PMV share over 95% sequence identity, and the xenotropic viruses share over 90% identity with the PMV (derived from sequences within reference and Genbank. Compared to this, an average pair of random isolates of HIV-1 in the U.S. are ~85-95% similar, depending on the region of the viral genome used for comparison. Thus it is conceivable that PMV, M-PMV and XMRV may cause the same disease(s), if they cause disease at all."


Ila R. Singh, 'Detecting Retroviral Sequences in Chronic Fatigue Syndrome' (Viruses, 3 November 2010) [6]


The Name

XMRV (Xenotropic Murine Leukemia Virus-Related Virus) was the name given to a human retrovirus that was first described in men with prostate cancer. [7] The virus is closely related to xenotropic murine leukemia viruses (MuLVs or MLVs), which are found in mice, but its sequence is clearly distinct from all known members of this group, and is not present at an endogenous retrovirus in the mouse genome.

XMRV and segments of other MLV-related viruses, have also been found in CFS patients. The segments of MLV-related viruses are more closely related to those of Polytropic mouse endogenous retroviruses than to those of XMRVs and are even less closely related to those of Ecotropic MLVs. XMRV in fact appears to be a recombinant of a Xenotropic and a Polytropic MLV. There is little genetic difference between a Xenotropic and a Polytropic; the key difference is really only in the sequences specifying the type of cell receptor they use for entry on the host cell.

The mouse version of XMRV, called xenotropic murine leukemia viruses(X-MLV)s, has been found in lab mouse strains. Whether it can infect other lab mice or wild mice, depends on if they have the necessary receptor, that would allow them to enter a cell. An endogenous retrovirus can become xentropic when the host either loses/or alters the cells receptor needed to enter a cell. Therefore it does not require the retrovirus to change.

See here for an explanation of some of these scientific terms


Proposed Name Change

Due to the difficulties with the name XMRV, and the discovery of segments of other MLV-related viruses, a name change has been proposed by those who attended the WPI Symposium. (17th August 2010) [8] The following reasons were cited for this proposal.

  • This retrovirus is a human, not mouse retrovirus.
  • It is the first and so far only gammaretrovirus known to infect people.
  • It is clearly not an "endogenous" retrovirus (one that is present in all genomes due to ancient infection).

The proposed new name for the virus is HGRV (Human Gamma Retro Virus). The name proposed for any illness caused by this infection is HGRAD (Human Gamma Retrovirus Associated Disease).


History

XMRV was first discovered by laboratories led by Joseph DeRisi at the University of California, San Francisco, and Robert Silverman and Eric Klein of the Cleveland Clinic. This group had sought to examine if a virus might be present in prostate cancer. [9] They found XMRV in prostate cancer tissue of men with a specific genetic defect in their antiviral defence pathway. [10] As this same genetic defect had also been found in several studies into ME/CFS, researchers at the Whittemore Peterson Institute undertook a study to test for XMRV in patients. This study was the first to isolate human XMRV virus from a disease population (ME/CFS) and showed it to be blood borne and transmissible. [11]


In a later study, it was shown that XMRV infection was not dependent upon the specific genetic defect. In further experiments the WPI was able to confirm infection by XMRV in 85% (up from 67%) of the 101 patients from the original study. [12]


Since the discovery of XMRV, several studies looking at either prostate cancer patients or CFS patients, have reported both positive and negative findings from around the world. Studies in Germany, the UK, China, the Netherlands, Ireland and the USA, have been unable to detect the retrovirus, whereas a number of studies from the USA continue to find XMRV in a significant number of prostate cancer patients. XMRV has also been found in healthy blood donors.


One study from Japan, reported at the 2010 Cold Springs Harbor Retrovirus Symposium, found that XMRV was in 1.7% of those donors tested. The second study to find XMRV in blood donors was also the first to support the findings of the WPI study. Although they did not find XMRV, they found segments of MLV-realated viruses in 86.5% of CFS patients, and 7% of blood donors. XMRV has also been detected in 9.9% immunosuppressant transplant patients from Germany [13],


Classification and genome

XMRV is a member of the Gammaretrovirus genus of the Orthoretrovirinae subfamily of Retroviridae with high sequence similarity to endogenous murine leukemia viruses. XMRV was so named because its envelope gene was similar to that of xenotropic murine leukemia virus (MuLV or MLV), an endogenous MLV that infects cells from non-mouse species including humans. Similar agents are found in a wide range of mammalian species and include the porcine endogenous retrovirus, the feline leukemia virus, the koala retrovirus, and the gibbon ape leukemia virus. Gammaretroviruses are much simpler than the complex deltaviruses such as human T-lymphotropic virus (HTLV ), or the complex lentiviruses such as human immunodeficiency virus (HIV). The XMRV genome includes gag, pol, and env genes but no accessory or regulatory genes. As the name implies, XMRV is believed to have originated in mice and is the first agent of its class to be identified in humans; it likely evolved as a result of a recombination event between polytropic and xenotropic MLV. Its pathogenic potential in humans is unknown. [14]


It has a single-stranded RNA genome that replicates through a DNA intermediate. The genome, approximately 8100 nucleotides in length, is 95% identical with several endogenous retroviruses of mice, and is 93-94% identical with several exogenous mouse viruses. [15] Different isolates of XMRV from Prostate Cancer and CFS published to date show very little sequence variation and form a distinct branch following phylogenetic analysis.


Evidence that XMRV is a Human Virus

  • Mapping of viral integration sites within human chromosomes. [16]
  • Presence of viral antibodies in human plasma. [17] [18]
  • Presence of viral proteins and nucleic acids in fresh and frozen tissue. [19] [20] [21]


Detection

A variety of methods have been employed by researchers to detect XMRV and segments of MLV-related viruses, with some more successful than others. As there is no official test for this family of retroviruses, a number of researchers have stated that multiple methods should be employed.


"We do not know at the moment what the differences is, if it's processing or what not, but I stand on the recommendation I made. Until we understand it better, negative PCR is not a stand alone assay for detection of this virus in clinical samples."
Francis Ruscetti, '1st International Workshop on XMRV: Q&A Wrap-up Session' (NIH, 8 September 2010, 37mins 24secs in) [22]


"We remain confident that applying multiple methods and rigorously following established protocols that have successfully detected XMRV will reveal a wider distribution of XMRV infection in humans than has currently been reported."
Mikovits et al., 'Distribution of Xenotropic Murine Leukemia Virus-Related Virus (XMRV) Infection in Chroinic Fatigue Syndrome and Prostate Cancer.' (AIDS review, July - September 2010, Volume 12 - Number. 3, page 152) [23]


Isolation of infectious XMRV from prostate cancer patients has not been published, whereas infectious XMRV has been shown in infected CFS patients by passage to lymph node carcinoma of the prostate (LNCaP), a prostate cell line robust for XMRV replication. [24] [25] Plasma from these individuals also had antibodies specific for the envelope protein of this type of retrovirus.


The authors of Lombardi et al. have stated that the most sensitive blood-based assays for detection of XMRV, in CFS patients, in decreasing order are:

  1. Performing nested PCR for gag sequences from LNCaP cells that have been co-cultured with subject’s plasma or activated PBMCs
  2. The presence of antibodies to XMRV Env in subject’s plasma
  3. Presence of gag products by nested PCR on stimulated PBMCs or detection of viral proteins expressed by activated PBMCs with appropriate antisera
  4. Nested RT-PCR of plasma nucleic acid or PCR from cDNA from unactivated PBMCs
  5. PCR of DNA from unactivated PBMC prepared from subject’s blood.


The authors of Lo et al. used nested PCR on PBMC-derived DNA samples, targeting the MLV-related virus gag gene, using both the previously described primer sets (Lombardi et al. and the Urisman et al) and an in-house–designed primer set with highly conserved sequences from different MLV-like viruses and XMRVs. RNA was also prepared from the deep-frozen plasma samples of their patients and analyzed by RT–PCR assay.

Suggested reasons for the differing results

  • Geographical differences in the distribution of MLV-related viruses.
  • High levels of sequence diversity. (Divergent MLV-related viruses, when using highly specific assays, may cause variant viruses to be missed.)
  • Use of a synthetic control to calibrate assay, rather than a known clinical sample.
  • Currently it is unknown whether infected individuals form antibodies to the viral proteins, and if so, to which viral proteins. (Therefore the presence or absence of antibodies to MLV proteins cannot presently be used to determine whether or not an individual is infected.)
  • Peripheral blood and prostate may not be the major reservoir in vivo.
  • Definition used to diagnose CFS.
  • Contamination with mouse cells.
  • That XMRV is not a human retrovirus, but a mouse retrovirus. Please see the 22Rv1 & Du145 cell lines page.


Prostate cancer

In the initial report on XMRV, the virus was detected in cancerous prostate tissues using a microarray containing samples of genetic material from about 950 viruses. The screen indicated the presence of a gammaretrovirus-like sequence in seven of eleven tumours homozygous for the R462Q mutation, but only in one of five tumours without the mutation. After isolation and cloning of the virus, an expanded screen found it present in 40% of tumours homozygous for R462Q and in only 1.5% of those without the mutation. Additionally, a 2009 study reported XMRV infection in 23% of subjects independent of the RNase L gene variation. [26]


Two studies in Germany [27] [28] and one study from Ireland [29] have been unable to find the retrovirus in patients with prostate cancer.


