title: Preliminary determination of the association between symptom expression and urinary metabolites in subjects with chronic fatigue syndrome.
abstract: Chronic fatigue syndrome (CFS) patients have a urinary metabolite labeled CFSUM1 with increased incidence (P < 0.004) and relative abundance (P < 0.00003). The relative abundances of urinary CFSUM1 and beta-alanine were associated with alterations in metabolite excretion and symptom incidence. In 20 CFS patients and 45 non-CFS subjects, symptom/metabolite associations were investigated by assessing symptom sensitivity and specificity, and symptom indices of total symptom incidence, CFS core symptoms, cognitive, neurological, musculoskeletal, gastrointestinal, infection-related and genitourinary symptom indices, as well as a visual analogue pain scale of average pain intensity. Thirty-three symptoms had significant (P < 0.005) sensitivity and specificity in the CFS patients compared to that in the non-CFS controls. Severe fatigue was the only symptom with 100% sensitivity and specificity and CFSUM1 excretion was the primary metabolite for expression of this symptom. All nine symptom indices had elevated responses in the CFS patients (all P < 0.0000001). Multiple regression analyses indicated that all the symptom indices had significant correlations (R) with changes in the urinary excretion of metabolites (P < 0.0001). CFSUM1 and beta-alanine were the first and second metabolites correlated with the CFS core symptom index and CFSUM1 was primarily associated with infection-related and musculoskeletal indices whereas beta-alanine was primarily associated with gastrointestinal and genitourinary indices. The strong associations of CFSUM1 and beta-alanine with CFS symptom expression provide a molecular basis for developing an objective test for CFS.
authors.affiliation: Collaborative Pain Research Unit, University of Sydney, Australia.
authors.forename: N R
authors.initials: NR
authors.lastname: McGregor
authors.forename: R H
authors.initials: RH
authors.lastname: Dunstan
authors.forename: M
authors.initials: M
authors.lastname: Zerbes
authors.forename: H L
authors.initials: HL
authors.lastname: Butt
authors.forename: T K
authors.initials: TK
authors.lastname: Roberts
authors.forename: I J
authors.initials: IJ
authors.lastname: Klineberg
mesh_terms: D000293:Adolescent; D000328:Adult; D015673:Fatigue Syndrome, Chronic / Q000652:urine*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D011759:Pyrrolidines / Q000652:urine*; D012044:Regression Analysis; D012680:Sensitivity and Specificity
chemical_list: C103601:3-amino-1-methylpyrrolidin-2-ol; D011759:Pyrrolidines