In the Press

Researchers identify biomarkers associated with chronic fatigue syndrome severity

Stanford investigators used high-throughput analysis to link inflammation to chronic fatigue syndrome, a difficult-to-diagnose disease with no known cure.

Researchers at the Stanford University School of Medicine have linked chronic fatigue syndrome to variations in 17 immune-system signaling proteins, or cytokines, whose concentrations in the blood correlate with the disease’s severity.

The findings provide evidence that inflammation is a powerful driver of this mysterious condition, whose underpinnings have eluded researchers for 35 years.

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Study finds brain abnormalities in chronic fatigue patients

Radiology researchers have discovered that the brains of patients with chronic fatigue syndrome have diminished white matter and white matter abnormalities in the right hemisphere.

Michael Zeineh and his colleagues studied the brains of patients with chronic fatigue syndrome and healthy people, and found distinct differences between the two groups.
Norbert von der Groeben

An imaging study by Stanford University School of Medicine investigators has found distinct differences between the brains of patients with chronic fatigue syndrome and those of healthy people.

The findings could lead to more definitive diagnoses of the syndrome and may also point to an underlying mechanism in the disease process.


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Stanford's Dr. Jose Montoya on Chronic Fatigue Syndrome

Stanford Health Library presents a talk featuring Dr. Jose Montoya, one of the world's leading specialists on chronic fatigue syndrome (CFS). CFS is a disorder which causes extreme fatigue that is unchanged with rest, and interferes with one's ability to attend to daily activities.

This talk features discussion about CFS and current research regarding diagnosis and treatment, and the possible CFS-infection connection.

Speaker: Jose G. Montoya, MD, Associate Professor of Medicine, Division of Infectious Diseases.

Watch this YouTube video featuring Dr. Montoya (1 hour, 13 minutes):

Demystifying chronic fatigue syndrome

Ruthann Richter on November 8, 2017

For years, infectious disease expert Jose Montoya, MD, has been frustrated by the mysteries of chronic fatigue syndrome (also known as myalgic encephalomyelitis) and the unexplainable and often debilitating symptoms of the many patients who come through his clinic at Stanford. But earlier this year, Montoya’s perseverance was rewarded and his optimism soared following a seven-year study he led that showed that the disease has a clear link to 17 immune system proteins, including 13 proteins that are pro-inflammatory.

This proved what scientists had suspected — that inflammation is the prime driver behind the disease, which affects between one and four million people, often with devastating effects. When the finding first came to light, Montoya told me he was “ecstatic.”

Scientists Edge Closer To Elusive Lab Test For Chronic Fatigue Syndrome

By Miriam E. Tucker

July 31, 2017

Imagine feeling horribly sick, day after day, yet doctors repeatedly tell you they can't find anything wrong. That typically happens to people with the mysterious illness commonly known as chronic fatigue syndrome. Research findings from Stanford University released Monday could point the way to a long-sought diagnostic laboratory test for the condition, and possibly a first-ever treatment.

Believed to affect at least a million people in the U.S., the condition is now increasingly termed myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS for short.

Many patients see the name "chronic fatigue syndrome" as trivializing and misleading, giving the impression that they're simply tired or depressed. In fact, they're experiencing profound exhaustion that isn't relieved with sleep, flu-like symptoms, muscle pain, "brain fog" and various other physical symptoms, all of which characteristically worsen with even minor exertion. (A 2015 Institute of Medicine report proposed the name "systemic exertion intolerance disease," but it hasn't really stuck.)

Read more: NPR's Health News

Stanford discovery: Biomarkers linked to Chronic Fatigue Syndrome

Evidence could lead to test for mysterious condition

By Lisa M. Krieger 

A new Stanford study has identified biomarkers linked to the severity of chronic fatigue syndrome, offering evidence that inflammation is a powerful driver of this mysterious disease, long dismissed as a psychological condition.

The team, led Dr. Jose Montoya of Stanford University School of Medicine, found that varying concentrations of 17 immune-system signaling proteins, or cytokines, in the blood correlate with the disease’s severity.

The underpinnings of the disease have eluded researchers for 35 years. Patients experience debilitating fatigue, often unable to walk, talk or even eat.

Read more: Take me to Mercury News

Is This Why You're Still So Tired?

Chronic fatigue syndrome finally gets its due.

By Cheryl Platzman Weinstock

Eight years ago, Ann Cavanagh Kramer was promoted to director of commercial sales at Visa. She transferred across the country to work at the company's San Francisco Bay Area office and spent the next six months traveling to attend conferences and meet potential clients. She was, in her own words, "at the top of my game." But after running a half marathon in October 2007, she suffered back-to-back viral infections. Then she began experiencing dizzy spells and fatigue so intense, she'd sleep for 15 to 16 hours a day. "When I wasn't working, I was sleeping," says Cavanagh Kramer, 38. She thought she might have a sinus infection, bronchitis, or the flu. Or maybe pneumonia. "No one could figure out what was wrong with me."

