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Raij T, Raij K. Association between fatigue, peripheral serotonin, and L-carnitine in hypothyroidism and in chronic fatigue syndrome. Front Endocrinol (Lausanne) 2024; 15:1358404. [PMID: 38505756 PMCID: PMC10948554 DOI: 10.3389/fendo.2024.1358404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 03/21/2024] Open
Abstract
Background Fatigue of unknown origin is a hallmark symptom in chronic fatigue syndrome (CFS) and is also found in 20% of hypothyroidism patients despite appropriate levothyroxine treatment. Here, we suggest that in these disorders, peripheral serotonin levels are low, and elevating them to normal range with L-carnitine is accompanied with reduced fatigue. Methods We conducted a retrospective analysis of follow-up clinical data (CFS N=12; hypothyroidism with fatigue N=40) where serum serotonin and fatigue levels were compared before vs. after 7 weeks of oral L-carnitine supplementation. Results After L-carnitine, serotonin increased (8-fold in CFS, Sig. = 0.002, 6-fold in hypothyroidism, Sig. < 0.001) whereas fatigue decreased (2-fold in both CFS and hypothyroidism, Sig. = 0.002 for CFS, Sig. < 0.001 for hypothyroidism). There was a negative correlation between serotonin level and fatigue (for CFS, rho = -0.49 before and -0.67 after L-carnitine; for hypothyroidism, rho = -0.24 before and -0.83 after L-carnitine). Conclusions These findings suggest a new link between low peripheral serotonin, L-carnitine, and fatigue.
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Affiliation(s)
- Tommi Raij
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department Of Neurobiology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, United States
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, MGH Department of Radiology, Boston, MA, United States
| | - Kari Raij
- Kruunuhaka Medical Center, Helsinki, Finland
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Helbing DL, Dommaschk EM, Danyeli LV, Liepinsh E, Refisch A, Sen ZD, Zvejniece L, Rocktäschel T, Stabenow LK, Schiöth HB, Walter M, Dambrova M, Besteher B. Conceptual foundations of acetylcarnitine supplementation in neuropsychiatric long COVID syndrome: a narrative review. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01734-3. [PMID: 38172332 DOI: 10.1007/s00406-023-01734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
Post-acute sequelae of COVID-19 can present as multi-organ pathology, with neuropsychiatric symptoms being the most common symptom complex, characterizing long COVID as a syndrome with a significant disease burden for affected individuals. Several typical symptoms of long COVID, such as fatigue, depressive symptoms and cognitive impairment, are also key features of other psychiatric disorders such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and major depressive disorder (MDD). However, clinically successful treatment strategies are still lacking and are often inspired by treatment options for diseases with similar clinical presentations, such as ME/CFS. Acetylcarnitine, the shortest metabolite of a class of fatty acid metabolites called acylcarnitines and one of the most abundant blood metabolites in humans can be used as a dietary/nutritional supplement with proven clinical efficacy in the treatment of MDD, ME/CFS and other neuropsychiatric disorders. Basic research in recent decades has established acylcarnitines in general, and acetylcarnitine in particular, as important regulators and indicators of mitochondrial function and other physiological processes such as neuroinflammation and energy production pathways. In this review, we will compare the clinical basis of neuropsychiatric long COVID with other fatigue-associated diseases. We will also review common molecular disease mechanisms associated with altered acetylcarnitine metabolism and the potential of acetylcarnitine to interfere with these as a therapeutic agent. Finally, we will review the current evidence for acetylcarnitine as a supplement in the treatment of fatigue-associated diseases and propose future research strategies to investigate the potential of acetylcarnitine as a treatment option for long COVID.
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Affiliation(s)
- Dario Lucas Helbing
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
- Leibniz Institute on Aging, Fritz Lipmann Institute, Jena, Germany
- Institute of Molecular Cell Biology, Jena University Hospital, Friedrich Schiller University Jena, 07745, Jena, Germany
| | - Eva-Maria Dommaschk
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Edgars Liepinsh
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
- Faculty of Pharmacy, Riga Stradins University, Riga, Latvia
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
| | - Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
| | - Liga Zvejniece
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
| | - Tonia Rocktäschel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
| | - Leonie Karoline Stabenow
- Institute of Molecular Cell Biology, Jena University Hospital, Friedrich Schiller University Jena, 07745, Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Helgi B Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, 751 24, Uppsala, Sweden
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Maija Dambrova
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
- Faculty of Pharmacy, Riga Stradins University, Riga, Latvia
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany.
