Proteomics of Cerebrospinal Fluid in Chronic Fatigue Syndrome
Condition: Chronic Fatigue Syndrome; Fibromyalgia; Gulf War Illness; Multiple Chemical Sensitivity; Interstitial Cystitis; Irritable Bowel Syndrome
MeSH terms: Fibromyalgia; Fatigue Syndrome, Chronic; Irritable Bowel Syndrome; Cystitis; Cystitis, Interstitial; Multiple Chemical Sensitivity; Syndrome; Fatigue
Study type: Observational

Summary: 
      The purpose of this study is:

        1. To identify specific set of proteins in the cerebrospinal fluid (fluid surrounding the
           brain and the spinal cord), that are believed to be seen in Chronic fatigue syndrome
           (CFS) patients, but not in healthy controls (HC). A similar study that the investigators
           had conducted before,suggested that significant changes in proteins in the cerebrospinal
           fluid may be due to the fundamental pathology of this disorder.

        2. Increased cerebrospinal fluid pressure (pressure that helps the cerebrospinal fluid to
           move around the brain and the spinal cord), may be related with certain symptoms like
           headache, sleep problems, light headedness, increased pain, excessive tiredness
           (fatigue) even with minimal work and memory problems.

        3. Assessment of Autonomic Nervous system function (Sympathetic nervous system)between the
           CFS and HC.

        4. Perform Lung Function Testing or pulmonary function test to estimate the lung capacities
           and score shortness of breath while performing breathing maneuvers.

        5. Dolorimetry (18 tender point test) for assessment of pain threshold.

        6. Capsaicin skin test

        7. Allergy skin test
    

Detailed description: 
      Neurological dysfunction is a key component of the clinical expression and case designation
      of chronic fatigue syndrome (CFS), fibromyalgia (FM)and other related conditions.If the
      central nervous system is involved, then evidence will be present in the cerebrospinal fluid.
      Distinct patterns of proteins will be present in Chronic fatigue syndrome (CFS) compared to
      healthy control (HC) subjects.

      Other testing in our study would include:

        1. a)Assessment of lung function and capacities. Additional interests are to assess the
           shortness of breath, lightheadedness, headache and chest tightness during the breathing
           maneuvers. The rationale for recording these symptoms is to understand the
           pathophysiology of sensory disturbances that are more noted in the CFS and Fibromyalgia
           group, but not in HC.

        2. Compare the blood pressure and heart rate response before and after hand grip exercise
           testing. This is a test to measure the Autonomic Nervous system function (Sympathetic
           nervous system).

        3. Skin tests like:

           i) Capsaicin skin test, to check for specific responses like burning sensation, area of
           skin redness, itchy sensation to varying doses of capsaicin (essence of chilli pepper),
           when placed on the forearm and to compare if there are any differences seen between the
           responses in CFS and Healthy controls.

           ii) Allergy skin test to look if there are any allergies that are seen in the set of CFS
           population.

        4. 18 tenderness point testing to compare the pain threshold before and after the lumbar
           puncture also know as the spinal tap. 18 tenderness point testing is a diagnostic test
           for Fibromyalgia.

        5. Many of the participants with CFS do have associated Migraine headaches and they
           complain of severe light and sound sensitivity. We are analysing those group of people
           and decision have to be made as to which medications would work at best, thus providing
           immediate relief from headache.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        1. Georgetown University Division of Rheumatology, Immunology and Allergy and other
             Divisions

          2. IRB-approved websites and support groups.

          3. IRB- approved advertisments

          4. Self-referral.
      
Biospecimen description: 
      Cheek swabs, on the right and left inner cheek. Others:Cerebrospinal fluid samples,Blood
      samples Urine samples.
    
Keywords: CFS,FM,CSF,Proteomics,Pain,Fatigue,GWI,IBS,IC,MCS.