Svak kobling mellom kronisk utmattelsessyndrom og pyruvat dehydrogenasemangel

Abstract

The author has completed the ICMJE form and reports the following conflicts of interest: He has received a fee for a lecture at a professional congress of psychiatrists that was supported by the pharmaceutical company Lundbeck Norge.Researchers studying the energy metabolism of patients with chronic fatigue syndrome have reached the conclusion that these patients have impaired pyruvate dehydrogenase function, but their measurements are not consistent with the changes we see in patients with primary genetic pyruvate dehydrogenase deficiency.A cross-sectional study published in December 2016 found a change in the pattern of amino acids in the plasma of patients with chronic fatigue syndrome. Gene expression in white blood cells and energy metabolism in muscle cells was also found to have changed (1). The authors interpret the results as an expression of functional inhibition of the enzyme pyruvate dehydrogenase, and they postulate dysregulation of the enzyme complex as a possible key factor in the pathogenesis associated with chronic fatigue syndrome.The study received extensive media coverage (2, 3), and the link to pyruvate dehydrogenase is published without reservations as an established fact (4, 5). At our laboratory we are now receiving samples for metabolic screening from patients with suspected fatigue syndrome. On the basis of my own experience with biochemical diagnostic workup for pyruvate dehydrogenase deficiency, I would like to point out weaknesses in the study that should have prompted much greater caution in the conclusions. Criticism of method and interpretationThe plasma amino acid concentrations of 200 patients and 102 healthy control persons were examined in the study. The researchers found significant differences between the two groups, but the implications of this are uncertain because they did not adhere to established diagnostic workup for pyruvate dehydrogenase deficiency, and because the samples were not taken in a standardised manner. THE AMINO ACID PATTERN IS NOT CONSISTENT WITH WHAT WE SEE IN PATIENTS WITH PRIMARY PYRUVATE DEHYDROGENASE DEFICIENCYPyruvate dehydrogenase deficiency results in an increased concentration of pyruvate, in muscle and nerve cells, for example. Pyruvate is converted into lactate and the amino acid alanine. Alanine is the only amino acid that is expected to be outside the reference range in plasma and cerebrospinal fluid in cases of primary pyruvate dehydrogenase deficiency (one

Syngespillet i nytt lys - opera i Norge fra 1790 til 1825

“…Her er det interessant å merke seg at danskene har hatt langt lettere for å inkludere norske forfatteres verk i den danske nasjonallitteratur, uten engang å ha behov for begrepet «felleslitteratur». 42 Norske litteraturhistorikere har på sin side tonet ned den felleseuropeiske selskapskulturen med dens dilettantselskaper, klubber og foreninger. I stedet har de vektlagt nasjonale markører som naturdiktning, folkelige viser og den nasjonale patos.…”

Kronisk utmattelsessyndrom og pyruvat dehydrogenasefunksjon

“…Les alle innleggene om kronisk utmattelsessyndrom og pyruvat dehydrogenase på våre nettsider Vi takker for kommentarer fra Yngve Thomas Bliksrud til vår studie (1). Samtidig undres vi hvorfor denne type debatt tas opp i Tidsskriftet og ikke i tidsskriftet som publiserte studien.…”