| The Ciguatera Epitope: So
What Do We Really Know Thus Far? by Alan Cocchetto Copyright © 2003 Let me start with the following: What do we really know at this time about the ciguatera epitope? Well, we do know that CFS patients test abnormal by three different scientific methods which include (A) Dr. Yoshitsugi Hokama's monoclonal antibody based ciguatera test (University of Hawaii Medical School); (B) Food and Drug Administration's (FDA) neuroblastoma test; (C) Competitive assay using the synthetic fragment of ciguatera. These together greatly assist in the identification of the toxin's structure, amount, and its unique characterization. In the Journal of Clinical Laboratory Analysis publication, available from our website on the Medical Breakthrough page or to our members by mail (see materials section in this issue), it was reported that 96% of CFS patients were identified as having abnormal amounts of ciguatera toxin! Furthermore, with this study, it certainly looks as though we are a rather cohesive bunch in terms of this test and that is great! Next, many have wondered what an epitope is? An epitope is a fragment of an antigen capable of specific antibody binding. The implications thus far are that the CFS serum lipids do resemble ciguatera in every test done to date. I am reminded of the old adage, if it looks like a duck and quacks like a duck, then it just might be a duck! But where to next? Well, the NCF has funded a research project aimed at identification and characterization of the CFS lipid that is reacting with the monoclonal antibody, "Purification and Biological Characteristics of the "Chronic Phase Lipid" in CFS, CCFP, and Other Diseases." This should prove to be very interesting and exciting work since therapeutic implications may be the direct result of this research effort! Next, has CFS really been associated with ciguatera poisoning? Well, see the references at the end of this article for consideration. However, one article eloquently points this out. From "CFS Following a Toxic Exposure" by Racciatti (2001), scientists examined many different subgroups of CFS and included ciguatera poisoning as a toxic cause of CFS. They found that these toxic patients had T-cell counts (CD4 - helper cells and CD8 - suppressor/cytotoxic cells) that were lower than those CFS patients who were considered post-viral CFS patients. Likewise toxic patients had much lower natural killer cell counts than post-viral patients and these toxic patients had much higher CD4/CD8 cell ratios than the post-viral patients as well. Quoting Racciatti's study "patients with a history of toxic exposure in fact showed a more severe dysfunction of the immune system in a statistically significant way" and so the "preliminary findings confirm the presence of a dysfunction of the immune system in CFS patients with a history of toxic exposure." Thus "CFS patients with a post-toxic exposure onset might represent a well defined CFS subgroup characterized by a specific immune dysfunction probably precipitated by the toxic exposure itself." I would have to say that this is certainly is agreement with numerous previous findings and medical observations. The NCF's ciguatera research discovery may aid in solidifying this hypothesis since 96% probably represents such a well defined CFS subgroup! Last of all, let me mention one other article for the naysayers out there. It is an article by Barton (1995) that also connects ciguatera poisoning to the development of CFS! But most of all, I can truly appreciate the article's contents from its title which is "Ciguatera Fish Poisoning: A Southern California Epidemic." Maybe it's time for the NCF's efforts to be taken seriously!!!!! (For a more detailed report, read "Current Summary of the NCF's Funded Research" in this issue.) References: Ting J, Brown A Ciguatera poisoning: A global issue with common management problems Eur J Emerg Med Dec; 8(4): 295-300, 2001 Racciatti D, Vecchiet J, Ceccomancini A, Ricci F, Pizzigallo E Chronic Fatigue Syndrome following a toxic exposure Sci Total Environ Apr 10; 270(1-3): 27-31, 2001 Chaudhuri A, Watson WS, Pearn J, Behan PO The symptoms of Chronic Fatigue Syndrome are related to abnormal ion channel function Med Hypotheses Jan; 54(1):59-63 , 2000 Chaudhuri A, Behan PO Neurological Dysfunction in Chronic Fatigue Syndrome Journal of Chronic Fatigue Syndrome 6(3-4): 51-68, 2000 Pearn J Differential Diagnosis: The Challenge of Chronic Fatigue Journal of Chronic Fatigue Syndrome 7(4): 17-31, 2000 Racciatti D, Barbeno A, Veechiet J, Pizzigallo E Clinical and Pathogenetical Characterization of 238 Patients of a Chronic Fatigue Syndrome Italian Center Journal of Chronic Fatigue Syndrome 5(3-4), 1999 Barton ED et al. Ciguatera Fish Poisoning: A Southern California Epidemic Western J Med 163(1): 31-34, 1995 Pearn J Ciguatera - A potent cause of the Chronic Fatigue Syndrome EOS J Immunol Immunopathol XV 1/2: 63-65, 1995 Gillespie NC, Lewis RJ, Pearn JH et al. Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management Med J Aust 145: 584-590, 1986
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