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Is chronic fatigue syndrome finally being taken seriously?

Once dismissed by many doctors as a psychological illness, new research suggests CFS has its roots in infection – and there is hope of successful treatment

By David Cox

Jose Montoya was a trainee doctor when his supervisor told him that if he continued specialising in treating chronic fatigue syndrome (CFS), he would end up homeless. “About 15 years ago, I started working with 10 patients who’d had their lives devastated by this illness,” says Montoya, now a professor at Stanford University and one of the world’s leading experts on the disease. “I had been able to help them, so I took my results to my academic mentor and he told me: ‘You are committing academic suicide. You’re turning your career into a mess.’”

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Chronic fatigue syndrome is a physical disorder,
not a psychological illness, panel says

By Lenny Berstein

Chronic fatigue syndrome is a "serious, debilitating" condition with a cluster of clear physical symptoms — not a psychological illness — a panel of experts reported Tuesday as it called for more research into a disease that may affect as many as 2.5 million Americans.

"We just needed to put to rest, once and for all, the idea that this is just psychosomatic or that people were making this up, or that they were just lazy," said Ellen Wright Clayton, a professor of pediatrics and law at Vanderbilt University, who chaired the committee of the Institute of Medicine, the health arm of the National Academy of Sciences.

Read more at The Washington Post

Stanford leads fight against chronic fatigue

Kelsey Vischer spent much of her teen years playing sports and performing in an Irish dance troop. But on the verge of leaving for college, her active life suddenly came to a screeching halt. That's when a case of mono evolved into a grueling battle against exhaustion.

"I couldn't get off the couch. My dad had to pick me up off the couch and carry me to the bathroom. It was very intense," Kelsey remembers.

Kelsey was finally directed to Jose Montoya, M.D., at Stanford's Chronic Fatigue clinic.
The clinic is dedicated to treating a condition that skeptics have challenged as not being a real disease.


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New technology could help doctors ID chronic fatigue syndrome in patients

By Cheryl Jennings

Endurance was never a problem for Ann Kavanagh-Kramer. For years she competed in long-distance runs from California to Europe.

Then, at age 30 her health suddenly changed.

"That was the hardest time, when I couldn't get out of bed," Kavanagh-Kramer said. "At times I was crawling to use the bathroom." 

She went from doctor to doctor for months searching for the cause of her fatigue. Without a diagnosis she would eventually undergo a battery of tests just to prove she was sick-enough to be placed on disability.

"I was called a hypochondriac in the early days. I was told I needed to go to physical therapy," she said.

Cavanaugh-Kramer finally turned to doctor Jose Montoya at Stanford's Chronic Fatigue Clinic. He diagnosed her condition as chronic fatigue syndrome, or CFS. 


Read more on ABC 7's newspage

Fatigue syndrome validated by influential group

By Erin Allday

Chronic fatigue syndrome is a real disease that can devastate patients’ lives, leaving them bed-bound and barely able to think clearly, and it requires serious treatment and speedy diagnosis, according to a report released Tuesday by the influential and widely respected Institute of Medicine.

The report also suggested a new name for the syndrome: systemic exertion intolerance disease. Patients with the disease and medical experts were skeptical of the name, but many otherwise heralded the long-anticipated report.

“The Institute of Medicine was able to come out and say this is real, it’s chronic and it devastates many lives,” said Dr. Jose Montoya, an infectious disease specialist who helped establish a chronic fatigue syndrome team at Stanford University a decade ago. “For 30 years very few voices were saying that and people were not listening. And now here comes an institute with such visibility and clout, saying those words.”

The report “has the potential to change the narrative of this disease,” Montoya said.


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Chronic fatigue patients frustrated with FDA

By Erin Allday

Jeannette Burmeister lives in Incline Village, Nev., where, twice a week, she gets a three-hour infusion of a drug to treat chronic fatigue syndrome that she says has very nearly saved her life.

But it comes at a steep price: Burmeister's husband and her 2-year-old daughter live more than 200 miles away in Menlo Park, and she's able to see them only once a week. Because the drug she says she needs - an experimental medication called Ampligen - isn't approved by the Food and Drug Administration, the only way she can get it is through a clinical trial run by a doctor in Nevada.

And as of this month, when the FDA officially refused to approve Ampligen for treatment of chronic fatigue, she's not sure how much longer she'll be able to get the drug.


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Is chronic fatigue syndrome an inflammatory disease?

By Maria Cohut — Published Tuesday, 1 August 2017

Chronic fatigue syndrome, or myalgic encephalomyelitis, has been controversial for years, as specialists have not been able to glean much of an insight into its causes. Now, a new study suggests that the condition is an inflammatory disease.

New research investigates the links between chronic fatigue syndrome and inflammation.

