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Cell transplant study shows early results
A preliminary study has
found that injecting patients with
lab-grown versions of their own immune cells may improve the overall function
and cognitive abilities of some people with CFIDS.
Researchers surgically extracted lymph nodes from 11 patients, then removed
immune cells from the nodes and grew more of them in a lab setting. The new
cells were then injected into the patients.
Many people with CFIDS have an imbalance of immune cells in their bodies. In
some cases, Th-1 helper cells are reduced while Th-2 types are increased. The
researchers in this study injected a higher proportion of Th-1 cells into the
patients to help improve their ratios.
During a 24-week follow-up period, researchers found that the patients showed
improvement on several function tests and also appeared to have improved
cognitive abilities. None showed any adverse reaction to the injection.
The authors stress that the results are preliminary and must be tested on a
larger scale before firm conclusions can be drawn. The study appeared in the
Journal of Chronic Fatigue Syndrome (volume 8, number 1, 2001); the
lead author is Nancy Klimas, MD, of the University of Miami.
Journal devotes issue to CFIDS
The journal Applied
Neuropsychology has published a 64-page section focusing on CFIDS-related
research. Below are highlights from three studies in the issue:
Multi-tasking hard for PWCs
People with CFIDS (PWCs) have more
difficulty than others trying to concentrate on several mental tasks at once,
according to research from American University and the National Institutes of
Researchers administered a battery of mental tests to 17 PWCs and 19 healthy
control subjects, then compared the results. The PWCs scored the same as
controls on tests for intelligence, memory and language, even though they
reported having diminished cognitive ability.
But the PWCs scored significantly worse than controls when asked to perform
divided-attention tasks, such as trying to identify letters on a computer screen
while listening to random words being played through headphones. Researchers do
not know why this occurred - but they speculate that their findings could
explain why PWCs show normal intelligence on tests but struggle to complete
everyday tasks such as driving a car and talking simultaneously. Since such
multi-tasking is common, researchers say it also could explain why PWCs feel
they have poor memory and other mental skills.
Symptoms improve, but function doesn't
A multi-year study of 35
PWCs found that the subjects' mood, fatigue, attention ability and overall
disability scores tended to improve over time. But the study also found that
most patients remained significantly impaired after the study period, which
covered a mean time of 42 months.
The PWCs were all participants at the New Jersey Fatigue Research Center, and
all met both the 1988
and 1994 case definitions for CFIDS. Forty-seven
patients began the study, and 35 completed it. At the beginning of the study,
each patient was given a thorough physical and psychological exam, and their
symptom severity was rated on a scale of one to six.
The patients were tracked for periods ranging from 24-63 months. They were
then re-evaluated by the same criteria used at the beginning of the study.
Fifty-seven percent of the patients showed overall symptom improvement.
Significant improvements were noted in information processing, memory and
disability levels. But overall, the patients symptoms remained severe - and
there was little improvement in functional abilities or employment status.
Keep in mind that research studies with fewer than 500 patients are
generally not considered statistically valid and may be questioned by the
medical community. The Chronicle reports on smaller studies due to the
lack of large-scale research projects and to keep you updated on emerging
JAMA STUDY FINDS PROMISE,
PROBLEMS IN CFIDS RESEARCH
comprehensive review of CFIDS research has found that several treatment options
show promise in easing symptoms of the disease. But the authors of the study,
published in the Sept. 19 issue of the Journal of the American Medical
Association, warn that research in the field is flawed and sparse, and
could lead to improper conclusions.
The authors looked at 44 studies of CFIDS treatments
conducted from 1986-2000. The treatments included graded exercise therapy (GET)
and cognitive behavioral therapy (CBT); pharmacological treatments such as
hydrocortisone, antidepressants and growth hormone; immunological treatments
such as Ampligen and alpha-interferon; dietary supplements; and
complementary/alternative treatments such as massage therapy.
Several treatments showed potential benefits,
including GET and CBT, according to the authors. All three trials of GET found
an overall improvement among patients who received the treatment when compared
to control subjects who did not. Three of the four trials for CBT showed
positive overall benefits as well.
But these treatments are not cures for CFIDS,
they work for everyone. GET, for instance, must be conducted under the close
supervision of trained therapists. Unsupervised exercise can lead to serious
relapses among people with CFIDS (PWCs). The studies of GET and CBT also had
higher-than-normal dropout rates for test subjects. In addition, the studies
excluded people who were unable to travel to clinics for therapy.
(Editor's note: Press coverage
of the JAMA study
has concerned CFIDS advocates, who fear that health care professionals may be
led to believe that unsupervised exercise is beneficial for PWCs. For
information on The CFIDS Association of America's response, please see the
Media Watch section.)
Other treatments showed possible limited benefits.
These included use of immunoglobulin and hydrocortisone. A host of other
treatments may eventually prove helpful - including Ampligen, antidepressants,
magnesium supplements and alpha-interferon - but the research is not sufficient
to make judgments at this point.
The JAMA authors found numerous research
shortcomings in the CFIDS field. In addition to the relative scarcity of
research, the studies conducted often failed to use objective measures for
symptom improvement; in many cases, patients were simply asked whether they felt
better after treatment. Subsets of patients, such as those unable to travel to
clinics for treatment, were often poorly studied.
These and other problems make drawing overall
conclusions about treatment options difficult. Standardizing outcome
measurements should be a priority in future studies, the authors write.