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany.
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Jinushi R, Masuda S, Tanisaka Y, Nishiguchi S, Shionoya K, Sato R, Sugimoto K, Shin T, Shiomi R, Fujita A, Mizuide M, Ryozawa S. Comparison of serum acylcarnitine levels in patients with myalgic encephalomyelitis/chronic fatigue syndrome and healthy controls: a systematic review and meta-analysis. J Transl Med 2023; 21:398. [PMID: 37337273 PMCID: PMC10280864 DOI: 10.1186/s12967-023-04226-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/chronic fatigue syndrome/systemic exertion intolerance disease (ME/CFS/SEID) is a condition diagnosed primarily based on clinical symptoms, including prolonged fatigue and post-exertional malaise; however, there is no specific test for the disease. Additionally, diagnosis can be challenging since healthcare professionals may lack sufficient knowledge about the disease. Prior studies have shown that patients with ME/CFS/SEID have low serum acylcarnitine levels, which may serve as a surrogate test for patients suspected of having this disease. This systematic review and meta-analysis aimed to investigate the differences in serum acylcarnitine levels between patients with ME/CFS/SEID and healthy controls. METHODS This systematic review was conducted using PubMed and Ichushi-Web databases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we included all studies from the databases' inception until February 17, 2023, that evaluated blood tests in both patients with ME/CFS/SEID and healthy control groups. The primary endpoint was the difference in serum acylcarnitine levels between the two groups. RESULTS The electronic search identified 276 studies. Among them, seven met the eligibility criteria. The serum acylcarnitine levels were analyzed in 403 patients with ME/CFS/SEID. The patient group had significantly lower serum acylcarnitine levels when compared with the control group, and the statistical heterogeneity was high. CONCLUSION The patient group had significantly lower serum acylcarnitine levels when compared with the control group. In the future, the measurement of serum acylcarnitine levels, in addition to clinical symptoms, may prove to be a valuable diagnostic tool for this condition.
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Affiliation(s)
- Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan.
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
- Department of General Internal Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
- Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 107-8402, Japan.
| | - Sakue Masuda
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kento Shionoya
- Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryo Sato
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kei Sugimoto
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Takahiro Shin
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Rie Shiomi
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
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Filippi M, Krähenmann R, Fissler P. The Link Between Energy-Related Sensations and Metabolism: Implications for Treating Fatigue. Front Psychol 2022; 13:920556. [PMID: 35800955 PMCID: PMC9255916 DOI: 10.3389/fpsyg.2022.920556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Energy-related sensations include sensation of energy and fatigue as well as subjective energizability and fatigability. First, we introduce interdisciplinary useful definitions of all constructs and review findings regarding the question of whether sensations of fatigue and energy are two separate constructs or two ends of a single dimension. Second, we describe different components of the bodily energy metabolism system (e.g., mitochondria; autonomic nervous system). Third, we review the link between sensation of fatigue and different components of energy metabolism. Finally, we present an overview of different treatments shown to affect both energy-related sensations and metabolism before outlining future research perspectives.
