CHRONIC FATIGUE SYNDROME
View from HHV-6 and Virus Meetings
Our scientific director recently returned from attending the HHV-6 conference and satellite meeting on viruses in CFS and postviral fatigue. Here's her take on the presentations she heard, including preliminary results from the Valcyte trial. http://www.cfids.org/cfidslink/2008/070903.asp
EBV Study Sheds Light on Immune Activation
The Journal of Affective Disorders recently published a study identifying pathways that correlate with fatigue and symptoms of chronic active Epstein-Barr virus (EBV) infection. This could have implications for understanding CFS. http://www.cfids.org/cfidslink/2008/080603.asp
Study Identifies Potential Gene Markers
A paper published by Takuya Saiki, MD, and his colleagues in the journal Molecular Medicine describes a defined gene cluster that could ultimately prove useful for differential diagnosis of CFS.
Wichita Study of Cortisol and Interleukin 6
The most recent paper drawn from the CDC’s Wichita population-based study describes finding lower cortisol levels and slightly higher interleukin 6 (IL-6) levels in people with CFS. The differences also appear to correlate with CFS severity. http://www.cfids.org/cfidslink/2008/060402.asp
Economic Impact of CFS Is Staggering
A study published April 8 in Dynamic Medicine adds to the evidence that the CFS imposes a substantial economic burden on the United States. The study, led by Dr. Leonard Jason at DePaul University, examined both community-based and tertiary samples of patients and found that the annual economic impact of CFS was $18.7 billion for the community sample and $23.9 billion for the tertiary sample. This is just the second study ever to measure the economic impact of CFS in the United States. The first, published by researchers at the CDC in 2004, found that the total value of lost productivity was $9.1 billion annually. The CDC study didn’t include health care costs in its estimates. But this new 2008 study includes both direct and indirect costs to determine the economic impact of the illness. Direct costs refer to medical costs like office visit charges, medical tests and medication costs. Indirect costs refer to work productivity losses, disability reimbursements, cost of services provided by caretakers, transportation and other expenses that aren’t direct medical costs. For the complete text of the study, go to http://www.dynamic-med.com/content/7/1/6
Chronic Pain Damages the Brain
Researchers at Northwestern University’s Feinberg School of Medicine in Chicago have found that chronic pain harms the brain’s wiring. In a study published in the February issue of the Journal of Neuroscience, the researchers found that long-term pain disrupts the equilibrium of the brain, causing the front region of the cortex to stay at full throttle instead of calming down. “This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain,” says Dr. Dante Chialvo, one of the study’s authors. “We know that when neurons fire too much they may change their connections with other neurons or even die because they can’t sustain high activity for so long.” The study concludes that chronic pain can disrupt brain function and cause problems like disturbed sleep, anxiety, depression and difficulty making decisions. The researchers say that the study points to the importance of finding new ways to treat pain not only to control the symptoms, but to prevent harm to the brain.
Etiology, Exercise and CFS
A recent study published in Psychosomatic Medicine examined 34 CFS patients from a large study of lifelong health and development (a birth cohort) and found that CFS was not associated with lower levels of activity and exercise throughout childhood. Suzanne Vernon, PhD, looks at the possible implications and shares her take on the subject. http://www.cfids.org/cfidslink/2008/040903.asp
Request for Applications Issued by CFIDS Association of America
The CFIDS Association of America issued its most recent Request for Applications (RFA) on March 3, 2008, soliciting research proposals that will advance the discovery of biomarkers and methods for early detection, objective diagnosis and effective treatment of chronic fatigue syndrome (CFS). Since 1987, the CFIDS Association has funded nearly $5 million in direct support of research studies. The deadline for receipt of Letters of Intent was 17:00 (U.S. Eastern time) on April 14, 2008. Instructions, eligibility requirements and other details can be found in the full text of the RFA at http://www.cfids.org/profresources/2008rfa.asp.
Science and Legal News on Postexertional Malaise
Studies by a University of Pacific research team funded by the CFIDS Association of America have led to publication of two papers documenting reduced function in CFS patients following exercise testing. Both papers demonstrate problems inherent with use of a single exercise test to assess CFS disability. Read more about these studies at http://www.cfids.org/cfidslink/2008/020602.asp.
Scientific Overview Published by Leading CFS Expert
Nancy Klimas, MD, a top CFS researcher and physician, recently published an overview of CFS findings for others in the medical field. The publication, Current Rheumatology Reports, keeps specialists abreast of medical advances by inviting experts like Klimas to consolidate noteworthy research findings on a specific topic. Her article highlights many of the significant CFS findings of the past year, focusing on inflammation, immune function and neuroendocrine interactions. The abstract is available at Current Rheumatology Reports.
Women with CFS Have Reduced Morning Cortisol Levels
A study of women with CFS shows that levels of the hormone cortisol collected first thing in the morning were lower than healthy women’s levels. Men with CFS had levels comparable to healthy men. The study, published by researchers at the CDC led by Urs Nater, was published in the December 26, 2007, issue of the Journal of Clinical Endocrinology & Metabolism. It studied 185 adults in Georgia, 75 of whom have CFS. It does not indicate whether the lower cortisol levels were a cause of CFS or an effect of the condition.