A USA study found that XMRV in prostate cancer rarely transforms cells, suggestive of indirect transformation. [30] In another prostate cancer study from the USA, XMRV protein and nucleic acids were found in malignant cells. [31]


On the 17 March 2011, the Journal of Urology published the abstracts of three papers that were to be published in April. Two were positive prostate cancer studies; one detected MRV's in the prostate tissue of 4/61 patients from Japan, three of which were found to have polytropic MLV gene sequences. The one patient found positive for XMRV sequence was retested with a blood sample and found negative. [32] The second study was a positive prostate cancer study from the USA [33], and the third showed that XMRV induces host genes that regulate inflammation and cellular physiology.[34]


Chronic fatigue syndrome

In 2009, the Whittemore Peterson Institute, National Cancer Institute and Cleveland Clinic, reported in 'Science' (Lombardi et al.), the detection of XMRV in 67% of Chronic Fatigue Syndrome patients. The authors hypothesised that XMRV could be a contributing factor in the pathogenesis of CFS. [35] The patients for this study were selected using the Fukuda and Canadian definitions for CFS, and came 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. This group accounted for 76 of the total samples with 25 from patients identified during the 1984 to 1988 CFS outbreak in Incline Village, Nevada. [36] Dr. William C Reeves, the former head of the CDC's CFS program, called the research exciting but preliminary, and said he was surprised that a prestigious journal like Science had published it. [37]


"We and others are looking at our own specimens and trying to confirm it..... If we validate it, great. My expectation is that we will not."
Dr. William C Reeves, former head of the CDC's CFS program, 'Is a Virus the Cause of Fatigue Syndrome?' (NYT, 12 October 2009) [38]


Four follow-up studies[39][40][41][42] failed to find evidence of XMRV in any of several hundred CFS patients or controls, however none of these have replicated the methodology used by Lombardi et al. and none have used the same criteria for selecting patients.


The reported association of XMRV and CFS published in Science generated worldwide media coverage. In further experiments the WPI was able to confirm infection by XMRV in 85% (up from 67%) of the 101 patients from the original study. [43]

Health officials put a hold on two conflicting studies

On 22nd June 2010, a journal in the Netherlands, ORTHO, leaked that the NIH (National Institutes of Health) and FDA (Food and Drug Administration) had independently confirmed the XMRV CFS findings as published in 'Science'. Confirmation had been issued by Dr. Harvey Alter of the NIH during a closed workshop on blood transfusion held on May 26-27 in Zagreb 2010, [44], and slides from the presentation are accessible online. Select 'Available Presentations', then Session 4 'Alter.pdf' ORTHO also contacted Dr. Harvey Alter for a reaction. He did not want to comment, but confirmed that a paper is soon to be published.


"The data in the Lombardi, et al Science manuscript are extremely strong and likely true, despite the controversy"


"Although blood transmission to humans has not been proved, it is probable. The association with CFS is very strong, but causality not proved. XMRV and related MLVs are in the donor supply with an early prevalence estimate of 3%‐7%. We (FDA & NIH) have independently confirmed the Lombardi group findings."

Alter H, 'Presentation to the IPFA/PEI 17th Workshop on "Surveillance and Screening of Blood Borne Pathogens" (Zagreb, 26-27 May 2010) [45]


On 30th June 2010, Amy Dockser Marcus reported in the Wall Street Journal, that two separate Government departments had reached contradictory conclusions. One group found a link, and the other didn't. And that both papers, although accepted for publication in separate science journals, the NIH/FDA positive study by PNAS (Proceedings of the National Academy of Sciences of the United States of America ) and the CDC negative study by 'Retrovirology', had been put on hold in early June by Health Officials. [46]


"My understanding was HHS [Department of Health and Human Services] wanted to get it straightened out. Both reports are from different branches of the government,"
Kuan-Teh Jeang, editor-in-chief of Retrovirology, 'Chronic-Fatigue Link to Virus Disputed' (WSJ, 30 June 2010) [47]


"It's fair to say it's not a usual kind of thing,"
John Coffin, Tufts University, 'Chronic-Fatigue Link to Virus Disputed' (WSJ, 30 June 2010) [48]


"The paper was accepted for publication in the journal Proceedings of the National Academy of Sciences of the United States of America but is on hold, according to Ashley Truxon, media coordinator for the journal."


"Kuan-Teh Jeang, editor-in-chief of Retrovirology, said the Switzer paper went through peer review and was accepted for publication when he got a call from the authors earlier this month. They asked that the Retrovirology paper be held."


"In an email between scientists familiar with the situation, viewed by the Wall Street Journal, a researcher said the two teams were asked to put their papers on hold because senior public-health officials wanted to see consensus—or at least an explanation of how and why the papers reached different conclusions, said the people familiar with the situation.


A spokesman for Department of Health and Human Services said the research was being reviewed. "All of these activities need to be completed in order to ensure HHS's commitment to the accuracy and relevancy of the scientific information it reports."

Amy Dockser Marcus, 'Chronic-Fatigue Link to Virus Disputed' (WSJ, 30 June 2010) [49]


On 1st July 2010, the CDC released their negative paper in 'Retrovirology'. [50] However the NIH/FDA positive study remained on hold.

"John T. Burklow, a spokesman for NIH, says the FDA-NIH paper has been accepted for publication but that the authors decided to pull it back to conduct additional experiments. Publication will depend on how long it takes to fully address questions. “It’s a matter of getting it right,” he says."


"Switzer says that after the FDA-NIH team submitted a paper with results different from their own, the CDC group decided to take a “scientific pause” to look at both papers, compare study methods and do additional experiments. After this review, they decided to proceed with publication—and he says no changes were made to their original manuscript."

Amy Dockser Marcus, 'CDC Team’s XMRV-Chronic Fatigue Syndrome Paper Is Out' (WSJ, 1 July 2010) [51]


"Let the science speak for itself"
Annette Whittemore, co-founder of the Whittemore Peterson Institute, 'CDC Team’s XMRV-Chronic Fatigue Syndrome Paper Is Out' (WSJ, 1 July 2010) [52]


On 10th August 2010, Mindy Kitei, of CFS Central, reported on her website that the NIH/FDA study was now back at the journal PNAS.


"The Alter paper is now in press, but I don't know when it will go online and until then there will be a press embargo,"
Dr. Randy Schekman, editor of PNAS, 'FDA/NIH paper in press' (CFS Central, 10 August 2010) [53]


On the 16th August 2010, The Reno Gazette Journal reported that Dr. Judy Mikovits (WPI), lead scientist of the Lombardi et al. paper, said that their findings have been replicated and confirmed by the U.S. Food and Drug Administration, and that the paper would be out in September. Mikovits also indicated that the WPI had new, unpublished data concerning the retrovirus, XMRV, that could lead to treatment of Chronic Fatigue Syndrome, and that this research would be published by the end of the year, probably in a clinical immunology journal. [54]


"There has been an issue over whether anybody could replicate our study, and it will not only confirm our findings but extend our findings, which is really exciting for us,"


“We have immune system profiles and we can tell by the immune system how the XMRV is doing the damage,” she said. “So we could have a diagnostic test to follow clinical treatment and show that people’s immune systems go back to normal. That’s the latest data that’s really amazing. That’s what we’re after.”

Dr. Judy Mikovits, lead researcher for the Whittemore Peterson Institute , 'Findings by Reno scientists confirmed by U.S. government' (RGJ.com, 16 August 2010) [55]


NIH/FDA MLV study

On Monday 23rd August 2010, PR Newswire leaked the results of the FDA/NIH study. Several different MLV gene sequences were identified in samples from 32 of the 37 patients with CFS (86.5 percent) and 3 of the 44 (6.8 percent) healthy blood donors. The study demonstrates a strong association between a diagnosis of CFS and the presence of MLV-like virus gene sequences in the blood.


"Although we find evidence of a broader group of MLV-related viruses, rather than just XMRV, in patients with CFS and healthy blood donors, our results clearly support the central argument by Lombardi et al. that MLV-related viruses are associated with CFS and are present in some blood donors."
Lo et al., 'Detection of MLV-related virus gene sequences in blood of patients with chronic fatigue syndrome and healthy blood donors' (PNAS, 23 August 2010, Page 5) [56]


“Viruses tend not to be homogenous,"


“The fact that we didn’t find XMRV doesn’t bother me because we already knew that retroviruses tend to be variable. They mutate a lot, basically. This is true of HIV and HCV [hepatitis C virus]. It’s not one virus. It’s a family of viruses.”

