Role of mitochondria, oxidative stress and the response to antioxidants in ME/CFS: a possible approach to SARS-CoV-2 ‘long-haulers’?, 2020, Tate et al

[Trish]

Review article:

Role of mitochondria, oxidative stress and the response to antioxidants in myalgic encephalomyelitis/chronic fatigue syndrome: a possible approach to SARS-CoV-2 ‘long-haulers’?

EmilyWood, Katherine H.Hall, WarrenTate (University of Otago, New Zealand)

https://www.sciencedirect.com/science/article/pii/S2095882X20300839

Abstract
A significant number of SARS-CoV-2 (COVID-19) pandemic patients have developed chronic symptoms lasting weeks or months which are very similar to those described for myalgic encephalomyelitis/chronic fatigue syndrome.

This paper reviews the current literature and understanding of the role that mitochondria, oxidative stress and antioxidants may play in the understanding of the pathophysiology and treatment of chronic fatigue.

It describes what is known about the dysfunctional pathways which can develop in mitochondria and their relationship to chronic fatigue. It also reviews what is known about oxidative stress and how this can be related to the pathophysiology of fatigue, as well as examining the potential for specific therapy directed at mitochondria for the treatment of chronic fatigue in the form of antioxidants.

This review identifies areas which require urgent, further research in order to fully elucidate the clinical and therapeutic potential of these approaches.

 

[Hutan]

The discussion about some of the papers I have looked at is not reassuring.

Castro-Marrero et al47,48 assessed clinical outcomes after supplementation with reduced nicotinamide adenine dinucleotide (NADH) and CoQ10 in ME/CFS. Castro-Marrero et al47 also claimed a direct improvement in mitochondrial function by finding a statistically significant increase in ATP levels and NAD+/NADH ratio in the intervention group. It is not clear if positive effects are due to CoQ10 alone or due to the combination of additional NADH, especially as treatment with NADH or CoQ10 alone had shown no changes in fatigue scores in previous studies.53,54

For example work in 2015 by the Castro-Marrero team on CoQ10 is discussed here; CoQ10 - Coenzyme Q10

(A more recent study by the same team further illustrates the problems with their studies - Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related QoL in ... ME/CFS, 2021, Castro-Marrero et al.)

MitoQ is a supplement developed by Otago University researchers - they are friends of Warren Tate, and he and his team have been trying to show that MitoQ can be helpful in ME/CFS. This study does report on the Mendus study which had a blinded investigation and an unblinded one. The blinded investigation found that MitoQ did not help ME/CFS symptoms at all, while in the unblinded investigation it appeared to. The authors here suggest that issues with the lack of confirmation of diagnosis and inability to confirm compliance with the dosage might have caused problems. That's potentially true, but there was not even a glimmer of a suggestion of a result in the blinded investigation.

Johnson and Grant55 performed a randomised controlled trial of MitoQ versus placebo in participants with ME/CFS conducted online via a website. Fifty one participants with ME/CFS were sent either MitoQ or placebo in the mail. No statistically significant improvement occurred. There were several limitations and potential biases to this study including a lack of ability to confirm the diagnosis, the usage of self-reported data and an inability to confirm compliance with the study. By contrast, another group of participants who took MitoQ without a matching placebo group, by purchasing the supplement themselves, found significant results and a reduction in clinical symptoms. So far, this online study is the only published study investigating MitoQ for ME/CFS.

I think this paper is useful as a list of relevant papers, but the analysis of them needed to be stronger.

This conclusion just is not warranted on the studies done to date.

On the basis of the research done with ME/CFS patients, we propose that MitoQ may alleviate the effects of the cytokine storm and restore the function of exhausted T cells through improving mitochondrial function, in ‘long haul’ or chronically ill SARS-CoV-2 patients as well.

I really want the Otago team to be producing great work - Warren Tate is a lovely man who has been a strong supporter of people with ME/CFS, has run the ME/CFS research programme on a shoestring for a long time and who keeps bringing young researchers into the field. And these are New Zealand researchers. But this paper does not show the necessary level of skepticism about the evidence base for CoQ10 and MitoQ as treatments for ME/CFS.

I know of a lot of people with ME/CFS who are spending money they can't afford in order to take MitoQ in the hope that it is doing something. The ongoing promotion of MitoQ by the Otago team is causing harm if the supplement doesn't really help. Rather than letting the possibility of a treatment drag on, it would be relatively easy to organise a blinded trial of MitoQ here in New Zealand. People could have their GPs confirm that they have an ME/CFS diagnosis, the MitoQ company could supply the tablets. There are people who could help organise a trial.