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Affiliation(s)
- Marco Filippi
- Psychiatric Services Thurgau, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Rainer Krähenmann
- Psychiatric Services Thurgau, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland
- *Correspondence: Rainer Krähenmann,
| | - Patrick Fissler
- Psychiatric Services Thurgau, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
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5
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Baraniuk JN, Kern G, Narayan V, Cheema A. Exercise modifies glutamate and other metabolic biomarkers in cerebrospinal fluid from Gulf War Illness and Myalgic encephalomyelitis / Chronic Fatigue Syndrome. PLoS One 2021; 16:e0244116. [PMID: 33440400 PMCID: PMC7806361 DOI: 10.1371/journal.pone.0244116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
Myalgic encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) and Gulf War Illness (GWI) share many symptoms of fatigue, pain, and cognitive dysfunction that are not relieved by rest. Patterns of serum metabolites in ME/CFS and GWI are different from control groups and suggest potential dysfunction of energy and lipid metabolism. The metabolomics of cerebrospinal fluid was contrasted between ME/CFS, GWI and sedentary controls in 2 sets of subjects who had lumbar punctures after either (a) rest or (b) submaximal exercise stress tests. Postexercise GWI and control subjects were subdivided according to acquired transient postexertional postural tachycardia. Banked cerebrospinal fluid specimens were assayed using Biocrates AbsoluteIDQ® p180 kits for quantitative targeted metabolomics studies of amino acids, amines, acylcarnitines, sphingolipids, lysophospholipids, alkyl and ether phosphocholines. Glutamate was significantly higher in the subgroup of postexercise GWI subjects who did not develop postural tachycardia after exercise compared to nonexercise and other postexercise groups. The only difference between nonexercise groups was higher lysoPC a C28:0 in GWI than ME/CFS suggesting this biochemical or phospholipase activities may have potential as a biomarker to distinguish between the 2 diseases. Exercise effects were suggested by elevation of short chain acylcarnitine C5-OH (C3-DC-M) in postexercise controls compared to nonexercise ME/CFS. Limitations include small subgroup sample sizes and absence of postexercise ME/CFS specimens. Mechanisms of glutamate neuroexcitotoxicity may contribute to neuropathology and “neuroinflammation” in the GWI subset who did not develop postural tachycardia after exercise. Dysfunctional lipid metabolism may distinguish the predominantly female ME/CFS group from predominantly male GWI subjects.
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Affiliation(s)
- James N Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Grant Kern
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Vaishnavi Narayan
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Amrita Cheema
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Centre, Georgetown University, Washington, DC, United States of America
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Vink M, Vink-Niese A. Multidisciplinary rehabilitation treatment is not effective for myalgic encephalomyelitis/chronic fatigue syndrome: A review of the FatiGo trial. Health Psychol Open 2018; 5:2055102918792648. [PMID: 30094055 PMCID: PMC6080079 DOI: 10.1177/2055102918792648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The FatiGo trial concluded that multidisciplinary rehabilitation treatment is more effective for chronic fatigue syndrome/myalgic encephalomyelitis in the long term than cognitive behaviour therapy and that multidisciplinary rehabilitation treatment is more cost-effective for fatigue and cognitive behaviour therapy for quality of life. However, FatiGo suffered from a number of serious methodological flaws. Moreover, it ignored the results of the activity metre, its only objective outcome. This jeopardizes the validity of FatiGo. Its analysis shows that there was no statistically significant difference between multidisciplinary rehabilitation treatment and cognitive behaviour therapy and neither are (cost-)effective. FatiGo's claims of efficacy of multidisciplinary rehabilitation treatment and cognitive behaviour therapy for chronic fatigue syndrome/myalgic encephalomyelitis are misleading and not justified by their results.
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Affiliation(s)
- Mark Vink
- Soerabaja Research Center, The
Netherlands
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van der Meer JW, Bleijenberg G. Chronic Fatigue Syndrome. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Filler K, Lyon D, Bennett J, McCain N, Elswick R, Lukkahatai N, Saligan LN. Association of Mitochondrial Dysfunction and Fatigue: A Review of the Literature. BBA CLINICAL 2014; 1:12-23. [PMID: 25147756 PMCID: PMC4136529 DOI: 10.1016/j.bbacli.2014.04.001] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fatigue is often described by patients as a lack of energy, mental or physical tiredness, diminished endurance, and prolonged recovery after physical activity. Etiologic mechanisms underlying fatigue are not well understood; however, fatigue is a hallmark symptom of mitochondrial disease, making mitochondrial dysfunction a putative biological mechanism for fatigue. Therefore, this review examined studies that investigated the association of markers of mitochondrial dysfunction with fatigue and proposes possible research directions to enhance understanding of the role of mitochondrial dysfunction in fatigue. A thorough search using PubMed, Scopus, Web of Science, and Embase databases returned 1,220 articles. After application of inclusion and exclusion criteria, a total of 25 articles meeting eligibility criteria were selected for full review. Dysfunctions in the mitochondrial structure, mitochondrial function (mitochondrial enzymes and oxidative/nitrosative stress), mitochondrial energy metabolism (ATP production and fatty acid metabolism), immune response, and genetics were investigated as potential contributors to fatigue. Carnitine was the most investigated mitochondrial function marker. Dysfunctional levels were reported in all the studies investigating carnitine; however, the specific type of carnitine that was dysfunctional varied. Genetic profiles were the second most studied mitochondrial parameter. Six common pathways were proposed: metabolism, energy production, protein transport, mitochondrial morphology, central nervous system dysfunction and post-viral infection. Coenzyme Q10 was the most commonly investigated mitochondrial enzyme. Low levels of Coenzyme Q10 were consistently associated with fatigue. Potential targets for further investigation were identified as well as gaps in the current literature.