Harvey Alter, 'The FDA/NIH/Harvard “XMRV” study: The same thing only different' (CFS Central, 23 August 2010) [57]


Lo et al. studied two sets of patients, 25 patients were from an academic medical center and 12 were referred by community physicians. Of the 25 from an academic medical center, all met the 1988 Holmes CDC criteria for CFS, and 21 also met the 1994 Fukuda CDC criteria. Diagnostic criteria for the 12 sent by individual clinicians in the mid-1990s were not known. Blood samples from the 25 from an academic centre were first taken for a study in 1993, with another 4 taken 2 years later, and another 8 taken 15 years later in 2010. The results were as follows: 24/25 (96%) patients from an academic centre were positive. All 4 patients blood taken 2 years later were positive, and 7/8 patients blood taken 15 years later were positive. Of those tested 15 years later, none had recovered. [58] Finally, 8/12 (66.7%) patients referred by community physicians were also positive.


The WPI had announced finding gag sequences that reflect greater variability from CFS patients than was originally reported for XMRV, at the May 2010 Cold Spring Harbor Laboratory (CSHL) conference on Retroviruses.


"We presented a paper at the Cold Spring Harbor RNA tumor virus meeting in May showing that patients reported in Lombardi [the Science paper] contained both X [XMRV] and P [polytropic MLV] variants as well as at least one other family member,"
Dr. Judy Mikovits, 'THE FDA/NIH/HARVARD “XMRV” STUDY: THE SAME THING, ONLY DIFFERENT' (CFS Central, 23 August 2010) [59]


Other scientists did not agree that the results from Lo et al. supported the central argument by Lombardi et al. that MLV-related viruses are associated with CFS.


"Let's be clear: This is another virus. They did not confirm [Mikovits's] results,"
Prof. Myra McClure, 'Second Paper Supports Viral Link to Chronic Fatigue Syndrome' (Science, 23 August 2010) [60]


Further Studies at the XMRV Conference

At the Q&A on day 2 of the 1st International XMRV Conference, on the 8th September 2010, 4 more positive studies were mentioned. Another from the WPI, using UK patients, and three poster presentations. According to Dr Paul Cheney another 4 negative studies were also presented. [61] Dr Judy Mikovits also reported that an issue with sample preparation had been discovered by the blood working group in the last two weeks, and that it may explain the different results between studies.


"...we have learned, literally in the last two weeks, in the blood working group, that processing may be a key, and we may have found an opportunity to have a processing protocol where everyone would find at least viral RNA in plasma and blood products without culture."
Judy Mikovits, '1st International Workshop on XMRV: Q&A Wrap-up Session' (NIH, 8 September 2010, 21mins 39secs in) [62]


At the conference Dr Frank Ruscetti (NCI) stated that some patients have more than one variety of MLV-related retrovirus.

"We identified both polytropic MLV and XMRV in some CFS patient samples."
Dr. Frank Ruscetti, 'Cleveland Clinic Twitter feed' (Twitter: Cleveland Clinic, 8 September 2010) [63]

The UK "Ashford 50" Study was presented at the conference. Blood samples from 50 UK ME/CFS patients were drawn at Ashford hospital London in April 2010 and sent to the National Cancer Institute USA for testing. Reference: Abstract O_13 http://regist2.virology-education.com/abstractbook/2010_8.pdf This was the first study showing that MLV viruses were present in the United Kingdom.

Further Studies Post XMRV Conference

On the 13th September 2010, the fifth negative study was published in Virology Journal. This study looked at 65 CFS patients in China, and 65 normal individuals out of 85 controls. They used real-time PCR or RT-PCR. [64] It is unknown if this is one of the 4 negative studies presented at the XMRV Conference, and highlighted by Dr Cheney.


On the 11th October 2010, the sixth negative study was published in Infectious Diseases Society of America. [65] This study looked at 293 people with different diseases. Of those 293, 32 had CFS using the Empiric definition - but later claimed to be Fukuda definition. [66] They used PCR & nested PCR. As with every other negative study, the test was calibrated to a synthetic version of XMRV, and not the wild version.


Mikovits at the NJCFSA Fall Conference

On the 18th October 2010, reports of the NJCFSA Fall Conference (Oct 17, Eatontown, NJ) started to circulate the web. XMRV had been found in those patients testing positive for MLV-related viruses, by Frank Ruscetti of the National Cancer Institute. [67] [68]


Blood Products Advisory Committee (BPAC) Meeting

At the BPAC meeting on the 14 December 2010, Phase II results of the Blood Working Group were announced.[69] Dr. Jonathan Stoye, presented a summary of current research on MLV-related human retroviruses and disease association. After this presentation, Christopher Cairns, who writes the Patient Advocate blog, questioned Dr. Stoye on what had happened to the 100 samples of American patients sent to Dr Kerr by Dr Enlander for use in a study. At the time Kerr was presumably working on an XMRV study with Stoye, Groom et al., which was published in February 2010. [70]. Stoye was unable to answer the question, and was not certain what had happened to those samples. [71]


Timetable of events:

  • Nov 2009: Samples had started to be collected.
  • Jan 2010: Stoye suggests they had all samples from Kerr by this point, but not clear if that included 100 American samples.
  • 11 Jan 2010: Groom et al. Received by publisher.
  • 15 Feb 2010: Groom et al. Accepted for publication.
  • 15 Feb 2010: Groom et al. published


During the BPAC meeting, Dr Mikovits also spoke of how longitudinal studies on patient samples concorded with the immune responses.

"We isolate virus from these people all the time. We have done longitudinal samples over decades and isolated virus from these patients and have concordance with the immune responses."
Dr Judy Mikovits, 'December 14, 2010: Blood Products Advisory Committee Meeting Transcript' (FDA, 14 December 2010) [72]


Four papers published in Retrovirology on contamination

On the 20 December 2010, 4 papers together with an accompanying article were published in the journal retrovirology. One was a prostate cancer study (Robinson et al.) looking at patients in the UK, Thailand and Korea, which found that samples had been contaminated. [73] The second (Oakes et al.) was a CFS study from the USA, which also found samples had been contaminated. [74] The third was a study from Japan (Sato et al.) which had been initiated by strange results from a CFS pilot study. These researchers discovered that a RT-PCR kit from Invitrogen (Superscript II RT and Platinum Taq), was contaminated with RNA derived from polytropic endogenous MLV (PmERV), a mouse monoclonal antibody. This test kit had been used by Lo et al., in the second positive MLV-related retrovirus study. [75]


The fourth study, from the UK (Hue et al.), looked at issues that might cause contamination. In particular they suggested the XMRV clones identified in previous studies, probably originated in a prostate cancer cell line called 22Rv1. A cell line is a permanently established cell culture that will proliferate indefinitely given appropriate fresh medium and space. In the case of 22RV1, it comes from a prostate cancer patient in 1993 (Pretlow et al, 2003). The authors of Hue et al. stated that they believe XMRV is a laboratory contaminant. However, this is false. The virus expressed by the 22RV1 cell line is XMRV (Knouff et al, 2009). These cells naturally express XMRV, and XMRV is found integrated into the DNA of these cells at about ten copies per genome (Knouff et al, 2009). The authors also claim sequences of XMRV expressed in the 22RV1 cell line are ancestral to the sequences found in XMRV sequences recently found in prostate cancer patients, which is true. The fact that the sequences of XMRV in these cell lines is ancestral to XMRV isolated some 17 years later is actually clear evidence of XMRV replicating, and naturally changing over time, as a result of reverse transcriptase, and provides direct evidence contradicting the hypothesis that XMRV is a laboratory contaminant. Further evidence belies the hypothesis that XMRV is a contaminant, including studies which have mapped integration of XMRV in prostate cancer DNA into cancer-suppressing or -causing genes (Dong et al, 2007; Kim et al, 2008). The presence of integrated DNA means that it is not a contaminant. Furthermore XMRV proteins have been detected in prostate cancer patients (Schlaberg et al 2009). These authors demonstrated that IHC increased detection rates by 400% compared to PCR. And Arnold et al. (2010) demonstrated the presence of antibodies to XMRV using FISH serology in prostate cancer patients who were otherwise healthy. Arnold and others also demonstrated that FISH improved detection rates by over 400% compared to PCR. [76]


In summary none of the four papers were able to show that the positive studies were caused by contamination. And all four of the studies were accepted for publication on the 20 December 2010, and published that same day.


Also on the 20 December 2010, a press release was issued by the Wellcome Trust to say that ME/CFS is not caused by XMRV. [77] The Wellcome Trust had part funded Hue et al. [78] This story was also picked up by news outlets across the world, including the BBC [79], The Independent [80], The Guardian [81], NHS Choices website [82], TWiV [83], Medpage Today [84] and many more.


However, the belief that XMRV was a contaminant was not supported many scientists in the field. Including John Coffin, co-author of two of the four papers, Oakes et al. and Robinson et al.

"The argument for lab contamination as a source of XMRV is subtle and indirect, and not, in my opinion, conclusive,"
John Coffin, PhD, 'Contamination May Have Marred XMRV Studies' (Medpage Today, 21 December 2010) [85]


Over the next several days thousand of people across the world began to voiced their dismay and disgust at this attempt to silence further research into the disease. This prompted the NHS to rename their article from the previous title 'Chronic fatigue syndrome 'not virus' to 'Chronic fatigue syndrome virus doubt'. [86]


Host of the virology blog TWiV, Vincent Racaniello (virologist), also received many responses from those alarmed by the tone of his article on the publication of the four studies, 'Is XMRV a laboratory contaminant?', and his quote that had appeared in the Chicago Tribune.

