Elenkov, I J, Wilder, R L, Chrousos, G P et al. · Pharmacological reviews · 2000
Your brain and immune system communicate constantly to keep your body healthy, and your nervous system plays a key role in this conversation. This review explains how nerve signals release chemicals called norepinephrine and epinephrine that can either calm down or activate your immune system depending on where in your body they act. Understanding this communication system may help explain why chronic conditions like fatigue syndromes involve both nervous system and immune system problems.
ME/CFS is characterized by dysregulated immune responses and autonomic nervous system dysfunction; this review provides a mechanistic framework for understanding how impaired sympathetic-immune communication could simultaneously cause excessive inflammatory responses in some contexts while failing to mount adequate defenses in others. The proposed pharmacological interventions (selective adrenoreceptor modulators, phosphodiesterase inhibitors) specifically mentioned for chronic fatigue syndrome suggest direct clinical relevance to ME/CFS pathophysiology.
This review does not provide direct clinical evidence that sympathetic-immune dysregulation causes ME/CFS, nor does it establish whether observed immune abnormalities in ME/CFS patients result from primary SNS dysfunction or secondary immune activation. The mechanistic concepts are largely derived from experimental models and acute infection/injury states rather than chronic disease models, limiting direct extrapolation to ME/CFS pathogenesis.
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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Primary citation
Elenkov, I J, Wilder, R L, Chrousos, G P, & Vizi, E S (2000). The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.. Pharmacological reviews. https://pubmed.ncbi.nlm.nih.gov/11121511/
BibTeX
@article{mecfsatlas-elenkov-2000-sympathetic-nerve,
author = {Elenkov, I J and Wilder, R L and Chrousos, G P and Vizi, E S},
title = {The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.},
journal = {Pharmacological reviews},
year = {2000},
note = {PubMed: 11121511},
url = {https://www.mecfsatlas.com/evidence/elenkov-2000-sympathetic-nerve},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/elenkov-2000-sympathetic-nerve
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