<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">PP</journal-id><journal-title-group><journal-title>Pharmacology &amp; Pharmacy</journal-title></journal-title-group><issn pub-type="epub">2157-9423</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/pp.2022.138023</article-id><article-id pub-id-type="publisher-id">PP-119312</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Chemistry&amp;Materials Science</subject><subject> Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  A Comparative Study of Antifatigue Effects of Taurine and Vitamin C on Chronic Fatigue Syndrome
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Shin-Hee</surname><given-names>Kim</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hyun-Jin</surname><given-names>Kim</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Semi</surname><given-names>Kim</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ju-Seop</surname><given-names>Kang</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Young</surname><given-names>Tae Koo</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sang</surname><given-names>Hun Lee</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dong-Hyun</surname><given-names>Paik</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>Medicine Park Co., Ltd., Seoul, Republic of Korea</addr-line></aff><aff id="aff2"><addr-line>Department of Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea</addr-line></aff><aff id="aff3"><addr-line>Kwang-Dong Pharmaceutical Co., Ltd., Seoul, Republic of Korea</addr-line></aff><pub-date pub-type="epub"><day>05</day><month>08</month><year>2022</year></pub-date><volume>13</volume><issue>08</issue><fpage>300</fpage><lpage>312</lpage><history><date date-type="received"><day>4,</day>	<month>July</month>	<year>2022</year></date><date date-type="rev-recd"><day>19,</day>	<month>August</month>	<year>2022</year>	</date><date date-type="accepted"><day>22,</day>	<month>August</month>	<year>2022</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Vitamin C and taurine (TR) are well known as active components for fatigue recovery. However, the mechanism of the anti-fatigue effects of vitamin C and TR is still unclear. Our study was designed to evaluate the anti-fatigue activities of vitamin C and TR in an animal test for fatigue and to compare the activities between vitamin C and TR. 
  Materials and Methods: Vitamin C, TR or their combination were orally administrated to mice once daily for 15 days, and then metabolic activities such as blood glucose, triglyceride (TG), lactate, and lactate dehydrogenase (LDH) as well as antioxidant activities such as malondialdehyde (MDA) and superoxide dismutase (SOD) were determined (evaluated) after forced swimming test (FST). 
  Results: Compared with the control group, C100, C200, and T50 showed a tendency to decrease mobility in FST. Moreover, TG (C100, C200, T200), LDH (C200), lactic acid (C100) and MDA (C50, C100, C200) levels were inhibited by vitamin C and TR. 
  Conclusions: These results suggest that vitamin C and TR have anti-fatigue activities in mice, with vitamin C providing a stronger effect.
 
</p></abstract><kwd-group><kwd>Vitamin C</kwd><kwd> Taurine</kwd><kwd> Chronic Fatigue Syndrome</kwd><kwd> Anti-Fatigue Effect</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Chronic fatigue syndrome (CFS) is a clinical condition defined by persistent fatigue lasting more than 6 months that is not amended by rest [<xref ref-type="bibr" rid="scirp.119312-ref1">1</xref>]. Chronic fatigue can cause serious health problems, and the lack of control over fatigue is emerging as an important issue [<xref ref-type="bibr" rid="scirp.119312-ref2">2</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref3">3</xref>]. There is no specific treatment except lifestyle change, and this lack of relief leads to chronic impairment of quality of life [<xref ref-type="bibr" rid="scirp.119312-ref4">4</xref>], CFS is associated with concentration deficiency, memory loss, muscle aches, and sleep deprivation and the global incidence of CFS and its prevalence have been steadily rising [<xref ref-type="bibr" rid="scirp.119312-ref5">5</xref>]. Nevertheless, there is no effective treatment to prevent CFS. Some reports have suggested that the combination of supplementation with essential nutrients and aerobic exercise is an effective approach to preventing CFS [<xref ref-type="bibr" rid="scirp.119312-ref6">6</xref>]. Therefore, one of the ways to suppress fatigue involves the elimination or inhibition of the production of fatigue-related metabolites during exercise. Physical fatigue is tightly associated with maintenance of the balance between nutrition and energy metabolism [<xref ref-type="bibr" rid="scirp.119312-ref7">7</xref>]. Water-soluble vitamins are one of the body’s most important antioxidants and are involved as a co-factor in more than 150 metabolic functions [<xref ref-type="bibr" rid="scirp.119312-ref8">8</xref>]. Vitamin C deficiency causes clinically related diseases. Fatigue, pain, cognitive disorders, and depression-like symptoms are known symptoms of a vitamin C deficiency [<xref ref-type="bibr" rid="scirp.119312-ref9">9</xref>]. Therefore, it is possible that vitamin C supplements can treat the symptoms of vitamin C deficiency, including fatigue, and relieve fatigue through neuroprotective and vasoprotective effects due to its antioxidant and anti-inflammatory properties [<xref ref-type="bibr" rid="scirp.119312-ref10">10</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref11">11</xref>].</p><p>Taurine is a sulfur-containing amino acid that is found abundantly in the heart, brain, retina and skeletal muscles of humans [<xref ref-type="bibr" rid="scirp.119312-ref12">12</xref>] and is an in vivo metabolite that acts as an antioxidant and antifatigue agent [<xref ref-type="bibr" rid="scirp.119312-ref13">13</xref>]. The major biological functions of TR vary but, include antioxidant [<xref ref-type="bibr" rid="scirp.119312-ref14">14</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref15">15</xref>], anti-inflammatory [<xref ref-type="bibr" rid="scirp.119312-ref16">16</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref17">17</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref18">18</xref>] vitagene activation [<xref ref-type="bibr" rid="scirp.119312-ref19">19</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref20">20</xref>], energy metabolism [<xref ref-type="bibr" rid="scirp.119312-ref21">21</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref22">22</xref>], neuroprotection [<xref ref-type="bibr" rid="scirp.119312-ref23">23</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref24">24</xref>] and immunomodulation [<xref ref-type="bibr" rid="scirp.119312-ref25">25</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref26">26</xref>] functions. Additionally, there are many studies showing TR as an antioxidant with a role in protecting against oxidative stress in the mitochondria [<xref ref-type="bibr" rid="scirp.119312-ref27">27</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref28">28</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref29">29</xref>].</p><p>However, there are no studies on the synergistic or dose-specific effects of vitamin C and TR on the anti-fatigue effect. Here, we analyzed fatigue-causing factors in mice to determine whether there is a synergistic effect and dose-specific effects between the antifatigue effects of TR and vitamin C.</p></sec><sec id="s2"><title>2. Materials and Methods</title><sec id="s2_1"><title>2.1. Materials</title><p>TR was purchased from Sigma-Aldrich (St. Louis, MO, USA). Vitamin C was obtained from Kwang Dong Pharmaceutical Co., Ltd. (Seoul, Korea). To detect MDA and SOD assay kits were purchased from Thermo Fisher Scientific (Waltham, MA, USA).</p></sec><sec id="s2_2"><title>2.2. Animal Care</title><p>Twelve-week-old, male ICR mice (Orient Bio Co. Republic of Korea) were used in the experiment after acclimation for 1 week. The animal use and care protocols for this experiment were approved by the Institutional Animal Care and Use Committee (IACUC), College of Medicine, Hanyang University, Seoul, Republic of Korea. All experiments and animal care performed in accordance with institutional guidelines (2016-0225A). Experimental animals were housed in standard cages maintained at a constant temperature of 25˚C &#177; 2˚C, humidity 55 &#177; 5%, and a 12-h light/dark cycle.</p></sec><sec id="s2_3"><title>2.3. In Vivo Antfatigue Experimental Design</title><p>Antifatigue experiments of forced swimming, TG, glucose, lactate, LDH, MDA, and SOD tests, were performed as described in previous studies [<xref ref-type="bibr" rid="scirp.119312-ref30">30</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref31">31</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref32">32</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref33">33</xref>]. To test the antifatigue effects of the treatments, 72 mice were randomly divided into 8 groups (n = 9) and treated for 15 days as follows: untreated group (saline); C50 group (50 mg/kg/day vitamin C); C100 group (100 mg/kg/day vitamin C); C200 group 200 mg/kg/day vitamin C); T50 group (50 mg/kg/day TR); T100 group (100 mg/kg/day TR); T200 group (200 mg/kg/day TR); and C50 + T50 group (50 mg/kg/day vitamin C and 50 mg/kg/day TR) (<xref ref-type="fig" rid="fig1">Figure 1</xref>).