Gene Study Targets Serotonin Function
As reported in the December 2007 issue of Psychoneuroendocrinology, a study examining 77 differences in genes related to serotonin function uncovered three markers in the receptor subtype called HTRA2a that appear to be associated with CFS. In this study conducted by researchers at Emory University and the CDC, investigators looked for genetic differences in people with CFS, focusing on several genes important to the function of the serotonergic system. They found that differences in one receptor for serotonin were associated with CFS. Laboratory experiments showed that these variations might cause different levels of this receptor to be available. Further analysis supported the implication that this receptor subtype may play a role in the pathogenesis of the illness.
Association Announces New Scientific Director to Advance CFS Research
Suzanne Vernon, PhD, has joined the staff as scientific director. She will lead the Association's research grants program and will strengthen networks to foster greater collaboration and speed progress in scientific discoveries about CFS. Read the Association's November 7, 2007, press release here and president & CEO Kim McCleary's perspective on this exciting announcement here.
Heart Rate Dysfunction Persists in Sleep
A study published in the September 27, 2007, issue of Autonomic Neuroscience found that increased heart rate and reduced heart rate variability in CFS patients was also present during sleep, suggesting an ongoing state of sympathetic autonomic dysfunction. Heart rate was monitored overnight, and levels of the adrenal hormones norepinephrine and aldosterone were also measured. Compared to the control subjects, the study participants with CFS had significantly higher mean heart rate (71.4 beats per minute vs. 64.8 beats for minute in control subjects) and reduced heart rate variability. CFS patients also had significantly lower plasma aldosterone and tended to have higher plasma norepinephrine levels. Limitation in moderate physical activity was strongly associated with the increased heart rate and decreased variability in the CFS patients. Nevertheless, among 42 study subjects with similar physical activity limitations, the subjects with CFS still displayed higher heart rate than the respective controls, suggesting that reduced physical activity could not fully explain the CFS-associated differences in ANS function. Researcher Roumiana Boneva and colleagues from the CDC conclude that the observation of heart rate and variability differences observed during sleep, coupled with higher baseline plasma norepinephrine and lower aldosterone, suggest a state of ANS dysfunction with perturbed neuroendocrine activity.
Enterovirus May Play a Role in Subset of CFS Cases
A September 13, 2007, paper by researchers John and Andrew Chia in the Journal of Clinical Pathology reports a study of CFS patients with prominent gastrointestinal symptoms. Using endoscopy and stomach biopsy, the investigators found evidence of enteroviral infection in 80 percent of 165 CFS patients tested and just 20 percent of 34 control subjects. This study was also presented in January at the 8th International Association for CFS/ME conference. As the authors state, more study is needed to confirm these findings, but this reports adds weight to a growing body of evidence that infections can trigger or perpetuate CFS in at least a subset of cases.
35 Genes Linked to illness Course in Postinfective CFS
The July 1, 2007, issue of Journal of Infectious Disease reports a study of a subset of CFS that follows Epstein-Barr virus infection. Researchers compared seven subjects whose illness did not resolve after six months with eight matched subjects who promptly recovered. Analysis of samples collected over time revealed 35 genes for which changes in expression were consistent with illness course. Signal transduction pathways, metal ion binding, and ion channel activity were implicated. This report builds on an earlier study of postinfectious CFS reported in the September 16, 2006, British Medical Journal (below) by Andrew Lloyd and collaborators in Australia and at the Centers for Disease Control and Prevention.
Lyrica Approved for Treatment of Fibromyalgia
Lyrica (pregabalin) has become the first drug approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia (FM). In a statement released June 21, 2007, the FDA affirmed that some fibromyalgia patients experience decreased pain after taking Lyrica, though the mechanism by which the drug produces such an effect is unknown.
New Prevalence Rates for CFS Published by CDC Researchers
A study published June 8, 2007, in Population Health Metrics provides evidence that CFS is a significant public health problem that affects millions of people in the United States. Researchers at the U.S. Centers for Disease Control & Prevention (CDC) surveyed more than 19,000 residents in Georgia and discovered that 2.54% of the people aged 18-59 met the clinical diagnosis for chronic fatigue syndrome. This is ten times higher than the rate researchers found in the 1990s when they surveyed residents of Wichita, Kansas, and six times higher than the rate found in Chicago, Illinois. Read the CFIDS Association’s press release at http://www.cfids.org/sparkcfs/pr060807.pdf and the full text of the article at http://www.pophealthmetrics.com/content/5/1/5.
