CIRS - Cutting Edge in Diagnosis and Treatment Conference

The "CIRS - Cutting Edge In Diagnosis and Treatment" event was held October 14-16, 2016 in Irvine, CA.  It was based on the work of Dr. Ritchie Shoemaker, MD.  Dr. Shoemaker has changed many lives by bringing attention to the problems that water-damaged buildings create for health in those that are genetically-susceptible.  Over time, it has become clear to me that Lyme was a relatively small issue as compared to mold illness in my own personal journey.  It has also become clear to me that if one has both of these issues in play, addressing the mold exposure should be a top priority.  Without doing so, it is unlikely that one will make significant progress with their overall treatment. 

While this event should have been ten times the size given the magnitude of the problem, it is great to see so many practitioners taking up the torch and incorporating mold treatment into their patient work.  The certified practitioner list is still smaller than what can meet the need, but I am very pleased to see the caliber of the people that are becoming experts in this work.

We are very fortunate that Dr. Shoemaker's work is well-organized for us with many resources at SurvivingMold.com.  All of the lectures are available for purchase as well and I recommend empowering yourself with knowledge and exploring these resources further.

Disclaimer: Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal licensed medical authority.

Disclaimer: This information was taken as notes during the conference and may not represent the exact statements of the speakers. Errors and/or omissions may be present.

Note: As this information may be updated as any errors are found, I kindly request that you link to this single source of information rather than copying the content below. If any updates or corrections are made, this will help to ensure that anyone reading this is getting the most current and accurate information. 

Chronic Inflammatory Response Syndrome is known as CIRS.  It is pronounced "sirs", not "sears".  

Keith Berndston, MD spoke on "What is CIRS?" and shared:

• He has never encountered a chronic medical condition where subjects suffer with as many challenges and insults as CIRS.
• We need to get CIRS accepted by the broader medical community and society as a whole.
• Molds and bacteria grow on damp building materials and form tiny particles which are inhaled and absorbed into the body and that cause harmful inflammation in those that are genetically prone to poor clearance.
• The good news is that CIRS is treatable.
• He has empathy for colleagues that are boxed in and felt the same way initially. Third parties control how doctors think and how they behave.
• Insurance companies easily change contract language to manage their revenue.
• It can cost up to $800 for one month of Cholestyramine or $400 for one month of Welchol.
• Schools do not have the funds needed to deal with remediation.
• Air samples are not adequate proof that an environment is safe.
• Difficult roads lead to beautiful destinations.

 Scott McMahon, MD spoke on "Alternate Means to Presumptive Diagnosis" and shared:

• The case definition for CIRS was documented by Dr. Shoemaker in 2006 and is in the GAO as of 2008.
• Tier 1 - exposure; see it, smell it, measure it. Need to have sufficient symptoms in 4 of 8 body systems.
• Tier 2 - labs. Need to have 3 of 6 labs from:
  • HLA DR
  • Abnormal VCS
  • Abnormal ADH/osmo
  • Abnormal ACTH/cortisol
  • Elevated MMP9
  • Low MSH
• Tier 3 - improvement. Symptoms and VCS should improve with treatment. Labs should improve.
• You have to see the patient, do the labs, treat them (out of moldy environment, treat, and then followup visit) before you meet the case definition for CIRS. This is not helpful in clinical practice and thus, alternate means are needed.
• They have developed 37 symptoms in 13 clusters. There is a good diagram of these 37 symptoms and 13 clusters here. 
• The screens used include the 37 symptoms, VCS test, comparison of relative strength of both shoulder's anti-gravity muscles, and total number of abnormal CIRS related labs.
• The labs used are HLA DR, VIP, MSH, ADH/osmo, ACTH/cortisol, TGFb1, MMP9, MARCoNS, anti-cardiolipin antibodies/anti-gliadin antibodies, and C4a.
• In children younger than 11, 4 abnormal tests are needed. In children 11 and older and adults, 5 abnormal tests are needed.
• 5 of 10 tests being abnormal does not happen by accident - 1 in 10 billion.
• He has found that cluster analysis is the most sensitive screening overall.
• To rule out CIRS, use the clusters. If there are only a few clusters, CIRS is unlikely as it is a condition that impacts many body systems.
• 3 abnormal screens or 4-5 abnormal labs means that the patients is unlikely to not have CIRS.

 Ritchie Shoemaker, MD spoke on "Differential Diagnosis" and shared:

• CIRS was discovered 20 years ago.
• Genomics will extend differential diagnosis like never before imagined.
• Do you wake up feeling refreshed? This is an MSH question.
• Do you have good days and bad days? This is typical of CIRS.
• Can call it CFS or Lyme - they all have the same common pathway.
• If you have a good day and then try to do something extra and then are worse, this is an indication that oxygen delivery is poor and that capillary hypoperfusion may be present.
• How is your memory? It is often best to ask the significant other this question.
• Do you have muscle aches?
• Other symptoms may include static shocks (low ADH and high osmo), clawing, trouble controlling temperature, abdominal pain without help from proton-pump inhibitors, migratory joint problems, morning stiffness, calf/hamstring/sartorius cramping at night.
• If there is a high SED rate or high CRP, you may have CIRS but you may also have something else.
• BUN elevation is not related to CIRS.
• Hypermobility is seen in 11-3-52B HLA types along with TGFb1 and autoimmunity.
• Dermatographia is a skin condition that can be related to elevated C4a. Can play "tic tac toe" on someone's back with your fingers.
• 45% have a resting tremor - can put a piece of paper over outstretched fingers to see the tremor.
• Labs: TGFb1, von Willebrand's (blood clotting), low VEGF, HLA, biofilm for MARCoNS, mass spec on MARCoNS broth coming soon, genomics.
• History is critical; be sure to take it.

Dennis Schoen mentioned the following on Researched Nutritionals products:

• Penn State completed research on Tri-Fortify (liposomal glutathione).
• It increased RBC levels of glutathione by 28% and reduced oxidative stress by 25%. It also increased NK cells by 400%.
• There is a 200-600% increase in NK cells with Transfer Factor Multi Immune.
• ATP Fuel supports the mitochondria and membrane repair. There was a 31% reduction in fatigue in 60 days in CFS, Lyme, Fibromyalgia, Gulf-War Syndrome. 30% improvement in cognitive function as it crosses the blood-brain barrier.

