Malato, João, Sotzny, Franziska, Bauer, Sandra et al. · Heliyon · 2021 · DOI
This study looked at whether people with ME/CFS have lower levels of a protein called ACE2, which the COVID-19 virus uses to enter cells. The researchers analyzed existing genetic data from ME/CFS patients and found that ACE2 levels were indeed reduced in ME/CFS patients compared to healthy people. The authors suggest this may put ME/CFS patients at higher risk for severe COVID-19 and recommend they be prioritized for vaccination.
ME/CFS patients report frequent viral infections and atypical immune responses, making understanding their COVID-19 vulnerability clinically important. If ME/CFS patients indeed have reduced ACE2 expression conferring higher COVID-19 risk, this evidence could inform public health vaccination priorities and clinical management strategies for this vulnerable population.
This study does not prove that low ACE2 expression causes ME/CFS or that it directly causes worse COVID-19 outcomes in ME/CFS patients—only that the association exists. The analysis is restricted to peripheral blood cells and may not reflect ACE2 levels in respiratory tissues where COVID-19 infection primarily occurs. The study is observational and cannot establish whether reduced ACE2 is a cause or consequence of ME/CFS pathology.
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
Malato, João, Sotzny, Franziska, Bauer, Sandra, Freitag, Helma, Fonseca, André, Grabowska, Anna D, et al. (2021). The SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) in myalgic encephalomyelitis/chronic fatigue syndrome: A meta-analysis of public DNA methylation and gene expression data.. Heliyon. https://doi.org/10.1016/j.heliyon.2021.e07665
BibTeX
@article{mecfsatlas-malato-2021-sars-cov-2,
author = {Malato, João and Sotzny, Franziska and Bauer, Sandra and Freitag, Helma and Fonseca, André and Grabowska, Anna D and Graça, Luís and Cordeiro, Clara and Nacul, Luís and Lacerda, Eliana M and Castro-Marrero, Jesus and Scheibenbogen, Carmen and Westermeier, Francisco and Sepúlveda, Nuno},
title = {The SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) in myalgic encephalomyelitis/chronic fatigue syndrome: A meta-analysis of public DNA methylation and gene expression data.},
journal = {Heliyon},
year = {2021},
doi = {10.1016/j.heliyon.2021.e07665},
note = {PubMed: 34341773},
url = {https://www.mecfsatlas.com/evidence/malato-2021-sars-cov-2},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/malato-2021-sars-cov-2
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