Journal of IiME Volume 6 Issue 1 (June 2012) because we now have research documenting a number of pathophysiologic processes involving the brain, the immune system, the neuroendocrine system and the autonomic nervous system”. Professor Anthony Komaroff from Harvard wrote: “Today we have powerful new research technologies… Newer molecular biology technologies allow us to study gene activity inside circulating immune system cells and to look for infectious agents with an accuracy that wasn’t possible two decades ago”. 2008 On 6th May 2008 the charity ME Research UK (MERUK) hosted an International Conference on ME/CFS Biomedical Research at the Wellcome Trust Conference Centre, Cambridge (“New Horizons 2008”), at which Professor Nancy Klimas from the University of Miami gave the first Keynote Lecture which was entitled “Clinical Aspects of ME/CFS”. Her emphasis was on the need to assess patients by sub-grouping on the basis of clinical tests and symptom clusters as outlined in the 2003 Canadian Consensus Definition, of which she was a co-author. In her view, the post-exertional nature of the symptoms is key. She described her model for the development of the disease and reviewed the chronic immune dysfunction; she also reviewed the evidence for viral persistence and reactivation before discussing the evidence for endocrine dysfunction such as reduced cortisol output. She noted that gene expression microarray data has become a highly productive tool, mentioning recent studies showing the differential expression of 35 genes for T-cell activation, neuronal and mitochondrial regulatory abnormalities. She particularly noted that pre-and post exercise challenge studies have indicated differences in genes that regulate ion transport and intracellular functions, saying it may be that evaluation of gene expression profiles will allow pathophysiologic sub-grouping of patients that could result in targeted therapies to impact immune function (with acknowledgement to Dr Neil Abbot). 2008 Invest in ME (Charity Nr. 1114035) On 23rd May 2008 the charity Invest in ME held its third International Conference on ME in London; it was attended by about 165 people including health care professionals and patients. Dr Jonathan Kerr (St George’s University, London) spoke on “Gene Expression in ME/CFS: A Means of Subtyping”. His team looked at a microarray of 47,000 genes from ME/CFS patients and controls taken from normal blood donors. Genes showing differential expression were further analysed using real-time PCR. 13 transcription factors were over-represented and differential expression was confirmed in 88 genes, these being associated with haematological and immunological diseases and function, cancer, apoptosis, immune responses and infections. Graphs showed hugely different results in ME/CFS patients compared with controls (with acknowledgement to Doris Jones MSc). 2008 “CFS is an incapacitating illness….The benefit of classifying individuals with CFS into diagnostic categories is that it facilitates selection of treatment methods, predictions of response to treatment and communication among clinicians and researchers….Evidence for multiple immunological abnormalities in CFS have frequently been reported in the literature….People with CFS appear to have two basic problems with immune function: 1) poor cellular function, with low natural killer cell 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. Natelson et al (Spinal fluid abnormalities in patients with chronic fatigue syndrome, 2005) found increases in cytokines (IL8 in some patients and IL-10 in others), and these findings support the hypothesis that in some patients with CFS, symptoms may be due to immune dysfunction within the central nervous system….If there are distinct subgroups, then treatment might need to be tailored to the differential needs of patients….Several studies suggest that subgroups of patients with CFS react differently to exercise than healthy controls….In (our) study we examined baseline measures involving immune function… for those who www.investinme.org Page 81 of 108

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