Understanding MARCoNS in Chronic Inflammatory Response Syndrome (CIRS): Impacts, Mechanisms, and Testing

Chronic Inflammatory Response Syndrome (CIRS) is a complex condition first described by Dr. Ritchie Shoemaker in the late 1990s. Since then, over 1,700 scientific studies have explored its complexities, and Dr Shoemaker has been at the forefront of much of this work. CIRS is defined as a multi-symptom, multi-system illness caused by exposure to biotoxins or neurotoxins derived from a biological source. It is associated with a distinct set of biochemical abnormalities and test results most often seen in genetically susceptible individuals. By considering mould as a trigger for this, alongside other triggers such as Lyme, we are able to contextualise the body’s response, rather than focusing on say just one element e.g. mycotoxins.

In the context of CIRS, understanding the role of MARCoNS (Multiple Antibiotic- Resistant Coagulase-Negative Staphylococci) is crucial, since approximately 80% of individuals with CIRS carry the Coag. Neg. Staph. commensal species deep within their nasal passages and sometimes within root canal cavities. When this organism becomes anti-biotic resistant it demands more attention. Two key concerns are firstly how MARCoNS can interfere with the production of alpha-melanocyte-stimulating hormone (α-MSH), a critical regulator involved in numerous physiological processes, including immune function and inflammation control, and secondly how the polycyclic- ether toxin it can produce mediates mitochondrial ribosomal expression.

What Are CoNS and MARCoNS?

Before delving into the specifics of MARCoNS and its’ association with CIRS, it is important to first understand the distinction between CoNS (Coagulase-Negative Staphylococci) and MARCoNS.

CoNS (Coagulase-Negative Staphylococci)

Coagulase-negative staphylococci (CoNS) are a group of Gram-positive bacteria that are typically part of the normal microbiota found on human skin and mucous membranes. The term "coagulase-negative" refers to the fact that these bacteria do not produce coagulase, an enzyme that plays a role in blood clot formation by converting fibrinogen into fibrin. This distinguishes CoNS from Staphylococcus aureus, a coagulase-positive pathogen known for its ability to cause a wide range of infections.

Although most CoNS species are generally harmless, they can become opportunistic pathogens, particularly in individuals with weakened immune systems or those with implanted medical devices. Species like Staphylococcus epidermidis are frequently implicated in infections such as catheter-related infections, bacteraemia, and endocarditis. In these cases, CoNS can act as opportunistic pathogens, causing infections in otherwise healthy individuals under certain conditions.

MARCoNS (Multiple Antibiotic-Resistant Coagulase-Negative Staphylococci)

MARCoNS are a subset of CoNS that have acquired resistance to multiple antibiotics, making them particularly problematic in clinical settings. There is thought to now be a 100% resistance to Penicillin-G. These resistant strains are typically found as nasal colonisers in individuals with chronic conditions such as CIRS and Lyme disease. One of the critical features of MARCoNS is the ability to form biofilms, which significantly complicates treatment.

A biofilm is a structured community of bacteria that adhere to surfaces, such as human tissue or medical devices like catheters and prosthetics. The bacteria within a biofilm are encased in a protective matrix made of extracellular polymeric substances (EPS), a sticky gel-like substance composed of proteins, sugars, and nucleic acids. This matrix serves as a physical barrier, shielding the bacteria from the immune system and from antibiotics, making them far more difficult to eliminate.

MARCoNS and CIRS

MARCoNS play a critical role in the pathogenesis of CIRS, not only due to the ability to form biofilms and decrease α-MSH, but also because they are capable of producing a variety of exotoxins contributing to a cascade of pro-inflammatory immune responses further exacerbating the symptoms of CIRS driving symptoms such as fatigue, cognitive dysfunction, joint pain, and muscle weakness.

MARCoNS also release haemolysins, which are toxins that can destroy red blood cells (RBCs) and damage endothelial cells in blood vessel linings causing increased vascular permeability. The destruction of RBCs can lead to haemolytic anaemia, reducing the oxygen-carrying capacity of the blood and worsening fatigue and other systemic symptoms. The combination of haemolysis and endothelial damage also creates an environment conducive to increased oxidative stress impairing cellular function and contributing to the widespread tissue dysfunction observed in CIRS.

However, the most significant effect of MARCoNS in CIRS is the ability to cleave and inactivate α-MSH. α-MSH, which is produced by the pituitary gland, plays a crucial role in maintaining immune homeostasis by reducing the release of pro-inflammatory cytokines and promoting wound healing. It also has regulatory effects on several other hormones and processes.