"These four papers are probably the beginning of the end of XMRV and CFS,"
Vincent Racaniello, 'Studies cloud chronic fatigue research' (Chicago Tribune, 20 December 2010) [87]


Eventually co-discoverer of XMRV Eric Klein commented on the TWiV blog, and corrected a vital point that Racaniello had either never seen or forgotten about.

"We have reported XMRV integration in fresh frozen prostate tissue taken directly from patients at radical prostatectomy that has never been put in tissue culture and believe this is solid evidence of authentic human infection . See Dong et al PNAS 2007 and Kim et al. J Virol 2008"
Eric Klein, Cleveland Clinic, 'Is XMRV a laboratory contaminant?' (TWiV blog, 22 December 2010) [88]


This information prompted Racaniello to rewrite his blog and retract to his statement to the Chicargo Tribune. [89]


On the 21 December 2010, Annette Whittemore and Dr Judy Mikovits appeared on Nevada Newsmakes, where they also confirmed Dr Coffin's opinion that the four papers had not proven that XMRV is a contaminant. Video Transcript


Close of 2010

On the 22 December 2010, a negative CFS and MS study from Germany (Hohn et al.) was published. The authors used PCR methods which they had employed in two other studies that also failed to detect MLV-related retroviruses. [90] One of these was a collaboration with the CDC, Switzer et al.


On the 22 December 2010, a review on the 1st International XMRV Workshop, by Stoye, Silverman (co-discoverer of XMRV), Boucher and Stuart Le Grice, which had been published on the Centre for Cancer Research website on the 17 December 2010 (part of the National Cancer Institute), was published in the journal Retrovirology. [91]


On the 23 December 2010, the BMJ parroted the Wellcome Trust press release and the news coverage in an attempt to also halt this research. [92]


On the 23 December 2010, Mindy Kitei published an interview with John Coffin on CFS Central. [93] Kitei asked Coffin if he had tested the 22Rv1 prostate cancer cell line for contamination, Coffin replied that he had, and it was negative. He also reaffirmed that it is the standard positive control for XMRV. Kitei also asked whether he would be testing any of the samples from Lombardi et al. or Lo et al. for contamination. Coffin said that Tufts University had no plans to do so, but that a group he was involved with at the NCI would be and that they would use the same assay Coffin had used in his last two papers, Robinson et al. and Oakes et al.


2011

On the 7 January 2011, the UK HPA (Health Protection Agency) updated its information on Infectious Disease Surveillance.

"XMRV [update]

Despite the increase in XMRV-related research there is still no consensus on the origin of this virus, whether there is any association between the presence of XMRV and any human disease effects, and the extent to which it is prevalent in the human population. Central to this uncertainty has been the lack of standardised methods for detecting viral nucleic acid and antibodies, as well as “gold standard” reference samples with which researchers can assess the specificity and sensitivity of their methods. The importance of careful validation of tests was highlighted in a series of papers in December 2010. These provided evidence that contamination of samples or reagents with ubiquitous mouse DNA has occurred in a variety of ways. Previous study results that suggested the presence of XMRV in humans may therefore be incorrect. Future assessments of the prevalence of XMRV should include more rigorous PCR and phylogenetic tests to exclude the possibility of contamination. Smith, Retrovirology December 2010 (and other papers in this issue)"

HPA, 'Infectious Disease Surveillance and Monitoring System for Animal and Human Health Summary of notable events/incidents of public health significance for the period 1st – 31st December 2010' (HPA, 7 January 2011) [94]


On the 25 January 2011, it was discovered that the 'CDC Foundation', had a new 'infectious disease' program called 'Synthesis of XMRV Peptides'.

"Synthesis of XMRV Peptides

To develop a mass spectrometry method that can be used to identify and quantify a novel protein produced by the prostate-cancer-associated retrovirus XMRV in patient samples.

  • Funding Partners: Emory University School of Medicine
  • Program Partners: CDC's National Center for Emerging and Zoonotic Infections"
CDC Foundation, 'Infectious disease program: Synthesis of XMRV Peptides (CDC Foundation, as of 25 January 2011) [95]


On the 4 February 2011, a negative study looking for XMRV and other viruses in cerebrospinal fluid of 43 CFS patients was published. [96]


On the 16 February 2011, two studies were published. One showed that Peripheral Blood Mononuclear Cells (PBMCs) were potentially a good source for XMRV [97] The other looked at Rhesus macaques infected with XMRV. Showing that after about a month XMRV was undetectable in blood, but at 9 months XMRV viremia was reactivated, confirming the chronicity of the infection.[98]


Post PACE Trial publication

On the 18 February 2011, the PACE trial was published in The Lancet. [99]


On the 22 February 2011, the NIH hosted three video-cast presentations on the web. [100] The first two, from Dr Lo [101] and Dr Alter [102], covered MRV research. The third, from Dr Gill, was outdated, echoing the current thinking of the CDC and CAA. [103]

"Gill asked Alter, “Is CFS a real disease—and if so, what’s its etiology?” Alter replied cryptically, as if he were the wisest of fortune cookies: “The answer depends on the effort to find the cause."
Charlotte von Salis, 'Training Day (CFS Central, 24 February 2011) [104]


"So why did many studies have different findings? This is obviously a very challenging question..."


"...and the way the clinical sample being prepared, and the processing of this, all can make a difference."


"And even more possible to me is that there is a variation of the PCR protocol, although everybody says we are following the same PCR assay, but if you look into all the detail, the cycles are different, annealing temperature slightly different, magnesium concentration slightly different. All of this, we really don't know how much that's going to make the difference. Today the topic is, is there a virus or not? is the virus responsible, or the causative agent of this, or not? That's all very far away at the present time because, when we are looking at this, we obviously are dealing with a very low rate of infection - a very low copy number in the blood, and many of these difference can certainly result in the PCR disparities"

Shyh-Ching Lo, 'Demystifying Medicine - Chronic Fatigue Syndrome: Is there a virus?' (NIH, 83min 04secs, 22 February 2011) [105]
"...but we did send, I forget, four samples to the CDC, what we have, and two of those test positive in our lab, but they could not test the positive"


"They had a negative one and then sent to us to test it. I say the CDC group of patients, most of their are negative in our hands."

Shyh-Ching Lo, 'Demystifying Medicine - Chronic Fatigue Syndrome: Is there a virus?' (NIH, 97min 20secs, 22 February 2011) [106]


On the 22 February 2011, the tenth negative study looking at patients with CFS was published. Again, unvalidated assays were used. It was a joint study by the CDC and Co-operative diagnostics. [107]


On the 25 February 2011, Retrovirology published another contamination paper from Greg Towers on behalf of the Wellcome Trust and the MRC. This time they claimed that previous prostate cancer studies were the result of contamination. [108]

CROI 2011

On the 27 February to the 2 March 2011, the 18 CROI conference was held in Boston. [109] Prior to the start of the conference XMRV Global Action reported on facebook that Andrea Whittemore had communicated that Mikovits and the Ruscetti's were not invited, and their abstracts not accepted for CROI. Frank Ruscetti was however to have an abstract at the conference on the creation of a new cell line for the detection of MRV retroviruses. [110]

"Thanks to Andrea, we now know that Dr. Judy Mikovits and Drs. Sandy and Frank Ruscetti were not invited and their abstracts were not accepted on how XMRV affects the immune system. In addition, John Coffin was part of this abstract committee."


"Update: We’d like to clarify the information above. We have confirmed that the Ruscetti/Mikovits work on how XMRV affects the immune system was submitted and NOT accepted for presentation at CROI. At least one paper, authored by Dr. Ruscetti was accepted."

XMRV Global Action, 'Dr. Mikovits/Drs. Ruscetti not Invited to the CROI - Please Email Concerns to:' (XGA Facebook, 27 February 2011) [111]


On the 1 March, one abstract, Pathak et al, stated that XMRV probably originated through recombination between two endogenous mouse viruses during passage of a human prostate cancer xenograft [112] [113]

"The 22Rv1 cell line was derived from a prostate cancer xenograft, CWR22. That was serially passaged in nude mice. So the question we wanted to ask was, is XMRV present in the CWR22 xenograft. So the xenograft line was developed by transplanting a human tumour into nude mice in 1992, and it was serially passaged in nude mice, most probably outbred strains, called NU/NU nude and harlan nude strain. For an unknown number of passages, and each passage being about one to two months. The tumour grows in an androgen dependant fashion, and castration and androgen depravation leads to regression of the tumour, and subsequent growth of an androgen independent tumour. And two of these androgen independent tumours 2152 and another one were used to derive the cell line 22Rv1, and an independent sister cell line called CWR-R1"


"The early xenografts are XMRV negative, the late xenografts from the cell lines are XMRV positive. So since the early xenografts do not contain XMRV, XMRV is not required to maintain and propagate the prostate cancer cells. In addition, if replication competent XMRV was present in these original xenografts we would have expected it to spread to all of the cells in the xenograft and that was not observed. Making it very likely that these early xenografts did not contain replication competent XMRV."