(Sorry, have made an edit to recognise that this paper could not have included results from the Castro-Marrero 2021 paper.)

 

[Mij]

Effect of Coenzyme Q10 and MitoQ on Mitochondrial Function in ME/CFS

Emily Wood

Bachelor of Biomedical Sciences with Honours - BBiomedSc (Hons), University of Otago
University of Otago
2022

Abstract​

New Zealand Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome CoQ10 Mitochondria Oxidative stress Antioxidants Mitochrondria Oxidative Stress Antioxidants Peripheral blood mononuclear cells (PBMCs)

Introduction
Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) is a complex and severe condition with unknown aetiology which affects over 20,000 people in New Zealand. Only in the last 20 years has it been considered to have a biological basis as opposed to being a psychiatric condition, and this has been strongly confirmed in the last 5 years. However, no specific aetiology or treatments have been found. There are reports the essential component of the electron transport chain, Coenzyme Q10 (CoQ10), is decreased in plasma and in peripheral blood mononuclear cells (PBMCs) of patients with ME/CFS, and that there may be contributing or exacerbating dysfunctions in mitochondrial and metabolic pathways. CoQ10, and the modified analogue that targets the molecule to mitochondria, MitoQ, have been investigated as potential therapies in ME/CFS. The aim of this research is to investigate the relationship between CoQ10 levels and mitochondrial function in ME/CFS and investigate the impact of CoQ10 and MitoQ on mitochondrial function.

Methods
Two ME/CFS cohorts totalling 23 participants were investigated in this research study, and there were 22 age/sex matched healthy controls. Plasma and purified PBMCs from the participants were analysed using an ELISA kit that could detect CoQ10.The mitochondrial functions of the participants were measured with a mitochondrial ‘stress test’ on the Seahorse Analyzer, before and after incubation with CoQ10 and MitoQ.

Results
Surprisingly, there was no significant difference in plasma or PBMC CoQ10 levels between the ME/CFS patients and the controls as previously reported, although the well-established decrease with age was seen in ME/CFS and control cohorts. PBMC CoQ10 levels however, of both patients and controls showed an association with their mitochondrial function. Incubation of CoQ10 in PBMCs enhanced the mitochondrial functions in ME/CFS in patients, however, the analogue MitoQ incubation, at the concentration used, caused major uncoupling of electron transfer from oxidative phosphorylation. An exploratory longitudinal supplementation study with the nutraceutical MitoQ in one patient showed an improvement in mitochondrial function by two months that was sustained through to month four, but then returned to pre -supplementation levels, possibly as a result of the stress of surgery.iii

Discussion
Our results demonstrate that plasma or PBMC CoQ10 concentration is not a distinct biomarker for ME/CFS, despite the low levels reported in other studies. The results from the incubation of PBMCs suggest CoQ10 can act to restore mitochondrial respiration in ME/CFS, which may result in positive clinical benefits, especially in individuals with low CoQ10. Given that the levels of CoQ10 can be influenced indirectly by lifestyle factors, and ME/CFS is a severely fatiguing illness that affects lifestyle practices, the study needs to be repeated with closer consideration given to confounding variables such as exercise and diet, and with larger cohorts. MitoQ needs to be tested in vitro at a much lower concentration range than that chosen for this study to avoid this undesirable uncoupling that masks any possible positive effects on functions involved in energy production. Further, a larger longitudinal supplementary study of MitoQ would be of benefit to investigate its potential in ME/CFS.

Conclusion
ME/CFS patients of a New Zealand cohort do not have lower plasma or immune cell concentrations of CoQ compared with an age/gender matched healthy controls as previously reported for another cohort. Differences in the bioenergetic capacity of mitochondria for the New Zealand ME/CFS patient group compared with the healthy controls were: increased rate of basal but decreased rate of maximum oxygen consumption, decreased ATP production, decreased spare respiratory capacity that would impact on the ability to respond to stress, and an increase in proton leak. These changes suggest there is a dysfunction in mitochondrial energy production in ME/CFS.

 

[Mij]

Conclusion
ME/CFS patients of a New Zealand cohort do not have lower plasma or immune cell concentrations of CoQ compared with an age/gender matched healthy controls as previously reported for another cohort. Differences in the bioenergetic capacity of mitochondria for the New Zealand ME/CFS patient group compared with the healthy controls were: increased rate of basal but decreased rate of maximum oxygen consumption, decreased ATP production, decreased spare respiratory capacity that would impact on the ability to respond to stress, and an increase in proton leak. These changes suggest there is a dysfunction in mitochondrial energy production in ME/CFS.