When MARCoNS cleave α-MSH, the resulting reduction in its activity can therefore have wide-reaching effects in the body:

Impaired Melatonin Production: α-MSH is involved in the regulation of melatonin, a hormone that helps control the sleep-wake cycle and has antioxidant and anti-inflammatory properties. With reduced α-MSH, melatonin production may also decrease, leading to sleep disturbances and a lack of restorative sleep. The disruption of melatonin can perpetuate a cycle of inflammation and immune dysregulation, as sleep is critical for regulating immune function.
Endorphin Imbalance: A decrease in α-MSH levels leads to lower endorphin production, which can contribute to chronic, sometimes unusual pain and general discomfort.
Malabsorption and Digestive Dysfunction: α-MSH modulate the permeability of the intestines and plays a role in nutrient absorption. With reduced α-MSH levels, the gut lining becomes more permeable. This increases the likelihood of malabsorption of nutrients and can result in gastrointestinal symptoms such as bloating, diarrhoea, and nutritional deficiencies, and cause the escape of LPS (lipopolysaccharides) from the gut to the blood stream, which in turn further exacerbate systemic inflammation.
Chronic Inflammation: As α-MSH is essential in suppressing the release of pro- inflammatory cytokines, a reduction in its activity results in high levels of cytokines producing flu-like symptoms and immune dysregulation contributing also to prolonged illness.
Reduced ADH (Antidiuretic Hormone): α-MSH influences the secretion of ADH, which helps regulate fluid balance by controlling water retention in the kidneys. Lower levels of α-MSH and therefore ADH can lead to increased thirst, frequent urination, electrolyte imbalances and susceptibility to static shocks, all common symptoms seen in CIRS.
α-MSH also has an influence on androgens, the hormones involved in libido, energy levels, and muscle mass. Reduced α-MSH may contribute to lower androgen levels, which could result in fatigue, decreased libido, and muscle weakness.
ACTH and Cortisol Dysregulation: α-MSH plays a role in regulating the secretion of ACTH (adrenocorticotropic hormone), which stimulates the adrenal glands to release cortisol, a key stress hormone. When α-MSH is decreased, it can lead to dysregulated cortisol metabolism, contributing to low or high secretion of cortisol. This hormonal imbalance can manifest as chronic fatigue, anxiety, low grade chronic inflammation or immune suppression, creating further challenges for those with CIRS.
Finally, aMSH has a role as an anti-microbial, its’ effects studied and published, in a fascinating area of research.

The effects of MARCoNS on CIRS are therefore profound, as these bacteria not only contribute to inflammation and tissue damage through the release of exotoxins and haemolysins but also disrupt critical hormonal pathways by cleaving α-MSH. Importantly, when α-MSH levels are low, the resultant dysregulated immune response can leave the person less able to fight off opportunistic infections and bacterial colonisation, including MARCoNS, so it rapidly becomes a vicious downward spiral. Critically, it can be near impossible to normalise α-MSH in a person with MARCoNS so addressing MARCoNS colonisation to restore the activity of α-MSH is hence a crucial component of managing CIRS and improving outcomes for affected individuals.

Testing for MARCoNS

with symptoms consistent with CIRS. Specialised nasal swab testing that identify nasal colonisation of MARCoNS and biofilms are necessary for accurate diagnosis. A result is considered positive if CoNS is present with two or more antibiotics from different classes showing resistance or intermediate status.

If MARCoNS are detected, appropriate treatment and/or therapeutic strategies can be implemented. Eradicating MARCoNS can help normalise α-MSH and improve all the associated downstream functions thus improving symptoms related to CIRS, particularly those linked to immune system dysfunction.

Testing with Colab Services

MD101 Nasal Swab Full Initial Test (MARCoNS)

The full initial nasal swab test considers both gram-positive and gram-negative bacterial presence, including Coag. Neg. Staph. Includes additional bacteria species, fungal testing and biofilm testing.

MD102 Nasal Swab: Bacteria & Biofilm (MARCoNS)

This test is part of the CIRS related nasal swab test series. Only if MARCoNS are tested positive then Biofilm will be tested. Does not include fungal testing, but will report on other important bacterial species.

MD103 Nasal Swab: Bacteria & Fungus (MARCoNS)

MARCoNS, key bacterial species and fungal are assessed.

Learning with Colab Services

If you are looking to deepen your understanding of CIRS and MARCoNS, our upcoming course, “Biotoxins in Clinical Practice,” is exactly what you need. In this course, you will gain in-depth knowledge about mould, mycotoxins and CIRS, learning how to identify at-risk clients and apply effective biotoxin protocols in your practice. We will guide you through every step, helping you feel confident in working with clients affected by biotoxin illness.

For more information or to register, please contact us: [email protected].