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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


[Ed. Note: We have heard from dozens and dozens of our members who have taken advantage of
the testing.  All, thus far, have been positive.]

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