Malkova, A M, Shoenfeld, Y · Autoimmunity reviews · 2023 · DOI
This review examined whether ME/CFS, fibromyalgia, and several other conditions share a common problem: the immune system mistakenly attacks nerve controls that regulate heart rate, blood pressure, and other automatic body functions. Researchers found that people with these conditions often have similar symptoms like fatigue, dizziness, and brain fog, and some have autoantibodies (immune proteins) that target nerve receptors. The authors propose this 'autonomic nervous system imbalance' could be a unifying mechanism explaining why these diverse conditions feel so similar.
This work may help explain why ME/CFS patients experience such consistent dysautonomic symptoms despite different disease triggers. If autoimmune autonomic dysfunction is confirmed as a common mechanism, it could accelerate development of blood tests for diagnosis and guide therapeutic strategies targeting GPCR autoimmunity, potentially benefiting multiple conditions simultaneously.
This review does not prove that GPCR autoimmunity causes ME/CFS or that all ME/CFS patients have this mechanism—it proposes a hypothesis based on published findings. The study is observational synthesis rather than controlled experimental evidence, and the proposed diagnostic criteria are not yet validated in prospective patient cohorts. Association of autoantibodies with disease 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 →
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Primary citation
Malkova, A M & Shoenfeld, Y (2023). Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants.. Autoimmunity reviews. https://doi.org/10.1016/j.autrev.2022.103230
BibTeX
@article{mecfsatlas-malkova-2023-autoimmune-autonomic,
author = {Malkova, A M and Shoenfeld, Y},
title = {Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants.},
journal = {Autoimmunity reviews},
year = {2023},
doi = {10.1016/j.autrev.2022.103230},
note = {PubMed: 36347462},
url = {https://www.mecfsatlas.com/evidence/malkova-2023-autoimmune-autonomic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/malkova-2023-autoimmune-autonomic
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