31. januar 2005 

http://www.separationsnow.com/basehtml/SepH/1,1353,6-5-7-0-44997-ezine-0-1,00.html

http://www.separationsnow.com/basehtml/SepH/1,,6-5-7-0-44997-ezine-0-4,00.html


Towards the accurate diagnosis of Gulf War Illness

Gulf War Illness shares many symptoms with chronic fatigue syndrome and
fibromyalgia syndrome that render accurate diagnoses difficult. All three
conditions are considered to be autonomic nervous system disorders, so might
induce changes in cerebrospinal fluid, which a preliminary proteomics study
has attempted to establish.

For many years following the 1990-1991 Gulf conflict, service veterans and
support staff complained of a broad range of symptoms that include chronic
fatigue, diarrhoea, migraines, dizziness, memory problems, loss of muscle
control and loss of balance. These were collectively classed as Gulf War
Syndrome (now more generally referred to as Gulf War Illness) but it was not
officially recognised as an illness. This despite the fact that about
700,000 US veterans alone have experienced undiagnosed illnesses, according
to reports from the General Accounting Office.

Numerous environmental and medical causes were cited for these illnesses, as
summarised in a CNN report. Tents and equipment were regularly sprayed with
pesticides and some service personnel wore pesticide strips on their legs.
Smoke and particles from oil well fires and infectious diseases are also
implicated. Troops were given a cocktail of drugs (anti-viral, anti-chemical
warfare, anti-biological warfare, and anti-parasite agents) that are safe
when taken individually but may not be safe when taken together. In
addition, the Pentagon revealed that thousands of US troops may have been
exposed to low-level doses of the nerve gas sarin when an Iraqi ammunition
depot was blown up.

In short, there are probably a number of factors involved. In 1999, the BMJ
reported the consensus that there is no GWS, because the various medical
conditions do not constitute a single illness. However in July 2004, the
National Gulf War Resource Center announced that GWS has been officially
confirmed as a disease.

Despite this bureaucratic recognition, problems remain with diagnosis. The
symptoms are extremely similar to those of chronic fatigue syndrome (CFS)
and fibromyalgia syndrome (FS), two related but distinct conditions.
Fibromyalgia syndrome is a chronic condition of widespread pain and profound
fatigue, and its underlying causes remain a mystery. Chronic fatigue
syndrome is exactly what it seems, a long-term fatigue from which there is
little respite and, again, no known cause.

All three conditions could be considered to be sensory and central nervous
system disorders, in which case, they may be characterised by changes in the
cerebrospinal fluid. A five-centre research study (see links below) has
compared the protein profiles from sufferers of GWI with those from CFS/FS
patients, classing CFS and FS as one condition. The preliminary results were
reported in a poster (ThPU 437) at the 52nd ASMS Annual Conference on Mass
Spectrometry and Allied Topics held in Nashville, TN in 2004, by Begona
Casado from the Department of Medicine at Georgetown University, Washington,
DC.

Proteins were extracted and analyzed by classical proteomics techniques.
After precipitation of the high-molecular-weight proteins from CSF, they
were digested with trypsin and analyzed by LC/MS/MS with electrospray
ionisation on a time-of-flight mass spectrometer. The raw data were searched
against protein databases. Naturally, many proteins were common to the CSF
from all types and controls, but some striking differences were also
detected.

Only fluid from the healthy patients contained the transthyretin
stabilisation protein, a key factor in amyloidogenesis. For GWI, unique
proteins were detected that were absent from the other conditions, including
chromogranin B and pigment epithelium-derived factor, which is considered a
marker for idiopathic low back pain. The CFS and FS samples contained 19
unique proteins, including angiotensinogen, antithrombin III and amyloid
protein. The most interesting proteins common to all illness groups included
ferroxidase and complement component 4A, as well as proteins associated with
pain and antioxidant functions.

So, although the causes of the three conditions are obscure, the
identification of apparently specific protein markers could lead to easier
diagnosis. In the case of GWI, special care has to be taken, since there are
so many different potential chemical and medical sources that biomarkers may
turn out to be related to only one source and not generally applicable to
the disease as a whole.