Software Vault: The Gold Collection/Software Vault - The Gold Collection (American Databankers) (1993).ISO/cdr13/cfs1291.zip/SCIENCE.TXT

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The following news update, written by Joseph Palca, appeared in
the December 1991 issue of SCIENCE magazine.  This electronic
version of that article was copied from the USA CFIDS/CFS BBS in
Augusta, Maine which is the most comprehensive source of CFS
information on any BBS.  It can be reached at telephone
1-207-623-8486.  The BBS' sysop, John Kossowan D.D.S., a CFS
patient, typed this article into his PC and also inserted his own
personal comments, which appear in brackets [].


SCIDEC91.TXT
------------


Research News


              "ON THE TRACK OF AN ELUSIVE DISEASE"

        "CHRONIC FATIGUE SYNDROME HAS BEEN SHOWN TO HAVE
          DISTINCTIVE CLINICAL FEATURES, BUT SO FAR NO
   CAUSATIVE AGENT -- IF THERE IS ONE -- HAS BEEN IDENTIFIED."


When reports first started coming in a few years ago of a strange
flu-like malady that struck victims in the prime of their lives,
leaving them with chronic, debilitating fatigue, few researchers
were willing to pay those reports much attention. The malady was
dismissed as the "yuppie flu" -- a 1980s version of an old
disease called neuro-myasthenia -- and was widely regarded as
merely a psychosomatic disorder that belonged in the real of
psychiatrists, not internists. But in recent months, the
disorder, dubbed Chronic Fatigue Syndrome (CFS), has begun to get
some scientific respect.

Congress, urged on by effective lobbying from patient-advocate
groups, has encouraged the federal government to enchance its
spending of CFS considerably -- from next to nothing 3 years ago
to little more than $6 million in the coming year -- and now the
investment is starting to pay off. A small but growing group of
virologists, immunologists, and neuro-endocrinologists has begun
to put together a picture of CFS that seems to set it apart from
other psychiatric and medical disorders that share some of the
same symptoms, and a handful of groups around the world are
feverishly trying to track down the cause of the syndrome. So
far, however, they have turned up little more than promising
leads.

[Comment from Sysop: PLEASE understand that SCIENCE magazine has
NEVER supported the cause of CFS to be a virus, very likely its
staff, having its offices located in Washington, DC, is under
heavy influence and pressure by the US Government and NIH staffs
to support a NO VIRUS theory to CFS. There is MUCH evidence that
a very potent virus is causing CFS, and that it IS very
contagious. Why some get CFS and some don't is due to genetic
immune makeup. Now back to the article.]

The Centers for Disease Control (CDC) is also taking the disease
seriously. Two years ago it set up four surveillance sites -- in
Atlanta, Reno, Grand Rapids, and Wichita -- to gather data on the
syndrome, and the agency now estimates that there are at least
100,000 cases of CFS in the United States. CDC will soon start a
national prevalence survey with part of the $2.8 million that
Congress put in the agency's budget for 1992.

Walter J.Gunn, who heads CFS program activities at CDC in
Atlanta, says research on the syndrome is at a stage similar to
the one that AIDS research was at a decade ago. Scientists were
then faced with a complex set of medical problems that were
related in some unknown way. Until HIV was discovered, no one
knew which of the various medical abnormalities was the cause of
AIDS, and which were merely opportunistic hanger-on. While no one
is suggesting that CFS will turn out to be the public health
problem that AIDS has become, Gunn expects that this peculiar
syndrome, like AIDS, will present an irresistible challenge that
will draw more and more talented researchers into the field.
"Success breeds success," says Stephen E. Straus, chief of the
laboratory of clinical investigation at the National Institute of
Allergy and Infectious Disease (NIAID). "When one shows that even
an amorphous syndrome like this one is amenable to scrutiny --
that you can generate reasonable data out of it -- other good
people start feeling it's worthwhile to venture into the field."