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Affiliation(s)
- Kristin Filler
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street Richmond, VA 23298-0567, USA
- National Institutes of Health, National Institute of Nursing Research, 3 Center Drive, Building 3, Room 5E26, Bethesda, MD, USA
- Corresponding author at: 1100 East Leigh Street Richmond, Virginia 23298-0567, USA. Tel.: + 1 301 496 8914.
| | - Debra Lyon
- University of Florida College of Nursing, PO Box 100197, Gainesville, FL 32610-0197, USA
| | - James Bennett
- Virginia Commonwealth University School of Medicine, 1201 East Marshall Street Richmond, VA 23298-0565, USA
| | - Nancy McCain
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street Richmond, VA 23298-0567, USA
| | - Ronald Elswick
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street Richmond, VA 23298-0567, USA
| | - Nada Lukkahatai
- National Institutes of Health, National Institute of Nursing Research, 3 Center Drive, Building 3, Room 5E26, Bethesda, MD, USA
| | - Leorey N. Saligan
- National Institutes of Health, National Institute of Nursing Research, 3 Center Drive, Building 3, Room 5E26, Bethesda, MD, USA
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Visible and near-infrared spectra collected from the thumbs of patients with chronic fatigue syndrome for diagnosis. Clin Chim Acta 2012; 413:1629-32. [DOI: 10.1016/j.cca.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/29/2012] [Accepted: 05/04/2012] [Indexed: 11/21/2022]
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10
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Reuter SE, Evans AM. Long-chain acylcarnitine deficiency in patients with chronic fatigue syndrome. Potential involvement of altered carnitine palmitoyltransferase-I activity. J Intern Med 2011; 270:76-84. [PMID: 21205027 DOI: 10.1111/j.1365-2796.2010.02341.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The underlying aetiology of chronic fatigue syndrome is currently unknown; however, in the light of carnitine's critical role in mitochondrial energy production, it has been suggested that chronic fatigue syndrome may be associated with altered carnitine homeostasis. This study was conducted to comparatively examine full endogenous carnitine profiles in patients with chronic fatigue syndrome and healthy controls. DESIGN A cross-sectional, observational study. SETTING AND SUBJECTS Forty-four patients with chronic fatigue syndrome and 49 age- and gender-matched healthy controls were recruited from the community and studied at the School of Pharmacy & Medical Sciences, University of South Australia. MAIN OUTCOME MEASURES All participants completed a fatigue severity scale questionnaire and had a single fasting blood sample collected which was analysed for l-carnitine and 35 individual acylcarnitine concentrations in plasma by LC-MS/MS. RESULTS Patients with chronic fatigue syndrome exhibited significantly altered concentrations of C8:1, C12DC, C14, C16:1, C18, C18:1, C18:2 and C18:1-OH acylcarnitines; of particular note, oleyl-L-carnitine (C18:1) and linoleyl-L-carnitine (C18:2) were, on average, 30-40% lower in patients than controls (P < 0.0001). Significant correlations between acylcarnitine concentrations and clinical symptomology were also demonstrated. CONCLUSIONS It is proposed that this disturbance in carnitine homeostasis is reflective of a reduction in carnitine palmitoyltransferase-I (CPT-I) activity, possibly a result of the accumulation of omega-6 fatty acids previously observed in this patient population. It is hypothesized that the administration of omega-3 fatty acids in combination with l-carnitine would increase CPT-I activity and improve chronic fatigue syndrome symptomology.
