BREAKTHROUGH: New Spinal Fluid Analysis Distinguishes Lyme from Chronic Fatigue Syndrome & Both from Healthy Controls

New tests suggest the central nervous system is involved in ME/CFS and Lyme, and that protein abnormalities in the CNS “are causes and/or effects of both conditions.” [Note: this news made headlines around the world, but was highlighted first Feb 23 on "The CBS Evening News with Katie Couric" – with the headline "Chronic fatigue syndrome – new scientific evidence that it's not in the mind of the patient but very real."]

Patients who suffer from Neurologic Post Treatment Lyme disease (nPTLS) and those with Chronic Fatigue Syndrome report similar symptoms. However, unique proteins discovered in spinal fluid can distinguish those two groups from one another and also from people in normal health, according to new research conducted by a team led by Steven E. Schutzer, MD, at the University of Medicine and Dentistry of New Jersey and Richard D. Smith, PhD, at Pacific Northwest National Laboratory.

Their findings, published Feb 23 by the free access journal PLoS ONE ( “Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome”), also suggest:

• That both conditions involve the central nervous system

• And that protein abnormalities in the central nervous system are causes and/or effects of both conditions.

The investigators analyzed spinal fluid from three groups of people. One group consisted of 43 patients who fulfilled the clinical criteria for Chronic Fatigue Syndrome (CFS). The second group consisted of 25 patients who had been diagnosed with, and treated for, Lyme disease but did not completely recover. The third group consisted of 11 healthy control subjects.

“Spinal fluid is like a liquid window to the brain,” says Dr. Schutzer.

By studying the spinal fluid, the research team hoped to find abnormalities that could be used as markers of each condition and could lead to improvements in diagnosis and treatment.
Taking advantage of previously unavailable methods for detailed analysis of spinal fluid, the investigators analyzed the fluid by means of high powered mass spectrometry and special protein separation techniques.

They found that each group had more than 2,500 detectable proteins. The research team discovered:

1. 738 proteins that were identified only in CFS but not in either healthy normal controls or patients with nPTLS; and

2. 692 proteins found only in the nPTLS patients.

Previously there had been no available candidate biomarkers to distinguish between the two syndromes, nor even strong evidence that the central nervous system is involved in those conditions.

This research represents the most comprehensive analysis of the complete spinal fluid proteome (collection of proteins) to date for both Chronic Fatigue Syndrome and Neurologic Post Treatment Lyme disease (nPTLS).

Prior to this study, many scientists believed that CFS was an umbrella category that included nPTLS. However, these results call those previous suppositions into question.

According to Dr. Schutzer, spinal fluid proteins can likely be used as a marker of disease, and this study provides a starting point for research in that area.

• “One next step will be to find the best biomarkers that will give conclusive diagnostic results,” he says.

• “In addition, if a protein pathway is found to influence either disease, scientists could then develop treatments to target that particular pathway.”

“Newer techniques that are being developed by the team will allow researchers to dig even deeper and get more information for these and other neurologic diseases, says Dr. Smith.

"These exciting findings are the tip of our research iceberg.”


Other authors included Thomas E. Angel, Tao Liu, Athena A. Schepmoes, Therese R. Clauss, Joshua N. Adkins and David G. Camp II of PNNL; Bart K. Holland of UMDNJ-New Jersey Medical School; Jonas Bergquist of Uppsala University in Sweden; P.K. Coyle of SUNY-Stony Brook; Brian A. Fallon of Columbia University; Benjamin H. Natelson of UMDNJ, Beth Israel Medical Center and Albert Einstein School of Medicine.

Funding sources included the National Institutes of Health, through NIAID, NIDA, NINDS, the National Center for Research Resources, the Swedish Research Council, Uppsala Berzelii Technology Center for Neurodiagnostics, SciLifeLab-Uppsala, Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory. Time for Lyme, Lyme Disease Association, and the Tami Fund.

Source: University of Medicine and Dentistry of New Jersey, press release, Feb 23, 2011

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