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Komaroff: inflammation correlates with symptoms in ME


Senior Member

Inflammation correlates with symptoms in chronic fatigue syndrome
  1. Anthony L. Komaroffa,1

It is not unusual for patients who say they are sick to have normal results on standard laboratory testing. The physician often concludes that there is no “real” illness and that the patients’ symptoms likely stem from a psychological disorder. An alternative conclusion, often honored in the breach, is that the standard laboratory tests are measuring the wrong things.

Chronic fatigue syndrome (CFS)―also called myalgic encephalomyelitis/chronic fatigue syndrome―is such an illness. Often, the condition begins suddenly, following an “infectious-like” illness. For years, patients do not return to full health. The illness waxes and wanes, and at its worst leads patients to be bedridden or unable to leave their homes. A report from the National Academies estimates that CFS affects up to 2.5 million people in the United States and generates direct and indirect expenses of $17–24 billion annually (1). The most widely used case definition (2) consists only of symptoms. This, along with typically normal results on standard laboratory tests, has raised the question of whether there are any “real” objective, biological abnormalities in CFS. In PNAS, Montoya et al. (3) report the latest evidence that there are such abnormalities.

Indeed, research over the past 30 y has discovered pathology involving the central nervous system (CNS) and autonomic nervous system (ANS), energy metabolism (with associated oxidative and nitrosative stress), and the immune system, as described in a detailed review (4). This Commentary will briefly summarize the evidence, providing citations only to work published since this review. I will then place the report by Montoya et al. (3) in context, and speculate about the pathophysiology of the illness.

Studies of the Nervous System


Senior Member
New England
I appreciate the editorial.

Komaroff summarises some of the most popular hypotheses (and presumably some of his favourite studies), though provides little in the way of original insight.

Komaroff is a very skillful summarizer and communicator in this field, which I have appreciated. However, I have seen that he is conservative about not extending his statements beyond what has been scientifically established. I tend to think this is because he is at Harvard Medical School as well as working in a politically tricky field (ours) and so treads cautiously. I have found this a little frustrating at times! However, what he lacks in a bold and more forward approach, he makes up for in his longevity, honesty and steady commitment. When I imagine the institutional settings he works in---committees, schools, hospitals, conferences and public communications--I can well imagine the cross currents he is dealing with, and so his conservative approach, conveyed honestly and pleasantly, to those who may not want to hear even that much, seems a little more heroic. He is one of the valuable players on our team--not the one who takes the ball down the field--but a supportive one who keeps us up in the competition. His work deserves my respect and appreciation.
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