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Diagnostic biomarker
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===Dysfunction of TCA and urea cycles=== A 2016 study in [[Japan]], by [[Emi Yamano|Yamano]], et al, looked at the differences in intermediate metabolite concentrations in the [[Citric acid cycle|tricarboxylic acid]] (TCA) and [[urea cycle]]s in CFS patients versus healthy controls: "CFS patients exhibited significant differences in intermediate [[metabolite]] concentrations in the [[Citric acid cycle|tricarboxylic acid]] (TCA) and urea cycles. The combination of [[ornithine]]/[[citrulline]] and [[Pyruvate dehydrogenase|pyruvate]]/[[isocitrate]] ratios discriminated CFS patients from healthy controls, yielding area under the receiver operating characteristic curve values of 0.801 (95% confidential interval [CI]: 0.711β0.890, Pβ<β0.0001) and 0.750 (95% CI: 0.584β0.916, Pβ=β0.0069) for training (nβ=β93) and validation (nβ=β40) datasets, respectively. These findings provide compelling evidence that a clinical diagnostic tool could be developed for CFS based on the ratios of metabolites in plasma."<ref name="Yamano, 2016" /> Obstacle for use: The specialized laboratory equipment needed for this test is usually only available in facilities engaged in research. The findings in this published study need to be validated through replication by other studies.
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