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Affiliation(s)
- S E Reuter
- From the School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, Australia.
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Characteristics of chronic fatigue syndrome in a Japanese community population : chronic fatigue syndrome in Japan. Clin Rheumatol 2011; 30:895-906. [PMID: 21302125 DOI: 10.1007/s10067-011-1702-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 09/29/2010] [Accepted: 01/24/2011] [Indexed: 01/04/2023]
Abstract
This study seeks to estimate the prevalence of chronic fatigue syndrome (CFS) and assess the characteristics of CFS in a community population in Japan using laboratory tests and questionnaires for lifestyle, fatigue states, and depression states. The design of this study is a cross-sectional observational study. The setting of this study is a medical health checkup program in a general hospital. This study was conducted with 1,430 Japanese (867 men and 563 women), 20 to 78 years of age. We classified participants who complained of fatigue according to the case definition of CFS proposed by the Centers for Disease Control and Prevention in the USA in 1994. Alcohol, caffeine, catechin and total polyphenol consumption, smoking status, sleep duration, and physical activity were evaluated using questionnaires. The prevalence of CFS was 1.0% (95% CI 0.5-1.6%) of a community population in Japan. Although various lifestyle factors of the participants with CFS were similar to those without chronic fatigue, average sleep duration was significantly shorter among the participants with CFS (5.5 ± 0.8 h) compared to those without chronic fatigue (6.3 ± 0.9 h, P < 0.001). Proportion at subjects having average sleep duration of less than 6 h was 64.3% among the participants with CFS in contrast to only 15.0% in those without chronic fatigue (P < 0.001). Among the eight case-defining symptoms, "Unrefreshing sleep" had high sensitivity and high specificity for screening CFS in Japanese population (92.9% and 87.8%, respectively). The average sleep duration was notably shorter in Japanese suffering from CFS. Further longitudinal study is needed to evaluate the possibility of extreme short sleep duration as a major cause of CFS in Japan.
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Zhang F, Jia Z, Gao P, Kong H, Li X, Lu X, Wu Y, Xu G. Metabonomics study of urine and plasma in depression and excess fatigue rats by ultra fast liquid chromatography coupled with ion trap-time of flight mass spectrometry. MOLECULAR BIOSYSTEMS 2010; 6:852-61. [PMID: 20567771 DOI: 10.1039/b914751a] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A novel metabonomic method based on fast liquid chromatography coupled with ion trap-time of flight mass spectrometry (UFLC/MS-IT-TOF) was applied to study the metabolic changes of plasma and urine in depression and excess fatigue rats. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were applied for classifying the depression, excess fatigue and the control rats. Metabolites which were important for the classification in the three groups of rats were selected as potential biomarkers and identified by MS(n) information achieved from UFLC/MS-IT-TOF analysis. Spermine, propionylcarnitine, butyrylcarnitine, phenylalanine, lysophosphatidylcholine (LPC) C14:0 and LPC C18:2 were down-regulated, methyl-hippuric acid and chenodeoxycholic acid (CDCA) were up-regulated significantly in plasma of the excess fatigue rats. Spermine, leucine, propionylcarnitine, and butyrylcarnitine decreased, hippuric acid, methyl-hippuric acid, cholic acid, CDCA and LPC C16:0 increased markedly in plasma of the depression rats. Ethyl N2-acetyl-L-argininate and N-methyl-2-pyridone-5-carboxamide (2-PY) (or N-methyl-4-pyridone-3-carboxamide (4-PY)) were down-regulated, leucylproline and pantothenic acid were up-regulated remarkably both in urine of depression and excess fatigue rats. The concentration of kynurenic acid and N2-succinyl-L-ornithine was low in urine of depression rats compared with control rats. Based on the data, correlation networks for depression and excess fatigue rats revealed the abnormality of nicotinate and nicotinamide metabolism, arginine metabolism, cholesterol metabolism, tryptophan metabolism and kynurenine metabolism in depression rats, and in excess fatigue rat alterations of energy metabolism, nicotinate and nicotinamide metabolism and lecithin metabolism. Our results provide novel insights in the complex metabolic mechanisms occurring in depression and excess fatigue rats.