Many researchers nevertheless remain skeptical that the syndrome
is anything more than just a neurotic complaint of
middle-aged white women, the group most frequently diagnosed with
CFS. "If you took a pill today you would still probably find many
practicing physicians and many scientists saying 'it's hasn't
been proved to me that there is a definitive disease with a
definitive objective abnormality that defines the disease,'" says
Anthony Komaroff, a general internist and clinical epidemiologist
at Brigham and Women's Hospital in Boston. Indeed, in the end it
may turn out that the medical and psychological components of the
disease are so intertwined that they may never be fully teased
apart. But Komaroff, who has just been awarded one of three
grants from NIAID to establish CFS cooperative Research Centers,
agrees with Straus that attitude is changing. "The evidence for
objective abnormalities is growing stronger."


PIECING TOGETHER THE CFS JIGSAW

The most compelling evidence comes from recent studies of the
symptoms of CFS. "The pattern that is emerging is a chronically
activated immune system, an immune system engaged is some kind of
chronic war against some kind of thing that it perceives as
foreign," says Komaroff. There have been reports that natural
killer cells and macrophages, two of the body's front-line
defenses against invading organisms, are reduced in either number
of function in CFS patients. In addition, a subset of white blood
cells called CD8 cells are activated, consistent with an immune
response to a viral infection. Komaroff and others have begun to
see a pattern of neurologic changes that seem to accompany other
CFS symptoms.

The latest published results also indicate that CFS patients have
altered levels of certain brain hormones, compared with control
subjects. NIAID's Straus says he and colleagues at the National
Institute of Mental Health and the University of Michigan decided
to look at the hypothalamus - pituitary - adrenal (HPA) axis
based on findings that that axis was altered in patients with
major clinical depression. If CFS patients showed a similar
alteration, it would add weight to the argument that CFS was
merely an elaboration of a psychiatric disorder.

After nearly 4 years of gathering data, researchers from the
three institutions published a paper earlier this  month in the
JOURNAL OF ENDOCRINOLOGY AND METABOLISM  confirming that the
HPA-axis in CFS was indeed altered, but not the way researchers
expected. Although the differences from normal controls were
modest, CFS patients consistently showed decreased levels of the
steroid hormone cortisol, and increased levels of the pituitary
hormone ACTH (adrenocortico-tropin hormone), exactly the opposite
of the changes seen with depression. This finding, says Straus,
"provides an alternative explanation for some of the immune
findings in the syndrome. Instead of presuming that there's a
chronic infection which is driving some of the abnormalities,
there may simply be a lack of steroid restraint on the immune
system which lets the immune system run at an abnormal level
unchecked." Straus says the next step will be to look at other
neuroendocrine pathways in CFS to see whether these are altered
as well.


NO SMOKING GUN

But while the symptoms of CFS are becoming clearer, the cause
remains murky. For the past year, virologists at CDC and
elsewhere have been focusing on work by Elaine DeFreitas of the
Wistar Institute in Philadelphia, who found evidence that a human
retrovirus similar to HTLV-II had infected CFS patients but not a
group of healthy control subjects (see SCIENCE Sept. 14,1990).
Patient advocate groups seized on DeFreitas' work as the ultimate
proof that CFS was not a psychiatric illness but one with a known
cause. DeFreitas' results were impressive enough to prompt CDC to
try to replicate the work, and to ask several other labs to do
likewise. But today, despite a year of efforts, no one can report
success. "We haven't yet been able to confirm her findings," says
CDC's Gunn. "But we haven't refuted her findings either."

Thomas Folks, a retrovirologist at CDC, says the problem with
replicating DeFreitas' work is that it is based on polymerase
chain reaction (PCR), amplication of tiny amounts of DNA in
cells. PCR can be a tricky technique in the best of
circumstances, and in this case, the DNA sequences found in
normal, uninfected cells. So if you increase the sensitivity of
the assay to look for what is certain to be a rare viral
sequence, you lose specificity and run the risk of a false
positive result. "You're working at the hairy edge of what's
possible in PCR," says Gunn. But, he adds, "there is every
likelihood that (DeFreitas' finding) will be CONFIRMED
eventually."

