Dudova, Dobrina, Bozhkova, Martina, Petrov, Steliyan et al. · International journal of molecular sciences · 2025 · DOI
This review brings together research showing that ME/CFS involves multiple body systems going wrong at the same time—including problems with the immune system, energy production in cells, hormone balance, and gut health. These problems appear to feed into each other, creating a cycle that keeps the illness going. The findings suggest ME/CFS is not just one thing breaking down, but rather many interconnected systems all struggling together.
This comprehensive synthesis helps clinicians and patients understand ME/CFS as a genuine biological disorder affecting multiple systems simultaneously, rather than a psychological condition. Identifying this interconnected network of dysfunction opens pathways for potential multi-targeted therapeutic approaches and validates the complexity patients experience.
This review does not establish which abnormalities are primary causes versus secondary consequences, nor does it prove that correcting one dysfunction will resolve others. The findings are correlational—showing that these biological changes occur in ME/CFS patients, not necessarily that they cause the illness. Individual studies cited may have small sample sizes or methodological limitations that affect the certainty of conclusions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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