title: The assessment of the energy metabolism in patients with chronic fatigue syndrome by serum fluorescence emission.
abstract: BACKGROUND
  Chronic fatigue syndrome (CFS) is a debilitating fatigue illness that has unknown etiology and lacks an objective diagnostic marker.
  
  
  OBJECTIVE
  To examine the metabolic component of CFS to determine if practitioners can use serum NAD(P)H concentration measurements to monitor metabolism and fatigue status in patients with CFS.
  
  
  METHODS
  The research team conducted a case-control study, comparing a group of patients who were diagnosed with CFS with a control group of healthy subjects. The team obtained venous blood samples from fasting patients to examine the serum NAD(P)H concentrations.
  
  
  METHODS
  The study occurred at the Riordan Clinic in Witchita, Kansas.
  
  
  METHODS
  The study included 44 CFS patients at the Riordan Clinic and 30 healthy control participants. The CFS patients presented a spectrum of symptoms that had existed for at least 6 months: new, unexplained, persistent, or relapsing chronic fatigue that bed rest did not resolve and that was severe enough to reduce daily activity significantly by 50% in conjunction with headache, muscle pain, pain in multiple joints, and unrefreshing sleep. In the control group, the research team enrolled subjects without diagnosis of disease or injury.
  
  
  METHODS
  The research team determined levels of serum reduced nicotinamide adenine dinucleotides (NADH and NAD[P]H) by measuring serum fluorescence emission at 450 nm. The team then conducted sensitivity and specificity analyses. Results NAD(P)H concentrations in serum of CFS participants averaged 8.0 ± 1.4 (standard deviation [SD]) nmol/mL, while those in the healthy controls averaged 10.8 ± 0.8 (SD) nmol/mL, a statistically significant difference. Using a cut-off concentration of 9.5 nmol/mL, the research team attained a sensitivity of 0.73 and a specificity of 1.0. An analysis of receiver-operator characteristics yielded an area under the curve of 0.9. The research team compared serum NAD(P)H to several endocrine and metabolic lab parameters. Serum NAD(P)H was directly correlated with serum CoQ10 levels and inversely correlated with urine hydroxyhemopyrrolin-2-one levels.
  
  
  CONCLUSIONS
  Based on these findings, the research team proposed using serum NAD(P)H, measured as an intrinsic serum-fluorescence emission, to monitor metabolism and fatigue status in patients with CFS. Following patients NAD(P)H levels over time may aid in selecting therapeutic strategies and monitoring treatment outcomes.
authors.affiliation: Riordan Clinic, Wichita, Kansas, USA. nmikirova@riordanclinic.org
authors.forename: Nina
authors.initials: N
authors.lastname: Mikirova
authors.forename: Joseph
authors.initials: J
authors.lastname: Casciari
authors.forename: Ronald
authors.initials: R
authors.lastname: Hunninghake
mesh_terms: D016022:Case-Control Studies; D004734:Energy Metabolism; D015673:Fatigue Syndrome, Chronic / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D005453:Fluorescence; D006801:Humans; D009249:NADP / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014451:Ubiquinone / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D014451:Ubiquinone; D009249:NADP; C024989:coenzyme Q10