What I Learned From My Article

Article: Neuroendocrine and Immune Contributors to Fatigue

Biology 1615 Lab


Jennifer Cunningham


July 17, 2014


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What I Learned From My Article
Because my father has Chronic Fatigue Syndrome, I have seen firsthand how it has affected
his life and our way of life, which drives my thirst to understand this disease. The authors define
Acute fatigue as a common protective mechanism of a healthy human body. In some individuals,
like my father, fatigue seems to be a plague, in which simple rest and lifestyle change does not
provide relief. Chronic fatigue (CF) is maladaptive or pathologic, lasting 6 months or more,
adversely affects physical/mental function, may have multiple/unknown causes, generally, no relief
is gained from usual restorative measures and is especially apparent in individuals with chronic
disease (Silverman, et al, 2010).
I learned that fatigue has subcategories of body dysregulation that are either a specific cause
or a cofactor of CF. Peripheral fatigue - organ-system dysfunction (muscle wasting and
inflammation or joint abnormalities), usually not associated with cognitive loss. Central Fatigue -
dysregulation of the bodys stress system associated with symptoms like: depression, sleep disorder,
anxiety, coping styles. The purpose of this study was to shed light on the effectiveness of the usual
restorative measures of pharmacologic, nonpharmacologic and cognitive-behavioral therapy
interventions currently used to treat long-term neural, endocrine, and immune system dysfunctions
that cause fatigue in the hopes of designing more effective restorative measures (Silverman, et al.,
2010).
The studies show how the autonomic and peripheral nervous systems communicate with the
immune system to activate psychogenic and physiologic stress pathways that affect mood or
behavior of patients during immune challenges. The cancer patient study tested glucocorticoid
hormones that shape the bodys immune responses, at a tissue level, in a cell-specific manner. This

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stimulates and suppresses immune cells reducing cortisol signaling which gives negative feedback
to the immune system and brain. The faulty stress system leads to dysregulation of multiple
physiological/behavioral systems that can cause fatigue, muscle aches, anxiety, cognitive
dysfunction and depression, increasing stress vulnerability (Silverman, et al., 2010).
Each study caught my attention and now I want to understand the correlation they have to CF.
A population-based study suggested childhood trauma experiences cause low cortisol levels that
may be an underlying cause or consequence of CF, further study was needed. One study tested
symptoms, such as fatigue, dizziness, concentration, hypotension, prolonged standing/head-up tilt
and heart rate. All further triggered symptoms of CF. A study tests enhanced antibody responses to
viral and bacterial infectious agents found the initial onset of infection was a factor, but chronic
symptoms were unlikely caused by active infections. The final studies tested immune disturbances
in blood cell auto-antibodies that alter and suppress several immune functions, but comparison
studies did not find clear evidence for immune abnormalities in CF patients (Silverman, et al, 2010).
I was surprised that they only tested and evaluated the dysregulation of stress systems through
blood, sweat and saliva samples. Blood samples testing hormones, cytokines and neuroactive
substances take a lot of time to perform invasive tests. To counter this, they use noninvasive saliva
and sweat samples. Salivary cortisol tests glucocorticoid receptors in saliva and the blood stream,
but due to time, it reduces accuracy. Salivary -Amylase uses a digestive enzyme as a biomarker to
test against exercise heart rate variability. Lastly, they use a 24-hour cutaneous sweat patch to test
sweat levels that strongly correlate to symptoms of depression and anxiety and reported pain/fatigue
symptoms. My first hand witness is in agreement with the authors, The most effective therapeutic
strategies may require multimodal action. Solutions and answers will take awhile to unravel and a
solution for one patient may or may not help another patient (Silverman, et al, 2010).

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References
Silverman, M.N. et al. Neuroendocrine and Immune Contributors to Fatigue. PM R. 2010 May ;
2(5): 338346. doi:10.1016/j.pmrj.2010.04.008.

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