</p></sec><sec id="s2_4"><title>2.4. Forced Swimming Test</title><p>The forced swim test (FST) carried out as described in the literature [<xref ref-type="bibr" rid="scirp.119312-ref34">34</xref>]. Briefly, following the last treatment with vitamin C, TR or distilled water, mice were individually placed into a glass cylinder (height: 25 cm, diameter: 10 cm) containing 10 cm of water at 23˚C - 25˚C for a 6 min swimming session. The duration of immobility defined as cessation of struggling to float motionless in the water, making only movements necessary to keep its head above water.</p></sec><sec id="s2_5"><title>2.5. In Vivo Measurement of Biochemical Parameters</title><p>To detect the anti-fatigue effects of vitamin C and TR, blood samples of mice</p><p>were collected, and sera were prepared by centrifugation at 3000 rpm at 4˚C for 10 min. Levels of GLU, TG, LDH, and lactic acid were determined using an autoanalyzer (Hitachi 7060, Hitachi, Japan). Levels of MDA and SOD were determined using commercially available kits from Thermo Fisher Scientific (Waltham, MA, USA).</p></sec><sec id="s2_6"><title>2.6. TEM for Mitochondria of Rat Femoral Muscle</title><p>The striated muscles of the quadriceps muscle of the right lower extremity of the mice were preserved in a fixed solution containing 4% paraformaldehyde, 1.25% glutaraldehyde, and 0.1 mol/L phosphate buffer (pH 7.4). After 24 hours, sections of the fixed tissue with a thickness of 10 - 50 μm were cut and dehydrated by sequential immersion in 70%, 90%, 95%, and 100% ethanol for 10 min each. Samples were then placed in epoxy resin, sliced into ultra-thin sections, and stained with uranium acetate and lead citrate. In the stained tissue sample, the state of the mitochondria was observed by transmission electron microscopy (TEM).</p></sec><sec id="s2_7"><title>2.7. Statistical Analysis</title><p>All values were expressed as mean &#177; S.D (n = 9). Data were analyzed using one-way ANOVA followed by subsequent multiple comparison test (Duncan). Differences were considered statistically signifiant at p &lt; 0.05.</p></sec></sec><sec id="s3"><title>3. Results</title><sec id="s3_1"><title>3.1. Forced Swimming Test</title><p>On day 1 and day 15, the time (sec) of the passive (immobillity) state was recorded during the FST. On the first day of administration, the floating time in all groups was less than 100 sec (data not shown). The floating times on the 15th day of oral dosing were 171.33 &#177; 76.67, 172.5 &#177; 62.82, and 174.16 &#177; 40.64 sec, respectively, in the C100, C200, and T50 groups, showing short but not significantly different floating status compared with the control group (<xref ref-type="fig" rid="fig2">Figure 2</xref>).</p></sec><sec id="s3_2"><title>3.2. In Vivo Measurement of Biochemical Parameters</title><p>Metabolic activities of blood glucose, triglycerides (TG), lactic dehydrogenase (LDH), and lactic acid, which are biochemical indicators of degree of fatigue of mice were investigated during the FST (Figures 3-6). There was no difference among groups in creatinine. Creatinine is a metabolite of creatine phosphate, and to increase with intense exercise (work). For glucose, there was no change after administration of vitamin C and TR. The vitamin C, T200, and C50T50 groups showed lower levels of TG compared with the 89.73 &#177; 31.08 mg/dl of the control group (p &lt; 0.05). The utilization rate of TG increases during long-term exercise (chronic fatigue). After administration of vitamin C or TR, TG was low in the vitamin C groups (especially C100 and C200), which seemed to lower the degree of fatigue. The level of LDH showed a significant difference in both</p><p>vitamin C groups compared with the control group, with the lowest level in the C200 group (p &lt; 0.05). The level of LDH, a fatigue-related physiological marker, showed a tendency to recover more in the vitamin C group than in the TR group. The level of lactic acid was low in the C100 group, but there was no difference between the groups. Lactic acid from LDH is produced during anaerobic metabolism, and is closely related to physical fatigue. In this study, there was a tendency for lactic acid decrease in the C100 group compared with the control group and TR group.