Immunological abnormalities in patients with Chronic Fatigue Syndrome (CFS)

Between January 1991 and January 1993, 265 patients who

fulfilled the CDC criteria of the working case definition of

Chronic Fatigue Syndrome (CFS) have been observed at our

Institution and submitted for clinical and laboratory

evaluation. One hundred and sixty-three patients were females

and 102 males, the median age was 35 years (range 4-55 years);

all patients reported profound and prolonged fatigue, lasting

for a median of 3 years (range 6 months-10 years), preceded or

accompanied at appearance by fever in 185 cases, and

neuropsychologic problems including inability to concentrate,

difficulty in thinking, confusion, irritability,

forgetfulness, and depression. The fatigue was so severe that

it required 102 patients to stop their working activities for

a period of time ranging from 3 months to 2 years (range 7

months). In 40 consecutive patients a comprehensive

immunologic testing by single and two-colour flow cytometry

was performed and results compared with a group of 35 healthy,

age- and sex-matched controls.

Whilst no significant differences were found in the

absolute numbers of circulating total T cells (CD3+) and of

total helper/inducer (CD4+) or suppressor/cytotoxic (CD8+) T

cells, an evident reduction in CD3-/CD16+ and CD57+/CD56+ NK

lymphocytes along with an expansion of the CD8+/CD56+ and

CD16-/CD56+ NK subsets, were found in the CFS group. In

addition, CD56+ NK cells from CFS subjects were found to

express an increased amount of cell adhesion molecules (CD11b,

CD11c, CD54) and activation antigens (CD38). Both the

percentage and absolute numbers of CD4+ T cells bearing the

CD45RA antigen appeared significantly reduced in CFS patients,

and CD4+ T lymphocytes from CFS subjects displayed an

increased expression of the intercellular adhesion molecule-1

(ICAM-1/CD54). Finally, the total numbers of circulating

(CD19+) B lymphocytes, were significantly higher in CFS cases

than in controls, and in 11 out of 30 CFS patients the

increase in circulating B cells was sustained by the expansion

of the CD5+/CD19+ subset of B lymphocytes. We conclude that

CFS is a syndrome not previously described in Italy, with

already known clinical characteristics and appears to be

associated with several immunologic abnormalities, including

those reported previously in cohort of patients from different

countries. We also show for the first time that CD56- NK cell

subsets from CFS patients display an abnormally increased

expression of cell adhesion molecules and activation markers.

Tirelli U, Marotta G, Improta S, Pinto A

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