PULLMAN, Wash. — An article in a recent issue of the journal Medical
Hypotheses by Washington State University biochemist Martin Pall suggests
a cause for chronic fatigue syndrome. In the article, “Elevated, Sustained
Peroxynitrite Levels as the Cause of Chronic Fatigue Syndrome,” Pall cites 11
different types of evidence to support his theory.

Pall’s theory suggests that a short-term stress, for example, infection, chemical
exposure or even physical or psychological trauma, can act to trigger a vicious
cycle that continues long after the stress is gone. The biochemistry of the
cycle centers on a potent oxidant, peroxynitrite, that is known to produce
several kinds of tissue and cell damage, including damage to the mitochondria
in cells that produce energy. Pall proposes that peroxynitrite acts in six
different positive feedback loops that, through a series of reactions of its
chemical precursors, succeeds in maintaining an excessive level of itself in the
body.

“Perhaps the most important part of this theory is that it suggests nine
different approaches to treatment, some using conventional drugs, some using
nutritional supplements and some using still experimental drugs,” said Pall. “A
number of these have been used by CFS patients and by physicians with some
apparent success.” The goal of the treatment is to reduce the damage caused
by the peroxynitrite and break the chemical cycle.

Pall is working with Dr. Albert G. Corrado of Richland on a pilot study of a
group of CFS/fibromylagia patients who are using a combination of 14
nutritional supplements to treat their diseases. “The trial is not placebo
controlled or double blinded because we have no funding to support such a
trial,” said Pall. “The two of us are donating our time and expenses, and the
patients are purchasing their own supplements. The assessment at the end of
the trial will be based on self-assessment by the patients involved. If we
receive sufficient favorable responses, it is our hope to obtain funding for a
properly controlled trial. I am interested in talking to physicians who may wish
to be involved in such a trial.”

Chronic fatigue syndrome, which affects some 800,000 people in the United
States, has been a puzzling disease with no adequate explanation for its
chronic nature and the complexity and variability of its symptoms, according to
Pall, who has himself recovered from a case of CFS.

“I believe that the elevated peroxynitrite theory provides attractive
explanations for the characteristics of CFS and, as a theory for which there is
substantial experimental support, is worthy of future study,” he said. “Most
importantly, it offers a fruitful way of looking at the disease and suggests
many different approaches to treatment. Because of its complexity, it is my
feeling that no single available approach to treatment will be completely
effective but that a combination may be.”

Pall also has received a grant from the Air Force Office for Scientific Research
to do related work on components of blood that may be changed by the
proposed biochemical mechanism. “The Air Force has an interest in the
research because many Gulf War veterans suffer from CFS,” said Pall. Last
year HealthComm International, a group founded to educate physicians on
new approaches to medical knowledge, named Pall “clinician of the month” for
the development of his theory.

Pall can be reached at pall@mail.wsu.edu or 509/335-1246.

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