Neuroimaging Tracks Fatigue in CFS
A team of researchers at University of Medicine and Dentistry of New Jersey explored the association between subjectively reported feelings of mental fatigue and the underlying brain activity during fatiguing cognition. They found that subjects with CFS exhibited significantly greater activity in several regions of the brain during fatiguing cognitive tasks. Their methods and results, as reported in NeuroImage, are summarized at http://www.cfids.org/cfidslink/2007/050703.asp
CFS Associated with Sleep Abnormalities
Sleep, the journal of the Associated Professional Sleep Societies, published a study in its May 1 issue that “finds that CFS is associated with a blunted slow wave activity (SWA) response to sleep challenge, suggesting an impairment of the basic sleep drive and homeostatic response.” For more information about the study, please visit http://www.eurekalert.org/pub_releases/2007-05/aaos-jsc042507.php
Studies Explore Childhood Fatigue
Several research teams tackled the topic of pediatric fatigue and CFS in studies published in the Journal of Chronic Fatigue Syndrome (Volume 13, Numbers 2/3). Read highlights at http://www.cfids.org/cfidslink/2007/060702.asp
Pediatric CFS Case Definition Published
A milestone in recognizing and treating pediatric CFS was reached in early 2007 when a pediatric-specific case definition for the illness was published by a working group from the International Association of CFS/ME (IACFS/ME). Read the details at
International CFS Research Meeting Reports Summarized
The International Association for CFS/ME held its biennial research conference January 10-14, 2007, bringing together hundreds of CFS researchers, clinicians, patients and advocates to hear the latest research and clinical advances. A summary of the conference is available at http://iacfs.net/p/1,522.html
Antiviral Drug to Be Studied as CFS Treatment by Stanford Researchers
Based on promising results from a preliminary study, Roche Pharmaceutical, which manufactures the drug valganciclovir under the brand name Valcyte, has granted $1.3 million to Dr. Jose Montoya to conduct a randomized, placebo-controlled, double-blind study set to begin this quarter at Stanford University Medical Center. The study will assess the effectiveness of the drug in treating a specific subset of CFS patients.
New Center for Molecular Medicine Will House Institute for
The University of Nevada School of Medicine broke ground in March 2007 on the Center for Molecular Medicine that will serve as the headquarters for the Whittemore Peterson Institute for Neuro-Immune Disease and the northern center for Nevada Cancer Institute. The Whittemore Peterson Institute will conduct research, provide clinical care of patients with CFS and fibromyalgia and develop educational programs for the community and physicians. The Institute also seeks answers for patients with other chronic systemic illnesses including atypical MS, Gulf War Syndrome and autism—diseases that result from complex disorders of the immune system and brain. Funding for the Center will come from private and public sources; the Nevada state legislature recently approved additional funding of $3 million in support. A local story about the Institute can be viewed at http://www.unr.edu/nevadanews/detail.aspx?id=2049
1.3% of Canadians Found to Have CFS in Recent Study
Data from the 2002 and 2003 Canadian Community Health Survey indicates that CFS and other conditions characterized by “medically unexplained physical symptoms” affect a substantial portion of the Canadian population. CFS was reported by 1.3% of the population, with twice as many women as men affected, and more people of lower income (compared to higher income) represented in the group. A summary of the survey results provided by Statistics Canada is available at http://www.statcan.ca/Daily/English/070112/d070112b.htm.
NIH Announces 7 New Grants for CFS Research
The National Institutes of Health will fund seven new studies related to interactions between the immune and neurological systems, with hopes of identifying new diagnostic markers and treatments for CFS. The awards are made following a special Request for Applications issued in July 2005 to stimulate interest in CFS research. The investigators and projects are described in an October 30, 2006, press release from the Office of Research on Women’s Health.
Working Memory Impaired in CFS
A collaborative study published by researchers in Spain and the U.K. finds that CFS patients do not engage the working memory network in the same way as healthy control subjects do, perhaps as a means to compensate for cognitive difficulties and attempt to achieve comparable performance. These results are consistent with patient reports of memory impairment. The study, “Probing the Working Memory System in CFS: A functional MRI study using n-Back Task,” was e-published in Psychosomatic Medicine on October 30, 2006.
Limited Studies of Early-Life Stress Put in Context
Two studies published in the November 6, 2006, issue of the Archives of General Psychiatry associate trauma in early life with CFS and CFS-like illness. However, each study has important limitations to consider, and the authors' conclusions should not be overgeneralized. See http://www.cfids.org/cfidslink/2006/stress.asp
Severity of Symptoms Shown to be Leading Factor in
CFS will follow documented infection with three agents in about 12% of cases. The severity of illness at the time of early infection was the greatest predictor for extended illness. This study of 253 patients, “Postinfective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study,” was published in the September 16, 2006, issue of the British Medical Journal.
Two Studies Report Gray Matter Reduction in the
Brains of CFS Patients
Researcher Floris de Lange summarizes findings from two independent research teams in Japan and the Netherlands that document changes to the brain structure of CFS patients, using high-resolution magnetic resonance imaging (MRI). Click here to read the article, as published in the summer 2006 issue of the CFIDS Chronicle.
Genetic and Enviornmental Factors Impact CFS Patients
People with CFS have hormonal and nervous system abnormalities that affect the body's ability to adapt to change, according to a series of papers published in the April 2006 issue of Pharmacogenomics by CDC researchers and collaborators from around the world. The CDC’s press release and a transcript of an April 20, 2006, media briefing are available at http://www.cdc.gov/cfs/cfshighlights.htm.