Dr C Little , Mr. George Georgiou 
1 324 Stephensons Road Mt Waverley, 3149 Vic
2 C/- of Department of Immunology
Royal Children's Hospital,
Flemington Road, Parkville, 3052
TheTGFß, T-Cell Immunoproteins and CFS
A number of studies have suggested immune abnormalities in CFS. Although there is no consensus on the issue, there is evidence to indicate immune activation but also impaired cell mediated immunity and reduced activity and numbers of natural killer cells. There are also variable reports of abnormalities of cytokine production, including of TNFa and TGFb.
The symptoms of CFS suggest the possibility of functional disturbances in the CNS. It is unclear as to the extent of which these alterations are due to identifiable biological processes. However, it is possible that at least in some cases of CFS, immune activation is occurring with effects on the central nervous system. If immune processes are activated in such cases, possible incitants include not only micro-organisms, but also environmental exposures including ingestants (i.e. foods) and airborne exposures such as chemicals and moulds. In some respects the symptoms of CFS resemble those reported in the disorders where immune processes are activated, for example, infectious diseases.
There are reports of patients developing symptoms typical of CFS following the ingestion of certain foods. In addition, there are similarities between symptoms described in patients with the controversial entity, chemical sensitivity, and CFS. Although well described immune process such as delayed hypersensitivity and IgE antibody production do not appear implicated in reactions to foods and chemicals in patients with CFS, there may be other possibilities.
Patients sensitive to foods/chemicals have been studied who develop symptoms resembling CFS on exposure. In a group of milk-intolerant patients, raised levels of IgG and TABM (T-cell antigen binding molecules) were found against three milk proteins. In a group of patients assessed as sensitive to solvents, there were raised levels of TABM, but not IgG, to benzoic acid conjugated to human serum albumin.
TABM are thought to play an important role in the suppression of cell mediated immunity and may accompany humoral immune response. Preliminary work indicates that these molecules are antigen specific and linked to immuno-suppressive cytokines, particularly TGFb. In sensitive patients, TABM may serve to concentrate cytokines such as TABM to where antigen is localized. These local concentrations of cytokines may affect local tissue function and perhaps central nervous system function.
Preliminary work in animals has shown that TGFb acts on afferent nerve endings to modulate the release of neuro-peptides such as substance P. It is proposed that TABM specific for environmental antigens may be implicated in symptom production in some patients with CFS.
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