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Study finds link between CFS and high lactate levels in the brain

Saturday 14 August 2010

NewYork-Presbyterian HospitalThe NewYork-Presbyterian Hospital reports:

Study Finds Link Between Chronic Fatigue Syndrome and High Lactate Levels in Brain

New York (May 15, 2009)

Chronic fatigue syndrome, a condition that was not long ago dismissed as the "yuppie flu," is now accepted as a legitimate diagnosis. The diagnostic criteria developed by the Centers for Disease Control (CDC) in 1994 have been widely disseminated, and the CDC now tracks chronic fatigue syndrome (CFS) and reports that between 1 and 4 million Americans suffer from the illness. But arriving at a definitive diagnosis of CFS remains difficult as there is no gold standard diagnostic test, and because CFS shares symptoms with several other medical and psychiatric conditions such as diabetes, thyroid disease, depression, anxiety, and substance abuse.

A Recent Study May Help Diagnosis Chronic Fatigue Syndrome

A recent brain scanning study by NewYork-Presbyterian/Weill Cornell Radiology Professor Dikoma C. Shungu, Ph.D. and colleagues may help open the way to diagnostic clarity. The study showed that a diagnosis of CFS is linked to elevated levels of lactate in the cerebrospinal fluid.

Dr. Shungu discovered the brain abnormality in CFS while using magnetic resonance spectroscopy (MRS) to research dysregulated brain function in people with mitochondrial diseases. "After doing metabolic workups in several people we discovered something surprising: several people who had been referred to us as having CFS or were suspected to have CFS turned out to have elevated lactate in their cerebrospinal fluid."

With a grant from the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America Dr. Shungu further explored the link between lactate and CFS. His study, published in October 2008 in the NMR in Biomedicine, found that more than 50 percent of the CFS patients studied had cerebrospinal fluid lactate levels up to 348 percent higher than the healthy controls.

With collaborators Dr. Sanjay Mathew from Mount Sinai School of Medicine and Dr. Benjamin Natelson from Beth Israel Medical Center, Dr. Shungu is now embarking on a new study to look at the mechanisms that may lead to the elevated lactate in CFS. Dr. Shungu and colleagues will compare patients with CFS with those with anxious depression, and with healthy controls.

Immune Reaction Sparks Chronic Fatigue Syndrome

CFS often develops on the heels of an initiating event such as flu-like illness said Dr. Shungu. The patient does not really recover from the illness – "they remain sick and start feeling very, very tired," he said. Elevated levels of lactate may be the end result of a chain of events: "The immune reaction to the infection leads to a build up of free radicals, which accumulate in such numbers that they create oxidative stress. Oxidative stress almost invariably attacks or destroys the mitochondria, which then become dysfunctional. When that happens glycolysis kicks in to give us more energy. The end product of glycolysis is lactate, also called lactic acid, which is what we're detecting."

Increased brain lactate might also be caused by decreased oxygenation in the brain, Dr. Shungu said. "Mitochondria require oxygen to operate. If oxygen levels are too low due to decreased blood flow, mitochondrial energy is not produced efficiently so glycolysis kicks in, and lactate, the end-product, is produced."

Brain Blood Flow Decreased in Chronic Fatigue Syndrome

In their new study Dr. Shungu and colleagues will use MRS to observe markers of oxidative stress, mitochondrial dysfunction and cerebral blood flow. "Preliminary studies have shown that brain blood flow is decreased in CFS compared to the other groups, which might be a cause for the increased lactate," said Dr. Shungu. "We want to know why the blood flow is decreased. To find out we're going to see if the markers of oxidative stress are elevated, which could cause vasoconstriction."

Dr. Shungu's recent study showed levels of lactate that varied considerably among the CFS patients in the study. "We actually had a very big spread – more than half of them had significantly increased lactate, but there were also patients who didn't have increased lactate. But that's very telling because it's consistent with the disease – it's a very, very heterogeneous condition and it's multisystem." The researchers have tightened the inclusion criteria in the new study so that they will be looking at a more homogenous population of CFS patients. "We're going to accept a group of patients who are quite similar in terms of symptoms, because if there is a spread in symptoms then there could be a lot of confusion."

Faculty Contributing to this Article:

Dikoma C. Shungu, Ph.D. is a Professor of Physics in Radiology at Weill Cornell Medical College, one of the affiliate medical colleges of NewYork-Presbyterian Hospital.

The article originally appeared here.



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