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Affiliation(s)
- Fengxia Zhang
- CAS Key laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China
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van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sakudo A, Kuratsune H, Kobayashi T, Tajima S, Watanabe Y, Ikuta K. Spectroscopic diagnosis of chronic fatigue syndrome by visible and near-infrared spectroscopy in serum samples. Biochem Biophys Res Commun 2006; 345:1513-6. [PMID: 16730652 DOI: 10.1016/j.bbrc.2006.05.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 05/10/2006] [Indexed: 12/01/2022]
Abstract
To investigate visible and near-infrared (Vis-NIR) spectroscopy enabling chronic fatigue syndrome (CFS) diagnosis, we subjected sera from CFS patients as well as healthy donors to Vis-NIR spectroscopy. Vis-NIR spectra in the 600-1100 nm region for sera from 77 CFS patients and 71 healthy donors were subjected to principal component analysis (PCA) and soft independent modeling of class analogy (SIMCA) to develop multivariate models to discriminate between CFS patients and healthy donors. The model was further assessed by the prediction of 99 masked other determinations (54 in the healthy group and 45 in the CFS patient group). The PCA model predicted successful discrimination of the masked samples. The SIMCA model predicted 54 of 54 (100%) healthy donors and 42 of 45 (93.3%) CFS patients of Vis-NIR spectra from masked serum samples correctly. These results suggest that Vis-NIR spectroscopy for sera combined with chemometrics analysis could provide a promising tool to objectively diagnose CFS.
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Affiliation(s)
- Akikazu Sakudo
- Department of Virology, Center for Infectious Disease Control, Research Institute for Microbial Diseases, Osaka University, Yamadaoka, Suita, Japan
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Jones MG, Goodwin CS, Amjad S, Chalmers RA. Plasma and urinary carnitine and acylcarnitines in chronic fatigue syndrome. Clin Chim Acta 2005; 360:173-7. [PMID: 15967423 DOI: 10.1016/j.cccn.2005.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 04/21/2005] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
Contradictory reports have suggested that serum free carnitine and acylcarnitine concentrations are decreased in patients with chronic fatigue syndrome (CFS) and that this is a cause of the muscle fatigue observed in these patients. Others have shown normal serum free carnitine and acylcarnitines in similar patients. We report here studies on free, total and esterified (acyl) carnitines in urine and blood plasma from UK patients with CFS and three control groups. Plasma and timed urine samples were obtained from 31 patients with CFS, 31 healthy controls, 15 patients with depression and 22 patients with rheumatoid arthritis. Samples were analysed using an established radioenzymatic procedure for total, free and esterified (acyl) carnitine. There were no significant differences in plasma or urinary total, free or esterified (acyl) carnitine between UK patients with CFS and the control groups or in renal excretion rates of these compounds. The data presented here show that, in the CFS patients studied, there are no significant abnormalities of free or esterified (acyl) carnitine. It is thus unlikely that abnormalities in carnitine homeostasis have any significant role in the aetiology of their chronic fatigue.
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Affiliation(s)
- Mark G Jones
- St. George's Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK
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Slottje P, Huizink AC, Twisk JWR, Witteveen AB, van der Ploeg HM, Bramsen I, Smidt N, Bijlsma JA, Bouter LM, van Mechelen W, Smid T. Epidemiological study air disaster in Amsterdam (ESADA): study design. BMC Public Health 2005; 5:54. [PMID: 15921536 PMCID: PMC1173116 DOI: 10.1186/1471-2458-5-54] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 05/30/2005] [Indexed: 11/28/2022] Open
Abstract
Background In 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, killing 43 victims and destroying 266 apartments. In the aftermath there were speculations about the cause of the crash, potential exposures to hazardous materials due to the disaster and the health consequences. Starting in 2000, the Epidemiological Study Air Disaster in Amsterdam (ESADA) aimed to assess the long-term health effects of occupational exposure to this disaster on professional assistance workers. Methods/Design Epidemiological study among all the exposed professional fire-fighters and police officers who performed disaster-related task(s), and hangar workers who sorted the wreckage of the aircraft, as well as reference groups of their non-exposed colleagues who did not perform any disaster-related tasks. The study took place, on average, 8.5 years after the disaster. Questionnaires were used to assess details on occupational exposure to the disaster. Health measures comprised laboratory assessments in urine, blood and saliva, as well as self-reported current health measures, including health-related quality of life, and various physical and psychological symptoms. Discussion In this paper we describe and discuss the design of the ESADA. The ESADA will provide additional scientific knowledge on the long-term health effects of technological disasters on professional workers.
