Journal of IiME Volume 6 Issue 1 (June 2012) 1994 The Second Biennial International Clinical and Research Conference co-sponsored by the American Association for Chronic Fatigue Syndrome (AACFS) was held in Ft Lauderdale, Florida, on 7th – 10th October 1994; it was also sponsored by the NIH, the CDC and the University of Miami. Dr Seymour Grufferman (Pittsburgh Cancer Institute) described an (ME)CFS outbreak in the North Carolina Symphony Orchestra; the cases demonstrated persistent decreases in NK cell cytotoxicity and CD56 and CD16 cell populations and elevations in the CD4 population. These alterations were not seen in control subjects and could not be attributed to stress or gender. He concluded that (ME)CFS cases have a broad dysregulation of the immune system that persists over time. Dr Richard Lanham (State University of New York) presented a study of autoimmune disease in the families of patients with (ME)CFS and found more autoimmune disorders in their families, including thyroiditis, lupus, rheumatoid arthritis and allergy, causing him to consider that (ME)CFS patients may have an inherited genetic predisposition to immunological diseases such as (ME)CFS. Dr Joseph Cannon (Pennsylvania State University) provided historical and scientific evidence that females are more resistant to infection than males because of upregulation of the immune system. However it is because of this upregulation that women are more susceptible to autoimmune diseases. Dr Alison Mawle (from the CDC) reported that patients with (ME)CFS suffer from higher rates of allergy-related symptoms than normal controls and these were present in 70% of patients investigated. Dr James Jones (National Jewish Centre for Immunology, Denver), in the “Ask The Experts” session, said: “There is literature that suggests that allergic patients, when they get sick, have more symptoms and are sicker longer than other individuals…A number of my patients with allergies have seen increases in their systemic illness when treated with immunotherapy”. Invest in ME (Charity Nr. 1114035) Dr Adrienne Bennett (from Brigham & Women’s Hospital, Boston) measured transforming growth factor beta (TGF) and found that it was elevated in (ME)CFS patients, which might reflect the body’s attempt to down-regulate an over-active immune system. Dr Lawrence Borish (National Jewish Centre for Immunology, Denver) measured TNF-, IL-1, IL-6 and IL-10 (all associated with lethargy and inflammation); they found that TNF- and INF- (interferon alpha) were increased in ME/CFS patients but decreased in major depression. Most remarkably, IL-10 was absent in ME/CFS patients (IL-10 is produced by all T-helper cells and is stimulated by TNF-, the presence of which implies an inflammatory reaction). The absence of IL-10 supports the characterisation of ME/CFS as an immune disorder with a defect in the immune system’s ability to suppress the on-going immune reaction. Dr Irving Salit (Toronto General Hospital) found that the percentage of CD4 (T-helper cells) was increased in ME/CFS patients (a finding that is seen in people with allergies) compared with chronically fatigued controls who did not meet the CDC case definition for ME/CFS. He determined that ME/CFS patients have “a variety of immunologic abnormalities (including deviations in) immunoglobulins, T lymphocyte subsets and cell mediated immunity”. Drs Roberto Patarca, Nancy Klimas and Mary Ann Fletcher et al (Miami) described three groups of ME/CFS patients based on patterns of cytokine dysregulation: (1) dysregulation of TNF-/ expression in association with changes in serum levels of IL-1, IL-4, (soluble) IL-2R and IL-1 receptor agonist; peripheral blood mononuclear cell-associated expression of IL-1, IL-6 and TNF- messenger RNA, and T-cell activation; (2) interrelated and dsyregulated expression of soluble TNF receptor types 1, (s)IL-6R and 2microglobulin, and significantly decreased lympho-proliferative activity; (3) significantly decreased NK cell cytotoxic activity. Dr Kenny De Meirleir (Brussels) studied 149 patients with ME/CFS, categorising patients’ functional abilities using the Karnofsky Performance Scale (KS) which scores from 100 www.investinme.org Page 48 of 108
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