Jill Carnahan, MD spoke on "Introduction to CIRS Treatment Protocol" and shared:

• First, I have to say that Dr. Carnahan is one of the functional medicine heroes in my world. I was very excited to meet her at this event. If you have not followed her work, I recommend following here work at http://www.jillcarnahan.com
• CIRS is a genetic predisposition to defective antigen presentation.
• HLA are like Pacmen and tell the immune system what is good and what is bad. The Pacmen sample the environment.
• GALT is 70% of the immune system.
• Pacmen are telling the immune system that DAMPS (damage-associated molecular patterns) and PAMPS (pathogen-associated molecular patterns) are present and lead to a massive cytokine production.
• Always ask about the house.
• She had her own issue with mold in her office and could not walk up a flight of stairs without being short of breath.
• VCS testing is very important. She does this monthly with patients and it can help to identify a potential exposure.
• CIRS is a merry-go-round that will not stop until we intervene and change the immune response.
• TGFb1 impacts TH17 and can result in autoimmunity. 11-3-52B HLA types are prone to that as Treg cells are diminished.
• Without HLA issues, the body gets rid of the toxin.
• MSH impacts histamine, mast cells, endocrine function such as thyroid, adrenals.
• 4-3-53 are more prone to depression, chronic pain, and fatigue.
• Low MSH is associated with IBD. Crohn's and colitis may be CIRS.
• Borrelia may create a toxin that creates a CIRS picture. It is not known yet whether or not Lyme co-infections create similar toxins.
• Stagnation of bile and difficulty getting bile out of the body (with the toxins still present) becomes a problem. The toxins are re-absorbed.
• Do you have a flat roof? Do you feel better in other locations?
• Ice-pick pain is characteristic of CIRS.
• An environmental trigger creates inflammation and dysbiosis.
• If MSH is normal, an ERMI score of < 2 is usually safe.
• If MSH is < 35 and c4a > 20,000, an ERMI score of < -1 is desired.
• TGFb1 is an immune suppressor.
• Environmental enteropathy related to tight junction damage.
• Immune system is weakened due to protein wasting enteropathy.
• Lowering TGFb1 enhances neurogenesis and muscle regeneration.
• TGFb1 impacts the kidneys and can create renal fibrosis.
• MMP9 increases blood-brain barrier permeability and is associated with COPD.
• MSH has endocrine effects including on the adrenals, thyroid, and aromatase.
• She mentioned a research probiotic that secretes MSH; Bifidobacterium longum. Unfortunately, this specific material is not known to be available commercially at this time.
• VEGF is involved in capillary permeability and edema.
• Most of her patients are gluten free. If they are not and have anti-gliadin antibodies, they should stop gluten.
• High leptin and weight gain are common in CIRS.
• ACTH/Cortisol - both are high or both are low.
• We need to remove as many toxic exposures as possible.
• You cannot get any good results if you continue to have exposure to CIRS-toxins. 
• Must remove yourself from exposure, lower C3a, C4a, MMP9, TGFb1, correct hormones, deal with autoimmunity, improve perfusion, eradicate MARCoNS, and correct cellular immunity.
• Cholestyramine is taken away from foods. It can bind Coumadin, thyroid, and other medications. 4 grams four times daily.
• It is taken 1 hour before or 2 hours after meals as we do not want to bind the fat in the foods.
• MARCoNS impacts the entire body. BEG spray may be used for 30 days.
• DHEA may be used to help support hormones.
• DDAVP (desmopressin) may be used for ADH-related issues but can lead to weight gain, swelling, edema, and headaches.
• MMP9 may be reduced with high dose fish oil.
• C3a may be reduced with high dose statin drugs (with CoQ10 administered concurrently).
• C4a may be reduced with Procrit.
• TGFb1 may be reduced with Losartan.
• Then, the last stage is VIP nasal spray.
• When using VIP, lipase levels should be monitored as it can lead to pancreatitis.
• 80% of environmental toxic exposures are from the air we breathe.
• The elephant in the room is the toxic overload from all sources. This includes personal care products, cleaning products, etc. It is the total body burden of toxicity that creates problems.
• We need clean air, clean food, clean water.
• Many other organisms can impact patients including Mycoplasma, Chlamydia, Borellia, Bartonella, Babesia, Protomyxzoa, EBV, HHV-6, CMV, HSV-1, HSV-2, Toxoplasmosis, Strep, and mold/fungal infections.

 Sandeep Gupta, MD spoke on "The Aussie CIRS Experience" and shared:

• Your Solution Compounding in Brisbane has been able to make many of the Shoemaker Protocol medications available such as Cholestyramine, BEG spray, and VIP spray.
• Australian Chronic Infectious Disease Society
• They do have a mold testing lab in New Castle that can do ERMI and HERTSMI-2 testing.
• A new 8 week course on CIRS available online - http://moldillnessmadesimple.com/
• He experienced the effects of CIRS personally after a flood at his home in Brisbane.
• 99% of his patients have a CIRS-susceptible HLA type.
• Average C4a is 17,578
• Average NeuroQuant Mold Score was 4.77.
• Average NeuroQuant Lyme Score was 1.22.
• Average TGFb1 was 6232.
• Average VEGF was 79.25.

 Mary Ackerley, MD spoke on "Brain on Fire: Neuroinflammation and CIRS" and shared:

• She is a board-certified psychiatrist.
• There are 37 top symptoms in water-damaged building exposures. So many of them relate to neurology. At least half of them relate to the brain.
• The 37 most frequent symptoms in CIRS-WDB can be found here.
• Executive functioning is difficult for people with CIRS and this makes coordinating a move, making a major change, etc. difficult to plan and execute.
• CIRS symptoms are often explained as anxiety or depression.
• Depression is the leading cause of disability in the world; we need to get the word out there that there may be other solutions.
• SSRIs are no better than placebo in mild to moderate depression.
• People are being treated for conditions they don't have with drugs that don't work very well.
• C4 gene on the HLA region of chromosome 6 was recently associated with schizophrenia.
• Neuroinflammation is involved with glial activation, leukocyte invasion, blood-brain barrier permeability, and pro-inflammatory cytokines.
• Causes of neuroinflammation may include:
  • Infections and Toxins: viral encephalopthy, mycotoxins, Lyme, Strep, Toxoplasmosis
  • Inflammatory and Autoimmune: Cytokines, Autoantibodies, Glial Activation, Mast Cells and Histamine
  • Trauma: Concussion
• Cognitive impairment in CIRS is real.
• In a study of 277 Polish children living in a home with visible mold, there was a significant decline in IQ; 10 points over 6 years.
• If you have kids, the answer should be clear - GET OUT!
• Inflammation can cause depression.
• It is hard to treat bipolar disorder until water-damaged building issues are under control.
• The immune system is a key player in schizophrenia; genetics plays a role.
• Alzheimer's involves cytokines and inflammation. IL-6, TNF-a, IL-1, IL-12, IL-18, TGFb1.
• Inhalation Alzheimer's has been seen.
• CIRS increases the risk for the development of Alzheimer's.
• Quinolinic acid has been linked to suicide.
• Low VEGF results in hypoperfusion which can lead to chronic fatigue, hypoperfusion of the extremities and of the brain.
• Exercise and diet are as effective as SSRIs for depression.
• Low VEGF has been associated with completed suicide in a Swedish patient study.
• Low ADH has been associated with negative interpersonal interactions.
• The brain uses more energy than any other organ; 25% of the oxygen and 20% of the calories - while being only 2% of the body weight.
• Sickness behavior is pro-inflammatory cytokine-based. Malaise, fatigue, psychomotor retardation, anhedonia (inability to feel pleasure), and social withdrawal.
• Guilt, worthlessness, and hopelessness are not seen in sickness behavior.

