Research News

Gulf War treatment trials to begin
Exercise and behavioral therapy will be tested along with an antibiotic as possible treatments for the complex and undiagnosed symptoms known as Gulf War syndrome.

The clinical trials come eight years after the Gulf War. Thousands of U.S., British and Canadian veterans who served in the Persian Gulf have complained of mysterious symptoms similar to those of CFIDS at a much higher rate than those who did not serve in the Gulf. The Pentagon and Department of Veterans Affairs are spending $20 million on randomized, controlled studies to begin in January.

The U.S. program comprises two clinical trials at veterans' hospitals across the country, using antibiotics in one study and exercise and behavior therapy in the other. The first will enroll 450 veterans with mycoplasma fermentans, which officials describe as a "hypothesized infectious cause" of undiagnosed symptoms. They will take the antibiotic doxycycline for 12 months. The second trial will enroll 1,356 veterans suffering fatigue, memory problems, and muscle and joint pain, to be treated with behavior therapy and exercise.

Nearly 697,000 Americans served in the Persian Gulf after Iraq's August 1990 invasion of Kuwait. A Centers for Disease Control study found that 45% of those who went to the Gulf complained of an illness characterized by fatigue, cognitive problems and muscle pain, with 6% having severe symptoms.

Gulf War CFIDS a milder form
Gulf War veterans with CFIDS tend to have a milder form of the illness than civilians with the illness and may have a better prognosis for recovery, according to a study by C. Pollet, B. Natelson and a team of researchers from New Jersey. The study was published in the Journal of Medicine (1998,  29(3-4):101-13). Of a group of 72 veterans with complaints of severe fatigue or chemical sensitivity, 33 met the case definition for CFIDS with 14 also having multiple chemical sensitivity.  Another six met the MCS definition but not that for CFIDS.

New hypothesis for CFIDS cause
Researchers at Ohio State University have published a new theory that CFIDS is caused by both a low-level viral infection and the body's immune response to it. The new theory by Ronald Glaser, professor of medical microbiology and immunology, and Janice Kiecolt-Glaser, professor of psychology and psychiatry, published in the American Journal of Medicine in October, arises from their research on the effects of stress on the human immune system.

"Our data suggests that stress may be causing the expression of certain viral proteins and that these proteins may be modulating the body's immune response, turning it on or off," Glaser said.

The theory holds that various latent viruses can be partially reactivated, meaning that viral proteins could be produced at levels high enough to cause a low-grade infection but too low to be seen using current laboratory assays. The researchers suggest that CFIDS patients could have an infection that is "more like a smoldering fire rather than a three-alarm blaze," which could be enough to increase production of various cytokines.

"A lot of the symptoms that you find in chronic fatigue syndrome are the same ones induced by cytokines during our normal immune response," Glaser said. He admits that studies of patients have yet to show a pattern of abnormal cytokine behavior that would substantiate their theory, but he believes that may be because knowledge about cytokines is still emerging and new ones are being identified.

Kiecolt-Glaser said stress and depression may be playing a related role. Earlier research has repeatedly shown that increased stress and depression can reactivate latent viruses, decrease the body's immune response and stimulate the production of certain cytokines linked to some CFIDS symptoms.

"Part of this is a chicken-and-egg problem," Kiecolt-Glaser said. "People diagnosed with CFIDS often are depressed since they're unable to carry out normal, daily activities. What we don't know is whether the depression followed the diagnosis of CFIDS or if it contributed to it. We do know, however, that this kind of depression can weaken our immune response."

Long-term effects on schooling
Elizabeth G. Dowsett, a microbiologist, and Jane Colby, a former school principal, are beginning a new project to assess the long-term effects of CFIDS on education. They're looking for PWCs up to age 30 to fill out a questionnaire. Participants can remain anonymous. Get a questionnaire through the Young Action Online web site (www.jafc.demon.co.uk/yaonline) or by writing to Jane Colby, PO Box 4347, Stock, Ingatestone, Essex, CM4 9TE, England.