The Effect of Coenzyme Q₁₀ on Symptoms of Mother and Son with Fibromyalgia Syndrome

To the Editor

Coenzyme Q₁₀ [CoQ₁₀] plays a crucial role in cellular metabolism, acting as the electron carrier between complexes I and II and complex III of the mitochondrial respiratory chain, and regulates uncoupling proteins, the transition pore, β-oxidation of fatty acids, and nucleotide pathway. Additionally, it has antioxidant and membrane-stabilizing properties (1). CoQ₁₀ is often reduced in patients with myopathy, either as a primary or a secondary event (2), and patients with all forms of CoQ₁₀ deficiency [primary and secondary] have shown clinical improvements after initiating oral CoQ₁₀ supplementation (3), and have been observed to experience a decrease in muscle pain associated with statin treatment by CoQ₁₀ supplementation (4).

Fibromyalgia syndrome [FMS] is a common chronic pain syndrome accompanied by other symptoms such as fatigue, headache, sleep disturbances, and depression. It is diagnosed according to the classification criteria established by the American College of Rheumatology (5). Pathophysiological mechanisms of FMS are difficult to identify, and current drug therapies demonstrate limited effectiveness, so drugs used to treat FMS have been focused to the management of single symptoms. Recently, we have observed CoQ₁₀ deficiency in blood mononuclear cells [BMCs] in FMS patients (6). Oral CoQ₁₀ supplementation in FMS seemed to provide beneficial effects in FMS patients in a previous pilot study, although this could be also due to the presence of Ginkgo biloba (7).

We now describe the results of oral CoQ₁₀ supplementation in mother and son patients with FMS and CoQ₁₀ deficiency. Four years ago, a mother, a 42-year-old woman, and son, a 16-year-old boy, were diagnosed with FMS by exclusion of other diseases and syndromes and in accordance with the American College of Rheumatology. The mother had daily episodes of intense musculoskeletal pain, stiffness, anxiety, migraine, and sleep disturbance. The son had daily episodes of intense musculoskeletal pain and sleep disturbance. Routine laboratory test yielded normal results. For treatment, they only used paracetamol on demand. Their visual analog scale scores were 7 and 6, respectively. The Fibromyalgia Impact Questionnaire scores were 60 and 51, respectively, and tender points were 17 and 11, respectively [Table 1]. Both mother and son participated in a study on mitochondrial dysfunction in BMCs showing higher levels of mitochondrial reactive oxygen species production and lipid peroxidation, reduced mitochondrial membrane potential and mitochondrial mass, low levels of CoQ₁₀, and higher levels of mitochondrial degradation [mitophagy] (6). Oxidative stress and mitochondrial degradation were reduced by CoQ₁₀ supplementation in BMCs (6).

Table 1 Charasteristic Findings of the Patients Pre- and Post-treatment with CoQ₁₀

	Mother	Son
Ase (year)	42	16
Duration of disease (years)	10	4
Sex	Female	Male
BMI	28	25
CoQ10 Treatment	Pre/Post	Pre/Post
Tender points	17/8	11/2
VAS total score, range 0–10	7/3	6/2
FIQ total score, range 0–80	61/26	51/20
CoQ10 in BMCs (pMolQ10/mgProtein)	121.2/207.2	107.9/193.1
LP in BMCs (nmol/million cells)	27.7/12.2	24.3/14.1

BMI: body mass index: VAS: visual analog scale; FIQ: Fibromyalgia Impact Questionnaire; LP: lipid peroxidation.

After informed consents were obtained, both mother and son were treated with 300 mg CoQ₁₀ divided in three doses. They experienced no adverse effects, and after three months, both mother and son reported a decrease in their symptoms. Specifically, they noted an improvement in sleep, mental alertness, a marked decrease in joint pain, and decrease of episodes and intensity of headache. After six months of treatment, the patients were evaluated and we observed an important decrement in visual analog scale, Fibromyalgia Impact Questionnaire, and tender point scores, given in Table 1. Lipid peroxidation in BMCs was significantly reduced by 56 percent in the mother and by 42 percent in the son, and CoQ₁₀ levels were increased in BMCs by 71 percent in the mother and by 79 percent in the son.

At the time of this writing, the patients were continuing to take CoQ₁₀ and were satisfied that the symptoms had abated. According to our results, we think that CoQ₁₀ might be a promising therapeutic agent in the treatment of symptoms in patients with FMS and CoQ₁₀ deficiency.

Mario D. Cordero

Centro Andaluz de Biología del Desarrollo

Universidad Pablo de Olavide-CSIC

Carretera de Utrera Km 1, Sevilla 41013, Spain

Email: [email protected]

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Fibromyalgia Syndrome and Coenzyme Q₁₀: Out of the Labyrinth?

Fibromyalgia syndrome [FMS] is a multifactorial condition, often associated with perpetuating factors such as peripheral stimuli [myofascial trigger points] or chronic illness [hypothyroidism and resistance to insulin (1)]. Several biological abnormalities have been reported in FMS with respect to neurotransmitters [substance P (2)], free radical production [malondialdehyde (3)], or cellular signaling disorders (4).

On the other hand, therapeutics based on antioxidant agents, such as magnesium, selenium, taurine, and vitamin A or E, are without effect in our experience, whereas adenosylmethionine and superoxide dismutase are poorly efficient in FMS. A recent trial on coenzyme Q₁₀ [CoQ₁₀] demonstrates that this treatment is efficient in a FMS patient family group associated with blood CoQ₁₀ changes (5).

The number of potential variables linked to FMS metabolic disorders is considerable, and their management is complex. However, even if CoQ₁₀ effects on Parkinson's disease or chronic fatigue syndrome are controversial, new therapeutic approaches are promising and need further investigations.

J Eisinger, D Starlanyl and T Ayavou

Hôpital G. Clemenceau BP1412

83056 Toulon, France