[Note from Sysop: yes, the CDC, from what I have been told many
months ago, had TO LEARN FROM DR.DEFREITAS THE SPECIAL
ULTRA-SOPHISTICATED TECHNIQUE THAT THIS SMART WOMAN INVENTED IN
ORDER TO ATTEMPT TO DUPLICATE HER EXCELLENT WORK, WHICH, FROM
WHAT I HAVE BEEN TOLD, WAS DUPLICATED BY THE CDC. WHY THE CDC
WILL NOT ADMIT TO IT RIGHT NOW, IS STRANGE AND IMPROPER.]

Some virologists think Gunn is overly optimistic, however. "There
are a lot of people who are frustrated" trying to confirm
DeFReitas, says Jay A.Levy, a virologist at the University of
California at San Francisco. So far, Levy himself has drawn a
blank, but he says he's just received some new reagents from her
and will try again. Peter O.Behan, professor of clinical
neurology at the University of Galsgow in Scotland, also tried to
replicate DeFreitas's work without success He now thinks she is
seeing a naturally occurring sequence. Despite repeated attempts,
SCIENCE could not reach DeFreitas for comment.

If DeFreitas' virus falls by the research wayside, it wouldn't be
the first to meet that fate in the search for a cause of CFS.
Five years ago, Epstein-Barr virus (EBV), one of a class of human
herpes viruses, looked like a good candidate, since most if not
all patients' initially diagnosed with the syndrome had EBV
antibodies (see SCIENCE, Oct.31,1986,p.541). Indeed, CFS was once
called chronic EBV infection. But subsequent groups of patients
failed to show evidence of EBV infection, and most researchers
ruled out the virus. Another herpes virus, HHV-6, also enjoyed a
brief spell in the limelight as the etiologic agent of CFS, but
it turns out to be nearly equally prevalent in healthy controls
as it is in CFS patients. In one recent study by Levy and his
colleagues (LANCET, Sept.21,p.707), all 63 CFS patients had
detectable antibodies to HHV-6, but so did 39 of 40 healthy
controls. In addition to HHV-6, Levy looked for any substantial
differences between CFS patients and controls in the production
of antibodies to a panoply of viruses, including cytomegalovirus,
EBV, rubeola, adenovirus, Coxsackie B4, and Papovavirus BK. He
found none. Significantly, neither group showed any evidence of
exposure to the three known classes of human retrovirus,
including HTLV-I/HTLV-II, HIV-I/HIV-2 and human spumavirus -- a
type of retrovirus also known as a foamy virus because of the
"foamy" appearance of the cytoplasm of infected cells.

The negative results on spumavirus present a particular puzzle,
given recent research by John Martin, a pathologist and
virologist at the University of Southern California. Martin is
claiming that he has recently cultured a spumavirus from more
than 200 CFS patients, and that he has obtained some sequence
data. These claims are being treated with some skepticism,
however.

Martin first pointed the finger at spumaviruses in February 1990
when he found viral particles in the cerebrospinal fluid of a
woman who was suffering from speech and motor problems as well as
extreme fatigue. Electron microscopy pictures convinced him that
he was seeing a spumavirus. But when Martin presented these
electron micrographs at a meeting sponsored by the National
Chronic Fatigue Syndrome Advisory Council held at the CDC in
Atlanta this September, those present were underwhelmed. Levy
said in an interview following the meeting that he couldn't make
out what they showed. Komaroff agreed that the data Martin
presented in Atlanta were inconclusive. And one virologist, who
was asked to review a paper Martin submitted for publication,
told SCIENCE that "most of what he shoed was negative or
uninterpretable."

