From New Scientist

From New Scientist Print Edition.
by Rowan Hooper

Source: http://www.newscientist.com/article/mg19025524.700;jsessionid=KG
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IT AFFECTS around one in every 1000 people in the UK, yet it attracts
only a fraction of the cash spent on other diseases such as HIV. Once
derided as "yuppie flu", the symptoms of chronic fatigue syndrome (CFS),
which include cramps, sleeplessness, weakness and headaches, often go
unrelieved. That could be about to change as physical evidence for CFS,
otherwise known as myalgic encephalomyelitis (ME), begins to stack up.

Last week, a meeting in London of CFS specialists heard from Jonathan
Kerr of St George's, University of London. Kerr and his team used two
techniques to look at differences in the expression of 47,000 genes and
their variants in people with CFS and a group of unaffected people.

They used a DNA microarray chip to examine gene expression in 27 people
with CFS and 54 controls. They also used "massive parallel signature
sequencing" to assess gene activity in 20 people with CFS and 20 without
by measuring the amount of mRNA each gene produces. The team ended up
with about 100 genes where differences in expression between CFS
patients and controls were most striking. Last year a pilot study
identified 35 faulty genes (New Scientist, 21 July 2005, p 9).

"Most of the abnormally expressed genes are involved in the immune
system," says Kerr, although he points out that the exact pattern of
gene expression varies between sufferers.

Both over and underactive immune expression have been blamed for the
symptoms of CFS in the past, but the lack of a single marker has
hampered diagnosis. Kerr's work, though preliminary, could herald two
breakthroughs: a treatment for the illness based on immune therapy, and
a diagnostic test based on a broad spectrum of proteins.

Kerr is in the process of setting up clinical trials using beta
interferon, a treatment for multiple sclerosis. It boosts the immune
system by enhancing the activity of natural killer cells, which fight
viruses. Since viruses are believed to play a role in triggering CFS in
many people, beta interferon might clear the infection and help them to
shake off CFS.

A test for a disease as misunderstood as CFS would also be invaluable.
Kerr's team has developed one that uses mass spectrometry to find
proteins that are present in people with CFS but not healthy controls. A
pilot study, currently being repeated, shows clear differences between
the two groups.

Meanwhile, Raymond Perrin, an osteopath from Manchester, who also
attended the meeting, says he has identified other physical
manifestations of the disease. Perrin thinks overloading of the lymph
ducts can be a factor leading to CFS in some people. Postural problems,
damage to the brain from a bang to the head, for example, or chemical or
emotional trauma, can place extra stress on the sympathetic nervous
system, he says. This can cause the lymph ducts to become overloaded or
engorged, contributing to the fatigue and pain suffered by CFS patients.
In more than 1000 cases of CFS he has seen, all patients appeared to
have problems with their lymphatic glands. "You can't always see the
swollen lymph vessels, but you can feel them under the surface of the
skin," he says.

Perrin uses soft tissue massage to treat CFS, which encourages lymph to
drain back into the bloodstream, and has submitted the results of
clinical trials demonstrating the success of the technique to the
journal Clinical Rehabilitation. "Every little helps," says Kerr. "There
is a rationale for why it works. It's non-specific, but manual lymphatic
drainage is a good thing."

Other "complementary" techniques may also be helpful, says Basant Puri,
a CFS specialist at Hammersmith Hospital, London. In some sufferers, a
deficiency of fatty acids such as omega-3 and omega-6 has been
implicated in the disease.
A poor diet can lead to deficiencies, but crucially, so can viral
infection, which can also depress the immune system. Puri says many
patients respond well to a combination of the fatty acids EPA and
evening primrose oil. "Fatty acid supplements should be available on the
National Health Service," he says.

Yet one of the biggest challenges facing those involved in CFS research
is that the underlying causes may vary from person to person and one
solution is unlikely to fit them all.

What is needed is more funding for further research into the condition,
says Ian Gibson MP, who chairs the UK parliamentary group for scientific
research into CFS/ME. The group is encouraging people who have had CFS
to write in with their stories. "We hope to form a true picture of ME
sufferers' hopes and concerns over the current work being undertaken in
the treatment and research of ME," says Gibson