Mary Ann Fletcher

Mary Ann Fletcher, Ph.D., is the first Schemel Professor for Neuro Immune Medicine at the Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA. Previously, she spent 40 years at the University of Miami Miller School of Medicine as a Professor of Medicine, Microbiology/Immunology and Psychology. She holds two U.S. Patents for developing tests to determine if a person has mononucleosis.

Dr. Fletcher is a voting member of the Chronic Fatigue Syndrome Advisory Committee, U.S. Department of Health and Human Services, for the term: 06/13/12 to 12/13/16.

Open Letter to The Lancet
Two open letters to the editor of The Lancet urged the editor to commission a fully independent review of the PACE trial, which the journal had published in 2011. In 2016, Dr. Fletcher, along with 41 colleagues in the ME/CFS field, signed the second letter.
 * 10 February 2016, An open letter to The Lancet, again - Virology blog

Education

 * Bachelor of Science in Microbiology from Texas Tech University
 * Master of Science in Immunology and Virology from University of Texas Medical School
 * Doctor of Philosophy in Immunochemistry from Baylor University
 * Postdoctoral research at Northwestern University in Chicago.

Notable studies

 * Dec 2016, Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women
 * 2016, Tracking post-infectious fatigue in clinic using routine Lab tests."ABSTRACT:'BACKGROUND: While biomarkers for chronic fatigue syndrome (CFS) are beginning to emerge they typically require a highly specialized clinical laboratory. We hypothesized that subsets of commonly measured laboratory markers used in combination could support the diagnosis of post-infectious CFS (PI-CFS) in adolescents following infectious mononucleosis (IM) and help determine who might develop persistence of symptoms. METHODS: Routine clinical laboratory markers were collected prospectively in 301 mono-spot positive adolescents, 4 % of whom developed CFS (n = 13). At 6, 12, and 24 months post-diagnosis with IM, 59 standard tests were performed including metabolic profiling, liver enzyme panel, hormone profiles, complete blood count (CBC), differential white blood count (WBC), salivary cortisol, and urinalysis....RESULTS: Lower ACTH levels at 6 months post-IM diagnosis were highly predictive of CFS (AUC p = 0.02). ACTH levels in CFS overlapped with healthy controls at 12 months, but again showed a trend towards a deficiency at 24 months. Conversely, estradiol levels depart significantly from normal at 12 months only to recover at 24 months (AUC p = 0.02). Finally, relative neutrophil count showed a significant departure from normal at 24 months in CFS (AUC p = 0.01). Expression of these markers evolved differently over time between groups. CONCLUSIONS: Preliminary results suggest that serial assessment of stress and sex hormones as well as the relative proportion of innate immune cells measured using standard clinical laboratory tests may support the diagnosis of PI-CFS in adolescents with IM.'"
 * 2016, Illness progression in chronic fatigue syndrome: a shifting immune baseline
 * 2014, Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome
 * 2012, Biomarkers for chronic fatigue. "'Abstract: Fatigue that persists for 6 months or more is termed chronic fatigue. Chronic fatigue (CF) in combination with a minimum of 4 of 8 symptoms and the absence of diseases that could explain these symptoms, constitute the case definition for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Inflammation, immune system activation, autonomic dysfunction, impaired functioning in the hypothalamic-pituitary-adrenal axis, and neuroendocrine dysregulation have all been suggested as root causes of fatigue. The identification of objective markers consistently associated with CFS/ME is an important goal in relation to diagnosis and treatment, as the current case definitions are based entirely on physical signs and symptoms. This review is focused on the recent literature related to biomarkers for fatigue associated with CFS/ME and, for comparison, those associated with other diseases. These markers are distributed across several of the body’s core regulatory systems. A complex construct of symptoms emerges from alterations and/or dysfunctions in the nervous, endocrine and immune systems. We propose that new insight will depend on our ability to develop and deploy an integrative profiling of CFS/ME pathogenesis at the molecular level. Until such a molecular signature is obtained efforts to develop effective treatments will continue to be severely limited."
 * 2012, Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue
 * 2010, A Formal Analysis of Cytokine Networks in Chronic Fatigue Syndrome Full Text
 * 2010, Plasma neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome
 * 2008, The associations between basal salivary cortisol levels and illness symptomatology in chronic fatigue syndrome. (Full text) "'Abstract: Hypocortisolism has been reported in chronic fatigue syndrome (CFS), with the significance of this finding to disease etiology unclear. This study examined cortisol levels and their relationships with symptoms in a group of 108 individuals with CFS. CFS symptoms examined included fatigue, pain, sleep difficulties, neurocognitive functioning, and psychiatric status. Alterations in cortisol levels were examined by calculation of mean daily cortisol, while temporal variation in cortisol function was examined by means of a regression slope. Additionally, deviation from expected cortisol diurnal pattern was determined via clinical judgment. Results indicated that fatigue and pain were associated with salivary cortisol levels. In particular, variance from the expected pattern of cortisol was associated with increased levels of fatigue. The implications of these findings are discussed.'"
 * 2001, Cytokine and Other Immunologic Markers in Chronic Fatigue Syndrome and Their Relation to Neuropsychological Factors
 * 2000, Comparative Analysis of Lymphocytes in Lymph Nodes and Peripheral Blood of Patients with Chronic Fatigue Syndrome
 * 1995, Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew