CFS/ME Biomedical Research

What is Chronic Fatigue Syndrome (CFS)?

CFS: US CDC - 1994 (Fukuda definition) Most widely used definition of CFS

BENIGN MYALGIC ENCEPHALOMYELITIS
Goodwin CS. Lancet Jan 3^rd 1981, p 37

The Impact of CFS/ME

Patients exhibit severe, long-term functional impairment. Substantial improvement is uncommon and is less than 6%.
Reference: Andersen MM et al. Illness and disability in Danish CFS patients at diagnosis and 5-year follow-up. J Psychosomatic Research 2004; 56: 217-229."

Vascular Involvement in CF/ME

CFS/ME: cerebral perfusion defects

HMPAO SPECT and T2 weighted MRI in a patient with CFS/ME

SPECT/PET imaging in Lyme Disease

Fallon BA et al. Functional brain imaging and neuropsychological testing in Lyme disease. Clin Inf Dis 1997; 25: S57-S63.
Sumiya H et al. Brain perfusion SPECT in Lyme neuroborreliosis. J Nucl Med 1997; 38: 1120-1122.
Logigian EL et al. Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology 1997; 49: 1661-1670.
Plutchok JJ et al. Serial brain SPECT imaging in chronic Lyme encephalopathy. J Nucl Med 1997; 38: 278P
Newberg A et al. Cerebral metabolic changes associated with Lyme disease. Nuclear Medicine Communications, 2002, 23, 773-777
Plotkin et al. FDG-PET studies of acute brainstem Lyme neuroborreliosis. J Neurosurg 102:927–929, 2005

Postural change in CFS/ME patients

There is a reduced cardiac output in severe CFS/ME with BP maintained at the cost of restricted flow, possibly resulting in a low flow circulatory state.
Reference: Peckerman et al. Abnormal Impedance Cardiography Predicts Symptom Severity in CFS. Am J Medical Science 2003;326:55-60

Biochemical & vascular markers in CFS/ME, OPIDN & GWS

Part I Clinical Examination: – SF36, MOS, history, symptoms
Part II Blood Flow: - Responses to NO, ACh & MCh
Part III Blood Tests:
i) Lipid analysis
ii) Enzymes (AChE, BChE, PON)
iii) Inflammatory markers
iv) Oxidative stress
a) Muscle b) endothelium c) phagocytic cells
v) Neutrophil apoptosis
vi) Arterial compliance
vii) Coagulation markers

CONCLUSION:

CFS/ME is Pro-oxidant and Pro-inflammatory

Strategy for CFS/ME research

Find the source(s) of free radicals
Muscle
Blood vessel endothelium
Inflammatory / Immune cells

Is Chronic Fatigue Syndrome a bacterial infection?

For many CFS patients it probably is

The problem is: which patients and with what infection

Acknowledgements

G. Kennedy PhD
C. Underwood MB ChB
F. Khan PhD
Hill PhD D.
Newton PhD
N.C. Abbot PhD
M. McLaren PhD
J.J.F. Belch MD FRCP

Vascular Diseases Research Unit Institute of Cardiovascular Research Department of Medicine University of Dundee