The morning panel discussion shared:

• If you don't follow the criteria and the steps of the CIRS protocol, VIP won't work. It may not hurt you, but it won't work.
• C4a should be sent to National Jewish Hospital and that has recently become a problem with Quest. New labs for C4a will be available shorty.
• With VIP, it is important to monitor lipase elevations.
• Headaches, dizziness, palpitations, and irritability on VIP generally pass quickly.
• MARCoNS biofilms destroy MSH. Part of correcting MSH is to deal with MARCoNS. VIP nasal spray may increase MSH.
• High osmolality with low ADH can lead to static shocks. People are cellularly dehydrated.
• CIRS and vaccinations - antigen presentation problems are not present for all antigens. Does not seem to be a problem with flu or pneumococcal vaccine.
• Multi-dose flu vaccines may still contain thimerosal. The vaccine itself may not be a problem, but adjuvants and toxins that are in them may add to the total load.
• Glyphosate has recently been found in nearly 100% of the vaccines.

Sonia Rapaport, MD spoke on "Shared Medical Appointments" and shared:

• There have been disaster declarations in the past 5 years for flooding in almost every state except for New Mexico and Arizona.
• High ERMI scores have been correlated to asthma severity.
• 24% of the population is susceptible to biotoxins from water-damaged buildings.
• 100% of her patients have a susceptible HLA type.
• HLA expression is not static; stressors may influence HLA expression. Traumas, accidents, EBV, Coxsackie.
• CIRS may impact 40 million people and there are only 18 certified CIRS providers in the US.
• She has been implementing shared medical appointments where she works a full day with a group of people that have the same condition. Each person gets individual time and also group time with her and her team throughout the day in an attempt to help more people.

Megan Doyle, JD spoke on "Yoga and CIRS" and shared:

• Yoga is a complementary system in CIRS.
• It is meant to empower individuals with health conditions to improve their health and well-being.
• There is an International Association of Yoga Therapists.
• Chronic pain, chronic fatigue, anxiety, migraines, weight issues, PTSD, osteoporosis, IBS, memory issues, stress may all benefit from yoga therapy.
• Yoga increases parasympathetic tone and the body moves itself towards healing.
• You become aware and then use that awareness to influence the direction of change.

Ritchie Shoemaker, MD spoke on "Multinuclear Atrophy and NeuroQuant" and shared:

• If we can show presence of brain injury with NeuroQuant, we can use genomics to show brain repair.
• Is atrophy a loss of substance or function?
• Is atrophy of gray matter confined to Alzheimer's? No
• We want to recognize and correct inflammation and show that correction reduces atrophy despite the progression of age.
• Atrophy in CIRS is not just atrophy but also edema. The CIRS protocol corrects edema in mold patients.
• They did a NeuroQuant study with 1043 patients; 306 male and 728 female. Data was from 110 providers.
• With age, the putamen, pallidum, and thalamus get smaller.
• With NeuroQuant, mold patients may have an enlarged forebrain and cortical gray matter, and palidum with atrophy of the caudate.
• In Lyme, there is a small putamen and enlarged right thalamus. Other things can cause a small putamen.
• Small putamen is far more common in Lyme. A large thalamus is almost diagnostic of what Lyme will do; especially on the right side.
• There are 8 possible points for mold and 4 possible points for Lyme.
• NeuroQuant cases and controls are very different.
• NeuroQuant Lyme and NeuroQuant mold are very different.
• Has shown that a lot of people diagnosed with Lyme did not have Lyme.
• NeuroQuant can be used to separate "likely Lyme" from "likely not Lyme".
• Lateral ventricle enlargement in younger people may be a sign of potential future dementia.
• MARCoNS may lead to gray matter nuclear atrophy. Are these organisms benign or are they making something?
• MARCoNS causes nuclear atrophy and this is worse when antifungals have been used.
• If using Diflucan for Candida, you may be creating a resistant staph organism.

 Mary Ackerley, MD spoke on "Sensitive People: Hypermobility, Large Cerebellums, and Low Dose VIP" and shared:

• Hypermobile people have an increased vulnerability to CIRS.
• If the length of the outstretched arms is from tip to tip is greater than your height, this is a long wingspan and more prone to CIRS.
• Being able to clasp your hands behind your back is not common.
• Ehlers Danlos Type 3 (EDS) often have higher incidence of IBS and Fibromyalgia.
• 49% of people with Tourette's in one study had hypermobility.
• Only 10% of the population is hypermobile.
• POTS is common with EDS.
• EDS is termed "benign" but many people with EDS get CIRS.
• SIBO may be an issue associated to the autonomic system and gastroparesis.  
• Of 152 CIRS patient NeuroQuants, 23 had EDS Type 3, 37 were hypermobile, 7 had severe OCD, 5 were pro-caliber athletes, 1 had Marfans.
• EDS is 1% of the population but 15.5% of her CIRS patients.
• Hypermobility is 10% of the population and 24% of her CIRS patients.
• The cerebellum is where 50% of the neurons are located. People with a large cerebellum may benefit from CBD oil as it is rich in cannabanoid receptors.
• A large cerebellum may reduce the ability of the brain to remove toxins.
• The large cerebellum group is the most sensitive to side effects of the overall CIRS protocol.
• Low dose VIP has been found to decrease neuroinflammation, improve neurological function, regenerate the hippocampus, regulate NMDA receptors and synaptic transmission, and modulate microglial activation.
• VIP can result in headaches, dizziness, vertigo, balance issues, irritability, anxiety, brain fog, depression, thoughts of suicide, and tachycardia.
• In patients unable to tolerate the normal protocol for CIRS, low dose VIP may reduce reactions and allow them to do the other steps in the protocol.  