"So the early xenografts do not contain XMRV, but they do contain PreXMRV-1 and 2"


"PreXMRV-1 and 2 are XMRV related proviruses, that are present in some nude mouse strains. PreXMRV-1 is replication defective, PreXMRV-2 the gag pol and env reading frames are open, and some earlier and late xenografts contain one or both of these proviruses."


"So taking this together the most likely explanation is that a recombinantion event between preXMRV-1 and preXMRV-2 generated XMRV sometime between passage seven of the xenograft and these late xenografts, between 1993 and 1996"

Pathak, VIDEO: 'XMRV Probably Originated through Recombination between 2 Endogenous Murine Retroviruses during in vivo Passage of a Human Prostate Cancer Xenograft' (CROI 2011, 1hour 49min 49sec, 1 March 2011) [114]
STOYE - "Can you exclude the possibility that the virus arose independently somewhere else and infected these cells during the in vivo passage?"

PATHAK - "The recombination event is unique, so the infection event would have to occur during the in vivo passage of the tumour, since it occurred before the cell line. Now, as we have discussed to exclude that possibility you would really have to characterise all mice in the world genetically, so the answer is no I can't exclude that possibility"

Stoye & Pathak, VIDEO - Q&A: 'XMRV Probably Originated through Recombination between 2 Endogenous Murine Retroviruses during in vivo Passage of a Human Prostate Cancer Xenograft' (CROI 2011, 2hour 00min 34sec, 1 March 2011) [115]
"I think it is fair to say that the initial report of an association between XMRV and CFS has not yet been replicated. There is one paper, namely that by Lo et al, which has been strongly argued is a support of the idea that a murine leukaemia virus-like virus is involved in CFS. However, I am not convinced by that paper. I am happy to discuss it later on. But I don't think that could be taken as positive evidence to confirm the study by Lombardi et al. So, not only has XMRV not been found in CFS patients, it has not yet been found in anything like the original 4% figure in control populations. So now there is considerable doubt about whether this virus is associated with XMRV."
Jonathan Stoye, CROI 18: 'Themed Discussion: XMRV: New Findings and Controversies' (Retroconference.org, 2 March 2011) [116]
"We do want to note that there is a bit of an asymmetry here, in that as Jonathan mentioned at the beginning, there have been some more positive studies about XMRV. Unfortunately none of those individuals are here today to talk about their work, so we're just going to have to have what we... can try to have a reasonable discussion in their absence."
Kathy Jones, CROI 18: 'Themed Discussion: XMRV: New Findings and Controversies' (Retroconference.org, 2 March 2011) [117]
TOWERS: "So the supernatant virus appears to be identical in fact, did you say, the sequence to the sequences that have been found in patient samples. So do you think that that means we can narrow down the source of any, if indeed it is a contamination some how. Do you think we can narrow that down to a supernatant source rather than a kind of cellular DNA of 22Rv1 cells, i.e. could cells have been infected beyond that for example."


KEARNEY: "Well, I can't say. I think there it could be multiple sources if contamination is the issue, there could be multiple sources for contamination, either from 22Rv1 cells, from virus, from mouse genomic DNA."


TOWERS: "Ok, but the sequence of the supernatent virus is identical, whereas the sequences of the cell DNA virus is a few changes?"


KEARNEY: "Well, actually that is not what we saw. We did single genome sequencing from cells from the 22Rv1 cells and we found only two genomes that were hypermutated and the rest were almost identical to what was in..."


TOWERS: "Almost?"


KEARNEY: "They were, essentially identical with maybe a single nucleotide change in one of the sequences..."


TOWERS: "Ok, so this 20 provirus I guess with maybe identical sequencing"


KEARNEY: "I think we did a total of 42 sequences"


UNKNOWN: "And that was GAG?"


KEARNEY: "That was GAG."

Kathy Jones, CROI 18: 'Themed Discussion: XMRV: New Findings and Controversies' (Retroconference.org, 2 March 2011) [118]


PETROPOULOS: "I am wondering if there are any known studies going on to look at say the PreXMRV-2, whether or not it behaves more like XMRV than other viruses?"


CINGOZ: "Actually currently the ongoing experiments are trying to figure out whether this virus, PreXMRV-2 is infectious by itself. When you just look at the full length sequence it seems to have open reading frames that are intact. So there seems to be no reason for it not to be infectious. However, we haven't done the experiment yet, so I don't have any results on that. Does that answer the question? And the other thing is... the Xenotropic, it has Xentropic LTRs like XMRV even though the sequence is a little different. However, the envelope is Polytropic unlike XMRV, so there could be differences there at least in the host tropism."


STOYE: "Could I add just, there is another interesting to me, facet of the biology of XMRV, it is dually sensitive to both FE1M and FE1B. I think there is going to be a fair amount of study of the biology of the virus, it is quiet an interesting virus, your right. But I think there is going to be less and less interest in studying its association with disease.


JONES: "Yea, I can agree. I know a lot of people who were working on just the basic biology of the virus. Particularly people who have worked with these mouse viruses for a number of years, and it does seem to be behaving differently. And I guess it is worth mentioning, I guess we have said this but, in regards to Greg's question, I mean this is, at least in culture, this is a replicating virus that can cause a productive infection in primary human cells in addition to cell lines and you can pass it to other cells. And as you said, and as Jonathan said it is different from a lot of known MLVs. So from a basic science prospective there is some interest in this virus."


BASHAM: "My question, San Francisco, just sort of following up on that. I think there is no doubt after this meeting that this virus arouse from a recombination as that original prostate tumour was explanted and propagated and it's extraordinarily infectious in vitro and clearly it is demonstrating infectivity in human x-plants in a variety of human cell lines. It can transmit into non-human primates. And I'm a little concerned, you know one this was human created through... in the laboratory and it's a highly infectious retrovirus and could it transmit to humans. Could it have subsequent to the event transmitted to humans. We've been doing studies using pedigreed negative controls, some of whom happen to be lab workers who are working with this virus who intermittently score positive in one lab or another and I've just ignored that but now I'm beginning to be a little concerned that might there be transient infections of humans. Has anyone embarked on studies to look at either nucleic acid or serologic detectability in lab workers who have or are working with these cell lines and ex-cetera?"


JONES: "I do know of some animal studies where the lab handlers are being monitored. I don't think anyone in the laboratory is...there's ethical reasons I think not to test each other."


STOYE: "One, I can talk about an anecdote among urologists in Britain who were suddenly alarmed that this cell line that they had been using was loaded with virus. I think there are some of us that have been working with XMRV or related viruses for... well I have been doing it for 35 years or something, and I know I'm negative or at least I was the last time I looked."


SWITZER: "I just wanted to add to that, we share your concern Mike and we have started a study looking at some archived specimens that we have from laboratory workers that we screened and found other simian retroviruses in for example, that we are going to look for XMRV evidence of other MuLVs."

Christos J. Petropoulos, Oya Cingoz, Jonathan Stoye, Kathy Jones, Mike Basham, Mark Switzer, CROI 18: 'Themed Discussion: XMRV: New Findings and Controversies' (Retroconference.org, 2 March 2011) [119]

Post CROI 2011

On the 9 March 2011, another negative CFS paper from Myra McClure was published in PLoS One. [120] This again used PCR to look at 48/186 patients used in her earlier CFS study Erlwein et al. [121] , and included two ELISA assays that had previously been used in Hohn et al. and had not detected the virus.


Pathogens in the Blood Supply

On the 29th March 2011, Mikovits and Lipkin gave web presentations for Pathogens in the Blood Supply. A conference hosted by The New York Academy of Sciences. [122] During the presentation Mikovits was asked whether she had any concerns about the 22Rv1 cell line, that had been suggested as the source of contamination for XMRV.

"No. And I will tell you two reasons for that. I think maybe Bob Silverman is not concerned about potential contamination. While he had that cell line in his freezer in 2000, was the last time anybody had actually done any experiments with it. We have never had the cell line in the state of Nevada. We sent samples and reagents to, I mean samples to Bob to do the PCR and the full length cloning. He never sent samples to us. So we don't have the cell line, we don't have any of the cell lines that were shown to be contaminated in the Hue paper, the Dowdy, and some of the others. We screened the sixty cell line screen of the NCI and didn't find any XMRV in any of the sixty cell line. So these other cell lines could have been contaminated in other labs that were using 22Rv1, and further supportive, Dusty Miller didn't publish in report that the cell line 22Rv1 cell line actually made XMRV, VP62, until five months after our paper was submitted and all our samples were done. So no, no concerns whatsoever."
Judy Mikovtis, 'Disease Associations of XMRV and MLV-Related Viruses' (WEBINAR: Pathogens in the Blood Supply, 1min 19sec, 29 March 2011) [123][124]

Mikovits also talked about the P and X strains of XMRV, Lo et al, and the primers used in Lombardi et al.