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Affiliation(s)
- Pauline Slottje
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Anja C Huizink
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jos WR Twisk
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Anke B Witteveen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Henk M van der Ploeg
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Inge Bramsen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Nynke Smidt
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Joost A Bijlsma
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Lex M Bouter
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Willem van Mechelen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Tjabe Smid
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- KLM Health Services, Schiphol Airport, the Netherlands
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Vermeulen RCW, Scholte HR. Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome. Psychosom Med 2004; 66:276-82. [PMID: 15039515 DOI: 10.1097/01.psy.0000116249.60477.e9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We compared the effects of acetylcarnitine, propionylcarnitine and both compounds on the symptoms of chronic fatigue syndrome (CFS). METHODS In an open, randomized fashion we compared 2 g/d acetyl-L-carnitine, 2 g/d propionyl-L-carnitine, and its combination in 3 groups of 30 CFS patients during 24 weeks. Effects were rated by clinical global impression of change. Secondary endpoints were the Multidimensional Fatigue Inventory, McGill Pain Questionnaire, and the Stroop attention concentration test. Scores were assessed 8 weeks before treatment; at randomization; after 8, 16, and 24 weeks of treatment; and 2 weeks later. RESULTS Clinical global impression of change after treatment showed considerable improvement in 59% of the patients in the acetylcarnitine group and 63% in the propionylcarnitine group, but less in the acetylcarnitine plus propionylcarnitine group (37%). Acetylcarnitine significantly improved mental fatigue (p =.015) and propionylcarnitine improved general fatigue (p =.004). Attention concentration improved in all groups, whereas pain complaints did not decrease in any group. Two weeks after treatment, worsening of fatigue was experienced by 52%, 50%, and 37% in the acetylcarnitine, propionylcarnitine, and combined group, respectively. In the acetylcarnitine group, but not in the other groups, the changes in plasma carnitine levels correlated with clinical improvement. CONCLUSIONS Acetylcarnitine and propionylcarnitine showed beneficial effect on fatigue and attention concentration. Less improvement was found by the combined treatment. Acetylcarnitine had main effect on mental fatigue and propionylcarnitine on general fatigue.
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Tarello W. Chronic fatigue syndrome (CFS) associated with Staphylococcus spp. bacteremia, responsive to potassium arsenite 0.5% in a veterinary surgeon and his coworking wife, handling with CFS animal cases. Comp Immunol Microbiol Infect Dis 2001; 24:233-46. [PMID: 11561958 DOI: 10.1016/s0147-9571(01)00012-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chronic fatigue syndrome (CFS) in human patients remain a controversial and perplexing condition with emerging zoonotic aspects. Recent advances in human medicine seem to indicate a bacterial etiology and the condition has already been described in horses, dogs, cats and birds of prey in association with micrococci-like organisms in the blood. To evaluate the possibility of a chronic bacteremia, a veterinary surgeon (the author) and his coworking wife, both diagnosed with CFS and meeting the CDC working case definition, were submitted to rapid blood cultures and fresh blood smears investigations. Blood cultures proved Staph-positive and micrococci-like organisms in the blood were repeatedly observed in the 3-year period preceding the arsenical therapy, during which several medicaments, including antibiotics, proved unsuccessful. Following treatment with a low dosage arsenical drug (potassium arsenite 0.5%, im., 1 ml/12 h, for 10 days) both patients experienced complete remission. At the post-treatment control made 1 month later, micrococci had disappeared from the blood, and the CD4/CD8 ratio was raising.
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