I've encountered an individual who had fibro, me/cfs, pots diagnosis. Turns out his small nerve fibers were fried by an antibiotic. His skin punch biopsy showed reduced fibers. This may not be the case in everyone, but SFN is extremely under diagnosed.

He was a chemist, and he ended up healing all his symptoms with pirenzepine. If I recall correctly they did the skin punch biopsy again and his physician was stunned when they saw regrowth of the fibers.

Today, WinSanTor is in stage 3 trials with their drug. They designed a cream with main ingredient being pirenzepine. They are targeting diabetes but the med appears to work for small nerve fibers as well.

Small nerve fibers control so much that any time people have weird unexplained symptoms it should be explored.

Very likely. All of these illnesses are diseases of the cells. We're entering the golden age of immune cell science. You figure out what immune cells are causing disease and how to restore them.

Here the T cells are imbalanced and a specific protein is found to regulate the imbalance but the interferon is countering the protein's effects. Now you can target that in many ways and run all sorts of clinical trials.

Maybe but the immune dysfunction goes further in ME/CFS its not just a problem of reduced CD4 and heightened CD8 (which are the two cell types they seem to be talking about) its a wider set of oddities that seem related to exhausted cells with not enough energy stuck in "there is infection near by" operation mode. It might help reduce symptoms that are caused by the imbalance so it would certainly be worth a trial when they work out the details.

Isn't thiamine tissue deficiency at the bottom of dysautonomia? Potentially leading to Alzheimer, MS, ALS over long periods of time if untreated depending on one's genetics and the way their body tries to adapt to it? I understand nobody tracks this over 30 years though. I think it's low-risk to try to address long-term tissue B1/B2/B3 deficiencies first and see if it helps.

"The initial symptoms of thiamine deficiency beriberi are those of dysautonomia [1], a broad term that describes any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST), vasovagal syncope, mitral valve prolapse dysautonomia, pure autonomic failure, neurocardiogenic syncope (NCS), neurally mediated hypotension (NMH), autonomic instability and a number of lesser-known disorders such as cerebral salt-wasting syndrome. Dysautonomia is associated with Lyme disease, primary biliary cirrhosis, multiple system atrophy (Shy–Drager syndrome) Ehlers–Danlos syndrome and Marfan syndrome for reasons that are not fully understood [2]. It has been hypothesized that the association of dysautonomia with so many different diagnoses is because a common form of dysautonomia originates from high calorie malnutrition. This leads to loss of oxidative efficiency (pseudo hypoxia) and subsequent disorganization of ANS controls that are mediated through the limbic system and brainstem."

It has been my hope that the number of me/cfs cases would finally drive enough research into autoimmune disorders in general, that we might finally figure it out. It seems very poorly understood from an outside perspective.