Chronic Fatigue– in the Department of Medicine

Current Research Projects

  1. Detection of pathogens such as herpes viruses, the Lyme disease agent, xenotropic murine leukemia virus-related virus (XMRV), Toxoplasma gondii, or any unknown pathogen that may be a trigger for chronic diseases such as CFS, CLD or other diseases. We are looking for such pathogens in a broad population of CFS patients at Stanford and comparing the findings to age- and sex-matched controls. Towards this aim we are collaborating with Manisha Desai, PhD, clinical associate professor of medicine, and Holden Maecker, PhD, director, Human Immune Monitoring Core, here at Stanford, and W. Ian Lipkin, MD, Director, Center for Infection & Immunity, John Snow Professor of Epidemiology, and Professor of Neurology and Pathology, and Mady Hornig, MA, MD, Associate Professor of Epidemiology, at Columbia University in New York City. We have met our recruitment goal of over 600 study participants, and are in the process of testing our blood samples for numerous pathogens, both known and unknown.
  2. Gene Expression and Immune System Dynamics of Infection in Acute and Chronic Diseases. Our team is working on new studies to understand the immune response and possible immune dysfunction observed in our patients. We are looking at gene expression, cytokine profiles, and phospho immunoflow to learn whether our patients’ immune response correlates with the presence of an infectious agent, organism, or pathogen, and to identify new markers from the blood that may help predict changes in disease over time and response to changes in medication. Thus far, we have analyzed 51 cytokines in over 600 individuals. Towards these goals we are collaborating closely with the Human Immune Monitoring Core facility at Stanford, including Mark Davis, PhD, professor of medicine in the division of microbiology and immunology, and Holden Maecker, PhD

  3. Is qEEG Resting State Peak Alpha Activity in Chronic Fatigue Syndrome Patients Different than Healthy Controls? A Pilot Study of the Clinical Utility of PAF Measurement in CFS. Marcie Zinn, Ph.D, an experimental neuropsychologist, focuses her research on the cognitive neuroscience of cognitive dysfunction in our patients. Through this project, we are evaluating peak alpha frequency measurements of CFS patients and healthy controls. We hope that our efforts will lead to validated tests that will improve our capacity to diagnose cognitive impairment as well as to evaluate treatment interventions.

  4. Immune System Dynamics in Cardiovascular Disease. Francois Haddad, MD, clinical assistant professor of medicine in the division of cardiovascular medicine, is working with our patients using a sub-maximal effort exercise testing machine to find an objective method to assess fatigue and physical impairment. Additionally, Dr. Haddad and his team of cardiologists utilize a device which evaluates endothelial dysfunction. Ultimately, we hope to improve our diagnostic capability as well as better evaluate the effects of CFS on cardiovascular health.

  5. Review of Magnetic Resonance Venography (MRV) Images of the Cerebral Venous System of Patients with Chronic Fatigue Syndrome. In collaboration with Michael Dake, MD, professor of medicine in the division of cardiothoracic surgery, we are investigating the correlation between the symptoms associated with Chronic Fatigue Syndrome and abnormal cerebral venous drainage.
  6. Collaborating with the Neuroradiology department at Stanford to investigate the role of novel magnetic resonance imaging (MRI) techniques (e.g. using a 3T magnet) in the hope of discovering biomarkers in the brain for infection-associated CFS. These MRI tests are not available for routine clinical use. Scott Atlas, MD, professor of medicine in the division of radiology, and his neuroradiology fellows are helping us analyze preliminary imaging data to apply for an NIH grant to begin a larger study on neuroimaging in CFS patients. 
  7. Xenotropic Murine Leukemia Virus-Related Virus (XMRV) and Murine Leukemia Virus (MLV) in Patients with Chronic Fatigue Syndrome. Under the leadership of W. Ian Lipkin, MD, Director, Center for Infection & Immunity, John Snow Professor of Epidemiology, and Professor of Neurology and Pathology at Columbia University, we engaged in a National Institutes of Health (NIH) funded, multi-site study analyzing the prevalence of XMRV and MLV in CFS patients. Results have recently been published. A multicenter blinded analysis indicates no association between chronic fatigue syndrome/myalgic encephalomyelitis and either xenotropic murine leukemia virus-related virus of polytropic murine leukemia virus. (please note this link will direct you to a webpage unaffiliated with Stanford University)

Recent Publications

  1. Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein-Barr virus IgG antibody titers. Watt T, Oberfoell S, Balise R, Lunn MR, Kar AK, Merrihew L, Bhangoo MS, Montoya JG. J Med Virol. 2012 Dec;84(12):1967-74. doi: 10.1002/jmv.23411. PMID: 23080504 [PubMed - in process]
  2. A Multicenter Blinded Analysis Indicates No Association between Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and either Xenotropic Murine Leukemia Virus-Related Virus or Polytropic Murine Leukemia Virus. Alter HJ, Mikovits JA, Switzer WM, Ruscetti FW, Lo SC, Klimas N, Komaroff, AL, Montoya JG, Bateman L, Levine S, Peterson D, Levin B, Hanson MR, Genfi A, Bhat M, Zheng H, Wang R, Li B, Hung GC, Lee LL, Sameroff S, Heneine W, Coffin J, Hornig M, Lipkin WI. MBio. 2012 Sep 18;3(5). pii: e00266-12. doi: 10.1128/mBio.00266-12. Print 2012. PMID: 22991430 [PubMed - in process]
  3. Antiviral therapy of two patients with chromosomally-integrated human herpesvirus-6A presenting with cognitive dysfunction. Montoya JG, Neely MN, Gupta S, Lunn MR, Loomis KS, Pritchett JC, Polsky, B, Medveczky PG. J Clin Virol. 2012 Sep;55(1):40-5. doi: 10.1016/j.jcv.2012.05.016. Epub 2012 Jul 5. PMID: 22770640

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