</p><p>To investigate the antioxidant effects of vitamin C and TR, MDA, and SOD activities were measured (<xref ref-type="fig" rid="fig7">Figure 7</xref> and <xref ref-type="fig" rid="fig8">Figure 8</xref>). For MDA, there was a significant difference in both the vitamin C group and the TR group compared with the control group (p &lt; 0.05). In particular, among the vitamin C group, the C50,</p><p>C100, and C200 groups were 1.46 &#177; 0.15 μM and 1.29 &#177; 0.28 μM, respectively showed a result of effective dose reduction to 1.02 &#177; 0.26 μM. The MDA level of the TR group was similar to the level of the C100 group regardless of the dose administered. MDA is known to increase lipid peroxidation by generating reactive oxygen species during strenuous exercise (work) or stress as an indicator of lipid peroxidation caused by oxidative stress. We confirmed that MDA could be reduced by administration of TR or vitamin C, and the lowest level was confirmed in the C200 group (p &lt; 0.05). We predicted that SOD activity would increase due to a decrease in concentration of MDA; however, there was no significant difference in SOD among the groups, with the highest value in the C100 group showing 101.65 &#177; 10.33 U/ml compared with the control group 89.57 &#177; 10.10 U/ml.</p></sec><sec id="s3_3"><title>3.3. TEM for Mitochondria of Rat Femoral Muscle</title><p>The mitochondria of the femoral muscle tissue did not show any specific differences among groups (<xref ref-type="fig" rid="fig9">Figure 9</xref>). As FST for 15 days does not appear to have any effect on mitochondria and muscle tissue, the effects of vitamin C and TR on mitochondria and muscle tissue must be determined with extended FST period or swimming time.</p></sec></sec><sec id="s4"><title>4. Discussion</title><p>Vitamin C and TR, widely used in energy drinks and functional foods, have multiple physiological functions and pharmacological benefits including anti-fatigue, antioxidant, anti-inflammatory, and neuroprotective activities [<xref ref-type="bibr" rid="scirp.119312-ref9">9</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref10">10</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref11">11</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref14">14</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref15">15</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref16">16</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref17">17</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref18">18</xref>]. However, functional foods and energy drinks contain additives such as caffeine, ginseng, vitamins, antioxidants, and sugar in addition to vitamin C and TR. The additives complicate the determination of the effects of pure vitamin C and TR on anti-fatigue. Therefore, in this study, we attempted to determine the exact effects of only vitamin C and TR in mouse fatigue. For this, we set doses in mice of 50, 100, and 200 mg/kg/day for vitamin C (250, 500, and 1000 mg for human comparison), and of 50, 100, and 200 mg/kg/day for TR (300, 600, and 1200 mg for human comparison) and administered them to groups for 15 days. Our anti-fatigue activity tests of vitamin C and TR in FST, an effective animal model for anti-fatigue effect screening [<xref ref-type="bibr" rid="scirp.119312-ref35">35</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref36">36</xref>], showed that the immobility time after FST on day 15 had a decreasing trend in mice treated with C100, C200, and T50 at 100, 200, and 50 mg/kg, respectively.</p><p>Moreover, the effects of vitamin C and TR in the FST were accompanied by attenuation of FST-induced fatigue on the physiological markers relevant for fatigue.