E2 ModeratePreliminaryPEM not requiredCase-ControlPeer-reviewedMachine draft
The assessment of the energy metabolism in patients with chronic fatigue syndrome by serum fluorescence emission.
Mikirova, Nina, Casciari, Joseph, Hunninghake, Ronald · Alternative therapies in health and medicine · 2012
Quick Summary
This study tested whether measuring a specific molecule in the blood called NAD(P)H could help diagnose and monitor ME/CFS. The researchers found that people with ME/CFS had lower levels of this energy-related molecule compared to healthy people, and this difference might be useful as a blood test marker for the disease.
Why It Matters
ME/CFS currently lacks an objective diagnostic biomarker, making diagnosis challenging and delaying treatment. If validated in larger populations, a blood test measuring NAD(P)H could enable earlier diagnosis, track disease severity, and help evaluate whether treatments are working by objectively measuring metabolic function.
Observed Findings
- CFS patients had mean serum NAD(P)H of 8.0 ± 1.4 nmol/mL versus 10.8 ± 0.8 nmol/mL in healthy controls (statistically significant difference).
- Using a cutoff of 9.5 nmol/mL yielded 73% sensitivity and 100% specificity for distinguishing CFS from healthy controls.
- Receiver-operator characteristic analysis showed an area under the curve of 0.9, indicating excellent discriminatory performance.
- Serum NAD(P)H was directly correlated with serum CoQ10 levels.
- Serum NAD(P)H was inversely correlated with urine hydroxyhemopyrrolin-2-one levels.
Inferred Conclusions
- Serum NAD(P)H measured via fluorescence emission may serve as an objective metabolic biomarker for ME/CFS.
- Metabolic dysfunction involving energy production pathways is present in ME/CFS patients and measurable via non-invasive blood testing.
- NAD(P)H monitoring could be used clinically to assess disease status and guide therapeutic selection.
Remaining Questions
- Does NAD(P)H level correlate with symptom severity, disease duration, or functional impairment in individual patients?
- Do NAD(P)H levels change over time in the same patient, and can changes predict clinical improvement or deterioration?
What This Study Does Not Prove
This study does not prove that low NAD(P)H causes ME/CFS fatigue or that treating it would improve symptoms. The cross-sectional design shows correlation but not causation, and the small sample size means results must be replicated in larger, multi-site cohorts before clinical adoption. The study also does not track whether NAD(P)H levels change with disease progression or treatment response.
Tags
Symptom:Unrefreshing SleepPainFatigue
Biomarker:MetabolomicsBlood Biomarker
Method Flag:PEM Not DefinedSmall SampleExploratory Only
Metadata
- PMID
- 22516851
- Review status
- Machine draft
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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