Dr. Dale Bredesen, MD spoke on "Alzheimer's and CIRS" and shared:

• Inhalational Alzheimer's can be caused by mycotoxins.
• Alzheimer's is the third leading cause of death and is on the rise.
• It is no longer mysterious.
• There are important genetics involved in Alzheimer's.
• Inflammation plays a role.
• Fasting insulin levels are intimately related to cognitive decline.
• Dr. Shoemaker's sees patients with Alzheimer's and Parkinson's that have CIRS.
• Leaky gut and the gut microbiome are important to explore.
• Pre-Diabetes is a risk factor for cognitive decline.
• We now have reversals of Alzheimer's.
• Alzheimer's is much more complex than HIV.
• It needs a functional medicine approach to explore all the possible pieces.
• He works with the Buck Institute.
• It takes 3-6 months to start to see improvement on his program; the RECODE program.
• We have a lot more arrows in the quiver than people realize.
• There is a lot that can be done now for cognitive decline.
• 5% of Alzheimer's are ApoE gene-related.
• The brain is a fat bucket.
• We needed something to fight microbes; that something was a pro-inflammatory state that was needed as part of evolution.
• ApoE3 appeared about 220,000 years ago, and ApoE2 about 80,000 years ago.
• 75 million are heterozygous for ApoE4.
• 7 million are homozygous for ApoE4.
• If you have no ApoE4, you have a 9% chance of getting Alzheimer's. If you have one, the chances are 30%. If you have two, the chances are 90%.
• ApoE4 shortens lifespan.
• There is an 80% reduction in SIRT1 with ApoE4. Resveratrol activates SIRT1.
• ApoE4 has more inflammation. ApoE3 is not as good as a pro-inflammatory state but is good for living in our society.
• Pre-Diabetes and Type 2 Diabetes are risk factors for Alzheimer's.
• Organisms produce amyloid in response to 3 metabolic and toxic perturbations:
  • 1) Inflammation - NFKb activation - could be infectious or not (trans-fats, etc.)
  • 2) Withdrawal of trophic support (dropped testosterone, BDNF, Vitamin D, estradiol)
  • 3) Exposure to toxins - metals and mycotoxins
• 500,000 Americans may have inhalational Alzheimer's.
• There is type 1, 2, and 3 Alzheimer's and combinations are common.
• Sleep apnea, trauma, and vascular insufficiency are factors.
• Need to optimize hormones, be in mild ketosis, exercise, and get the right nutrients.
• This is not a one drug disease. It is more like a roof with 36 holes.
• What is referred to as Alzheimer's (plaques) is a protective response.
• Type 1 and Type 2 are cousins. Type 3 is different - young people, ApoE4 negative, low zinc, low triglycerides, depression, issues with math problems, toxins, Lyme, MARCoNS, Babesia.
• High C4a, high TGFb1, low MSH can be seen in Alzhiemer's.

Larry Schwartz, CIEC spoke on "To Move or Not to Move...That Is The Question" and shared:

• There is a consensus paper on investigation of water-damaged buildings available.
• The Mold Propensity Index is gives a risk assessment for water damage and mold.
• MPI gives an indication of the potential for a home to develop water damage. Corrections can then be implemented to reduce the risk to acceptable levels if elevated.
• HERTSMI-2 looks at 5 mold species.
• ERMI Category 1 molds are not commonly found in non-WDB homes. Category 2 molds are more commonly found in non-WDB homes.
• Based on the MPI, HERTSMI-2, and the HERTSMI-2 ratio, you can create a MOVEME score.
• Larry's web site is: http://www.safestartiaq.com 

Michael Schrantz, CIEC spoke on "A Mold Safe Home Assessment Through Virtual Boots on the Ground" and shared:

• He is working to provide virtual assessments of a home.
• Will have Safe Start Analytics up in January 2017.

David Lark, B.App.Sci, CIEC, CMC spoke on "HERTSMI-2 and Re-Occupancy" and shared:

• He talked about the "WDB Soup" and this was one of the takeaways from the event that had not previously set in with my understanding of "mold illness". We think about mold and mycotoxins, but the list of inflammagens in a water-damaged building is long. While I was aware of this previously, I don't think I had ever seen the list and seeing how long it is really made a connection for me.
• It includes: mycotoxins, bioaerosols, cell fragments, cell wall components, hyphal fragments, Conidia, Beta Glucans, Mannans, Spirocyclic drimanes, inorganic xenobiotics, gram negative bacteria, gram positive bacteria, Actinomycetes, Nocardia, Mycobacteria, Protozoa, Chlamydia, Mycoplasma, endotoxins, lipopolysaccharides, hemolysins, proteinases, chitinases, siderophores, microbial VOCs, building material VOCs, coarse particulates, fine particulates, ultrafine particulates, nano-sized particulates. The list can be found here.
• In fact, after the event, Dr. Shoemaker shared with me that mycotoxins are less than 1% of the problem. That was an important piece of information that I had also not previously heard.
• HERTSMI-2 is "Health Effects Roster Type Species Mycotoxin Inflammagen Formers 2nd Version". Now don't we like HERTSMI-2?
• It is not a building index, but how an individual will respond to an exposure. Will this building make me sick?
• There are representative molds used from the different groups of mold types to assess the building risk for a person.
• If the HERTSMI-2 is > 15, there is a 100% risk of recurrence of CIRS. If it is <11, the risk is less than 2%.
• Tools that can be used are ERMI, HERTSMI-2, Neuroquant, Transcriptomics, and Next Gen Sequencing.

Vince Neal, CIEC spoke on "Safe House!" and shared:

• Air Oasis HCT355 showed clear progress with VCS testing.
• It seemed to have more of an impact than Cholestyramine.
• ERMI went from 14.4 to 5.7 and HERTSMI-2 of 12 reduced to 4.
• VCS testing may be a good tool for evaluating re-exposure.
• Many symptoms improved over an 8-week period.
• Reducing inhalable contaminants led to improvements in both VCS and symptoms.
• May be able to reduce inflammation without removal from the home. 