"This was the gag PCR used in Urisman et al, you would never detect the Polytopic virus in that patient. So if you didn't have X. In the Lo study they didn't have XMRV, they had PMRV, then you would have missed that and you would have called that negative. And that is the PCR primer that was used in most of the, in many of the negative studies because they used the Urisman et al primers, which of course we used in our study as well, but we also developed a sensitive Nested PCR."
Judy Mikovtis, 'Disease Associations of XMRV and MLV-Related Viruses' (WEBINAR: Pathogens in the Blood Supply, 7min 1sec, 29 March 2011) [125][126]


State of Knowledge Workshop (NIH)

On the 7 and 8 April 2011, the Trans-NIH ME/CFS Research Working Group held a conference to identify gaps in research into ME/CFS. Two patient advocates, Mary Schweitzer and Pat Fero, were nominated by the community to help in planning the event and the CFIDS Association of America were automatically included in the committee, for reasons unknown, with both Kim McCleary and Suzanne Vernon also attending the event. Several excellent presentations were given by Leonard A. Jason, Kenneth J. Friedman, Mary Schweitzer and Pat Fero. The main discussion and topic however was HGRV's, which consisted of talks by Judy Mikovits, John Coffin, and was moderated by Harvey Alter one of the authors of Lo et al. Although both Mikovits, Alter and others have data showing HGRV's consist of xentropic, polytropic and modified polytropic varieties, John Coffin voiced his belief that the Xenotropic variety should be left behind as he felt his unpublished data indicated the virus had originated in the prostate cancer cell line 22Rv1 and that this cell line, although never used in the WPI lab, must have contaminated the samples from Lombardi et al. His opinion on this matter was also unable to explain the serology results from Lombardi at al and the vast difference between controls and patients in this blinded study.

COFFIN: "I cannot address what's going on with sequences that I don't know"


MIKOVITS: "It's not sequences, it's proteins, it's antibody response."


COFFIN: "With viruses and proteins of sequences that I don't know. If we get these sequences of these other viruses into GenBank where people can look at them, then we can do some analysis."


MIKOVITS: "We put the phylogenetic analysis up there."


VERNON: "John, you are not going to be here tomorrow, I would like to pick your brain to know what you see as the next steps for XMRV and all these."


COFFIN: "I see the next step as leaving the virus that we know as XMRV behind. I don't...I just don't see...I don't see how that... Now that doesn't mean there's not another gammaretrovirus that is not sufficiently cross reactive with the primers and things that have been used to not be... I think the... I just... I think however that enough evidence has been presented that there is some infectious cause here. Maybe another retrovirus it's entirely possible that it's worth continuing to do it. I would say however that we are continuing to participate in studies like the Blood Working Group study, and the study that is enrolling and seeing patients right now at NCI. Patients are coming in, collected patients who have been told they are XMRV positive by various assays and we are going to do a very through work up on these patients, using exactly the same sort of conditions that I mentioned, where every patient is... patients and controls are brought in treated as much as possible blindly. At least every single sample that is taken is taken exactly the same set of reagents, tubes and so on and so forth. And those are going, were just going to work those up through all of the assays we have available at the NCI. And the NCI have I have to say has done a huge amount of work on this. It's taken a huge amount of resources and diverted from other things to work on this problem. Ever before since the Science paper..."


(...)


MIKOVITS: "Just that it has never been addressed the fact that all of our patients and controls and studies now, from at least six studies, from thousands of patients around the world, the patients are infected, the virus is isolated, proteins not PCR, not sequences, an immune response to multiple proteins is far more evidence that there is a human gammaretrovirus infection associated with this disease, than it is any kind of a contaminant. Especially since no infected cell line has ever been used in our laboratory."


COFFIN: "And has no cell line ever been ever used in your laboratory ever?"


MIKOVITS: "No XMRV infected cell lines"


COFFIN: "There are some lines of LNCaPs that are contaminated perhaps with this virus"


MIKOVITS: "Ours are not. We do it every single week, we do all of the tests"


COFFIN: "There are some lines of Jurkat that are contaminated, many many cell lines..."


MIKOVITS: "We don't have Jurkat growing in our laboratory where we isolated these viruses. We directly isolated from the blood."


Mikovits & Coffin, 'State of the Knowledge Workshop on ME/CFS Research (Day 1)' (NIH, 7 April 2011) [127]

Singh's paper published (Shine et al)

On the 4 May 2011, Ila Singh's study (Shin et al) was published.[128] Using new unvalidated assays this paper reported finding no XMRV or others MLV-related viruses in 100 CFS patients and 200 healthy volunteers. The paper stated that a clone had been used to check each assay was capable of detecting XMRV.


"We could reliably detect less than 5 copies of XMRV plasmid DNA in a background of 400 ng of human placental DNA, and the assay was linear over a large range, viz. 5000 to 5 copies of viral DNA."
Shin et al, 'Absence of XMRV and other MLV-related viruses in patients with Chronic Fatigue Syndrome' (Journal of Virology, line 306/7, 4 May 2011) [129]
"Positive control reactions were reliably positive for 50 and 5 copies of XMRV plasmid DNA."
Shin et al, 'Absence of XMRV and other MLV-related viruses in patients with Chronic Fatigue Syndrome' (Journal of Virology, line 322/23, 4 May 2011) [130]


On the 6 May 2011, Mindy Kitei published an interview with Singh on her site CFS Central. [131] Singh made several statements that contradicted the published paper of Shin et al during this interview.


"The samples from Mikovits' patients (...) We did not know which of them were positive, so could not use them as positive controls.(...) there are no real patient 'positive controls' for XMRV. In order to use patient samples as controls, you'd have to first be absolutely certain that these patients have XMRV. (...) So we used what you call a 'clone' for our PCR studies. (...) But remember, this clone was isolated from a patient (a prostate cancer patient)."


"Our prostate cancer study was entirely on prostate tissues. (...) there was no way to go back to those patients and obtain blood samples."


"For the viral culture studies, we used very small amounts of titrated virus that was grown in the lab as positive controls. And all of these positive controls were always positive."

Ila Sigh, 'DR. ILA SINGH' (CFS Central, 6 May 2011) [132]


Singh had previously stated on the 8 August 2010, in an interview with Vincent Racaniello on TWiV, that use of a synthetic sample was not sufficient to prove an assay is capable of detecting the virus in blood.


"It’s just not sufficient to show that something can detect something in a plasmid template. It’s hard to know if it’s going to detect something in a matrix that’s as complicated as blood or cellular DNA. So I think that’s probably one of the biggest reasons for why people find different results.."
Ila Sigh, 'TWiV 94: XMRV with Dr. Ila Singh' (TWiVl, 8 August 2010) [133]


The paper Shin et al also mistakenly stated that 14 patients from Lombardi et al had also been tested. In an article in the WSJ Dr Mikovits made it clear that only 2 had come from Lombardi et al. One of these two had been used to create a full length clone and was the source for the electron microscopy image of the budding virus.[134]


"In conjunction with a third-party phlebotomy service, we also collected, in a blinded manner, samples from 14 patients in the cohort used in the original CFS-XMRV study performed at the Whittemore Peterson Institute (WPI) (12)."
Shin et al, 'Absence of XMRV and other MLV-related viruses in patients with Chronic Fatigue Syndrome' (Journal of Virology, line 87/89, 4 May 2011) [135]
"...one of the statements in today’s paper is incorrect. She tells Health Blog that not all of the 14 people who previously tested positive for XMRV were part of the original Science paper; only two of them were."
Amy Dockser Marcus, 'Study Finds No Link Between XMRV and Chronic Fatigue Syndrome' (WSJ, 4 May 2011) [136]


On the 4 May 2011, with assistance from the CFIDS Association, Virology blog journalist Vincent Racaniello posted an article on the Singh paper (Shin et al). [137] In response to this article, Ian Lipkin, the scientist hired to conduct the multi lab study for the NIH, sent Racaniello a letter to correct his misunderstanding of the situation. [138]


"Dear Vince-


We have a plethora of explanations for how CFS/XMRV/MLV studies could go awry. However, we don’t have evidence that they have. Absent an appropriately powered study representing blinded analyses by Mikovitz and Lo/Alter of samples from well characterized subjects using their reagents, protocols and people, all we have is more confusion.


I remain agnostic. We won’t have answers until the end of 2011.


The NIH will post something on our study today.

Ian"

Ian Lipkin, 'Ian Lipkin on XMRV' (Virology blog, 6 May 2011) [139]


CDC detects XMRV in prostate cancer patients

On the 4 May 2011, the CDC reported detecting XMRV in a few patients (3/162) with prostate cancer. [140] This was the first time the CDC had detected XMRV outside of the Blood XMRV Working Group.


