TITLE:
Navigating Anti-Fatigue Effect: Aqueous Extract of Cistanche tubulosa plus QH in Vitro and in Vivo Study
AUTHORS:
Chin-Tsai Chou, Chien-Liang Chao, Ai-Ling Yeh, Chao-Jih Wang, Wen-Fang Huang, Ya-Ting Wu, Chi-Chang Huang, Jian-Gang Long, Muh-Hwan Su
KEYWORDS:
Ubiquinol, Cistanche tubulosa, Anti-Fatigue, Exercise Performance, C2C12, OCR
JOURNAL NAME:
Open Access Library Journal,
Vol.13 No.1,
January
12,
2026
ABSTRACT: The effects of coenzyme Q10 (CoQ10) on exercise-induced fatigue remain unclear, as previous studies have reported inconsistent results. To address fatigue associated with physiological stress, the combined use of Cistanche tubulosa aqueous extract (CTE) and ubiquinol (QH) has increasingly been reported to provide antioxidant benefits and support mitochondrial energy production, including adenosine triphosphate (ATP) synthesis; however, the underlying mechanisms remain to be fully elucidated. This study aimed to evaluate the potential synergistic effects of QH in combination with CTE on fatigue reduction and performance enhancement under physiological challenge. The CTE100 plus QH group demonstrated significant improvements in forelimb grip strength and exhaustive swimming time compared with QH alone, indicating enhanced physical performance. In the mechanistic assessment of anti-fatigue activity, the CTE100 plus QH group showed reduced serum levels of lactate, ammonia, and creatine kinase (CK) after acute exercise, as well as increased concentrations of free fatty acids (FFA). Although these differences were not statistically significant relative to the QH-only group, the results demonstrated a consistent downward trend in acute fatigue-related biomarkers. To further investigate the metabolic regulatory effects of CTE plus QH, a TNF-α-induced C2C12 cell injury model was employed. Cellular metabolism was assessed by measuring mitochondrial oxygen consumption rate (OCR) using the Seahorse XF24 extracellular flux analyzer. The results showed that the combination of CTE and QH enhanced ATP production and maximal respiratory capacity compared with QH alone. Overall, these findings suggest that the anti-fatigue effects observed in animal studies may be partially attributable to the ability of CTE to enhance mitochondrial respiratory oxygen consumption.