Journal of IiME Volume 6 Issue 1 (June 2012) 2007 “Understanding how non-pharmacologic interventions differentially affect the subgroups of patients with CFS might provide insights into the pathophysiology of this illness….Baseline measures of normal versus abnormal cortisol were compared on a variety of immune markers….Subgroups of individuals with CFS may react differently to exercise than healthy controls….Early researchers describing nonpharmacologic behavioural interventions for CFS reported high levels of success (Deale, Chalder, Marks & Wessely, 1997;…Sharpe et al 1996), but more recent studies have had somewhat more mixed results…. Those individuals with most impaired HPA axis function might be least able to improve with non-pharmacologic interventions….Jeres, Cleare, Wessely, Wood and Taylor (2005) have confirmed that mean cortisol levels are significantly lower for individuals with CFS when compared with controls across the entire 24-hour span….Many studies do show that CFS is characterised by hypocortisolemia…It is possible that some individuals with CFS have a cortisol deficiency and others do not, but when all are combined into one large CFS category, these important differences are ignored….Immunologic abnormalities have frequently been reported in the CFS literature…(a) poor cellular function, with low natural killer cell (NKC) cytotoxicity and frequent immunoglobulin deficiencies (most often IgG1 and IgG3) and (b) elevations of activated T lymphocytes, including cytotoxic T cells, and elevations of circulating cytokines….The results of one study found that immunologic functioning did not improve as a result of CBT (Peakman, Deale, Wessely et al, 1997); however, that study did not subgroup according to baseline cortisol findings….In (our) study, baseline measures of normal versus abnormal cortisol were compared on a variety of immune markers….The results of this study demonstrate that….individuals with normal baseline cortisol levels exhibited the most improvement….This indicates that those who are most impaired on HPA functioning might be least able to improve when provided with nonpharmacologic interventions….There were significant time and interaction effects of the CD45RA-CD62L- subsets. The normal cortisol group experienced decreasing levels of this subset over the intervention, whereas the abnormal group underwent a significant expansion. This Invest in ME (Charity Nr. 1114035) effector subset has been shown in healthy subjects to express high levels of 1 and 2 integrins that are required for homing to inflamed tissues and produce perforin and high levels of IL-4, IL-5 and IFN….The continued expansion of this subset in the abnormal cortisol group suggests that a stimulus, present in these individuals but absent in the normal cortisol group, is responsible for driving the proliferation….The modulation of these effector subsets in distinctly different directions, that are associated with HPA axis abnormalities and efficacy of CBT, likely represents an important component of the immune dysfunction associated with the pathogenetic process of CFS…. In summary, subgroups of individuals with either normal or abnormal cortisol levels exhibited different outcomes in a nonpharmacologic treatment trial….This suggests that cortisol levels may serve as an important marker for individuals with CFS that might benefit from non-pharmacologic interventions such as cognitive behavioural therapies” (Leonard A Jason, Mary Ann Fletcher et al. JCFS 2007:14(4):39-59). 2008 In January 2008 the CFIDS Association of America produced a special publication entitled “Defining Moments – 20 years of making CFS history”, the key message being that “Scientific research…has provided incontrovertible evidence that CFS is one of the most complex and widespread illnesses of our time, and that there is a sound scientific basis for the biological origins of the disease (but) many physicians are still incredibly resistant to treating CFS”. Professor Nancy Klimas wrote: “Over the years, people have often asked me if CFS is an immune disorder, a brain disease or a dysfunction of the endocrine system….As an immunologist, I once would have said CFS is clearly an immune dysfunction state, while an endocrinologist would call attention to the adrenal glands irregularities, and a specialist in the autonomic nervous system would be convinced CFS is all about blood pressure abnormalities. Given what we’ve discovered about the illness, I now tell people CFS is all of these things. We know that (ME) chronic fatigue syndrome has identifiable biologic underpinnings www.investinme.org Page 80 of 108
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