</p><p>The present study demonstrates anti-fatigue activities of vitamin C and TR in FST. Specifically, all vitamin C levels tested significantly lowered levels LDH and MDA compared with control group. LDH activity indicates the degree of lactate metabolism and represents anti-fatigue activity [<xref ref-type="bibr" rid="scirp.119312-ref37">37</xref>]. Some diseases are relevant to oxidative damage caused by lipid peroxidation, which can produce harmful metabolites [<xref ref-type="bibr" rid="scirp.119312-ref38">38</xref>]. MDA is a product of lipid peroxidation, and its elevation indicates oxidative damage to the cell membrane [<xref ref-type="bibr" rid="scirp.119312-ref39">39</xref>]. In the present study, the vitamin C and TR supplemented group clearly demonstrated an ability to decrease MDA formation. This result suggests that the anti-fatigue effect of vitamin C probably occurred by preventing lipid oxidation via modifying activities of several enzymes. After oral administration of vitamin C or TR for 15 days, the level of SOD was not significantly different among the groups. SOD is an enzyme that acts in the first step of the antioxidant defense system and catalyzes the conversion of free oxygen radicals to H<sub>2</sub>O<sub>2</sub> [<xref ref-type="bibr" rid="scirp.119312-ref33">33</xref>]. It is then decomposed into non-toxic water and oxygen by the catalytic action of glutathione peroxidase or catalase [<xref ref-type="bibr" rid="scirp.119312-ref40">40</xref>].</p><p>In relation to this mechanism, it is expected that results that are more reliable can be confirmed through measurement of glutathione peroxidase or catalase. Since the effects of MDA and SOD were positively changed by the intake of vitamin C and TR, we believe that the improved antioxidant efficacies of vitamin C and TR can be compared through extension of the study. Another possible explanation for the anti-fatigue effect following treatment with vitamin C and TR could involve TG (or fat) mobilization during exercise, as indicated by the decrease in TG level. Such an effect might become advantageous during prolonged exercise, since better utilization of TG allows the sparing of glycogen and glucose and delays fatigue [<xref ref-type="bibr" rid="scirp.119312-ref33">33</xref>] [<xref ref-type="bibr" rid="scirp.119312-ref41">41</xref>]. We found that the level of TG in C100, C200, and T200 was significantly lower than that of the control group. This suggests that vitamin C can be helpful in maintaining an active state. Further experiments are needed to determine the mechanisms by which vitamin C can affect fat mobilization.</p><p>The performance of long-term exercise can induce apoptosis in skeletal muscle mitochondria and lead to oxidative stress and inflammation to result in fatigue. Vitamin C, an exogenous antioxidant, is a free radical scavenger. Conversely, TR, involved mitochondrial health maintenance, but taurine is not a direct radical scavenger [<xref ref-type="bibr" rid="scirp.119312-ref42">42</xref>]. We expected vitamin C and TR to play potential roles in the oxidative stress of mitochondria, but our results did not show any effect on oxidative stress. Further research on oxidative stress-related regulatory factors of mitochondria is needed. Taken together, some of our results show that vitamin C and TR possess anti-fatigue activity. Moreover, vitamin C100 and C200 demonstrated higher potency to induce an anti-fatigue activity compared with TR.</p><p>Therefore, the finding of vitamin C100 supports this suggestion and C200 reduced the levels of TG, LDH, and MDA compared with other groups. Further studies on extended administration period, administration pathways, and some biological mechanisms are needed to clarify these effects.</p></sec><sec id="s5"><title>5. Conclusion</title><p>We showed that taurine has positive anti-fatigue effects, but vitamin C is more effective. Adequate doses of vitamin C for fatigue suppression and recovery in mice are considered to be between 100 and 200 mg/kg/day. We concluded that oral administration of vitamin C may be upregulated active status and inhibited chronic fatigue.</p></sec><sec id="s6"><title>Acknowledgements</title><p>The authors would like to thank Kwang Dong Pharmaceutical Co., Ltd. for research funding.</p></sec><sec id="s7"><title>Author Contribution</title><p>Conceptualization: JS Kang, SH Kim, YT Koo, SH Lee, DH Paik; Investigation: SH Kim; Statistical analysis: SH Kim, Hyun-Jim Kim, Semi Kim; Supervision: JS Kang; Writing—original draft: SH Kim; Writing—review &amp; editing: JS Kang, SH Kim; All authors read and approved the final manuscript.</p></sec><sec id="s8"><title>Conflicts of Interest</title><p>The authors declare no conflicts of interest regarding the publication of this paper.</p></sec><sec id="s9"><title>Cite this paper</title><p>Kim, S.-H., Kim, H.-J., Kim, S., Kang, J.-S., Koo, Y.T., Lee, S.H. and Paik, D.-H. (2022) A Comparative Study of Antifatigue Effects of Taurine and Vitamin C on Chronic Fatigue Syndrome. 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