Greg Weatherman, CMC spoke on "Microbial VOCs: Finding the Invisible" and shared:

• His web site is http://www.survivingremediation.com 
• MVOCs are produced by mold and bacteria during their growth or metabolism depending on moisture, temperature, and food sources.
• Soil produce MVOCs after rainfall. MVOCs may be a first sign of a leaking window.
• 1000 chemicals are produced as MVOCs.
• Ethanol is produced by mold and bacteria as MVOC.
• Crawlspaces can be checked for MVOC emissions. Liners can cost 5-10K.
• MVOCs have been shown to go through a thin sheet of plastic. We need something good enough to stop radon even if that is not the intent.
• The source of mold in nature is soil. One should never have bare soil below a house.
• MVOCs are vapors that behave like water.
• Lab cost for testing MVOCs is about $200.
• MVOCs adsorb to other particles and surfaces. Air exchanges work for MVOCs if they don't adsorb to particles.
• MVOC emissions occur before fungal fragments become airborne.
• Total VOCs can be misleading as many modern furnishings and finishings have VOC emissions.
• The nose is a valuable test instrument.
• There is not a standard collection method for ERMI. It requires 5 mg of dust collected over 2 square meters. How it is collected is not standard when looking at variations worldwide.

Michael Schrantz, CIEC and Mary Ackerley, MD spoke on "It Takes a Village" and shared:

• It takes a village to get a CIRS patient better.
• Assume every patient you talk to is or could become chemically sensitive in terms of the things you do.
• CIRS-WDB is an inflammatory response of the innate immune system when exposed to the air and dust in water-damaged buildings.
• The relative risk of illness with exposure is increased in specific HLA genotypes.
• They have dry heat and dry mold in Arizona.
• PAMPS and DAMPS are Pathogen-Associated Molecular Patterns and Danger-Associated Molecular Patterns.
• The innate immune system responds broadly and non-specifically to viruses, bacteria, and fungi. This causes inflammation with collateral damage.
• Allergies use the new, more precise adaptive immune system. CIRS is not an allergy.
• In 1829 CIRS cases, patients less than 19 years old averaged 19 of 37 symptoms. Those 19 and above averaged 25 of 37 symptoms. Healthy controls averaged 3 of 37 symptoms.
• The inflammagens and toxic exposures in a water-damaged building goes far beyond mold. It is not just about mold but about pathogens and inflammagens and toxigens.
• Remediation often fails to consider the health needs of the CIRS-WDB patients.
• HERTSMI-2 score correlates to the relapse rate of patients.
• You will not find Stachybotrys in air sample testing as it falls quickly to the surfaces and is very sticky.

The IEP panel discussion shared:

• Dr. Sandeep Gupta mentioned that he had a overflowing bathtub in his home. He was failing the VCS testing. He installed Air Oasis and continued to test VCS testing regularly.
• With VCS testing, there are 5 columns and 9 rows. The pass or fail is based on columns C and D. You pass if you have > 5 correct in column D and > 6 correct in column C in both eyes.
• He was a 4 in both columns C and D and failed the VCS. He ran the Air Oasis 24 hours a day and improved by 1 point in column D. He then moved the Air Oasis downstairs and started improving rapidly. Not only did he pass the VCS but was even getting items in column E which may be finer markers of exposures. Many patients get zero in column E.
• The VCS test can worsen within minutes after exposure to a WDB.
• Standardizing the collection for an ERMI is imperative. This is being worked on. David Lark mentioned that should be done with a horizontal wipe in one direction only. Still needs consensus.
• Larry Schwartz suggested avoiding areas close to plumbing fixtures and avoid floors that may have walking contaminants.
• Greg Weatherman suggested having a look at each structure and how it operates. What are the potential exposures, air sources, etc.?
• You may dilute the results with pooling dust from several sites, floors, etc.
• Door frames, fan blades and other places with less cleaning may represent historic dust vs. furniture which may be more current dust.
• Greg Weatherman suggested looking at high humidity. He felt that you may not have good success with Air Oasis unless you were in a lower humidity environment.
• Larry Schwartz suggested that when selling a house, most people accept a spore trap test which doesn't work for CIRS. Sales close even in homes where mold may be disclosed if the spore trap testing is clean.
• Michael Schrantz suggested that when it comes to personal belongings "when in doubt, throw it out". Health is #1.
• Greg Weatherman mentioned that he doesn't tell anyone to throw anything out. The state of their innate immune system today may be in shambles but a year later they may be able to deal with it. My understanding of his comment was not that they may not need to be removed while the patient is healing, but that at a later time, they may be able to be reintroduced vs. entirely thrown away.
• Greg mentioned that the group 2 (common outdoor) molds can be elevated which may make an overall ERMI look better than it is. This can happen from leaving windows open or AC units that are incubating outdoor molds. Add Group 2 and Group 1 and if the total is over 30, you have a problem.  
• With indoor air quality, have to find and remove the source of the issue as well as considering filtration and ventilation.
• In commercial buildings, ventilation is #1. In homes, you can add a device to bring in outdoor air.
• Greg mentioned that anything that requires containment for demolition should not be done by a homeowner. Clients can do damp wiping outside of a containment area, but would have to take legal responsibility for what they do and hold the contractor harmless.
• Greg mentioned that if a client has CIRS and is not working with a CIRS doctor, it won't end well. Is it the environment or something internal to the patient? MVOCs will not show with HERTSMI-2, ERMI, or spore traps.
• Larry has seen some contradictory results with HERTSMI-2 and patient response. Some with higher scores do fine; some with lower scores do poorly. EMFs, VOCs, etc. are not being looked at. There could be an inflammagen cloud in the home which is an invisible fog (or smog) going on in the home.
• Greg mentioned that vehicles are hard to clean and the HVAC ducting may need to be replaced. It may be better to get a new car. Ozone does not work and may degrade the wiring, seals, etc. and create more VOCs.
• Swamp coolers should all go in David's opinion.

