Preliminary determination of the association between symptom expression & urinary metabolites in subjects with chronic fatigue syndrome

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.

McGregor NR, Dunstan RH, Zerbes M, Butt HL, Roberts TK, Klineberg IJ

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