For his part, Martin insists he was confronted by a hostile,
unreceptive audience at the CDC, whose members were unwilling to
listen to new ideas.  "I would have expected some courtesy," he
said in a telephone interview. Many researchers contacted by
SCIENCE said they were upset that Martin has taken his research
results to the new media before publishing it in the scientific
literature. News of Martin's spumavirus has appeared in NEWSWEEK,
THE NEW YORK TIMES, and THE WALL STREET JOURNAL, but not in any
refereed journal.

Since that meeting, Martin has been busy culturing the virus from
CFS patients, and he says he's about to submit his new results to
a peer-reviewed journal. He's still facing an unsympathetic
audience, however: "I've seen every shred of data he's willing to
share," says Komaroff, and he is unconvinced that a spumavirus is
involved. "We looked for the only currently known human
spumavirus 3 years ago and found absolutely no evidence of that,"
he says. But even Komaroff isn't yet ready to shut the door
completely on these rare retroviruses. "If there were a new
spumavirus, we could have missed that," he admits.


Komaroff isn't bothered by the failure so far to find the smoking
gun causing CFS. "My view of the illness, which I suspect is
probably the prevalent view among scientists and clinicians
studying it, is that it's very unlikely that there is a single
etiologic agent," he says. "It's a syndrome that probably has
multiple triggers."  But CDC's Gunn doesn't agree: "I have
trouble buying this thing about multiple causes, because when you
look for them they're not there."  Gunn believes that researchers
will ultimately find a single, major causative factor, and he
would not be surprised if it turned out to be a retrovirus, since
that class of virus has already been shown to attack both the
immune system and the brain.


SKEPTICISM PERSISTS

The failure to nail down the cause of CFS is, however, fueling
the skepticism of researchers who argue that it would be more
profitable to focus on the psyche than the immune system of CFS
patients. "I don't think that there is any solid, reliable,
reproducible evidence that patients with chronic fatigue syndrome
are in any way immunologically, virologically, or biochemically
different form any other patients with a chief complaint of
chronic fatigue," says Peter Manu, an internist at the University
of Connecticut. Manu says that at the time they are diagnosed
with the syndrome, at least three quarters of all CFS patients
have a psychiatric disorder that all of us have noted in these
people is the sole cause of Chronic Fatigue Syndrome or of
chronic fatigue," he says. "But it is the only dignosable one."

[Comment from the Sysop: Dr.Manu is an internist, NOT a
virologist or immunoloigst, and he therefore, is practicing
OUTSIDE of his specialty to say he is an expert on psychology and
an expert on immunology. He is committing gross mal-practice and
it is only a matter of time before he is sued by a patient, for
ignoring the obvious immune problems in CFS caused by a virus.]

Manu goes on to argue that the search for a single virus agent is
pointless.  [Comment from the Sysop: Again , Manu is practicing
OUTSIDE of his specialty, and should NOT be commenting on viruses
as being the cause. He can't legally do so.]  "I do not think
there's any reason for going for such an arcane etiology," he
says. "I cannot see any infection that will predominantly affect
middle-aged, college-educated white women. It just doesn't make
any epidemiologic sense to me."

While Gunn admits that the majority of patients the CDC is seeing
are white women, he says the experience in other countries --
notably Autrailia -- suggests that CFS is equally distributed
between men and women. As for the suggestion that a psychiatric
disorder explains most CFS symptoms, Gunn says that at least half
of the patients referred to CDC neither have a diagnosable
psychiatric disorder at the time they are diagnosed with CFS, nor
do they subsequently develope one.

There will clearly be plenty of room for doubts about the nature
of CFS unless a causative agent is identified -- just as there
was in the early days of AIDS. but even if a CFS virus is found,
there will likely be many questions left unresolved. Like AIDS,
it could be years before all the pieces of the CFS puzzle fall
into place.

by Joseph Palca

-- end of document --