title: Chronic fatigue syndrome and circulating cytokines: A systematic review.
abstract: There has been much interest in the role of the immune system in the pathophysiology of chronic fatigue syndrome (CFS), as CFS may develop following an infection and cytokines are known to induce acute sickness behaviour, with similar symptoms to CFS. Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines, a search was conducted on PubMed, Web of Science, Embase and PsycINFO, for CFS related-terms in combination with cytokine-related terms. Cases had to meet established criteria for CFS and be compared with healthy controls. Papers retrieved were assessed for both inclusionary criteria and quality. 38 papers met the inclusionary criteria. The quality of the studies varied. 77 serum or plasma cytokines were measured without immune stimulation. Cases of CFS had significantly elevated concentrations of transforming growth factor-beta (TGF-β) in five out of eight (63%) studies. No other cytokines were present in abnormal concentrations in the majority of studies, although insufficient data were available for some cytokines. Following physical exercise there were no differences in circulating cytokine levels between cases and controls and exercise made no difference to already elevated TGF-β concentrations. The finding of elevated TGF-β concentration, at biologically relevant levels, needs further exploration, but circulating cytokines do not seem to explain the core characteristic of post-exertional fatigue.
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Blundell
authors.affiliation: East London Foundation NHS Trust, London, United Kingdom.
authors.forename: K K
authors.initials: KK
authors.lastname: Ray
authors.affiliation: Barts Health Trust, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Buckland
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom. Electronic address: p.d.white@qmul.ac.uk.
authors.forename: P D
authors.initials: PD
authors.lastname: White
mesh_terms: D016207:Cytokines / Q000097:blood* / Q000276:immunology*; D015673:Fatigue Syndrome, Chronic / Q000097:blood* / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D016212:Transforming Growth Factor beta / Q000097:blood / Q000276:immunology
chemical_list: D016207:Cytokines; D016212:Transforming Growth Factor beta
keywords: Chemokine; Chronic fatigue syndrome; Cytokine; Immune system; Myalgic encephalomyelitis; Pathophysiology; Systematic review; Transforming growth factor-beta