Kell, Douglas B, Pretorius, Etheresia · The Biochemical journal · 2022 · DOI
This paper proposes that ME/CFS, Long COVID, and some other chronic diseases may be caused by a harmful cycle involving tiny blood clots blocking small blood vessels, followed by damage when blood flow returns. The authors suggest that this process creates harmful molecules called free radicals and triggers inflammation and other problems. They review existing evidence that treatments like antioxidants, anti-inflammatory drugs, and blood thinners might help address these underlying mechanisms.
Understanding potential underlying biological mechanisms in ME/CFS is crucial for developing targeted treatments. If microclots and ischaemia-reperfusion injury contribute to ME/CFS pathology, this could explain why patients experience post-exertional malaise and suggest specific, mechanism-based therapeutic strategies that might be tested in clinical trials.
This is a theoretical review that does not present new experimental evidence or prove that microclots directly cause ME/CFS. The proposed mechanisms remain mechanistic hypotheses that require validation through prospective studies, biomarker research, and clinical trials. Correlation between proposed mechanisms and disease symptoms does not establish causation.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Kell, Douglas B & Pretorius, Etheresia (2022). The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications.. The Biochemical journal. https://doi.org/10.1042/BCJ20220154
BibTeX
@article{mecfsatlas-kell-2022-potential-role,
author = {Kell, Douglas B and Pretorius, Etheresia},
title = {The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications.},
journal = {The Biochemical journal},
year = {2022},
doi = {10.1042/BCJ20220154},
note = {PubMed: 36043493},
url = {https://www.mecfsatlas.com/evidence/kell-2022-potential-role},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/kell-2022-potential-role
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