Moss, R B, Mercandetti, A, Vojdani, A · Journal of clinical immunology · 1999 · DOI
This study looked at whether a molecule called TNF-alpha, which helps control inflammation in the body, is elevated in people with ME/CFS. Researchers compared blood levels of TNF-alpha in patients with ME/CFS to healthy people without the condition. They found that people with ME/CFS had significantly higher levels of TNF-alpha, suggesting that inflammation may play a role in the disease.
This early immunological research provided foundational evidence that ME/CFS may involve dysregulated inflammatory pathways, shifting the understanding of the disease beyond purely psychiatric explanations. The findings suggested potential therapeutic targets, such as TNF-alpha blockers, which could open new treatment avenues for patients with limited current options.
This study does not prove that TNF-alpha elevation causes ME/CFS—only that an association exists. It does not establish whether elevated TNF-alpha is a primary driver of symptoms, a secondary effect of the disease process, or a biomarker of disease state. The cross-sectional design cannot determine causation or identify optimal therapeutic targets without further research.
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
Moss, R B, Mercandetti, A, & Vojdani, A (1999). TNF-alpha and chronic fatigue syndrome.. Journal of clinical immunology. https://doi.org/10.1023/a:1020595709352
BibTeX
@article{mecfsatlas-moss-1999-tnf-alpha,
author = {Moss, R B and Mercandetti, A and Vojdani, A},
title = {TNF-alpha and chronic fatigue syndrome.},
journal = {Journal of clinical immunology},
year = {1999},
doi = {10.1023/a:1020595709352},
note = {PubMed: 10535608},
url = {https://www.mecfsatlas.com/evidence/moss-1999-tnf-alpha},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/moss-1999-tnf-alpha
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