Metabolic Similarities Between CFS and Dauer.
Many of the pathways and metabolites that were abnormal in CFS are also known to be features of dauer, a well-studied, long-lived survival and persistence state triggered by environmental stress (
35,
36) (
Table 5). Interestingly, we found that the direction of CFS abnormalities was opposite to metabolic syndrome (
37) and opposite to the metabolic response to infection, inflammation, or environmental stress that has been called the CDR (
7). For example, cholesterol, phospholipid, sphingolipid, and purine metabolism are all decreased in CFS and dauer but are increased in metabolic syndrome and the stereotyped CDR (
Table 5). These facts suggest that CFS is an evolutionarily conserved, genetically regulated, hypometabolic state similar to dauer that permits survival and persistence under conditions of environmental stress but at the cost of severely curtailed function and quality of life.