Larry Schwartz, CIEC spoke on "New Construction" and shared:

• All that glitters may not be gold.
• Every property has some degree of LCM (Larry, Curly, and Mo) Syndrome.
• Gypsum drywall vs. plaster (which is not a source of food for mold); this changed in 1976.
• More mold is found in newer construction homes; though there are many factors involved.
• Chaetomium and Stachybotrys need a fair amount of water over a period of time.
• Newer homes are tighter with few air exchanges.
• Green homes are about energy efficiency; not about being less of an issue in terms of the potential to be water-damaged. The more energy efficient, the tighter and more vulnerable the home is to humidity and mold.
• Try to find a builder that will follow specific recommendations for construction to minimize the potential for future problems.
• There should be a slab foundation rather than a basement or crawlspace.
• 25% of soil is fungal material. All leaves, twigs, etc. are decomposed by fungi.
• A basement is better than a crawlspace but slab is ideal. It eliminates many water intrusions as well as fungal and radon soil gases coming into the home.
• Basements want to suck in air from any cracks.
• The air going into the HVAC system should not come from a crawlspace or basement.
• There should be no wall-to-wall carpeting. It is a bad thing and a receptacle for everything in the air. Every time you walk, you spray inflammagens into the air.
• Even with a hepa vaccum, particles smaller than .03 microns still go into the air. Ventilate a room when vacuuming.
• Windows should be good quality. 25% of windows from various manufacturers leak.
• Do not finish a basement until it has settled in order to be able to identify cracks.
• No "flex" ductwork as it is impossible to clean.
• Properly seal all vents and plenum junctions.
• There should be no furnace humidifier as it creates condensation.
• No UV light on the furnace as it may lead to respiratory issues; some with no UV felt better in absence of mold being identified.
• Substitute plywood for OSB (Oriented Strand Board); harder wood is more resistant to mold and rot. Plywood has fewer resins.
• In water damage vulnerable areas, use a mold proof style drywall where the surface is fiberglass and can be painted. Apply fungicide on hot spot locations.
• Use non-urea formaldehyde insulation in walls.
• If finishing a basement, use steel wall studs instead of wood. Use mold-proof drywall and insulation. Stop drywall insulation several inches from the floor. Painted plastic base trim is better than wood.
• No carpeting. No VOC paints.
• For ventilation, bath exhaust fans need to be powerful enough to move moisture out of the air. Have HRV or ERV power ventilation system installed on HVAC with slight positive pressure differentiation.
• Minimize valleys on roofs.
• Have oversized gutters and downspouts.
• Extend downspouts 3-5 feet from foundation walls.
• Make sure soils are compacted at the foundation wall and pitched away.
• Have pitched safety covers over window wells.
• Have a good VOC filter for the first few years to deal with paints, cabinets, etc.
• For wood floors, install pre-finished woods. Do not stain, sand, or lacquer in the home.
• Use the highest ground available.
• No steep grades coming to the foundation.
• Face geographically with the bedroom, family room, and kitchen on the leeward side of prevailing winds.
• Avoid close proximity to ponds and woods.
• Tract home builders will not allow changes and don't generally have much luck with them.

Joe Musto, PhD spoke on "MARCoNS" and shared:

• He runs Microbiology DX.
• Researching biofilms of MARCoNS-positive cultures.
• Biofilm produced by any organism makes it much more resistant to anti-infective drugs.
• Antibiotic resistance is a terrible factor in our life.
• Penicillin came out for soldiers to avoid losing limbs to Staph in WWII.
• Staph then produced beta-lactamase which made it resistant to penicillin.
• The bugs are winning now.
• Biofilm production by organisms compounds resistance issues.
• It is a mechanical barrier to antimicrobials and immune system cells.
• They have a biofilm assay that can be done on MARCoNS-positive test results. More information here.
• They can differentiate a weak biofilm response from a negative.
• In 233 patients that they looked for biofilms, 71% had biofilms and 28% were negative.
• Staph aureus in the presence of coag-negative staph inhibits the coag-negative staph.
• They do not see Staph aureus with coag-negative staph.
• EDTA is very effective at killing MARCoNS by itself.
• EDTA is in BEG spray at a 1% concentration but still resistance is observed with MARCoNS.
• EDTA breaks biofilms and kills the organism in a test tube.
• If one is recultured and still positive, it may be a compliance issue.
• If there was one pattern of susceptibility for the first culture and a different pattern after treatment and reculture, it is a different strain. Does the spouse carry it? Does a dog carry it? It has been found in dogs.
• MARCoNS is becoming resistant to Gentamicin.
• They are doing some research on various silver solutions as well as other antimicrobial oils that may be helpful for MARCoNS treatment in the future.

Mary Ackerley, MD spoke on "Dental MARCoNS" and shared:

• This was one of the bigger new insights; that MARCoNS is also found in cavitations.
• We have a cribriform plate where pathogens can generally be found.
• Patients with trigeminal neuralgia have improved with revisiting infection in a dental site. In some people, this has also then unblocked them such that they could do other treatments.
• They have started to collect samples from biological dentists from extractions and cavitations.
• It takes 40% bone erosion for these to be seen on an x-ray.
• Wisdom teeth extraction sites and old root canals are commonly infected.
• Often, root canals are the start of people going downhill.
• Looking at 12 patients with 13 dental cultures, 11 of 12 patients had nasal MARCoNS; 8 of 13 dental cultures had dental MARCoNS.
• Most people cleared MARCoNS after having appropriate dental work done.
• Tubules in dentin are 3 miles in length and fill with bacteria.
• Root canals lead to bacteria multiplying in the dental tubules.
• When doing a nasal culture, she likes to do both nostrils at the same time.
• IOAMT is an organization of dentists that do the cone-beam CT, ozone, and cavitation work.

Ritchie Shoemaker, MD spoke on "Mass Spec of MARCoNS" and shared:

• People with MARCoNS that have CIRS did not get better when treating MARCoNS first.  Need to do Cholestyramine first then MARCoNS.
• Lowest MSH is observed in people with MARCoNS.
• There is less biofilm in dental organisms than in nasal organism.
• Patients with MARCoNS are low MSH.
• Patients with MARCoNS don't get better until MARCoNS is eradicated.
• Coag negative staph likes artificial joints and heart valves.
• Dog, but not cat, noses may have MARCoNS.
• Can be found in wet buildings.
• News flash is that it is found in dental cavitations.
• XTip is used to obtain dental cultures.
• Several docs are finding MARCoNS in dental cavitations.
• Periodontal disease often gets better with VIP.
• Don't treat with nasal antifungals.
• MARCoNS may be a reservoir of an unknown compound or toxin being produced as this is found in the supernatant of the MARCoNS.
• It is a 1000 dalton size molecule that looks like palytoxin from dinoflagellates.
• Palytoxin is a neurotoxin; including of the central and peripheral nervous system.
• At present, some call it the "Ackerley toxin".
• More research is needed to determine if it is antigenic.
• Do not use BEGI ever. This is BEG with the antifungal Itraconazole. It has been discovered that pharmaceutical antifungals create resistant MARCoNS organisms.
• They are exploring the use of silver solutions and plain EDTA as possible new solutions for MARCoNS.