XMRV replication in mucosal sites

On the 12 May 2011, an abstract title of 'XMRV replicates preferentially in mucosal sites in vivo: Relevance to XMRV transmission?' was posted on Retrovirology, for the 15th International Conference on Human Retroviruses: HTLV and Related Viruses, which was to be held in June 2011. [141][142] The abstract authors included Silverman and Klein, the co-discovers of XMRV. Other abstracts for the conference were also posted. [143]

XMRV-associated CFS inflammatory signature (Lombardi, 2011)

On the 13 May 2011, the journal "In Vivo" published a list of forthcoming papers, one of which was new study from the WPI, that had found a Distinct Inflammatory Signature for Xenotropic Murine Leukemia Virus-related Virus-associated Chronic Fatigue Syndrome (XMRV-associated CFS).[144][145][146] This cytokine/chemokine expression profile was found to be is highly predictive of acute onset XMRV positive ME/CFS (and vice versa) relative to healthy controls. This profile is therefore capable of being used as a diagnostic test for ME.

"This study identifies a signature of 10 cytokines and chemokines which correctly identifies XMRV/CFS patients with 93% specificity and 96% sensitivity. Conclusion: These data show, for the first time, an immunological pattern associated with XMRV/CFS."
In Vivo - ABSTRACT: 'Xenotropic Murine Leukemia Virus-related Virus-associated Chronic Fatigue Syndrome Reveals a Distinct Inflammatory Signature' (In Vivo, 16 May 2011) [147]


Another paper, also published on the 13 May 2011 in the journal of Virology, provided data on integration site for XMRV in CD4+ T cells in vitro, and found that whilst XMRV prefers to integrate into DNAse-vulnerable regions, it also likes to integrate into the outer curves of nucleosomes.[148]Forum discussion on this paper


Science publishes two questionable papers (Knox et al. & Paprotka et al)

On the 31 May 2011, two papers were released in Science Express. The first, Knox et al., was another negative study looking for XMRV in ME/CFS patients. The authors of this study had managed to obtain some samples from people who had originally been in Lombardi et al. paper. But in this study, they did not use the same methods as in Lombardi et al. and they had not clinically validated their assays.[149][150]


The other paper, Paprotka et al., purported to have found the origin of XMRV.[151][152] This study, which had been presented at CROI earlier in the year, claimed that a prostate cancer cell line called 22Rv1, which is infected with XMRV, was responsible for contaminating the positive studies. They describe how they believe that two mouse viruses, claimed to predate XMRV and which they called PreXMRV-1 and 2, must have recombined at some time during the creation of the cell line as it was passaged through lab mice. However, they were not able to show which mice were used for xenografting in the construction of 22Rv1, they were not able to show that the two viruses predate XMRV and they even detected XMRV env sequences in the earlier xenografts, which would argue against XMRV having been created during xenografting and for the patient actually having been infected with XMRV. The cell line 22Rv1 has also never been in the WPI lab, or in the state of Nevada, and in Silverman's prostate cancer studies it was in a freezer and had not been used for several years. One of the authors of Paprotka et al, John Coffin, had previously stated that low sequence diversity was also evidence against contamination, but in this paper was now claiming the opposite.

"There is more than 90% DNA sequence identity between XMRV and xenotropic MLV, and their biological properties are virtually indistinguishable (6–9), leaving little doubt that the former is derived from the latter by one or more cross-species transmission events. There are several lines of evidence that trans mission happened in the outside world and was not a laboratory contaminant. One is that XMRVs from disparate loca- tions and from both chronic fatigue syndrome and prostate cancer patients are nearly identical: The viral genomes differ by only a few nucleotides, whereas there are hundreds of sequence differences between XMRVs and xenotropic murine leukemia proviruses of lab- oratory mice. Other evidence includes the presence of XMRV and high amounts of antibodies to XMRV and other MLVs in chronic fatigue syndrome and prostate cancer patients."
John M. Coffin and Jonathan P. Stoye, 'A New Virus for Old Diseases?' (Science, 8 October 2009) [153]
"The available XMRV sequences all have the same six recombination junctions predicted in the hypothetical recombinant, and differ from the consensus XMRV by 3 – 14 nucleotides. These differences may be the result of errors during PCR or sequencing, or mutations during the passage of XMRV in another cell line."
Paprotka et al., 'Recombinant Origin of the Retrovirus XMRV' (Science Express, 31 May 2011) [154]


On the 26th May 2011, Science magazine, contacted the corresponding author of Lombardi et al., Judy Mikovits, and asked in an editorial expression of concern if the authors would consider retracting their paper, Lombardi et al. Mikovits held a conference call with the other authors of Lombardi et al. and they agreed not to retract the paper as it was scientifically premature to do so. [155] Annette Whittemore, President of the WPI and the clinical board of the WPI also wrote to the editor of Science magazine to voice their concerns at them issuing a editorial expression of concern.[156][157][158] This story was leaked to the media, by persons unknown, before publication of Knox et al. [159]

“that is an unusual situation to retract a paper under.’
PNAS editor-in-chief Randy Schekman, 'Given Doubt Cast on CFS-XMRV Link, What About Related Research?' (WSJ, 1 June 2011) [160]


Millers mouse paper to be published

On the 14 February 2011, Dusty Miller gave a statement to CFS central about a study he was to have published the following day in the Journal of Virology.[161] He claimed to have found a mouse virus that was similar to PreXMRV-2 and said that part of it also matched XMRV. At the same time his student, Andy Vaughn, made several comments on Facebook regarding the unpublished paper.[162] Miller's paper was not published the following day, but Miller posted a comment on the CFS Central blog, saying it would likely appear the following week.[163]


On the 15 May 2011, the NCI released a propaganda video on the Paprotka et al., which feature Vinay Pathak and Stuart LeGrice.[164]


On the 15 May 2011, Bridget Huber had her second negative ME/CFS study published. This paper used two novel chelmiluminescence immunoassays (CMIAs) and a Western blot to test patient plasma on 112 patients and 36 healthy controls. [165]

XMRV & other diseases

Please see the wiki page on XMRV & other diseases

Contamination claims

Some have claimed that the positive results are the cause of mouse contamination. However, this has been rigorously ruled out by testing at all stages for mouse contamination and using non mouse labs. Now certain people have tried to claim that XRMV is the contamination and that it has come from infected cell lines. However, Lombardi et al has never used the infected cell lines in their experiments and those cell lines have never been in their lab.


Please see the 22Rv1 & Du145 cell lines page for more details on the infected cell lines.


Contamination Assays

IAP assay

John Coffin's lab developed a new mouse contamination assay based on intracisternal A particle (IAP), a repeated element that presents about 1,000 copies per mouse genome. Coffin claims that the test can detect mouse DNA contamination in many samples where mitochondrial DNA doesn't. However others such as Lo, believe that the mitochondria PCR assay is much more sensitive in detecting the mouse DNA. [166] It is also possible that, as this assay has not been validated, that it may be producing false positives, either though identifying human IAPs instead of only mouse IAPs, or thorough the transference of mouse IAPs to humans via mouse viruses.


It is also interesting to note that Lo has retested his samples using the unvalidated IAP assay, but has found no contamination.

" An extremely sensitive mouse mitochondrial DNA has always been negative in the Lo laboratory. Lo has done the IPA assay that Dr. Coffin recommended. That is also negative. There just has been no evidence for contamination. Although you could say maybe the negatives could be negative somehow and the positives positive for contamination reasons, it really is not logical that that would be so."
Harvey Alter, 'December 14, 2010: Blood Products Advisory Committee Meeting Transcript' (FDA, 14 December 2010) [167]


Epigenetic's

Epigenetic responses to MLV infections will change with time as genes are manipulated.


Immune System

APOBEC3G

APOBEC3G is an antiviral defence protein that attacks viral RNA, and changes its sequences specific location. Groom and Paprotka have reported that cell lines that express APOBEC3G reduce the titre of infectious XMRV, when they were put in cell lines that didn't express APOBEC3G. [168][169] On the 29 march 2011, Mikovits reported at the Pathogens in the Blood Supply webinar, that following integration into PBMC chromosomes, provirus whose RNA has been attacked by APOBEC3G should exhibit G to A hypermutation. That they had tested XMRV and found considerable hypermutation, and consequently this was further evidence that XMRV is a human infection, because the anti viral defence mechanism is occurring. They also had shown that the hypermutation was between 2 to 7%, which is not 99% similar, which the six samples in the gene bank represent. Next they also tested whether this edited XMRV could still make infectious virus and showed it could. [170]


Co-pathogens

Transmission

XMRV is closely related to several known xenotropic mouse viruses. These viruses recognize and enter cells of non-rodent species by means of the cell-surface xenotropic and polytropic murine leukemia virus receptor (XPR1). Several authors have speculated that XMRV could be sexually transmitted. [171][172][173] Both cell-associated and cell-free transmission were reported in vitro by Lombardi et al. [174] The virus has also been found in respiratory tracts and respiratory secretions of infected individuals[175]


Judy Mikovits of the Whittemore Peterson Institute has stated that XMRV has "almost certainly entered the U.S. blood supply system, but did not know whether it would be susceptible to the same heat treatments that successfully kill off the AIDS virus in blood products." [176] A United States federal consortium is now working to determine the prevalence of XMRV in the blood supply and the suitability of different detection methods.[177][178]


On the 26 May 2011, Advances in Virology published a paper from Silverman and Klein that showed VP62 XMRV displays 'tissue tropism'. It readily infects some tissues and not others. This research used IHC and FISH, methods that are not prone to contamination error. [179]


Infectious

Infectious XMRV has been identified in ME/CFS by Lombardi et al. and by Frank Ruscetti in an unpublished prostate cancer study. [180] XMRV has also been shown to still be infectious despite the APOBEC3G antiviral defence protein. [181]


MLV viruses can be spread through saliva. XMRV may also be spread this way, and it has been highlighted that it could also be aerosolised.


