Article Index

Etiology (causes) and biomarkers

The possibility of an enteroviral infection as a trigger for ME/CFS in some patients remains intriguing. Enteroviral infections mostly cause flu-like gastrointestinal symptoms (nausea, diarrhea) during the Summer months. John Chia MD (a pathologist and infectious disease specialist in Torrance, California) has long maintained that he and his son contracted ME/CFS from an enterovirus. Using paraffin-embedded biopsies from 132 PWCs, enteroviral protein VP1 was detected in 82% and and dsDNA in 64% of cases. He and his son both recovered by using an herbal antiviral (Equilibrant, see “Treatments” below).

Dr. Martin Lerner, an infectious disease specialist at Wayne State University (Michigan) presented an interesting poster concerning EB virus and ME/CFS. He treated 6 PWCs with valacyclovir (Valtrex, 14.3 mg/kg every 6 hours) for more than 12 months. Checking periodically for the continued presence of EBV, he found no evidence of EBV replication, but instead found “latent abortive reactive replication.” That is, the whole virus was not being manufactured in the body, but various parts of the virus were. These fragments were not infective.

Harvey Moldofsky is a sleep specialist in Toronto, and one of the first doctors to study Fibromyalgia, or fibrositis as it was known in 1975. Moldofsky reported an outbreak of SARS (Severe Acute Respiratory Distress Syndrome, a frequently fatal disease caused by the coronavirus) in Toronto. Of thousands infected, he studied 22 subjects, 21 of whom were first responder / healthcare workers, who developed chronic symptoms after infection. The symptoms included persistent fatigue, chronic widespread pain, disordered sleep, and depression. Thus, severe viral infections may be counted as one of the many triggers for CFS/ME/FM.

Adverse childhood experiences were evaluated by Jose Alegre (Hospital Vall d’Hebron, Barcelona SP) in 133 adult PWCs. Using personal interviews, childhood adverse experiences were reported by 40%. These included physical abuse (10.4%), sexual abuse (10.4%), emotional neglect (13.7%), and bullying (14.8%).

[Ed. note:  some have suggested childhood emotional traumas as one of the major risk factors for ME/CFS, while others conclude that childhood trauma may cause chronic fatigue but not ME/CFS. This paper suggests that the majority of PWCs are not traumatized, and does not prove any causal relationship between trauma and ME/CFS.]

Our old friend, Byron Hyde (Nightingale Foundation, Ottawa) was on hand to warn about a high incidence of thyroid cancer in Canadian patients. One hundred consecutive patients underwent “total body investigation” including thyroid ultrasound and/or scanning. The incidence of thyroid malignancy in this group exceeded 6000 per 100,000, whereas the natural incidence is only 30 per 100,000. Malignant nodules were usually solitary, hypervascular, and > 1cm in diameter.

[Ed note:  I have seen only an occasional thyroid malignancy in our population of patients, no more than expected. Hyde’s findings are not alarming, therefore, but will cause me to investigate thyroid nodules more aggressively.]

Mary Ann Fletcher and Nancy Klimas (University of Miami) performed prospective cytokine studies in PWCs to determine which biomarkers were most abnormal compared to controls. They found that Lymphotoxin A (or LT, increased 257%), IL4 (240%), IL6 (100%), IL 12 (120%) IL5 (95%), and Neuropeptide Y were most increased above controls, while NK cell numbers were decreased. Lymphocyte Proliferation to mitogen stimulation was decreased, and lymphocyte activation markers (CD26, CD38) were increased. They found little difference in IL13, IL10, IL2, TNFα, IFN, IL15, and IL8. These findings may lead to markers for ME/CFS, and suggest that T cells are metabolically limited in performing their helper function.

[Ed. note:  Cytokines are notoriously difficult to measure and vary over time (see Ekua Brenu’s work above). The other findings are not new. Of interest, Neuropeptide Y is frequently increased in ME/CFS and correlates best with perceived stress, anger, depression, negative thoughts, and maladaptive coping.]