Ray Robson from Hi Tech Air Solutions spoke briefly about their air reactor and shared:

• They created the air reactor 7 years ago.
• They are able to help a number of people.
• Create a safe haven inside the home to give the body a chance to heal.
• Photocatalytic technology has been using for 45 years by the military and others.
• The OH radical lasts for 5-15 seconds and is unstable.
• They stabilize the molecule so that it lasts much longer.
• They have been able to get rid of mycotoxins in the home.
• The device has been able to clean up clothing, books, paintings, and other personal belongings such that the person is no longer reacting to them.

Jimmy Ryan, PhD spoke on "Water Damaged Buildings: Effects of VIP on Gene Expression" and shared:

• He runs ProGeneDX.
• They have looked at the effects of VIP on CIRS patients.
• Exposure to WDBs lead to: deficiency of VIP and MSH; elevated MMP9, TGFb1, C4a; dysregulated VEGF, cortisol, and ADH/osmolality.
• It is a complex illness when one is exposed to a water-damaged building.
• DNA copies certain genes that find a ribosome to make a protein that carries out a function that the DNA needs.
• Functional genomics - a stimulus to the cell leads to cell response by producing a set of genes to give the organism immunity, toxin clearance, tissue clearance, etc.
• They can measure messages from DNA with RNA sequences to measure the transcriptome (all RNA molecules produced in the cell at any given time). This changes based on conditions.
• These are sensitive indicators of health hazards and treatment status.
• 23andme is DNA and does not change.
• With his work, this is realtime information; what is the amplitude of this gene?
• The difference is susceptibility (23andme) vs. disease status (his method) or ingredients (23andme) vs. end product (his method).
• He measured before and after gene expression in 15 people that used VIP.
• They then looked at the genes that changed by at least 1.7 fold.
• They found 1400 genes that changed significantly with VIP.
• These were ribosomal genes involved in metabolism and immunoglobulin genes.
• Genes involved in ribosomal function and oxygen transport.
• Gamma hemoglobin is seen CIRS but not normal adults.
• The ribosomal functions are stressed. VIP removes the stress and the genes are turned down. This may be what is being seen.
• The importance of ribosomal gene dysregulation is significant.  Even more significant is the emerging reality that the injury is correctable.
• Mitochondrial genes pre and post-VIP are very different; genes are downregulated possibly because the pressure or stress has been removed from the system.
• The focus on mitochondria often seen in the CFS/Lyme/Mold arena is a downstream event from nuclear-encoded mitochondrial gene dysfunction.
• Once the system has healed, the genes are turned down.
• VIP may be promoting healing which causes a downregulation of genes due to the removal of stress in the body systems.
• There are ribosomal, mitochondrial, Ikaros, innate response, and CD markers that change.
• Ikaros is involved in zinc finger transcription factors which impact stem cell differentiation and as cells differentiate into T and B cells.
• Defensins are antimicrobial peptides from neutrophils - upregulate pro-inflammatory mediators and downregulate anti-inflammatory mediators. These were downregulated after VIP treatment.
• 4 CD markers were significantly downregulated with VIP.
• VIP may correct protein and energy production by altering ribosomal and mitochondrial function.
• VIP has a calming effect on the upregulated immune system.
• VIP slows down innate granzyme and defensins; body no longer needs.
• VIP may upregulate Ikaros and can slow lymphoid proliferation as well as increase VIP receptor density.
• Information emerging from genomics is leading to revolutionary advances in thought and approaches to treating illness.

Ritchie Shoemaker, MD spoke on "NeuroQuant and Therapy" and shared:

• There are patterns of nuclear atrophy in CIRS patients.
• The intervening agent at present is VIP.
• Improvement with VIP continued after 24 weeks of therapy.
• 6-12 doses per day showed improvement over 0-5 doses per day.
• Higher dose VIP for 6 months in one study led to correction similar to controls.  While the numbers to date are small, this finding is significant.
• High dose, longer-duration VIP works best.
• The traditional ideas around the reversibility of Alzheimer's are wrong.
• The medicine of the past does not include the correction of gray matter nuclear atrophy or genomics, but CIRS medicine does.

Another panel discussion shared these thoughts:

• What comes first, MARCoNS or low MSH? Dr. Shoemaker noted that when MSH is low, there is an 80% likelihood of having MARCoNS. People with normal MSH are not likely to have MARCoNS.
• A question was asked about using silver for MARCoNS. Dr. Musto mentioned that they are exploring the use of colloidal silver options. He is also exploring various oils such as curcumin, oregano, and artemisinin.
• Dr. Ackerley mentioned that she uses a lot of NAC; it is related to dopamine transport in the caudate that Parkinson's patients benefit from.
• She has seen significant improvements in energy after cavitation surgery in some patients.
• Coconut pulling seems to be helpful in general.
• Many people have Alzheimer's without amyloid and many have amyloid without Alzheimer's.
• Dr. Shoemaker mentioned that MMP9 and TGFb1 are big deals in atrophy; C4a is not.
• Porphyromonas gingivalis can disappear with VIP.
• For ADH, electrolytes may be helpful if DDAVP is not tolerated.  VIP restores MSH to above 35 less than 20% of the time.
• Babesia makes a glycosylphosphatidylinositol toxin; malaria also makes it.
• Dr. Ackerley mentioned that one patient had 13 amalgams and 4 cavitations done in one procedure. She does not recommend doing all of this in one visit. She also mentioned that she likes to swab both nares for a MARCoNS culture.
• Dr. Musto mentioned that 30% of the population carries Staphylococcus aureus.
• Some have explored BEG with Mucolox but here has been no data on this. Dr. Ackerley felt this was a helpful option.
• Dr. Ackerley mentioned that if fungus shows up on a swab test, BEG is used, then fungus does not show up again.
• Dr. Musto suggested that BEG or EDTA with nothing else is effective against yeast and common molds.
• Dr. Shoemaker mentioned that it is becoming more difficult to eradicate MARCoNS with BEG spray in one month. EDTA may take six months. In the past BEG spray was one month but the water is muddier with horizontal gene transfer. Be very cautious around MARCoNS treatment until more data is available; antifungals make the problem worse.
• Nasal probiotics may make sense in the future. Some have explored Lactobacillus sakei which is found in Kimchi.
• Antifungals lead to antibiotic resistance. This may be induced more by Itraconazole than Ketoconazole. It is unclear whether or not oral Itraconazole can do this. Editor note: In a separate discussion with Dr. Shoemaker after the conference, he suggested that taking Nystatin for Candida may also not be a good idea.
• Nystatin seems to lead to Gentamycin and Vancomycin resistance in Dr. Ackerley's patients.
• Dr. Shoemaker noted that Rifampin is a great drug for MARCoNS. However, Rifampin resistance is also observed coming out of the Lyme community when Rifampin has been used for the treatment of Bartonella.
• Dr. Ackerley mentioned that Xylitol has been shown to help with biofilms in a number of studies.
• Dr. Bredesen will have a book out in May 2017 that will go into the subtypes of Alzheimer's.
• Alzheimer's may be inflammatory or infectious. It may be associated with insulin resistance. It may be a withdrawal of trophic support such as BDNF, estradiol, D3, B12, pregnenolone. It may also overlap with CIRS in that TGFb1 and other CIRS markers are abnormal; may be associated with mercury, mycotoxins.  Diet, exercise, sleep, and stress management are important.
• Mild ketosis enhances BDNF (brain-derived neutrotrophic factor).
• Ashwaganda removes amyloid and curcumin may interact with amyloid.
• Alzheimer's is a protective response associated with chronic innate immune activation in the brain.
• Alzheimer's is the neurosyphilis of the 21st century.
• Dr. Shoemaker mentioned that over 40% of CIRS patients get lost in familiar places.
• Dr. Bredesen mentioned that the problem starts 20 years before the Alzheimer's is diagnosed.
• Nanosomix is doing blood testing in the Alzheimer's arena to see where someone is headed it so that they can be treated and get better.

