Journal of IiME Volume 6 Issue 1 (June 2012) The 8th International Association of Chronic Fatigue Syndrome (IACFS, formerly the AACFS) Conference was held at Fort Lauderdale, Florida, from 10th-14th January 2007. The following notes are taken from published reports of conference attendees (including Professor Charles Lapp, Dr David Bell, Dr Rosamund Vallings, Dr Lesley Ann Fein, Virginia Teague, Pat Fero, Cort Johnson, John Herd and Pamela Young, whose various reports are on the internet), to whom grateful acknowledgment is made. The conference was attended by over 250 clinicians and researchers from 28 different countries and there was a strong sense that they were all co-operating to build on the science, and that it is the science that has freed the world from any doubt that ME/CFS is a legitimate disease with an aetiology that is not rooted in the psyche. It was described as “this miserable illness”. One of the most striking elements was the convergence of research findings: the three areas that came up again and again were inflammation, mitochondrial abnormalities, and vascular problems. There was a significant confluence of findings on (i) elastase (a protease enzyme which digests and degrades a number of proteins, including elastin, a substance that supports the structural framework of the lungs and other organs); (ii) vascular problems; (iii) apoptosis (programmed cell death); (iv) free radical production (highly damaging to DNA, to cell membranes and to proteins); and (v) the presence of inflammation in ME/CFS. In ME/CFS, testing for elastase, RNase-L, Creactive protein, selected cytokines and NK cell activity are recommended because they are objective markers of pathophysiology and severity. The importance of sub-tying was recognised and emphasised. There are elevated pro-inflammatory cytokines (immunologically-based chemicals that can cause viral symptoms) in patients with ME/CFS. Invest in ME (Charity Nr. 1114035) Dr Brian Gurbaxani and Dr Suzanne Vernon et al (CDC, Atlanta) demonstrated that increased levels of IL-6 correlate well with C-reactive protein (CRP) and are proportionate to symptom severity in ME/CFS. Dr Barry Hurwitz from the University of Miami showed that pro-inflammatory cytokines have a secondary effect in reducing red blood cell (RBC) volume, due to probable suppression of RBC production in the bone marrow. Professor Mary Ann Fletcher, a colleague of Professor Nancy Klimas from the University of Miami, found that perforin (a molecule in cytotoxic lymphocytes) is low in ME/CFS, as are NK cells. Anthony Komaroff (Professor of Medicine, Harvard) summarised the immune abnormalities that have been demonstrated in ME/CFS. These include activated CD8 (T cells); poorly functioning NK cells; novel findings – seen only in ME/CFS -of abnormalities of the 2-5A pathway (RNase-L ratio); cytokine abnormalities (pro-inflammatory dysregulation); increased TGF, and 27 times more circulating immune complexes than in controls. Other areas of abnormality seen in ME/CFS that were addressed at this conference included the cardiovascular system (especially the evidence of microvascular inflammatory problems and arterial stiffening; the evidence that 70% of people with ME/CFS have a low red blood cell volume; the low cardiac index of ME/CFS patients, this being so severe that it falls between the value of patients with myocardial infarction and those in shock, and inverted T waves), brain imaging (especially the evidence of reduced blood flow to the brain including the area responsible for the autonomic nervous system; the evidence of reduced grey matter volume, and the evidence of arteriolar vasculopathy or a blood vessel disease described as a “systemic mico-vascular inflammatory process”, a process that would affect not only the brain but every organ system in the body), proteomics (the “unbelievable” finding of unique markers in the cerebrospinal fluid of ME/CFS patients that are completely absent from the control group, and the finding of one protein – keratin – that is associated with inflammation of membranes covering the brain and spinal cord), www.investinme.org Page 76 of 108
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