News Release: University at Albany, June 20,2013.
University at Albany's East Campus Biotech Company Makes Major Fibromyalgia Discovery
Researchers Reveal a Rational Biological Source of Pain in the Skin of Patients with Fibromyalgia
RENSSELAER, N.Y. (June 20, 2013) – A major breakthrough in fibromyalgia was discovered by Integrated Tissue Dynamics LLC (INTiDYN), a biotechnology company housed and supported at the University at Albany’s East Campus in Rensselaer, New York.
Published in the peer reviewed journal Pain Medicine, the official journal of the American Academy of Pain Medicine, the study details the first physically detectable pathology providing a logical rationale for the debilitating symptoms of fibromyalgia.
The unique microscopic analyses were conducted at INTiDYN by former and current Albany Medical College researchers, Frank L. Rice, PhD, and Phillip J. Albrecht, PhD. INTiDYN was founded at the UAlbany's East Campus which is developed and maintained by the University at Albany Foundation.
Fibromyalgia is a severely debilitating affliction characterized by widespread deep tissue pain, tenderness in the hands and feet, fatigue, sleep disorders, and cognitive decline. However, routine testing has been largely unable to detect a biological basis for fibromyalgia, and standard diagnosis is based upon subjective patient pain ratings, further raising questions about the true nature of the disease.
For many years, the disorder was believed to be psychosomatic and often attributed to patients' imagination. Currently approved therapeutics that provide at least partial relief to some fibromyalgia patients are thought to act solely within the brain where imaging techniques have detected hyperactivity of unknown origin referred to as "central sensitization." However, an underlying cause has not been determined, leaving many physicians still in doubt about the true origins or even the existence of the disorder.
The breakthrough discovery by scientists at INTiDYN provides a biological rationale for this enigmatic disease. The study was conducted in collaboration with renowned Albany Medical Center neurologist and pain specialist Dr. Charles E. Argoff, the study primary investigator, and his collaborators Dr. James Wymer also at Albany Medical College and Dr. James Storey of Upstate Clinical Research Associates in Albany, NY.
"Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands," said Dr. Rice, President of Intidyn and the senior researcher on the study. "This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics."
Nerve Endings Come In Many Forms
Three years ago, INTiDYN scientists published the discovery of an unknown nervous system function among the blood vessels in the skin in the journal Pain, the official journal of the International Association for the Study of Pain.
"We analyzed the skin of a particularly interesting patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for our highly sensitive and richly nuanced sense of touch," Dr. Rice explained. "Interestingly however, this patient had surprisingly normal function in day-to-day tasks, but the only sensory endings we detected in his skin were those around the blood vessels."
Dr. Rice added, "We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidence that the blood vessel endings could also contribute to our conscious sense of touch… and also pain."
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The fibromyalgia study was funded by investigator-initiated research proposals approved by Forest Laboratories and Eli Lilly. Both pharmaceutical companies have developed FDA-approved medications with similar functions (Serotonin/Norepinephrine Reuptake Inhibitors, SNRI) that provide at least some degree of relief for many fibromyalgia patients.
"Knowing how these drugs were supposed to work on molecules in the brain," Dr. Albrecht added, "We had evidence that similar molecules were involved in the function of nerve endings on the blood vessels. Therefore, we hypothesized that fibromyalgia might involve a pathology in that location."
As the results demonstrate, they were correct.
To analyze the nerve endings, Drs. Rice, Albrecht, and postdoctoral researcher Dr. Quanzhi Hou, used INTiDYN’s unique microscopic technology to study small skin biopsies (less than half the size of a pencil eraser) collected from the palms of fibromyalgia patients, who were being diagnosed and treated by Drs. Argoff, Wymer and Storey.
Referred to as ChemoMophometric Analysis (CMA), the technology originated from research by Dr. Rice at the Karolinska Institute in Stockholm, Sweden. The study was limited to women, who have over twice the occurrence of fibromyalgia than men. What the team uncovered was an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves, called arteriole-venule (AV) shunts, which form a direct connection between arterioles and venules (see diagram).
Dr. Rice describes their function, "We are all taught that oxygenated blood flows from arterioles to capillaries, which then convey the deoxygenated blood to the venules. The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature."
A Thermostat for the Skin
In humans, these types of shunts are unique to the palms of our hands and soles of our feet which work like the radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold and put on gloves.
"The excess sensory innervation may itself explain why fibromyalgia patients typically have especially tender and painful hands," said Dr. Albrecht. "But in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients."
A Role in Regulating Blood Flow throughout the Body
Although they are mostly limited to the hands and feet, the shunts likely have another important function which could account for the widespread deep pain, achiness, and fatigue that occurs in fibromyalgia patients.
"In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism," noted Dr. Rice. "As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactivity in the brain."
Dr. Albrecht also points out that alterations of normal blood flow may underlie other fibromyalgia symptoms, such as non-restful sleep or cognitive dysfunctions. "The data do appear to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients,"he stated.
Senior Research Chair of the Alan Edwards Center for Pain Research at McGill University, Dr. Gary Bennett, commented after seeing the results. "It is exciting that something has finally been found," he remarked. "We can hope that this new finding will lead to new treatments for fibromyalgia patients who now receive little or no relief from any medicine."
This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not "all in a patient’s head,"which should provide an enormous relief to those suffering with fibromyalgia, while changing the clinical opinion of the disease and guiding future approaches for successful treatments.
About Integrated Tissue Dynamics LLC (INTiDYN): Integrated Tissue Dynamics LLC, located within the Capital Region’s TechValley at the University at Albany’s East Campus in Rensselaer, NY, provides flexible and scalable pre-clinical and clinical research and consulting capabilities on skin and nerve related chronic pain afflictions in collaboration with the pharmaceutical industry, government agencies, academia, and a network of pain specialists throughout the United States. The Intidyn ChemoMorphometric Analysis (CMA) platform can be used to detect chemical and structural changes in the skin and other tissues related to chronic pain, numbness, and itch associated with a wide variety of afflictions, including diabetes, shingles, complex regional pain syndrome, carpal tunnel syndrome, sciatica, fibromyalgia, psoriasis, chemotherapy, unintended side effects of pharmaceuticals, and others.