Michael Rothman, MD spoke on "Revici Meets CIRS" and shared:

• Editor note: Dr. Rothman's approach is very different from others who spoke at the event. The Revici approach has been discussed in previous notes I have shared from the Simon Yu conference in 2015 which are at http://www.betterhealthguy.com/incurables.
• Stresses physics and quantum mechanics over chemistry.
• When you look at the periodic table, there are recognized patters that are right in front of your eyes.
• With pain patterns, there is physiologic pain and pathologic pain.
• Physiologic pain is caused by a noxious stimuli such as a pin prick. When the pin is removed, the pain stops.
• Pathological pain may be damaged tissue such as a burn where the pain continues after the stimuli is removed.
• As urinary pH goes up, pain goes up. As pH goes down, pain goes down. Though, some had the opposite pattern.
• Normal urine pH would fluctuate around 6.1-6.2.
• Patients may be anaerobic or dysaerobic and this leads to specific treatment interventions. Treating impacts VCS immediately.
• This approach has the potential to help "sensitive" patients.
• In POTS, every patient is dysaerobic; low cortisol, low aldosterone, sympathetic activity.
• Junk food, junk light, junk air, and junk people are all around us; we need to reduce the stresses on our systems.  

Neil Hirschenbein, MD spoke on "CIRS and Lyme Disease" and shared:

• Marshall Protocol looks at 25-hydroxy Vitamin D (storage form) vs. 1,25-Dihydroxy Vitamin D. When 25 is low and 1,25 is high, this is due to infection.
• The protocol removes vitamin D, gives Benicar, and rotates antibiotics such as Minocycline, Clindamycin, Zithromax, Demeclocycline, and Bactrim. The rotation is very low dose.
• He uses VCS, MSH, HLA-DR, MMP9, VEGF, C4a, TGFb1, VIP, etc. and finds that 90% are abnormal.
• He had one patient that had confirmed exposure that did not show urinary mycotoxins with RealTime Labs testing.
• He has done about 150 NeuroQuant tests and found that most with Lyme test positive for mold.
• Start with Shoemaker Protocol - get out of mold, use Cholestyramine, test for MARCoNS, and use VIP.
• If not getting better, consider Lyme. He uses Byron White Formulas and Beyond Balance. 

Scott McMahon, MD spoke on "Experience with the First 6 Years" and shared:

• The scoring criteria for NeuroQuant for Lyme were patients with known CDC positive results or a known tick bite with EM rash.
• UPS drivers make more in 17 years than a doctor.
• With CIRS, adults had 26.2 of 37 symptoms with 11.9 of 13 clusters average.
• For any given symptom on the list, 45% or more of his patients experience that symptom.
• Symptom frequency is higher in older patients.
• He compared his findings for symptom prevalence to those reported by Dr. Shoemaker and found very similar results; 97% of his patients vs. 92% of Shoemaker's had fatigue, for example.
• 64.1% with CIRS failed VCS which requires the first 7 in column C and first 6 in column D to pass. It evaluates capillary hypoperfusion at the retina.
• Dr. Shoemaker sees a 92% failure rate in VCS testing with CIRS patients.
• Visual contrast in general starts to fall in one's 60s which may make the test less reliable in older people.
• 88% of Dr. Shoemaker's patients had a dreaded or mold HLA-DR. In Dr. McMahon's patients, it was 92%.
• For HLA, 97.9% had either dreaded, mold, Lyme, or low MSH.
• VIP is abnormal in 71.5%; MSH in 93%.
• MSH is a go to for CIRS. If it is normal, you don't have CIRS.
• TGFb1 abnormal in 79.8%; MMP9 in 68.1%; C4a in 73.5%; ADH/osmo in 87.9%.
• 73% were positive for MARCoNS.
• Response to therapy is very high when getting out of the moldy environment and taking Cholestyramine or Welchol.
• Dr. McMahon's patient results have shown that Dr. Shoemaker's data held up.

Keith Berndston, MD spoke on "Biotoxin Pathway 2.0" and shared:

• Editor's note: Dr. Berndston generously shared the slides from his talk which can be found at http://www.betterhealthguy.com/biotoxinpathway.
• WDB bioinflammagens are the main problem. It is the uncontrolled response to PAMPS (pathogen associated molecular patterns) that are the main issue. 1 in 4 is HLA susceptible.
• MAMPS are microbe-associated molecular patterns.
• A failure to clear PAMPS are the primary cause of CIRS.
• It is the humoral arm of innate immunity; not antibodies.
• C3a is a marker for bacterial membranes.
• PAMPS find toll-like receptors that set off reactions in the cells.
• NODS are inside the cells and recognize DAMPS (danger-associated molecular patterns).
• DAMPS are molecules from cells that are being destroyed or apoptosis.
• RIGS activate inflammasomes and these try to control inflammation inside the cell.
• Defensins are found in the crypts of the intestinal villi. Alpha defensins are secreted by Paneth cells.
• Sepsis is an overwhelming inflammation with an infectious component; great suffering, high mortality.
• CIRS is overwhelming inflammation without an infectious component; great suffering, low mortality. It is a "Sepsis Lite".

Disclaimer: While I attempted to accurately represent the statements of the various speakers, it is possible that the above contains errors or inaccuracies. If you have any corrections to the content listed above, please Contact Me.