The issue of transmission is being studied. An abstract with the title, 'XMRV replicates preferentially in mucosal sites in vivo: Relevance to XMRV transmission?' has been submitted for the 15th International Conference on Human Retroviruses: HTLV and Related Viruses, which is to be held in June 2011. The abstract authors included Silverman and Klein, the co-discovers of XMRV. [182]

XMRV is capable of infecting lab mice

Originally mouse X-MLVs (Xenotropic MLVs) were defined by their inability to infect cells of their natural mouse hosts. It is now clear that X-MLVs actually have the broadest host range of the MLVs. Nearly all nonrodent mammals are susceptible to X-MLVs, and all species of wild mice and several common strains of laboratory mice are X-MLV susceptible. [183]


XMRV can infect cells other than those expressing XPR1

XMRV can use the cell surface receptor XPR-1 (xenotropic and polytropic retrovirus receptor 1) to gain entry into cells. XPR-1 is found in a diverse array of tissues: lymphocytes, hepatocytes, as well as cells in the brain, pancreas, kidney, prostate, and muscle. It has also been demonstrated that XMRV can use alternative receptor(s) and/or mechanism(s) to gain entry. [184]


Blood Donation

The association of XMRV and CFS reported in 'Science' prompted Health Canada,[185][186] the New Zealand Blood Service,[187] and The Australian Red Cross Blood Service[188] in 2010, to ban blood donations from individuals with CFS. On June 18th 2010, the American Association of Blood Banks, recommended actively discouraging potential donors who have been diagnosed by a physician as having CFS from donating blood or blood components.[189] On the 4th September 2010, Times of Malta, reported that the National Blood Transfusion Services for Malta were also deferring patients with a history of ME from donating blood.[190]


In the United Kingdom patients cannot give blood until they have recovered. This ban has been in place since at least 1989, and is not specific to XMRV. [191] [192] On the 13th August 2010, an interent blogger published a letter from the Department of Health (UK) stating that a lifetime blood ban would be soon put in place. [193] On the 27 August 2010, the ME Association, after contacting the Department of Health, confirmed that from the 1st November 2010, those who have had ME/CFS would be permanently excluded from donating blood. [194] More details on the history of this announcement can be found on the United Kingdom wiki page, under the 'Blood Donations' section.


On the 3 December 2010, the American Red Cross announced that they would defer indefinitely any donor who reveals during the donor interview that they have been diagnosed with CFS. [195]


On the 10 December 2010, the Norwegian Directorate of Health introduced a ban on ME/CFS patients from donating blood due to the finding of MLV-related retroviruses.[196]


On the 14 December 2010, at the Blood Products Advisory Committee Meeting on the 14, the Food & Drug Administration (FDA), USA, asked the Blood Products Advisory Committee (BPAC) to vote on whether the scientific data support asking donors about a medical history and/or diagnosis of CFS as a basis for indefinite deferral. The panel voted 9 to 4 in favour of indefinite deferral of CFS patients based on all evidence that it will promote donor and recipient safety. This recommendation will now be reviewed by the FDA, which typically follows the advice of such panels but is not required to do so. There is no timetable yet on a final decision. [197][198]


On the 14 April 2011, the MEA reported that the Irish Blood Transfusion Service had permanently banned blood donations on the 9 August 2010 from those with a current or previous diagnosis of CFS because of XMRV.[199][200]


On the 17 May 2011, slides from a presentation on XMRV by Indira K. Hewlett, Ph.D (Chief, Laboratory of Molecular Virology, DETTD/CBER/FDA) to the XXII SoGAT meeting (14/15 April 2011) were circulated on the web.[201]


SUMMARY:

  • Canada - any donor who has a medical history of CFS will be indefinitely deferred from donating blood. (6 April 2010) [202]
  • New Zealand - patients with a diagnosis of CFS are permanently deferred. (April 2010) [203]
  • Australia - will indefinitely defer donors who have been diagnosed with CFS diagnosis. (23 April 2010) [204]
  • USA - its member blood collectors, through the use of donor information materials available at the donation site, actively discourage potential donors who have been diagnosed by a physician with CFS [also known as chronic fatigue and immune dysfunction syndrome (CFIDS) or myalgic encephalomyelitis (ME)] from donating blood or blood components. [205]
  • Malta - deferring donors permanently if they have a history of Myalgic Encephalomyelitis (ME). (4 September 2010) [206]
  • UK - blood donors who report that they have had ME/CFS will be permanently excluded from giving blood in the UK. [207] (Mentioned 13 August 2010, Implemented 1 November 2010) [208]
  • USA - The American Red Cross will defer indefinitely any donor who reveals during the donor interview that they have been diagnosed with CFS. [209]
  • Norway - Those with a ME/CFS diagnosis are banned from donating blood. [210]
  • USA - FDA Blood Products Advisory Committee (BPAC) voted to recommend indefinite deferral of CFS patients based on all evidence that it will promote donor and recipient safety. This is to be achieved by asking donors about a medical history and/or diagnosis of CFS [211][212]
  • Ireland - Irish Blood Transfusion Service: Permanently excluded from donating blood if you have a current or previous diagnosis of CFS. To protect the donor and recipient's health due to XMRV. [213][214]

1st International XMRV conference

The 1st workshop on XMRV is to be held on the 7-8 September 2010, at the National Institutes of Health in Bethesda, Maryland, USA, and will cover pathogenesis, clinical and public health Implications. [215]


Click here to see further details of the 1st International XMRV conference


USA Multi-Center Study

On the 8th September 2010, the WSJ reported that NIH director Francis Collins had asked Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, to direct a multi-center study of CFS patients to try to get to the bottom of the conflicting papers. In the same article, Fauci pointed toward the use of different patients for the discrepant results, and said that he had asked W. Ian Lipkin, a professor of epidemiology at Columbia University’s Mailman School of Public Health, to head up the study. Lipkin also noted that the way labs process the blood samples or the tests they use, could also be a contributing factor. [216]


The study will involve fresh blood samples from 100 CFS patients and 100 similar, but healthy people — 25 of each group from four different sites around the country, to provide geographic diversity. The samples will be processed, blinded and sent to the FDA, the CDC and the Whittemore Peterson Institute. If a lab finds a sample is positive for XMRV, further tests will be needed to confirm the result. If one lab finds a positive sample but another lab doesn’t, the same samples can be shipped again, with a new blinded code, to be tested again. If a lab gets the same result, it is valid.


Lipkin has stated that, it may turn out that certain labs are simply more proficient than others at finding XMRV and related viruses.


Testing

XMRV Testing

Dr Judy Mikovits has indicated that the WPI is now working on a test to measure how the immune system is functioning, thereby allowing them to assess the effectiveness of any treatment.


"We have immune system profiles and we can tell by the immune system how the XMRV is doing the damage,” “So we could have a diagnostic test to follow clinical treatment and show that people’s immune systems go back to normal. That’s the latest data that’s really amazing. That’s what we’re after."
Dr Judy Mikovits, 'Findings by Reno scientists confirmed by U.S. government' (RGJ.com, 16 August 2010) [217]


Treatment

Currently three antiretrovirals have shown promise in vitro (in the lab): Zidovudine (AZT), Tenofovir and Raltegravir.


More info can be found on the Antiretroviral Therapy page.


Treatment Possibilities for the New Human Retroviruses


Links

ME or CFS Research Studies

Research studies for other diseases

Further XMRV research studies

Assay development

Claimed origin of XMRV

Contaminated equipment research studies

Contaminated cell lines research studies

Knox & Paprotka Editorials & updated official pages

Reviews

Thesis on XMRV

Slides from unofficial talks

Animal Studies

Relevant MLV research

Relevant HIV research

Editorials on XMRV

Article on XMRV in journals

Government information on XMRV

1st International XMRV Conference

11th Symposium on Antiviral Drug Resistance

Additional CFS Information

Demystifying Medicine - Lo & Alter NIH 22 Feb 2011 Videocast

CROI 2011

Pathogens in the Blood Supply 2011

15 International Conference on Human Retroviruses: HTLV and Related Viruses (June 2011)

Patents

Ampligen

Blood donation & Blood XMRV Working Group

XMRV Resources

CDC (USA)

HPA, DoH (UK)

European Centre for disease prevention and control (ECDC)

WPI & CAA on the XMRV Studies

WPI/McClure Correspondance

Van Kuppeveld/WPI Correspondence

Gerwyn

MRV Treatment

Wall Street Journal

Further News Coverage

Press Release from Wellcome Trust

Press Release from University of Utah

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