Chronic fatigue syndrome (CFS), sometimes known as myalgic encephalomyelitis (ME), is a condition that has been puzzling specialists for years, many of whom have been struggling to identify its causes and devise an appropriate treatment. Some, however, have deniedCFS/ME's legitimacy due to wide-ranging symptoms that make it hard to diagnose.

Characterized by often debilitating fatigue, and sometimes accompanied by pain and difficulties in retaining focus, CFS/ME affects between 836,000 and 2.5 million people in the United States, according to the Centers for Disease Control and Prevention (CDC).


New Recognition for Chronic Fatigue

By Jane E. Brody — Published Nov. 27, 2017

Having recently endured more than a month of post-concussion fatigue, I can’t imagine how people with so-called chronic fatigue syndrome navigate through life with disabling fatigue that seemingly knows no end. Especially those who are erroneously told things like “It’s all in your head,” “Maybe you should see a psychiatrist,” or “You’d have a lot more energy if only you’d get more exercise.”

After years of treating the syndrome as a psychological disorder, leading health organizations now recognize that it is a serious, long-term illness possibly caused by a disruption in how the immune system responds to infection or stress. It shares many characteristics with autoimmune diseases like rheumatoid arthritis but without apparent signs of tissue damage.

Accordingly, doctors now typically refer to it as myalgic encephalomyelitis, meaning brain and spinal cord inflammation with muscle pain, and in scientific papers it is often written as ME/CFS. At the same time, a major shift is underway as far as how the medical profession is being advised to approach treatment.


A reboot for chronic fatigue syndrome research

Research into this debilitating disease has a rocky past. Now scientists may finally be finding their footing.

By Amy Maxmen — Published January 3, 2018

Name a remedy, and chances are that Elizabeth Allen has tried it: acupuncture, antibiotics, antivirals, Chinese herbs, cognitive behavioural therapy and at least two dozen more. She hates dabbling in so many treatments, but does so because she longs for the healthy days of her past. The 34-year-old lawyer was a competitive swimmer at an Ivy-league university when she first fell ill with chronic fatigue syndrome, 14 years ago. Her meticulous records demonstrate that this elusive malady is much worse than ordinary exhaustion. “Last year, I went to 117 doctor appointments and I paid $18,000 in out-of-pocket expenses,” she says.

Dumbfounded that physicians knew so little about chronic fatigue syndrome — also known as myalgic encephalomyelitis or ME/CFS — Allen resolved several years ago to take part in any study that would have her. In 2017, she got her chance: she entered a study assessing how women with ME/CFS respond to synthetic hormones.

Value of Circulating Cytokine Profiling During Submaximal Exercise Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome


Blood markers of chronic fatigue syndrome could pave the way to a diagnostic test

By Catherine Caruso — Published July 31, 2017

In an effort to find the cause of chronic fatigue syndrome, researchers have identified 17 immune molecules whose concentrations in patients’ blood correlate with disease severity.

Why it matters:

Chronic fatigue syndrome (CFS) is poorly understood and notoriously difficult to diagnose or treat, and some medical professionals question whether it is psychological or biological in nature. One area of research has been cytokines — molecules the immune system uses to communicate while combating foreign invaders in the body.

“For many years medical scientists have speculated that the symptoms of CFS might be caused by cytokines,” said Dr. Anthony Komaroff, a physician at Brigham and Women’s Hospital not involved in the study. “Past studies have shown high levels of many cytokines in people with CFS, but it was not clear that these high levels were causing symptoms.”

The nitty-gritty:

Dr. Jose Montoya, an infectious disease specialist at Stanford University, and his colleagues looked at cytokines in the blood serum of 192 people with CFS and 392 healthy controls. They deployed a system called Luminex, which used a combination of microbeads filled with cytokine-capturing antibodies and lasers to pull out 51 different cytokines from serum samples and quantify how much of each cytokine was present.

Molecular profile hints at inflammatory processes in chronic fatigue

By Lisa Rapaport — Published July 31, 2017

(Reuters Health) — People with severe symptoms of chronic fatigue syndrome have a molecular signature in their blood made up of 17 immune system signaling molecules that are elevated, which may provide insight into how inflammation contributes to the mysterious condition.

Inflammation is the immune system’s response to injuries and illnesses. The study identified variations in molecules known as cytokines that are responsible for sending messages and sounding an alarm, including several that can trigger inflammation.

Chronic fatigue syndrome can involve years of crippling pain and exhaustion, but is a controversial diagnosis because patients can’t take a test to prove they have it. The current study results build on earlier experiments linking inflammation to the condition and might one day help create a blood test to diagnose it or lead to effective treatments, researchers say.

“What is at stake here is ‘proof of concept’ that this disease is real,” said lead study author Dr. Jose G. Montoya of Stanford University School of Medicine in California.

“Patients have been humiliated, ostracized, and ignored,” Montoya said by email.

Millions of people worldwide, including more than 1 million in the U.S. alone, suffer from chronic fatigue syndrome, the researchers note in the Proceedings of the National Academy of Sciences.