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Chronic Fatigue Syndrome: A Presumptive Mitochondrial Disorder (CFS:M)

Primary Purpose

Chronic Fatigue Syndrome

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Nutraceutical supplements
Placebo
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Fatigue Syndrome focused on measuring myalgic encephalopathy, chronic fatigue syndrome, post viral infection, fatigue, muscle pain, unrefreshing sleep, fuzzy thought, poor memory, forgetfulness

Eligibility Criteria

25 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subjects must meet the criteria for CFS of the US Centers for Disease Control and Prevention (CDC), which requires persistent, unexplained fatigue for at least 6 months, concurrent with four of the following:

  • impaired memory/concentration
  • sore throat, new headaches
  • unrefreshing sleep, muscle pain
  • multi-joint pain
  • tender lymph nodes
  • post-exertional malaise

As well, due to the frequency of visits subjects must currently reside in the greater New York area.

Exclusion Criteria:

  • shortness of breath
  • heart disease
  • high blood pressure
  • other severe chronic illnesses
  • clinical depression
  • generalized anxiety disorder
  • insomnia
  • inflammatory arthritis
  • anemia
  • hypothyroidism
  • other conditions associated with significant fatigue
  • history of alcohol, tobacco, or drug abuse

Sites / Locations

  • Columbia University Department of Clinical Genetics

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Nutraceuticals

Placebo

Arm Description

Subjects will receive a combination of 4 nutraceuticals (CoEnzyme Q10, acetyl-L-carnitine, alpha-lipoic acid, docosahexaenoic acid (DHA)) and a multivitamin.

Outcomes

Primary Outcome Measures

Change in rate of fatigue status and other CFS symptoms
Rate of decrease in fatigue and other CFS symptoms, as measured by SF-36 and The Fatigue Assessment Instrument.

Secondary Outcome Measures

Change in brain lactate and glutathione levels
Patients will undergo nuclear magnetic resonance spectroscopy of the brain prior to starting therapy (baseline) and repeat it after 6 months of therapy.

Full Information

First Posted
November 9, 2011
Last Updated
April 9, 2015
Sponsor
Columbia University
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1. Study Identification

Unique Protocol Identification Number
NCT01471652
Brief Title
Chronic Fatigue Syndrome: A Presumptive Mitochondrial Disorder
Acronym
CFS:M
Official Title
Chronic Fatigue Syndrome: Correction of Mitochondrial Dysfunction by Conditioning Exercise and Nutraceutical Therapy.
Study Type
Interventional

