Disturbance in carnitine homeostasis in CFS

Reuter SE, Evans AM., University of South Australia, Adelaide, SA, AUSTRALIA:

Abstract
Objective.  The underlying aetiology of chronic fatigue syndrome is currently unknown; however, in light of carnitine's critical role in mitochondrial energy production, it has been suggested that chronic fatigue syndrome may be associated with altered carnitine homeostasis.

This study was conducted to comparatively examine full endogenous carnitine profiles in chronic fatigue syndrome patients and healthy controls. Design.  A cross-sectional, observational study. Setting and subjects.  Forty-four patients with chronic fatigue syndrome and 49 age- and gender-matched healthy controls were recruited from the community and studied at the School of Pharmacy & Medical Sciences, University of South Australia. Main outcome measures.  All participants completed a fatigue severity scale questionnaire and had a single fasting blood sample collected which was analysed for L-carnitine and 35 individual acylcarnitine concentrations in plasma by LC-MS/MS. Results.  Chronic fatigue syndrome patients exhibited significantly altered concentrations of C8:1, C12DC, C14, C16:1, C18, C18:1, C18:2 and C18:1-OH acylcarnitines; of particular note, oleyl-L-carnitine (C18:1) and linoleyl-L-carnitine (C18:2) were, on average, 30-40% lower in patients than controls (p<0.0001). Significant correlations between acylcarnitine concentrations and clinical symptomology were also demonstrated.

Conclusions.  It is proposed that this disturbance in carnitine homeostasis is a result of a reduction in carnitine palmitoyltransferase-I (CPT-I) activity, possibly due to the accumulation of omega-6 fatty acids previously observed in this patient population.

It is hypothesised that the administration of omega-3 fatty acids in combination with L-carnitine would increase CPT-I activity and improve chronic fatigue syndrome symptomology.