THEORY EMERGES ON FATIGUE AILMENT Scott Hensley Wall Street Journal, Technology & Health, 9/19/00 Toronto - Viruses that insidiously damage heart muscle may be the cause of chronic fatigue syndrome, a mysterious malady that many physicians have written off as a psychological condition, according to a provocative new study by an infectious disease expert. At a major scientific conference here, Martin Lerner, a doctor at William Beaumont hospital in Royal Oak, Mich., presented data on a series of patients, including himself, who developed the debilitating condition and were later treated, with apparent success, with potent antiviral drug regimens. "It is an infectious disease," that primarily attacks the heart, Dr. Lerner declared at a meeting of the American Society of Microbiology. Dr. Lerner said daylong cardiac monitoring found that 95% of chronic-fatigue patients he and his research team tested in two separate small studies had abnormal electrocardiograms indicative of heart damage. Dr. Lerner said he suspects the heart damage is caused by Epstein-Barr virus and cytomegalovirus, both long implication in the condition. The damage to the heart occurred, he believes, when the viruses were held in partial check by the patient's immune systems. Though the immune systems appear to have kept the viruses from reproducing, Dr. Lerner said partial bits of the viruses that were being produced appear to be causing heart damage. Raymond Swarts, an infectious-disease specialist unconnected to Dr. Lerner's group, called the findings "fantastic and very compelling." Dr. Swarts, who practices medicine in Reno, Nev., cautions that more studies are necessary. A test for the hard-to-diagnose syndrome would represent a significant clinical advance. Chronic-fatigue syndrome now is diagnosed by a rough checklist of symptoms and a process of elimination. The key clinical finding is that patients have persistent or relapsing fatigue for six months or more. In fact, doctors have argued whether the syndrome is a disease at all and even if it is, exactly how prevalent it might be. By some estimates, the syndrome affects about six in every 100,000 people. After implicating viruses as the cause of the syndrome, Dr. Lerner tested possible treatments. Many of the patients, including Dr. Lerner who were infected by Epstein-Barr virus regained cardiac function and returned to normal life after taking high doses of valacyclovir (brand name Valtrex), an antiviral drug made by Glaxo Wellcome PLC, for several months. Patients with cytomegalovirus received ganciclovir (Cytovene), another antiviral drug made by Roche Holding AG. Dr. Lerner became interested in chronic-fatigue syndrome when he fell ill in 1988 at age 58. He thought at first that he had heart disease, and an examination by doctors confirmed that his heart was weak. Later, he suspected there was more to the picture. In 1996, he began antiviral drug therapy and his heart function returned to normal. The smoking gun in Dr. Lerner's investigation came from patient samples of heart tissue. The viruses had weakened their hearts by scrambling the normally well-ordered muscle fibers. Glaxo Wellcome is funding a trial of antiviral treatments for chronic fatigue syndrome, that just got under way, said Robert Deeter, an antiviral clinical specialist with the drug company. Dr. Lerner holds patents to diagnose chronic-fatigue syndrome with cardiac monitors and to treat the condition with antiviral agents. He has another patent pending for the use of immunological agents to diagnose the condition.