title: Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology.
abstract: Chronic fatigue syndrome (CFS) is a complex illness, which is often misdiagnosed as a psychiatric illness. In two previous reports, using (1)H MRSI, we found significantly higher levels of ventricular cerebrospinal fluid (CSF) lactate in patients with CFS relative to those with generalized anxiety disorder and healthy volunteers (HV), but not relative to those with major depressive disorder (MDD). In this third independent cross-sectional neuroimaging study, we investigated a pathophysiological model which postulated that elevations of CSF lactate in patients with CFS might be caused by increased oxidative stress, cerebral hypoperfusion and/or secondary mitochondrial dysfunction. Fifteen patients with CFS, 15 with MDD and 13 HVs were studied using the following modalities: (i) (1)H MRSI to measure CSF lactate; (ii) single-voxel (1)H MRS to measure levels of cortical glutathione (GSH) as a marker of antioxidant capacity; (iii) arterial spin labeling (ASL) MRI to measure regional cerebral blood flow (rCBF); and (iv) (31)P MRSI to measure brain high-energy phosphates as objective indices of mitochondrial dysfunction. We found elevated ventricular lactate and decreased GSH in patients with CFS and MDD relative to HVs. GSH did not differ significantly between the two patient groups. In addition, we found lower rCBF in the left anterior cingulate cortex and the right lingual gyrus in patients with CFS relative to HVs, but rCBF did not differ between those with CFS and MDD. We found no differences between the three groups in terms of any high-energy phosphate metabolites. In exploratory correlation analyses, we found that levels of ventricular lactate and cortical GSH were inversely correlated, and significantly associated with several key indices of physical health and disability. Collectively, the results of this third independent study support a pathophysiological model of CFS in which increased oxidative stress may play a key role in CFS etiopathophysiology.
authors.affiliation: Department of Radiology, Weill Medical College of Cornell University, New York, NY 10021, USA. dcs7001@med.cornell.edu
authors.forename: Dikoma C
authors.initials: DC
authors.lastname: Shungu
authors.forename: Nora
authors.initials: N
authors.lastname: Weiduschat
authors.forename: James W
authors.initials: JW
authors.lastname: Murrough
authors.forename: Xiangling
authors.initials: X
authors.lastname: Mao
authors.forename: Sarah
authors.initials: S
authors.lastname: Pillemer
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Dyke
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Medow
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Natelson
authors.forename: Julian M
authors.initials: JM
authors.lastname: Stewart
authors.forename: Sanjay J
authors.initials: SJ
authors.lastname: Mathew
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003710:Demography; D015673:Fatigue Syndrome, Chronic / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005978:Glutathione / Q000378:metabolism*; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000378:metabolism / Q000503:physiopathology; D009929:Organ Size; D018384:Oxidative Stress; D010710:Phosphates / Q000378:metabolism; D012039:Regional Blood Flow / Q000502:physiology; D013113:Spin Labels; D055815:Young Adult
chemical_list: D010710:Phosphates; D013113:Spin Labels; D019344:Lactic Acid; D005978:Glutathione