The Banbury Center Workshop

Cold Spring Harbor Laboratory
February 23-26, 2003

During February 23-26, 2003, the Centers for Disease Control and Prevention (CDC) and the CFIDS Association of America cosponsored a meeting, Towards Understanding of Cellular and Molecular Mechanisms of Medically Unexplained Fatigue, at the Banbury Center, Cold Spring Harbor Laboratory, New York.

The objective of the meeting was to identify gaps in current approaches to the study of medically unexplained fatigue. In particular, will further progress require paradigm shifts, new technologies, or simply more work in currently established directions?

The first morning focused on chronic fatigue and the state of the science. Presentations and discussion reviewed the spectrum of ailments in medically unexplained fatiguing illnesses, the magnitude of medically unexplained fatigue as a public health problem, cognitive behavioral and emotional factors in chronic fatigue, neuroendocrine perturbations in chronic fatigue, and acute infection-immunologic perturbations and chronic fatigue. The afternoon session was concerned with influences on the structure and function of the brain. Presentations covered the relevance of cerebral perfusion and neurometabolic-synaptic activity to CFS, regulation of the neurohypophyseal system, communication between the brain and the immune system, and immunologic stress, the brain, and CFS.

The second day began with a session on infection, immunity, sex, and the brain. There were presentations and discussion concerning neuroendocrine regulation of immunity, maternal infection, fetal brain development and health, chronic consequences of persistent infection, and immunity. This was followed by a series of talks and discussion on analytical approaches searching for markers applicable to medically unexplained fatigue. This encompassed what psychopharmacology tells us about the pathophysiology of medically unexplained fatigue, biomarker discovery in illness with no lesion, sex (male vs. female) as a determinant of disease, and microchimerism.

The third day involved discussion of presentations and preparation of a report on future research directions to better understand the cellular and molecular mechanisms of medically unexplained fatigue.

Meeting Participants

Invited participants included:

• Jack C. de la Torre
  University of California, San Diego, CA
• Birgitta Evengard
  Karolinska Institute, Stockholm, Sweden
• Carol M. Artlett
  Thomas Jefferson University, Philadelphia, PA
• Anthony J Cleare
  Guy's King's and St Thomas' School of Medicine, London, UK
• Mary Ann Fletcher
  University of Miami School of Medicine, Miami, FL
• Eleanor Hanna
  National Institutes of Health, Bethesda, MD
• Leonard A. Jason
  DePaul University, Chicago, IL
• Kevin D. Karem
  CDC, Atlanta, GA
• Andrew Lloyd
  University of New south Wales, Sydney, Australia
• Ian Hickie
  St George Hospital, Sydney, Australia
• James F. Jones
  National Jewish Medical and Research Center, Denver, CO
• Kimberly Kenney
  CFIDS Association of America, Charlotte, NV
• Steven F. Maier
  University of Colorado, Boulder, CO
• Andrew H. Miller
  Emory University, Atlanta, GA
• Rosane Nisenbaum
  CDC, Atlanta, GA
• Paul H. Patterson
  California Institute of Technology, Pasadena, CA
• Mangalathu Rajeevan
  CDC, Atlanta, GA
• Sharon Shriver
  Penn State University, University Park, PA
• Esther M. Sternberg
  National Institutes of Health, Bethesda, MD
• Dimitris Papanicolaou
  Emory University, Atlanta, GA
• Charles L. Raison
  Emory University, Atlanta, GA
• William C. Reeves
  CDC, Atlanta, GA
• Celia D. Sladek
  University of Colorado Health Sciences Center, Denver, CO
• Elizabeth R. Unger
  CDC, Atlanta, GA
• Suzanne Vernon
  CDC, Atlanta, GA
• Simon Wessely
  Institute of Psychiatry, London, UK
• Peter D. White
  St. Bartholomew's Hospital, London, UK
• Ute Vollmer-Conna
  University of New South Wales, Sydney, Australia
• Toni Whistler
  CDC, Atlanta, GA