Maes, Michael, Andrés-Rodríguez, Laura, Vojdani, Aristo et al. · CNS & neurological disorders drug targets · 2023 · DOI
This study looked at people with schizophrenia who also experience fatigue and pain symptoms similar to ME/CFS and fibromyalgia. Researchers found that these symptoms may be caused by a breakdown in the intestinal barrier (the paracellular pathway), which allows harmful substances into the bloodstream and triggers immune system activation. This immune activation then produces neurotoxic byproducts that may cause the fatigue and pain symptoms.
This study identifies potential shared mechanisms between ME/CFS-like symptoms and immune/intestinal barrier dysfunction, offering insights into pathways that may contribute to ME/CFS fatigue and pain. Understanding zonulin and paracellular barrier breakdown could inform future diagnostic and therapeutic approaches for ME/CFS patients. The work bridges psychiatric, immunological, and somatic symptom research, expanding understanding of how physical symptoms develop from immune activation.
This study does not prove that paracellular pathway breakdown causes fatigue and pain symptoms—only that they are associated. The study was conducted in schizophrenia patients, so findings may not directly apply to primary ME/CFS; schizophrenia-related immune abnormalities may differ. Cross-sectional design cannot establish causality or temporal relationships between barrier dysfunction and symptom onset.
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
Maes, Michael, Andrés-Rodríguez, Laura, Vojdani, Aristo, Sirivichayakul, Sunee, Barbosa, Decio S, & Kanchanatawan, Buranee (2023). In Schizophrenia, Chronic Fatigue Syndrome- and Fibromyalgia-Like Symptoms are Driven by Breakdown of the Paracellular Pathway with Increased Zonulin and Immune Activation-Associated Neurotoxicity.. CNS & neurological disorders drug targets. https://doi.org/10.2174/1871527321666220806100600
BibTeX
@article{mecfsatlas-maes-2023-schizophrenia-chronic,
author = {Maes, Michael and Andrés-Rodríguez, Laura and Vojdani, Aristo and Sirivichayakul, Sunee and Barbosa, Decio S and Kanchanatawan, Buranee},
title = {In Schizophrenia, Chronic Fatigue Syndrome- and Fibromyalgia-Like Symptoms are Driven by Breakdown of the Paracellular Pathway with Increased Zonulin and Immune Activation-Associated Neurotoxicity.},
journal = {CNS & neurological disorders drug targets},
year = {2023},
doi = {10.2174/1871527321666220806100600},
note = {PubMed: 35946099},
url = {https://www.mecfsatlas.com/evidence/maes-2023-schizophrenia-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/maes-2023-schizophrenia-chronic
Contribute
Private, reviewed by a human. Not a public comment thread.