"Imagine feeling horribly sick day after day yet doctors repeatedly tell you they cant 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 longsought diagnostic laboratory test for the condition and possibly a firstever treatment. Believed to affect at least a million people in the U.S. the condition is now increasingly termed myalgic encephalomyelitischronic fatigue syndrome https or MECFS for short. Many patients see the name chronic fatigue syndrome as trivializing and misleading giving the impression that theyre simply tired or depressed. In fact theyre experiencing profound exhaustion that isnt relieved with sleep flulike symptoms muscle pain brain fog and various other physical symptoms all of which characteristically worsen with even minor exertion. A  Institute of Medicine report http proposed the name systemic exertion intolerance disease but it hasnt really stuck. Article continues after this message from our sponsor The symptoms can range from mild to extremely severe with about a quarter of patients so ill theyre mostly or completely confined to bed. Now the Stanford researchers have linked MECFS to variations in certain cytokines http immunesignaling proteins that track with illness severity. The study results http were published online Monday in the the Proceedings of the National Academy of Sciences. The link to gradation in severity rather than simply seeking a positive versus negative result represents a new approach to the search for biological markers for the illness. The study involved  MECFS patients and  healthy controls matched for age and sex. Out of  cytokines investigated via sophisticated fluorescencebased testing https only two of the cytokines differed in their total concentrations between the MECFS and control groups. But levels of  of the cytokines varied dramatically between the patients with mild versus severe MECFS symptoms. Of those  cytokines  were types that promote inflammation. This is significant because symptoms in these patients and findings from other studies also suggest that chronic inflammation plays a major role in the illness. This is a field that has been full of skepticism and misconception where patients have been viewed to have invented their disease. These data clearly show the contrary and demonstrate what can be achieved when we couple good research design with new technology lead author Dr. Jose Montoya httpsprofiles.stanford.edujosemontoya professor of infectious diseases at Stanford tells Shots. According to Dr. Anthony L. Komaroff httpsconnects.catalyst.harvard.eduProfilesdisplayPerson a Harvard internist and epidemiologist who has written a commentary to accompany the study For many years medical scientists have speculated that the symptoms of MECFS might be caused by cytokines molecules that the immune system use to wage war against foreign invaders of the body. Past studies have shown high levels of many cytokines but it was not clear that these high levels were causing symptoms. What the latest research shows Komaroff tells Shots is that levels of many cytokines do correlate with symptoms The higher the blood level the worse the symptoms. That supports the theory that the cytokines are a cause of the symptoms. So why do routine lab tests that doctors order often come back negative or not informative in MECFS patients Simply put Montoya says those tests arent measuring the right things. Two classic laboratory measures of inflammation are sedimentation rate  the ability of red blood cells to clump together which isnt a factor in MECFS  and Creactive protein which reflects levels of a single cytokine that wasnt one of those linked to severity in this study. Inflammation is much more complicated than two imperfect old measures Montoya says. Were showing an inflammation that has not been seen before. The multidisciplinary Stanford team is now working on developing a panel that could be used commercially that would test for around five of the  cytokines and would likely involve the doctor first classifying patients by severity in order to interpret the results. Such a test could both establish the diagnosis and serve to monitor patients responses to treatment. Whats more the findings also point to possible treatment with immunemodifying or antiinflammatory therapy. Montoya hopes that by publishing these findings a team of researchers somewhere in the world will see these cytokines and say they have the drug for that inflammation. We hope drug companies will pursue it. Indeed a major drug trial is now being conducted in Norway investigating whether the immunemodifying drug rituximab alleviates MECFS symptoms after preliminary studies httpjournals.plos.orgplosonearticleid.journal.pone. suggested that it did in some patients. Interestingly the drug is approved to treat certain autoimmune diseases and also nonHodgkin lymphoma a cancer that one study found uniquely occurs at a higher rate https among older people with MECFS. Komaroff also notes a recent increase in research funding https by the National Institutes of Health which has included a comprehensive inhouse study http aimed at unraveling the underlying causes of the condition. And in an ongoing privately funded study Stanford geneticist Ron Davis httpsmed.stanford.eduprofilesronalddavistabbio and a team including three Nobel laureates https is taking a similar big data approach https to investigate a group of MECFS patients who are all severely ill including Davis own adult son. There is much to learn Komaroff writes in the journal. Hopefully a decade from now doctors will know better what to measure and more importantly what to do to ease the suffering caused by this illness."