2. Study Status

Record Verification Date
April 2015
Overall Recruitment Status
Withdrawn
Why Stopped
PI left the institution
Study Start Date
March 2012 (undefined)
Primary Completion Date
February 2013 (Actual)
Study Completion Date
February 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Columbia University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The pathogenesis of chronic fatigue syndrome (CFS) is poorly understood and no effective therapy has been developed. Recent studies suggest that a preceding viral infection causes mitochondrial dysfunction of the brain and skeletal muscle of genetically susceptible individuals. There is no specific laboratory test to identify patients with CFS. However, certain clinical manifestations are similar to those seen in mitochondrial disorders. Both patients with mitochondrial disorders and CFS manifest elevated serum lactate levels after exercise, and demonstrate elevated brain cerebrospinal fluid levels and decreased brain glutathione levels on nuclear magnetic resonance (NMR) spectroscopy. Therapy consisting of daily conditioning exercise, dietary recommendations, and nutraceutical supplements (ENT) has been show to be beneficial in treating patients with mitochondrial disorders. Similar therapy has been instituted in individual patients with CFS and has been shown to also improve their clinical conditions. A placebo-controlled trial will be undertaken in 24 CFS patients aged 25-55. Patients fulfilling the CDC criteria for CFS will participate in this 6 month study. Other medical causes for fatigue will be excluded. Half the patients will receive treatment consisting of daily conditioning exercise plus nutraceutical supplements (ENT), that has been shown to be beneficial for patients with mitochondrial dysfunction, while the other half will receive daily conditioning exercise and placebo tablets. Response to ENT will be evaluated by maximum oxygen consumption (VO2max) and circulating lactate levels during & after treadmill exercise, a 6-minute walk test, and a fatigue questionnaire. In addition, whether ENT corrects the elevated brain cerebrospinal fluid levels and decreased brain glutathione levels will be measured. To ensure compliance to therapy patients will be monitored frequently. The objective of this study is to assess the safety and efficacy of ENT and whether ENT leads to sustained improvement of CFS patients compared to their baseline status, and compared to an exercised group of patients not receiving supplements.
Detailed Description
Chronic fatigue syndrome (CFS), also known as myalgic encephalitis (ME), is clinically characterized as a multisystem illness exhibiting debilitating fatigue, musculoskeletal pain, disturbed sleep, and impaired memory and concentration. Its diagnosis is non-specific and symptom based, with no real biomarkers yet identified. The etiology and pathophysiology of CFS remain obscure. There is a long-standing hypothesis that individuals with CFS have normal metabolism and their fatigue is psychological, with energy being wasted through the processes of anxiety, stress, and depression. The more CFS is investigated, however, the clearer it becomes that this is incorrect, and that it is probably a metabolic dysfunction resulting in insufficient energy production. A number of studies have suggested that there may be a genetic contribution to CFS. In addition, a severe viral illness frequently predisposes the onset of CFS, while a number of pathogens have been linked to CFS (2, 3, 6). Although some patients develop CFS after an acute infection such as mononucleosis, some investigators believe it arises from the reactivation of a latent virus in the host, both resulting in a chronic low-level activation of the immune system. As more data are acquired, we and others believe that CFS is actually a metabolic mitochondrial dysfunction resulting in insufficient energy production. Mounting evidence indicates that viral infections in genetically susceptible individuals can cause changes in mitochondrial function. Many features observed in CFS are similar to those seen in genetic mitochondrial disorders. Firstly, some muscle biopsies in patients with CFS have shown both abnormal mitochondrial degeneration and severe deletions of mitochondrial DNA genes. Mitochondrial dysfunction increases the production of free radicals and reactive oxygen species (ROS), which cause oxidative damage, believed to contribute to CFS pathogenesis. Carnitine is required for metabolic reactions including mitochondrial fatty acid oxidation. A deficiency of serum acylcarnitine has been observed in CFS patients, suggesting that there is increased utilization of carnitine in CFS, thereby decreasing energy production. In mitochondrial disorders, utilization of pyruvate is decreased, resulting in higher circulating and muscle levels of lactate, as well as decreased oxidative phosphorylation and energy production. Brain ventricular cerebrospinal lactate is elevated, and brain glutathione is decreased, in both mitochondrial disorders and CFS. In CFS patients cerebrospinal lactate is increased by approximately 300% compared to that found in generalized anxiety disorder and healthy individuals. Using brain NMR spectroscopy, the distinction between CFS and psychological disorders can be demonstrated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Fatigue Syndrome
Keywords
myalgic encephalopathy, chronic fatigue syndrome, post viral infection, fatigue, muscle pain, unrefreshing sleep, fuzzy thought, poor memory, forgetfulness

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nutraceuticals
Arm Type
Active Comparator
Arm Description
Subjects will receive a combination of 4 nutraceuticals (CoEnzyme Q10, acetyl-L-carnitine, alpha-lipoic acid, docosahexaenoic acid (DHA)) and a multivitamin.
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Nutraceutical supplements
Intervention Description
CoEnzyme Q10: oral gel capsule bid Acetyl L-carnitine: oral capsule bid Alpha Lipoic Acid: oral tablet qd Docosahexaenoic acid: oral gel capsule bid
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Capsule form to imitate the following nutraceuticals: Placebo 1: oral gel capsule bid Placebo 2: oral capsule bid Placebo 3: oral tablet qd Placebo 4: oral gel capsule bid
Primary Outcome Measure Information:
Title
Change in rate of fatigue status and other CFS symptoms
Description
Rate of decrease in fatigue and other CFS symptoms, as measured by SF-36 and The Fatigue Assessment Instrument.
Time Frame
0, 3, and 6 months
Secondary Outcome Measure Information:
Title
Change in brain lactate and glutathione levels
Description
Patients will undergo nuclear magnetic resonance spectroscopy of the brain prior to starting therapy (baseline) and repeat it after 6 months of therapy.
Time Frame
0 and 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must meet the criteria for CFS of the US Centers for Disease Control and Prevention (CDC), which requires persistent, unexplained fatigue for at least 6 months, concurrent with four of the following: impaired memory/concentration sore throat, new headaches unrefreshing sleep, muscle pain multi-joint pain tender lymph nodes post-exertional malaise As well, due to the frequency of visits subjects must currently reside in the greater New York area. Exclusion Criteria: shortness of breath heart disease high blood pressure other severe chronic illnesses clinical depression generalized anxiety disorder insomnia inflammatory arthritis anemia hypothyroidism other conditions associated with significant fatigue history of alcohol, tobacco, or drug abuse
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alfred E Slonim, MD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Columbia University Department of Clinical Genetics
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States

12. IPD Sharing Statement

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Chronic Fatigue Syndrome: A Presumptive Mitochondrial Disorder

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